SF 2933

1st Unofficial Engrossment - 86th Legislature (2009 - 2010)

Posted on 12/26/2012 11:17 p.m.

1.1A bill for an act 1.2relating to human services; making changes to continuing care policy and 1.3personal care assistance services;amending Minnesota Statutes 2008, sections 1.4144A.071, subdivision 4b; 144A.161, subdivision 1a; 245A.03, by adding a 1.5subdivision; 256B.0911, subdivision 4d; 256B.092, subdivision 4d; 626.557, 1.6subdivision 9a; Minnesota Statutes 2009 Supplement, sections 144.0724, 1.7subdivision 11; 256B.0625, subdivision 19c; 256B.0651, by adding a 1.8subdivision; 256B.0652, subdivision 6; 256B.0653, subdivision 3; 256B.0659, 1.9subdivisions 1, 3, 4, 10, 11, 13, 14, 18, 19, 20, 21, 24, 27, 30, by adding a 1.10subdivision; 256B.0911, subdivisions 1a, 2b, 3a, 3b; repealing Minnesota 1.11Statutes 2008, section 256B.0919, subdivision 4. 1.12BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 1.13ARTICLE 1 1.14CONTINUING CARE POLICY 1.15    Section 1. Minnesota Statutes 2009 Supplement, section 144.0724, subdivision 11, 1.16is amended to read: 1.17    Subd. 11. Nursing facility level of care. (a) For purposes of medical assistance 1.18payment of long-term care services, a recipient must be determined, using assessments 1.19defined in subdivision 4, to meet one of the following nursing facility level of care criteria: 1.20     new text begin (1) the person requires formal clinical monitoring at least once per day; new text end 1.21    (1) new text begin (2) new text end the person needs the assistance of another person or constant supervision to 1.22begin and complete at least four of the following activities of living: bathing, bed mobility, 1.23dressing, eating, grooming, toileting, transferring, and walking; 1.24    (2) new text begin (3) new text end the person needs the assistance of another person or constant supervision 1.25to begin and complete toileting, transferring, or positioning and the assistance cannot 1.26be scheduled; 2.1    (3) new text begin (4) new text end the person has significant difficulty with memory, using information, daily 2.2decision making, or behavioral needs that require intervention; 2.3    (4) new text begin (5) new text end the person has had a qualifying nursing facility stay of at least 90 days new text begin ; new text end 2.4     new text begin (6) the person meets the nursing facility level of care criteria determined 90 days new text end 2.5 new text begin after admission or on the first quarterly assessment after admission, whichever is later new text end ; or 2.6    (5) new text begin (7) new text end the person is determined to be at risk for nursing facility admission or 2.7readmission through a face-to-face long-term care consultation assessment as specified 2.8in section 256B.0911, subdivision 3a, 3b, or 4d, by a county, tribe, or managed care 2.9organization under contract with the Department of Human Services. The person is 2.10considered at risk under this clause if the person currently lives alone or will live alone 2.11upon discharge and also meets one of the following criteria: 2.12    (i) the person has experienced a fall resulting in a fracture; 2.13    (ii) the person has been determined to be at risk of maltreatment or neglect, 2.14including self-neglect; or 2.15    (iii) the person has a sensory impairment that substantially impacts functional ability 2.16and maintenance of a community residence. 2.17    (b) The assessment used to establish medical assistance payment for nursing facility 2.18services must be the most recent assessment performed under subdivision 4, paragraph 2.19(b), that occurred no more than 90 calendar days before the effective date of medical 2.20assistance eligibility for payment of long-term care services. In no case shall medical 2.21assistance payment for long-term care services occur prior to the date of the determination 2.22of nursing facility level of care. 2.23    (c) The assessment used to establish medical assistance payment for long-term care 2.24services provided under sections 256B.0915 and 256B.49 and alternative care payment 2.25for services provided under section 256B.0913 must be the most recent face-to-face 2.26assessment performed under section 256B.0911, subdivision 3a, 3b, or 4d, that occurred 2.27no more than 60 calendar days before the effective date of medical assistance eligibility 2.28for payment of long-term care services. 2.29    Sec. 2. Minnesota Statutes 2008, section 144A.071, subdivision 4b, is amended to read: 2.30    Subd. 4b. Licensed beds on layaway status. A licensed and certified nursing 2.31facility may lay away, upon prior written notice to the commissioner of health, up to 50 2.32percent of its licensed and certified beds. A nursing facility may not discharge a resident 2.33in order to lay away a bed. Notice to the commissioner shall be given 60 days prior 2.34to the effective date of the layaway. Beds on layaway shall have the same status as 2.35voluntarily delicensed and decertified beds and shall not be subject to license fees and 3.1license surcharge fees. In addition, beds on layaway may be removed from layaway at any 3.2time on or after one year after the effective date of layaway in the facility of origin, with a 3.360-day notice to the commissioner. A nursing facility that removes beds from layaway 3.4may not place beds on layaway status for one year after the effective date of the removal 3.5from layaway. The commissioner may approve the immediate removal of beds from 3.6layaway if necessary to provide access to those nursing home beds to residents relocated 3.7from other nursing homes due to emergency situations or closure. In the event approval 3.8is granted, the one-year restriction on placing beds on layaway after a removal of beds 3.9from layaway shall not apply. Beds may remain on layaway for up to five new text begin ten new text end years. The 3.10commissioner may approve placing and removing beds on layaway at any time during 3.11renovation or construction related to a moratorium project approved under this section 3.12or section 144A.073. new text begin Nursing facilities are not required to comply with any licensure or new text end 3.13 new text begin certification requirements for beds on layaway status. new text end 3.14    Sec. 3. Minnesota Statutes 2008, section 144A.161, subdivision 1a, is amended to read: 3.15    Subd. 1a. Scope. Where a facility is undertaking closure, curtailment, reduction, or 3.16change in operations, new text begin or where a housing with services unit registered under chapter 144D new text end 3.17 new text begin is closed because the space that it occupies is being replaced by a nursing facility bed that new text end 3.18 new text begin is being reactivated from layaway status, new text end the facility and the county social services agency 3.19must comply with the requirements of this section. 3.20    Sec. 4. Minnesota Statutes 2008, section 245A.03, is amended by adding a subdivision 3.21to read: 3.22     new text begin Subd. 9. new text end new text begin Permitted services by an individual who is related. new text end new text begin Notwithstanding new text end 3.23 new text begin subdivision 2, paragraph (a), clause (1), and subdivision 7, an individual who is related to a new text end 3.24 new text begin person receiving supported living services may provide licensed services to that person if: new text end 3.25     new text begin (1) the person who receives supported living services received these services in a new text end 3.26 new text begin residential site on July 1, 2005; new text end 3.27     new text begin (2) the services under clause (1) were provided in a corporate foster care setting for new text end 3.28 new text begin adults and were funded by the developmental disabilities home and community-based new text end 3.29 new text begin services waiver defined in section 256B.092; new text end 3.30     new text begin (3) the individual who is related obtains and maintains both a license under new text end 3.31 new text begin chapter 245B and an adult foster care license under Minnesota Rules, parts 9555.5105 new text end 3.32 new text begin to 9555.6265; and new text end 3.33     new text begin (4) the individual who is related is not the guardian of the person receiving supported new text end 3.34 new text begin living services. new text end 4.1 new text begin EFFECTIVE DATE. new text end new text begin This section is effective the day following final enactment. new text end 4.2    Sec. 5. Minnesota Statutes 2009 Supplement, section 256B.0625, subdivision 19c, 4.3is amended to read: 4.4    Subd. 19c. Personal care. Medical assistance covers personal care assistance 4.5services provided by an individual who is qualified to provide the services according to 4.6subdivision 19a and sections 256B.0651 to 256B.0656, provided in accordance with a 4.7plan, and supervised by a qualified professional. 4.8"Qualified professional" means a mental health professional as defined in section 245.462, 4.9subdivision 18 , or 245.4871, subdivision 27; or a registered nurse as defined in sections 4.10148.171 to 148.285, a licensed social worker as defined in section new text begin sections new text end 4.11 new text begin 148D.010 and 148D.055 new text end , or a qualified developmental disabilities specialist under section 4.12245B.07, subdivision 4 . The qualified professional shall perform the duties required in 4.13section 256B.0659. 4.14    Sec. 6. Minnesota Statutes 2009 Supplement, section 256B.0651, is amended by 4.15adding a subdivision to read: 4.16     new text begin Subd. 17. new text end new text begin Recipient protection. new text end new text begin (a) Providers of home care services must provide new text end 4.17 new text begin each recipient with a copy of the home care bill of rights under section 144A.44 at new text end 4.18 new text begin least 30 days prior to terminating services to a recipient, if the termination results from new text end 4.19 new text begin provider sanctions under section 256B.064, such as a payment withhold, a suspension of new text end 4.20 new text begin participation, or a termination of participation. If a home care provider determines it is new text end 4.21 new text begin unable to continue providing services to a recipient, the provider must notify the recipient, new text end 4.22 new text begin the recipient's responsible party, and the commissioner 30 days prior to terminating new text end 4.23 new text begin services to the recipient because of an action under section 256B.064, and must assist the new text end 4.24 new text begin commissioner and lead agency in supporting the recipient in transitioning to another new text end 4.25 new text begin home care provider of the recipient's choice. new text end 4.26     new text begin (b) In the event of a payment withhold from a home care provider, a suspension of new text end 4.27 new text begin participation, or a termination of participation of a home care provider under section new text end 4.28 new text begin 256B.064, the commissioner may inform the Office of Ombudsman for Long-Term Care new text end 4.29 new text begin and the lead agencies for all recipients with active service agreements with the provider. new text end 4.30 new text begin At the commissioner's request, the lead agencies must contact recipients to ensure that the new text end 4.31 new text begin recipients are continuing to receive needed care, and that the recipients have been given new text end 4.32 new text begin free choice of provider if they transfer to another home care provider. In addition, the new text end 4.33 new text begin commissioner or the commissioner's delegate may directly notify recipients who receive new text end 4.34 new text begin care from the provider that payments have been withheld or that the provider's participation new text end 5.1 new text begin in medical assistance has been suspended or terminated, if the commissioner determines new text end 5.2 new text begin that notification is necessary to protect the welfare of the recipients. For purposes of this new text end 5.3 new text begin subdivision, "lead agencies" means counties, tribes, and managed care organizations. new text end 5.4    Sec. 7. Minnesota Statutes 2009 Supplement, section 256B.0652, subdivision 6, 5.5is amended to read: 5.6    Subd. 6. Authorization; personal care assistance and qualified professional. 5.7    (a) All personal care assistance services, supervision by a qualified professional, and 5.8additional services beyond the limits established in subdivision 11, must be authorized 5.9by the commissioner or the commissioner's designee before services begin except for the 5.10assessments established in subdivision 11 and section 256B.0911. The authorization for 5.11personal care assistance and qualified professional services under section 256B.0659 must 5.12be completed within 30 days after receiving a complete request. 5.13    (b) The amount of personal care assistance services authorized must be based 5.14on the recipient's home care rating. The home care rating shall be determined by the 5.15commissioner or the commissioner's designee based on information submitted to the 5.16commissioner identifying the following: 5.17    (1) total number of dependencies of activities of daily living as defined in section 5.18256B.0659 ; 5.19    (2) number new text begin presence new text end of complex health-related needs as defined in section 5.20256B.0659 ; and 5.21    (3) number new text begin presence new text end of new text begin Level I new text end behavior descriptions as defined in section 5.22256B.0659 . 5.23    (c) The methodology to determine total time for personal care assistance services for 5.24each home care rating is based on the median paid units per day for each home care rating 5.25from fiscal year 2007 data for the personal care assistance program. Each home care rating 5.26has a base level of hours assigned. Additional time is added through the assessment and 5.27identification of the following: 5.28    (1) 30 additional minutes per day for a dependency in each critical activity of daily 5.29living as defined in section 256B.0659; 5.30    (2) 30 additional minutes per day for each complex health-related function as 5.31defined in section 256B.0659; and 5.32    (3) 30 additional minutes per day for each behavior issue as defined in section 5.33256B.0659 new text begin , subdivision 4, paragraph (d) new text end . 5.34    (d) A limit of 96 units of qualified professional supervision may be authorized for 5.35each recipient receiving personal care assistance services. A request to the commissioner 6.1to exceed this total in a calendar year must be requested by the personal care provider 6.2agency on a form approved by the commissioner. 6.3    Sec. 8. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 10, 6.4is amended to read: 6.5    Subd. 10. Responsible party; duties; delegation. (a) A responsible party shall 6.6enter into a written agreement with a personal care assistance provider agency, on a form 6.7determined by the commissioner, to perform the following duties: 6.8    (1) be available while care is provided in a method agreed upon by the individual 6.9or the individual's legal representative and documented in the recipient's personal care 6.10assistance care plan; 6.11    (2) monitor personal care assistance services to ensure the recipient's personal care 6.12assistance care plan is being followed; and 6.13    (3) review and sign personal care assistance time sheets after services are provided 6.14to provide verification of the personal care assistance services. 6.15Failure to provide the support required by the recipient must result in a referral to the 6.16county common entry point. 6.17    (b) Responsible parties who are parents of minors or guardians of minors or 6.18incapacitated persons may delegate the responsibility to another adult who is not the 6.19personal care assistant during a temporary absence of at least 24 hours but not more 6.20than six months. The person delegated as a responsible party must be able to meet the 6.21definition of the responsible party. The responsible party must ensure that the delegate 6.22performs the functions of the responsible party, is identified at the time of the assessment, 6.23and is listed on the personal care assistance care plan. The responsible party must 6.24communicate to the personal care assistance provider agency about the need for a delegate new text begin new text end 6.25 new text begin delegated new text end responsible party, including the name of the delegated responsible party, dates 6.26the delegated responsible party will be living with the recipient, and contact numbers. 6.27    Sec. 9. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 11, 6.28is amended to read: 6.29    Subd. 11. Personal care assistant; requirements. (a) A personal care assistant 6.30must meet the following requirements: 6.31    (1) be at least 18 years of age with the exception of persons who are 16 or 17 years 6.32of age with these additional requirements: 6.33    (i) supervision by a qualified professional every 60 days; and 7.1    (ii) employment by only one personal care assistance provider agency responsible 7.2for compliance with current labor laws; 7.3    (2) be employed by a personal care assistance provider agency; 7.4    (3) enroll with the department as a personal care assistant after clearing a background 7.5study. new text begin Except as provided in subdivision 11a, new text end before a personal care assistant provides 7.6services, the personal care assistance provider agency must initiate a background study on 7.7the personal care assistant under chapter 245C, and the personal care assistance provider 7.8agency must have received a notice from the commissioner that the personal care assistant 7.9is: 7.10    (i) not disqualified under section 245C.14; or 7.11    (ii) is disqualified, but the personal care assistant has received a set aside of the 7.12disqualification under section 245C.22; 7.13    (4) be able to effectively communicate with the recipient and personal care 7.14assistance provider agency; 7.15    (5) be able to provide covered personal care assistance services according to the 7.16recipient's personal care assistance care plan, respond appropriately to recipient needs, 7.17and report changes in the recipient's condition to the supervising qualified professional 7.18or physician; 7.19    (6) not be a consumer of personal care assistance services; 7.20    (7) maintain daily written records including, but not limited to, time sheets under 7.21subdivision 12; 7.22    (8) effective January 1, 2010, complete standardized training as determined by the 7.23commissioner before completing enrollment. Personal care assistant training must include 7.24successful completion of the following training components: basic first aid, vulnerable 7.25adult, child maltreatment, OSHA universal precautions, basic roles and responsibilities of 7.26personal care assistants including information about assistance with lifting and transfers 7.27for recipients, emergency preparedness, orientation to positive behavioral practices, fraud 7.28issues, and completion of time sheets. Upon completion of the training components, 7.29the personal care assistant must demonstrate the competency to provide assistance to 7.30recipients; 7.31    (9) complete training and orientation on the needs of the recipient within the first 7.32seven days after the services begin; and 7.33    (10) be limited to providing and being paid for up to 310 hours per month of personal 7.34care assistance services regardless of the number of recipients being served or the number 7.35of personal care assistance provider agencies enrolled with. 8.1    (b) A legal guardian may be a personal care assistant if the guardian is not being paid 8.2for the guardian services and meets the criteria for personal care assistants in paragraph (a). 8.3    (c) Effective January 1, 2010, persons who do not qualify as a personal care assistant 8.4include parents and stepparents of minors, spouses, paid legal guardians, family foster 8.5care providers, except as otherwise allowed in section 256B.0625, subdivision 19a, or 8.6staff of a residential setting. 8.7 new text begin EFFECTIVE DATE. new text end new text begin This section is effective retroactively from July 1, 2009. new text end 8.8    Sec. 10. Minnesota Statutes 2009 Supplement, section 256B.0659, is amended by 8.9adding a subdivision to read: 8.10     new text begin Subd. 11a. new text end new text begin Exception to personal care assistant; requirements. new text end new text begin The personal care new text end 8.11 new text begin assistant for a recipient may be allowed to enroll with a different personal care assistant new text end 8.12 new text begin provider agency upon initiation of a new background study according to chapter 245C, if new text end 8.13 new text begin all of the following are met: new text end 8.14     new text begin (1) the commissioner determines that a change in enrollment or affiliation of the new text end 8.15 new text begin personal care assistant is needed in order to ensure continuity of services and protect the new text end 8.16 new text begin health and safety of the recipient; new text end 8.17     new text begin (2) the chosen agency has been continuously enrolled as a personal care assistance new text end 8.18 new text begin provider agency for at least two years; new text end 8.19     new text begin (3) the recipient chooses to transfer to the personal care assistance provider agency; new text end 8.20     new text begin (4) the personal care assistant has been continuously enrolled with the former new text end 8.21 new text begin personal care assistance provider agency since the last background study was completed; new text end 8.22 new text begin and new text end 8.23     new text begin (5) the personal care assistant continues to meet requirements of subdivision 11, new text end 8.24 new text begin excluding paragraph (a), clause (3). new text end 8.25 new text begin EFFECTIVE DATE. new text end new text begin This section is effective retroactively from July 1, 2009. new text end 8.26    Sec. 11. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 13, 8.27is amended to read: 8.28    Subd. 13. Qualified professional; qualifications. (a) The qualified professional 8.29must be employed by new text begin work for new text end a personal care assistance provider agency and meet the 8.30definition under section 256B.0625, subdivision 19c. Before a qualified professional 8.31provides services, the personal care assistance provider agency must initiate a background 8.32study on the qualified professional under chapter 245C, and the personal care assistance 9.1provider agency must have received a notice from the commissioner that the qualified 9.2professional: 9.3    (1) is not disqualified under section 245C.14; or 9.4    (2) is disqualified, but the qualified professional has received a set aside of the 9.5disqualification under section 245C.22. 9.6    (b) The qualified professional shall perform the duties of training, supervision, and 9.7evaluation of the personal care assistance staff and evaluation of the effectiveness of 9.8personal care assistance services. The qualified professional shall: 9.9    (1) develop and monitor with the recipient a personal care assistance care plan based 9.10on the service plan and individualized needs of the recipient; 9.11    (2) develop and monitor with the recipient a monthly plan for the use of personal 9.12care assistance services; 9.13    (3) review documentation of personal care assistance services provided; 9.14    (4) provide training and ensure competency for the personal care assistant in the 9.15individual needs of the recipient; and 9.16    (5) document all training, communication, evaluations, and needed actions to 9.17improve performance of the personal care assistants. 9.18    (c) Effective January 1, 2010, the qualified professional shall complete the provider 9.19training with basic information about the personal care assistance program approved 9.20by the commissioner within six months of the date hired by a personal care assistance 9.21provider agency. Qualified professionals who have completed the required trainings new text begin new text end 9.22 new text begin training new text end as an employee with new text begin a worker from new text end a personal care assistance provider agency do 9.23not need to repeat the required trainings new text begin training new text end if they are hired by another agency, if 9.24they have completed the training within the last three years. 9.25    Sec. 12. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 21, 9.26is amended to read: 9.27    Subd. 21. Requirements for initial enrollment of personal care assistance 9.28provider agencies. (a) All personal care assistance provider agencies must provide, at the 9.29time of enrollment as a personal care assistance provider agency in a format determined 9.30by the commissioner, information and documentation that includes, but is not limited to, 9.31the following: 9.32    (1) the personal care assistance provider agency's current contact information 9.33including address, telephone number, and e-mail address; 9.34    (2) proof of surety bond coverage in the amount of $50,000 or ten percent of the 9.35provider's payments from Medicaid in the previous year, whichever is less; 10.1    (3) proof of fidelity bond coverage in the amount of $20,000; 10.2    (4) proof of workers' compensation insurance coverage; 10.3     new text begin (5) proof of liability insurance; new text end 10.4    (5) new text begin (6) new text end a description of the personal care assistance provider agency's organization 10.5identifying the names of all owners, managing employees, staff, board of directors, and 10.6the affiliations of the directors, owners, or staff to other service providers; 10.7    (6) new text begin (7) new text end a copy of the personal care assistance provider agency's written policies 10.8and procedures including: hiring of employees; training requirements; service delivery; 10.9and employee and consumer safety including process for notification and resolution 10.10of consumer grievances, identification and prevention of communicable diseases, and 10.11employee misconduct; 10.12    (7) new text begin (8) new text end copies of all other forms the personal care assistance provider agency uses in 10.13the course of daily business including, but not limited to: 10.14    (i) a copy of the personal care assistance provider agency's time sheet if the time 10.15sheet varies from the standard time sheet for personal care assistance services approved 10.16by the commissioner, and a letter requesting approval of the personal care assistance 10.17provider agency's nonstandard time sheet; 10.18    (ii) the personal care assistance provider agency's template for the personal care 10.19assistance care plan; and 10.20    (iii) the personal care assistance provider agency's template for the written 10.21agreement in subdivision 20 for recipients using the personal care assistance choice 10.22option, if applicable; 10.23    (8) new text begin (9) new text end a list of all trainings new text begin training new text end and classes that the personal care assistance 10.24provider agency requires of its staff providing personal care assistance services; 10.25    (9) new text begin (10) new text end documentation that the personal care assistance provider agency and staff 10.26have successfully completed all the training required by this section; 10.27    (10) new text begin (11) new text end documentation of the agency's marketing practices; 10.28    (11) new text begin (12) new text end disclosure of ownership, leasing, or management of all residential 10.29properties that is used or could be used for providing home care services; and 10.30    (12) new text begin (13) new text end documentation that the agency will use the following percentages of 10.31revenue generated from the medical assistance rate paid for personal care assistance 10.32services for employee personal care assistant wages and benefits: 72.5 percent of revenue 10.33in the personal care assistance choice option and 72.5 percent of revenue from other 10.34personal care assistance providers. 10.35    (b) Personal care assistance provider agencies shall provide the information specified 10.36in paragraph (a) to the commissioner at the time the personal care assistance provider 11.1agency enrolls as a vendor or upon request from the commissioner. The commissioner 11.2shall collect the information specified in paragraph (a) from all personal care assistance 11.3providers beginning July 1, 2009. 11.4    (c) All personal care assistance provider agencies shall complete mandatory training 11.5as determined by the commissioner before enrollment as a provider. Personal care 11.6assistance provider agencies are required to send all owners, qualified professionals 11.7employed by the agency, and all other managing employees to the initial and subsequent 11.8trainings new text begin training new text end . Personal care assistance provider agency billing staff shall complete 11.9training about personal care assistance program financial management. This training is 11.10effective July 1, 2009. Any personal care assistance provider agency enrolled before that 11.11date shall, if it has not already, complete the provider training within 18 months of July 1, 11.122009. Any new owners, new qualified professionals, and new managing employees are 11.13required to complete mandatory training as a requisite of hiring. 11.14    Sec. 13. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 30, 11.15is amended to read: 11.16    Subd. 30. Notice of service changes to recipients. The commissioner must provide: 11.17    (1) by October 31, 2009, information to recipients likely to be affected that (i) 11.18describes the changes to the personal care assistance program that may result in the 11.19loss of access to personal care assistance services, and (ii) includes resources to obtain 11.20further information; and 11.21    (2) notice of changes in medical assistance home care new text begin personal care assistant new text end services 11.22to each affected recipient at least 30 days before the effective date of the change. 11.23The notice shall include how to get further information on the changes, how to get help to 11.24obtain other services, a list of community resources, and appeal rights. Notwithstanding 11.25section 256.045, a recipient may request continued services pending appeal within the 11.26time period allowed to request an appeal. 11.27    Sec. 14. Minnesota Statutes 2009 Supplement, section 256B.0911, subdivision 1a, 11.28is amended to read: 11.29    Subd. 1a. Definitions. For purposes of this section, the following definitions apply: 11.30    (a) "Long-term care consultation services" means: 11.31    (1) assistance in identifying services needed to maintain an individual in the most 11.32inclusive environment; 11.33    (2) providing recommendations on cost-effective community services that are 11.34available to the individual; 12.1    (3) development of an individual's person-centered community support plan; 12.2    (4) providing information regarding eligibility for Minnesota health care programs; 12.3    (5) face-to-face long-term care consultation assessments, which may be completed 12.4in a hospital, nursing facility, intermediate care facility for persons with developmental 12.5disabilities (ICF/DDs), regional treatment centers, or the person's current or planned 12.6residence; 12.7    (6) federally mandated screening to determine the need for a institutional level of 12.8care under section 256B.0911, subdivision 4, paragraph (a); 12.9    (7) determination of home and community-based waiver service eligibility including 12.10level of care determination for individuals who need an institutional level of care as 12.11defined under section 144.0724, subdivision 11, or 256B.092, service eligibility including 12.12state plan home care services identified in section new text begin sections new text end 256B.0625, subdivisions 6, 12.137, and 19, paragraphs (a) and (c), new text begin and 256B.0657, new text end based on assessment and support plan 12.14development with appropriate referrals new text begin , including the option for consumer-directed new text end 12.15 new text begin community supports new text end ; 12.16    (8) providing recommendations for nursing facility placement when there are no 12.17cost-effective community services available; and 12.18    (9) assistance to transition people back to community settings after facility 12.19admission. 12.20    (b) "Long-term care options counseling" means the services provided by the linkage 12.21lines as mandated by sections 256.01 and 256.975, subdivision 7, and also includes 12.22telephone assistance and follow up once a long-term care consultation assessment has 12.23been completed. 12.24    (c) "Minnesota health care programs" means the medical assistance program under 12.25chapter 256B and the alternative care program under section 256B.0913. 12.26    (d) "Lead agencies" means counties or a collaboration of counties, tribes, and health 12.27plans administering long-term care consultation assessment and support planning services. 12.28    Sec. 15. Minnesota Statutes 2009 Supplement, section 256B.0911, subdivision 2b, 12.29is amended to read: 12.30    Subd. 2b. Certified assessors. (a) Beginning January 1, 2011, each lead agency 12.31shall use certified assessors who have completed training and the certification processes 12.32determined by the commissioner in subdivision 2c. Certified assessors shall demonstrate 12.33best practices in assessment and support planning including person-centered planning 12.34principals and have a common set of skills that must ensure consistency and equitable 12.35access to services statewide. Assessors must be part of a multidisciplinary team of 13.1professionals that includes public health nurses, social workers, and other professionals 13.2as defined in paragraph (b). For persons with complex health care needs, a public health 13.3nurse or registered nurse from a multidisciplinary team must be consulted. new text begin A lead agency new text end 13.4 new text begin may choose, according to departmental policies, to contract with a qualified, certified new text end 13.5 new text begin assessor to conduct assessments and reassessments on behalf of the lead agency. new text end 13.6    (b) Certified assessors are persons with a minimum of a bachelor's degree in social 13.7work, nursing with a public health nursing certificate, or other closely related field with at 13.8least one year of home and community-based experience or a two-year registered nursing 13.9degree with at least three years of home and community-based experience that have 13.10received training and certification specific to assessment and consultation for long-term 13.11care services in the state. 13.12    Sec. 16. Minnesota Statutes 2009 Supplement, section 256B.0911, subdivision 3a, 13.13is amended to read: 13.14    Subd. 3a. Assessment and support planning. (a) Persons requesting assessment, 13.15services planning, or other assistance intended to support community-based living, 13.16including persons who need assessment in order to determine waiver or alternative care 13.17program eligibility, must be visited by a long-term care consultation team within 15 13.18calendar days after the date on which an assessment was requested or recommended. After 13.19January 1, 2011, these requirements also apply to personal care assistance services, private 13.20duty nursing, and home health agency services, on timelines established in subdivision 5. 13.21Face-to-face assessments must be conducted according to paragraphs (b) to (i). 13.22    (b) The county may utilize a team of either the social worker or public health nurse, 13.23or both. After January 1, 2011, lead agencies shall use certified assessors to conduct the 13.24assessment in a face-to-face interview. The consultation team members must confer 13.25regarding the most appropriate care for each individual screened or assessed. 13.26    (c) The assessment must be comprehensive and include a person-centered 13.27assessment of the health, psychological, functional, environmental, and social needs of 13.28referred individuals and provide information necessary to develop a support plan that 13.29meets the consumers needs, using an assessment form provided by the commissioner. 13.30    (d) The assessment must be conducted in a face-to-face interview with the person 13.31being assessed and the person's legal representative, as required by legally executed 13.32documents, and other individuals as requested by the person, who can provide information 13.33on the needs, strengths, and preferences of the person necessary to develop a support plan 13.34that ensures the person's health and safety, but who is not a provider of service or has any 13.35financial interest in the provision of services. 14.1    (e) The person, or the person's legal representative, must be provided with written 14.2recommendations for community-based services new text begin , including consumer-directed options, new text end 14.3or institutional care that include documentation that the most cost-effective alternatives 14.4available were offered to the individual. For purposes of this requirement, "cost-effective 14.5alternatives" means community services and living arrangements that cost the same as or 14.6less than institutional care. 14.7    (f) If the person chooses to use community-based services, the person or the person's 14.8legal representative must be provided with a written community support plan, regardless 14.9of whether the individual is eligible for Minnesota health care programs. A person may 14.10request assistance in identifying community supports without participating in a complete 14.11assessment. Upon a request for assistance identifying community support, the person must 14.12be transferred or referred to the services available under sections 256.975, subdivision 7, 14.13and 256.01, subdivision 24, for telephone assistance and follow up. 14.14    (g) The person has the right to make the final decision between institutional 14.15placement and community placement after the recommendations have been provided, 14.16except as provided in subdivision 4a, paragraph (c). 14.17    (h) The team must give the person receiving assessment or support planning, or 14.18the person's legal representative, materials, and forms supplied by the commissioner 14.19containing the following information: 14.20    (1) the need for and purpose of preadmission screening if the person selects nursing 14.21facility placement; 14.22    (2) the role of the long-term care consultation assessment and support planning in 14.23waiver and alternative care program eligibility determination; 14.24    (3) information about Minnesota health care programs; 14.25    (4) the person's freedom to accept or reject the recommendations of the team; 14.26    (5) the person's right to confidentiality under the Minnesota Government Data 14.27Practices Act, chapter 13; 14.28    (6) the long-term care consultant's decision regarding the person's need for 14.29institutional level of care as determined under criteria established in section 144.0724, 14.30subdivision 11 , or 256B.092; and 14.31    (7) the person's right to appeal the decision regarding the need for nursing facility 14.32level of care or the county's final decisions regarding public programs eligibility according 14.33to section 256.045, subdivision 3. 14.34    (i) Face-to-face assessment completed as part of eligibility determination for 14.35the alternative care, elderly waiver, community alternatives for disabled individuals, 14.36community alternative care, and traumatic brain injury waiver programs under sections 15.1256B.0915 , 256B.0917, and 256B.49 is valid to establish service eligibility for no more 15.2than 60 calendar days after the date of assessment. The effective eligibility start date 15.3for these programs can never be prior to the date of assessment. If an assessment was 15.4completed more than 60 days before the effective waiver or alternative care program 15.5eligibility start date, assessment and support plan information must be updated in a 15.6face-to-face visit and documented in the department's Medicaid Management Information 15.7System (MMIS). The effective date of program eligibility in this case cannot be prior to 15.8the date the updated assessment is completed. 15.9    Sec. 17. Minnesota Statutes 2009 Supplement, section 256B.0911, subdivision 3b, 15.10is amended to read: 15.11    Subd. 3b. Transition assistance. (a) A long-term care consultation team shall 15.12provide assistance to persons residing in a nursing facility, hospital, regional treatment 15.13center, or intermediate care facility for persons with developmental disabilities who 15.14request or are referred for assistance. Transition assistance must include assessment, 15.15community support plan development, referrals to long-term care options counseling 15.16under section 256B.975, subdivision 10, for community support plan implementation 15.17and to Minnesota health care programs, new text begin including home and community-based waiver new text end 15.18 new text begin services and consumer-directed options through the waivers, new text end and referrals to programs 15.19that provide assistance with housing. Transition assistance must also include information 15.20about the Centers for Independent Living and the Senior LinkAge Line, and about other 15.21organizations that can provide assistance with relocation efforts, and information about 15.22contacting these organizations to obtain their assistance and support. 15.23    (b) The county shall develop transition processes with institutional social workers 15.24and discharge planners to ensure that: 15.25    (1) persons admitted to facilities receive information about transition assistance 15.26that is available; 15.27    (2) the assessment is completed for persons within ten working days of the date of 15.28request or recommendation for assessment; and 15.29    (3) there is a plan for transition and follow-up for the individual's return to the 15.30community. The plan must require notification of other local agencies when a person 15.31who may require assistance is screened by one county for admission to a facility located 15.32in another county. 15.33    (c) If a person who is eligible for a Minnesota health care program is admitted to a 15.34nursing facility, the nursing facility must include a consultation team member or the case 15.35manager in the discharge planning process. 16.1    Sec. 18. Minnesota Statutes 2008, section 256B.0911, subdivision 4d, is amended to 16.2read: 16.3    Subd. 4d. Preadmission screening of individuals under 65 years of age. (a) 16.4It is the policy of the state of Minnesota to ensure that individuals with disabilities or 16.5chronic illness are served in the most integrated setting appropriate to their needs and have 16.6the necessary information to make informed choices about home and community-based 16.7service options. 16.8    (b) Individuals under 65 years of age who are admitted to a nursing facility from a 16.9hospital must be screened prior to admission as outlined in subdivisions 4a through 4c. 16.10    (c) Individuals under 65 years of age who are admitted to nursing facilities with 16.11only a telephone screening must receive a face-to-face assessment from the long-term 16.12care consultation team member of the county in which the facility is located or from the 16.13recipient's county case manager within 40 calendar days of admission. 16.14    (d) Individuals under 65 years of age who are admitted to a nursing facility 16.15without preadmission screening according to the exemption described in subdivision 4b, 16.16paragraph (a), clause (3), and who remain in the facility longer than 30 days must receive 16.17a face-to-face assessment within 40 days of admission. 16.18    (e) At the face-to-face assessment, the long-term care consultation team member or 16.19county case manager must perform the activities required under subdivision 3b. 16.20    (f) For individuals under 21 years of age, a screening interview which recommends 16.21nursing facility admission must be face-to-face and approved by the commissioner before 16.22the individual is admitted to the nursing facility. 16.23    (g) In the event that an individual under 65 years of age is admitted to a nursing 16.24facility on an emergency basis, the county must be notified of the admission on the 16.25next working day, and a face-to-face assessment as described in paragraph (c) must be 16.26conducted within 40 calendar days of admission. 16.27    (h) At the face-to-face assessment, the long-term care consultation team member or 16.28the case manager must present information about home and community-based options new text begin , new text end 16.29 new text begin including consumer-directed options, new text end so the individual can make informed choices. If the 16.30individual chooses home and community-based services, the long-term care consultation 16.31team member or case manager must complete a written relocation plan within 20 working 16.32days of the visit. The plan shall describe the services needed to move out of the facility 16.33and a time line for the move which is designed to ensure a smooth transition to the 16.34individual's home and community. 16.35    (i) An individual under 65 years of age residing in a nursing facility shall receive a 16.36face-to-face assessment at least every 12 months to review the person's service choices 17.1and available alternatives unless the individual indicates, in writing, that annual visits are 17.2not desired. In this case, the individual must receive a face-to-face assessment at least 17.3once every 36 months for the same purposes. 17.4    (j) Notwithstanding the provisions of subdivision 6, the commissioner may pay 17.5county agencies directly for face-to-face assessments for individuals under 65 years of age 17.6who are being considered for placement or residing in a nursing facility. 17.7    Sec. 19. Minnesota Statutes 2008, section 626.557, subdivision 9a, is amended to read: 17.8    Subd. 9a. Evaluation and referral of reports made to common entry point unit. 17.9    The common entry point must screen the reports of alleged or suspected maltreatment for 17.10immediate risk and make all necessary referrals as follows: 17.11    (1) if the common entry point determines that there is an immediate need for 17.12adult protective services, the common entry point agency shall immediately notify the 17.13appropriate county agency; 17.14    (2) if the report contains suspected criminal activity against a vulnerable adult, the 17.15common entry point shall immediately notify the appropriate law enforcement agency; 17.16    (3) if the report references alleged or suspected maltreatment and there is no 17.17immediate need for adult protective services, the common entry point shall notify new text begin refer all new text end 17.18 new text begin reports of alleged or suspected maltreatment to new text end the appropriate lead agency as soon as 17.19possible, but in any event no longer than two working days; new text begin and new text end 17.20    (4) if the report does not reference alleged or suspected maltreatment, the common 17.21entry point may determine whether the information will be referred; and 17.22    (5) new text begin (4) new text end if the report contains information about a suspicious death, the common entry 17.23point shall immediately notify the appropriate law enforcement agencies, the local medical 17.24examiner, and the ombudsman established under section 245.92. Law enforcement 17.25agencies shall coordinate with the local medical examiner and the ombudsman as provided 17.26by law. 17.27    Sec. 20. new text begin ELDERLY WAIVER CONVERSION. new text end 17.28     new text begin Notwithstanding Minnesota Statutes, section 256B.0915, subdivision 3b, a person new text end 17.29 new text begin age 65 or older with an MT home care rating on January 1, 2010, is eligible for the elderly new text end 17.30 new text begin waiver program and shall be considered a conversion for purposes of accessing monthly new text end 17.31 new text begin budget caps equal to no more than the person's monthly spending under the personal care new text end 17.32 new text begin assistance program on January 1, 2010. new text end 18.1    Sec. 21. new text begin DIRECTION TO COMMISSIONER; CONSULTATION WITH new text end 18.2 new text begin STAKEHOLDERS. new text end 18.3     new text begin The commissioner shall consult with stakeholders experienced in using and new text end 18.4 new text begin providing services through the consumer-directed community supports option during new text end 18.5 new text begin the identification of data to be used in future development of an individualized budget new text end 18.6 new text begin methodology for the home and community-based waivers for individuals with disabilities new text end 18.7 new text begin under the new comprehensive assessment. new text end 18.8ARTICLE 2 18.9PERSONAL CARE ASSISTANT SERVICES 18.10    Section 1. Minnesota Statutes 2009 Supplement, section 256B.0653, subdivision 3, 18.11is amended to read: 18.12    Subd. 3. Home health aide visits. (a) Home health aide visits must be provided 18.13by a certified home health aide using a written plan of care that is updated in compliance 18.14with Medicare regulations. A home health aide shall provide hands-on personal care, 18.15perform simple procedures as an extension of therapy or nursing services, and assist in 18.16instrumental activities of daily living as defined in section 256B.0659 new text begin , including assuring new text end 18.17 new text begin that the person gets to medical appointments if identified in the written plan of care new text end . Home 18.18health aide visits must be provided in the recipient's home. 18.19    (b) All home health aide visits must have authorization under section 256B.0652. 18.20The commissioner shall limit home health aide visits to no more than one visit per day 18.21per recipient. 18.22    (c) Home health aides must be supervised by a registered nurse or an appropriate 18.23therapist when providing services that are an extension of therapy. 18.24    Sec. 2. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 1, 18.25is amended to read: 18.26    Subdivision 1. Definitions. (a) For the purposes of this section, the terms defined in 18.27paragraphs (b) to (p) new text begin (r) new text end have the meanings given unless otherwise provided in text. 18.28    (b) "Activities of daily living" means grooming, dressing, bathing, transferring, 18.29mobility, positioning, eating, and toileting. 18.30    (c) "Behavior," effective January 1, 2010, means a category to determine the home 18.31care rating and is based on the criteria found in this section. "Level I behavior" means 18.32physical aggression towards self, others, or destruction of property that requires the 18.33immediate response of another person. 19.1    (d) "Complex health-related needs," effective January 1, 2010, means a category to 19.2determine the home care rating and is based on the criteria found in this section. 19.3    (e) "Critical activities of daily living," effective January 1, 2010, means transferring, 19.4mobility, eating, and toileting. 19.5    (f) "Dependency in activities of daily living" means a person requires assistance to 19.6begin and complete one or more of the activities of daily living. 19.7    (g) new text begin "Extended personal care assistance service" means personal care assistance new text end 19.8 new text begin services included in a service plan under one of the home and community-based services new text end 19.9 new text begin waivers authorized under sections 256B.49, 256B.0915, and 256B.092, subdivision new text end 19.10 new text begin 5, which exceed the amount, duration, and frequency of the state plan personal care new text end 19.11 new text begin assistance services for participants who: new text end 19.12     new text begin (1) need assistance provided periodically during a week, but less than daily will not new text end 19.13 new text begin be able to remain in their home without the assistance, and other replacement services new text end 19.14 new text begin are more expensive or are not available when personal care assistance services are to be new text end 19.15 new text begin terminated; or new text end 19.16     new text begin (2) need additional personal care assistance services beyond the amount authorized new text end 19.17 new text begin by the state plan personal care assistance assessment in order to ensure that their safety, new text end 19.18 new text begin health, and welfare are provided for in their homes. new text end 19.19     new text begin (h) new text end "Health-related procedures and tasks" means procedures and tasks that can 19.20be delegated or assigned by a licensed health care professional under state law to be 19.21performed by a personal care assistant. 19.22    (h) new text begin (i) new text end "Instrumental activities of daily living" means activities to include meal 19.23planning and preparation; basic assistance with paying bills; shopping for food, clothing, 19.24and other essential items; performing household tasks integral to the personal care 19.25assistance services; communication by telephone and other media; and traveling, including 19.26to medical appointments and to participate in the community. 19.27    (i) new text begin (j) new text end "Managing employee" has the same definition as Code of Federal Regulations, 19.28title 42, section 455. 19.29    (j) new text begin (k) new text end "Qualified professional" means a professional providing supervision of 19.30personal care assistance services and staff as defined in section 256B.0625, subdivision 19.3119c . 19.32    (k) new text begin (l) new text end "Personal care assistance provider agency" means a medical assistance 19.33enrolled provider that provides or assists with providing personal care assistance services 19.34and includes a personal care assistance provider organization, personal care assistance 19.35choice agency, class A licensed nursing agency, and Medicare-certified home health 19.36agency. 20.1    (l) new text begin (m) new text end "Personal care assistant" or "PCA" means an individual employed by a 20.2personal care assistance agency who provides personal care assistance services. 20.3    (m) new text begin (n) new text end "Personal care assistance care plan" means a written description of personal 20.4care assistance services developed by the personal care assistance provider according 20.5to the service plan. 20.6    (n) new text begin (o) new text end "Responsible party" means an individual who is capable of providing the 20.7support necessary to assist the recipient to live in the community. 20.8    (o) new text begin (p) new text end "Self-administered medication" means medication taken orally, by injection 20.9or insertion, or applied topically without the need for assistance. 20.10    (p) new text begin (q) new text end "Service plan" means a written summary of the assessment and description of 20.11the services needed by the recipient. 20.12     new text begin (r) "Wages and benefits" means wages and salaries, the employer's share of FICA new text end 20.13 new text begin taxes, Medicare taxes, state and federal unemployment taxes, workers' compensation, new text end 20.14 new text begin mileage reimbursement, health and dental insurance, life insurance, disability insurance, new text end 20.15 new text begin long-term care insurance, uniform allowance, and contributions to employee retirement new text end 20.16 new text begin accounts. new text end 20.17    Sec. 3. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 3, 20.18is amended to read: 20.19    Subd. 3. Noncovered personal care assistance services. (a) Personal care 20.20assistance services are not eligible for medical assistance payment under this section 20.21when provided: 20.22    (1) by the recipient's spouse, parent of a recipient under the age of 18, paid legal 20.23guardian, licensed foster provider, except as allowed under section 256B.0651, subdivision 20.2410 , or responsible party; 20.25    (2) in lieu of other staffing options in a residential or child care setting; 20.26    (3) solely as a child care or babysitting service; or 20.27    (4) without authorization by the commissioner or the commissioner's designee. 20.28    (b) The following personal care services are not eligible for medical assistance 20.29payment under this section when provided in residential settings: 20.30    (1) effective January 1, 2010, when the provider of home care services who is not 20.31related by blood, marriage, or adoption owns or otherwise controls the living arrangement, 20.32including licensed or unlicensed services; or 20.33    (2) when personal care assistance services are the responsibility of a residential or 20.34program license holder under the terms of a service agreement and administrative rules. 21.1    (c) Other specific tasks not covered under paragraph (a) or (b) that are not eligible 21.2for medical assistance reimbursement for personal care assistance services under this 21.3section include: 21.4    (1) sterile procedures; 21.5    (2) injections of fluids and medications into veins, muscles, or skin; 21.6    (3) home maintenance or chore services; 21.7    (4) homemaker services not an integral part of assessed personal care assistance 21.8services needed by a recipient; 21.9    (5) application of restraints or implementation of procedures under section 245.825; 21.10    (6) instrumental activities of daily living for children under the age of 18 new text begin , except new text end 21.11 new text begin when immediate attention is needed for health or hygiene reasons integral to the personal new text end 21.12 new text begin care services and the need is listed in the service plan by the assessor new text end ; and 21.13    (7) assessments for personal care assistance services by personal care assistance 21.14provider agencies or by independently enrolled registered nurses. 21.15    Sec. 4. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 4, 21.16is amended to read: 21.17    Subd. 4. Assessment for personal care assistance services; limitations. (a) An 21.18assessment as defined in subdivision 3a must be completed for personal care assistance 21.19services. 21.20    (b) The following limitations apply to the assessment: 21.21    (1) a person must be assessed as dependent in an activity of daily living based on 21.22the person's new text begin daily new text end need new text begin or need on the days during the week the activity is completed new text end , 21.23on a daily basis, for: 21.24    (i) cuing and constant supervision to complete the task; or 21.25    (ii) hands-on assistance to complete the task; and 21.26    (2) a child may not be found to be dependent in an activity of daily living if because 21.27of the child's age an adult would either perform the activity for the child or assist the child 21.28with the activity. Assistance needed is the assistance appropriate for a typical child of 21.29the same age. 21.30    (c) Assessment for complex health-related needs must meet the criteria in this 21.31paragraph. During the assessment process, a recipient qualifies as having complex 21.32health-related needs if the recipient has one or more of the interventions that are ordered by 21.33a physician, specified in a personal care assistance care plan, and found in the following: 21.34    (1) tube feedings requiring: 21.35    (i) a gastro/jejunostomy new text begin gastrojejunostomy new text end tube; or 22.1    (ii) continuous tube feeding lasting longer than 12 hours per day; 22.2    (2) wounds described as: 22.3    (i) stage III or stage IV; 22.4    (ii) multiple wounds; 22.5    (iii) requiring sterile or clean dressing changes or a wound vac; or 22.6    (iv) open lesions such as burns, fistulas, tube sites, or ostomy sites that require 22.7specialized care; 22.8    (3) parenteral therapy described as: 22.9    (i) IV therapy more than two times per week lasting longer than four hours for 22.10each treatment; or 22.11    (ii) total parenteral nutrition (TPN) daily; 22.12    (4) respiratory interventions including: 22.13    (i) oxygen required more than eight hours per day; 22.14    (ii) respiratory vest more than one time per day; 22.15    (iii) bronchial drainage treatments more than two times per day; 22.16    (iv) sterile or clean suctioning more than six times per day; 22.17    (v) dependence on another to apply respiratory ventilation augmentation devices 22.18such as BiPAP and CPAP; and 22.19    (vi) ventilator dependence under section 256B.0652; 22.20    (5) insertion and maintenance of catheter including: 22.21    (i) sterile catheter changes more than one time per month; 22.22    (ii) clean self-catheterization more than six times per day; or 22.23    (iii) bladder irrigations; 22.24    (6) bowel program more than two times per week requiring more than 30 minutes to 22.25perform each time; 22.26    (7) neurological intervention including: 22.27    (i) seizures more than two times per week and requiring significant physical 22.28assistance to maintain safety; or 22.29    (ii) swallowing disorders diagnosed by a physician and requiring specialized 22.30assistance from another on a daily basis; and 22.31    (8) other congenital or acquired diseases creating a need for significantly increased 22.32direct hands-on assistance and interventions in six to eight activities of daily living. 22.33    (d) An assessment of behaviors must meet the criteria in this paragraph. A recipient 22.34qualifies as having a need for assistance due to behaviors if the recipient's behavior requires 22.35assistance at least four times per week and shows one or more of the following behaviors: 23.1    (1) physical aggression towards self or others, or destruction of property that requires 23.2the immediate response of another person; 23.3    (2) increased vulnerability due to cognitive deficits or socially inappropriate 23.4behavior; or 23.5    (3) verbally aggressive and resistive to care. 23.6    Sec. 5. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 11, 23.7is amended to read: 23.8    Subd. 11. Personal care assistant; requirements. (a) A personal care assistant 23.9must meet the following requirements: 23.10    (1) be at least 18 years of age with the exception of persons who are 16 or 17 years 23.11of age with these additional requirements: 23.12    (i) supervision by a qualified professional every 60 days; and 23.13    (ii) employment by only one personal care assistance provider agency responsible 23.14for compliance with current labor laws; 23.15    (2) be employed by a personal care assistance provider agency; 23.16    (3) enroll with the department as a personal care assistant after clearing a background 23.17study. Before a personal care assistant provides services, the personal care assistance 23.18provider agency must initiate a background study on the personal care assistant under 23.19chapter 245C, and the personal care assistance provider agency must have received a 23.20notice from the commissioner that the personal care assistant is: 23.21    (i) not disqualified under section 245C.14; or 23.22    (ii) is disqualified, but the personal care assistant has received a set aside of the 23.23disqualification under section 245C.22; 23.24    (4) be able to effectively communicate with the recipient and personal care 23.25assistance provider agency; 23.26    (5) be able to provide covered personal care assistance services according to the 23.27recipient's personal care assistance care plan, respond appropriately to recipient needs, 23.28and report changes in the recipient's condition to the supervising qualified professional 23.29or physician; 23.30    (6) not be a consumer of personal care assistance services; 23.31    (7) maintain daily written records including, but not limited to, time sheets under 23.32subdivision 12; 23.33    (8) effective January 1, 2010, complete standardized training as determined 23.34by the commissioner before completing enrollment. new text begin The training must be available new text end 23.35 new text begin in languages other than English and to those who need accommodations due to new text end 24.1 new text begin disabilities. new text end Personal care assistant training must include successful completion of the 24.2following training components: basic first aid, vulnerable adult, child maltreatment, 24.3OSHA universal precautions, basic roles and responsibilities of personal care assistants 24.4including information about assistance with lifting and transfers for recipients, emergency 24.5preparedness, orientation to positive behavioral practices, fraud issues, and completion of 24.6time sheets. Upon completion of the training components, the personal care assistant must 24.7demonstrate the competency to provide assistance to recipients; 24.8    (9) complete training and orientation on the needs of the recipient within the first 24.9seven days after the services begin; and 24.10    (10) be limited to providing and being paid for up to 310 hours per month of personal 24.11care assistance services regardless of the number of recipients being served or the number 24.12of personal care assistance provider agencies enrolled with. new text begin The number of hours worked new text end 24.13 new text begin per day shall not be disallowed by the department unless in violation of the law. new text end 24.14    (b) A legal guardian may be a personal care assistant if the guardian is not being paid 24.15for the guardian services and meets the criteria for personal care assistants in paragraph (a). 24.16    (c) Effective January 1, 2010, persons who do not qualify as a personal care assistant 24.17include parents and stepparents of minors, spouses, paid legal guardians, family foster 24.18care providers, except as otherwise allowed in section 256B.0625, subdivision 19a, or 24.19staff of a residential setting. 24.20    Sec. 6. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 13, 24.21is amended to read: 24.22    Subd. 13. Qualified professional; qualifications. (a) The qualified professional 24.23must be employed by a personal care assistance provider agency and meet the definition 24.24under section 256B.0625, subdivision 19c. Before a qualified professional provides 24.25services, the personal care assistance provider agency must initiate a background study on 24.26the qualified professional under chapter 245C, and the personal care assistance provider 24.27agency must have received a notice from the commissioner that the qualified professional: 24.28    (1) is not disqualified under section 245C.14; or 24.29    (2) is disqualified, but the qualified professional has received a set aside of the 24.30disqualification under section 245C.22. 24.31    (b) The qualified professional shall perform the duties of training, supervision, and 24.32evaluation of the personal care assistance staff and evaluation of the effectiveness of 24.33personal care assistance services. The qualified professional shall: 24.34    (1) develop and monitor with the recipient a personal care assistance care plan based 24.35on the service plan and individualized needs of the recipient; 25.1    (2) develop and monitor with the recipient a monthly plan for the use of personal 25.2care assistance services; 25.3    (3) review documentation of personal care assistance services provided; 25.4    (4) provide training and ensure competency for the personal care assistant in the 25.5individual needs of the recipient; and 25.6    (5) document all training, communication, evaluations, and needed actions to 25.7improve performance of the personal care assistants. 25.8    (c) Effective January new text begin July new text end 1, 2010, the qualified professional shall complete the 25.9provider training with basic information about the personal care assistance program 25.10approved by the commissioner within six months of the date hired by a personal care 25.11assistance provider agency. Qualified professionals who have completed the required 25.12trainings as an employee with a personal care assistance provider agency do not need to 25.13repeat the required trainings if they are hired by another agency, if they have completed the 25.14training within the last three years. new text begin The required training shall be available in languages new text end 25.15 new text begin other than English and to those who need accommodations due to disabilities, online, or new text end 25.16 new text begin by electronic remote connection, and provide for competency testing to demonstrate an new text end 25.17 new text begin understanding of the content without attending in-person training. A qualified professional new text end 25.18 new text begin is allowed to be employed and is not subject to the training requirement until the training is new text end 25.19 new text begin offered online or through remote electronic connection. A qualified professional employed new text end 25.20 new text begin by a personal care assistance provider agency certified for participation in Medicare as new text end 25.21 new text begin a home health agency is exempt from the training required in this subdivision. The new text end 25.22 new text begin commissioner shall ensure there is a mechanism in place to verify the identity of persons new text end 25.23 new text begin completing the competency testing electronically. new text end 25.24    Sec. 7. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 14, 25.25is amended to read: 25.26    Subd. 14. Qualified professional; duties. (a) Effective January 1, 2010, all personal 25.27care assistants must be supervised by a qualified professional. 25.28    (b) Through direct training, observation, return demonstrations, and consultation 25.29with the staff and the recipient, the qualified professional must ensure and document 25.30that the personal care assistant is: 25.31    (1) capable of providing the required personal care assistance services; 25.32    (2) knowledgeable about the plan of personal care assistance services before services 25.33are performed; and 25.34    (3) able to identify conditions that should be immediately brought to the attention of 25.35the qualified professional. 26.1    (c) The qualified professional shall evaluate the personal care assistant within the first 26.214 days of starting to provide new text begin regularly scheduled new text end services for a recipient except for the 26.3personal care assistance choice option under subdivision 19, paragraph (a), clause (4). new text begin For new text end 26.4 new text begin the initial evaluation, new text end the qualified professional shall evaluate the personal care assistance 26.5services for a recipient through direct observation of a personal care assistant's work new text begin . new text end 26.6 new text begin Subsequent visits to evaluate the personal care assistance services provided to a recipient new text end 26.7 new text begin do not require direct observation of each personal care assistant's work and shall occur new text end : 26.8    (1) at least every 90 days thereafter for the first year of a recipient's services; and 26.9    (2) every 120 days after the first year of a recipient's service or whenever needed for 26.10response to a recipient's request for increased supervision of the personal care assistance 26.11staff new text begin ; and new text end 26.12     new text begin (3) after the first 180 days of a recipient's service, supervisory visits may alternate new text end 26.13 new text begin between unscheduled phone or Internet technology and in-person visits, unless the new text end 26.14 new text begin in-person visits are needed according to the care plan new text end . 26.15    (d) Communication with the recipient is a part of the evaluation process of the 26.16personal care assistance staff. 26.17    (e) At each supervisory visit, the qualified professional shall evaluate personal care 26.18assistance services including the following information: 26.19    (1) satisfaction level of the recipient with personal care assistance services; 26.20    (2) review of the month-to-month plan for use of personal care assistance services; 26.21    (3) review of documentation of personal care assistance services provided; 26.22    (4) whether the personal care assistance services are meeting the goals of the service 26.23as stated in the personal care assistance care plan and service plan; 26.24    (5) a written record of the results of the evaluation and actions taken to correct any 26.25deficiencies in the work of a personal care assistant; and 26.26    (6) revision of the personal care assistance care plan as necessary in consultation 26.27with the recipient or responsible party, to meet the needs of the recipient. 26.28    (f) The qualified professional shall complete the required documentation in the 26.29agency recipient and employee files and the recipient's home, including the following 26.30documentation: 26.31    (1) the personal care assistance care plan based on the service plan and individualized 26.32needs of the recipient; 26.33    (2) a month-to-month plan for use of personal care assistance services; 26.34    (3) changes in need of the recipient requiring a change to the level of service and the 26.35personal care assistance care plan; 27.1    (4) evaluation results of supervision visits and identified issues with personal care 27.2assistance staff with actions taken; 27.3    (5) all communication with the recipient and personal care assistance staff; and 27.4    (6) hands-on training or individualized training for the care of the recipient. 27.5    (g) The documentation in paragraph (f) must be done on agency forms. 27.6    (h) The services that are not eligible for payment as qualified professional services 27.7include: 27.8    (1) direct professional nursing tasks that could be assessed and authorized as skilled 27.9nursing tasks; 27.10    (2) supervision of personal care assistance completed by telephone; 27.11    (3) agency administrative activities; 27.12    (4) training other than the individualized training required to provide care for a 27.13recipient; and 27.14    (5) any other activity that is not described in this section. 27.15    Sec. 8. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 18, 27.16is amended to read: 27.17    Subd. 18. Personal care assistance choice option; generally. (a) The 27.18commissioner may allow a recipient of personal care assistance services to use a fiscal 27.19intermediary to assist the recipient in paying and accounting for medically necessary 27.20covered personal care assistance services. Unless otherwise provided in this section, all 27.21other statutory and regulatory provisions relating to personal care assistance services apply 27.22to a recipient using the personal care assistance choice option. 27.23    (b) Personal care assistance choice is an option of the personal care assistance 27.24program that allows the recipient who receives personal care assistance services to be 27.25responsible for the hiring, training, scheduling, and firing of personal care assistants new text begin new text end 27.26 new text begin according to the terms of the written agreement with the personal care assistance choice new text end 27.27 new text begin agency required under subdivision 20, paragraph (a) new text end . This program offers greater control 27.28and choice for the recipient in who provides the personal care assistance service and when 27.29the service is scheduled. The recipient or the recipient's responsible party must choose a 27.30personal care assistance choice provider agency as a fiscal intermediary. This personal 27.31care assistance choice provider agency manages payroll, invoices the state, is responsible 27.32for all payroll-related taxes and insurance, and is responsible for providing the consumer 27.33training and support in managing the recipient's personal care assistance services. 28.1    Sec. 9. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 19, 28.2is amended to read: 28.3    Subd. 19. Personal care assistance choice option; qualifications; duties. (a) 28.4Under personal care assistance choice, the recipient or responsible party shall: 28.5    (1) recruit, hire, schedule, and terminate personal care assistants and a qualified 28.6professional new text begin according to the terms of the written agreement required under subdivision new text end 28.7 new text begin 20, paragraph (a) new text end ; 28.8    (2) develop a personal care assistance care plan based on the assessed needs 28.9and addressing the health and safety of the recipient with the assistance of a qualified 28.10professional as needed; 28.11    (3) orient and train the personal care assistant with assistance as needed from the 28.12qualified professional; 28.13    (4) effective January 1, 2010, supervise and evaluate the personal care assistant with 28.14the qualified professional, who is required to visit the recipient at least every 180 days; 28.15    (5) monitor and verify in writing and report to the personal care assistance choice 28.16agency the number of hours worked by the personal care assistant and the qualified 28.17professional; 28.18    (6) engage in an annual face-to-face reassessment to determine continuing eligibility 28.19and service authorization; and 28.20    (7) use the same personal care assistance choice provider agency if shared personal 28.21assistance care is being used. 28.22    (b) The personal care assistance choice provider agency shall: 28.23    (1) meet all personal care assistance provider agency standards; 28.24    (2) enter into a written agreement with the recipient, responsible party, and personal 28.25care assistants; 28.26    (3) not be related as a parent, child, sibling, or spouse to the recipient, qualified 28.27professional, or the personal care assistant; and 28.28    (4) ensure arm's-length transactions without undue influence or coercion with the 28.29recipient and personal care assistant. 28.30    (c) The duties of the personal care assistance choice provider agency are to: 28.31    (1) be the employer of the personal care assistant and the qualified professional for 28.32employment law and related regulations including, but not limited to, purchasing and 28.33maintaining workers' compensation, unemployment insurance, surety and fidelity bonds, 28.34and liability insurance, and submit any or all necessary documentation including, but not 28.35limited to, workers' compensation and unemployment insurance; 29.1    (2) bill the medical assistance program for personal care assistance services and 29.2qualified professional services; 29.3    (3) request and complete background studies that comply with the requirements for 29.4personal care assistants and qualified professionals; 29.5    (4) pay the personal care assistant and qualified professional based on actual hours 29.6of services provided; 29.7    (5) withhold and pay all applicable federal and state taxes; 29.8    (6) verify and keep records of hours worked by the personal care assistant and 29.9qualified professional; 29.10    (7) make the arrangements and pay taxes and other benefits, if any, and comply with 29.11any legal requirements for a Minnesota employer; 29.12    (8) enroll in the medical assistance program as a personal care assistance choice 29.13agency; and 29.14    (9) enter into a written agreement as specified in subdivision 20 before services 29.15are provided. 29.16    Sec. 10. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 20, 29.17is amended to read: 29.18    Subd. 20. Personal care assistance choice option; administration. (a) Before 29.19services commence under the personal care assistance choice option, and annually 29.20thereafter, the personal care assistance choice provider agency, recipient, or responsible 29.21party, each personal care assistant, and the qualified professional new text begin and the recipient or new text end 29.22 new text begin responsible party new text end shall enter into a written agreement. The new text begin annual new text end agreement must new text begin be new text end 29.23 new text begin provided to the recipient or responsible party, each personal care assistant, and the new text end 29.24 new text begin qualified professional when completed, and new text end include at a minimum: 29.25    (1) duties of the recipient, qualified professional, personal care assistant, and 29.26personal care assistance choice provider agency; 29.27    (2) salary and benefits for the personal care assistant and the qualified professional; 29.28    (3) administrative fee of the personal care assistance choice provider agency and 29.29services paid for with that fee, including background study fees; 29.30    (4) grievance procedures to respond to complaints; 29.31    (5) procedures for hiring and terminating the personal care assistant; and 29.32    (6) documentation requirements including, but not limited to, time sheets, activity 29.33records, and the personal care assistance care plan. 29.34    (b) Effective January 1, 2010, except for the administrative fee of the personal care 29.35assistance choice provider agency as reported on the written agreement, the remainder 30.1of the rates paid to the personal care assistance choice provider agency must be used to 30.2pay for the salary and benefits for the personal care assistant or the qualified professional. 30.3The provider agency must use a minimum of 72.5 percent of the revenue generated by 30.4the medical assistance rate for personal care assistance services for employee personal 30.5care assistant wages and benefits. 30.6    (c) The commissioner shall deny, revoke, or suspend the authorization to use the 30.7personal care assistance choice option if: 30.8    (1) it has been determined by the qualified professional or public health nurse that 30.9the use of this option jeopardizes the recipient's health and safety; 30.10    (2) the parties have failed to comply with the written agreement specified in this 30.11subdivision; 30.12    (3) the use of the option has led to abusive or fraudulent billing for personal care 30.13assistance services; or 30.14    (4) the department terminates the personal care assistance choice option. 30.15    (d) The recipient or responsible party may appeal the commissioner's decision in 30.16paragraph (c) according to section 256.045. The denial, revocation, or suspension to 30.17use the personal care assistance choice option must not affect the recipient's authorized 30.18level of personal care assistance services. 30.19    Sec. 11. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 21, 30.20is amended to read: 30.21    Subd. 21. Requirements for initial enrollment of personal care assistance 30.22provider agencies. (a) All personal care assistance provider agencies must provide, at the 30.23time of enrollment as a personal care assistance provider agency in a format determined 30.24by the commissioner, information and documentation that includes, but is not limited to, 30.25the following: 30.26    (1) the personal care assistance provider agency's current contact information 30.27including address, telephone number, and e-mail address; 30.28    (2) proof of surety bond coverage in the amount of $50,000 or ten percent of the 30.29provider's payments from Medicaid in the previous year, whichever is less; 30.30    (3) proof of fidelity bond coverage in the amount of $20,000; 30.31    (4) proof of workers' compensation insurance coverage; 30.32    (5) a description of the personal care assistance provider agency's organization 30.33identifying the names of all owners, managing employees, staff, board of directors, and 30.34the affiliations of the directors, owners, or staff to other service providers; 31.1    (6) a copy of the personal care assistance provider agency's written policies and 31.2procedures including: hiring of employees; training requirements; service delivery; 31.3and employee and consumer safety including process for notification and resolution 31.4of consumer grievances, identification and prevention of communicable diseases, and 31.5employee misconduct; 31.6    (7) copies of all other forms the personal care assistance provider agency uses in 31.7the course of daily business including, but not limited to: 31.8    (i) a copy of the personal care assistance provider agency's time sheet if the time 31.9sheet varies from the standard time sheet for personal care assistance services approved 31.10by the commissioner, and a letter requesting approval of the personal care assistance 31.11provider agency's nonstandard time sheet; 31.12    (ii) the personal care assistance provider agency's template for the personal care 31.13assistance care plan; and 31.14    (iii) the personal care assistance provider agency's template for the written 31.15agreement in subdivision 20 for recipients using the personal care assistance choice 31.16option, if applicable; 31.17    (8) a list of all trainings and classes that the personal care assistance provider agency 31.18requires of its staff providing personal care assistance services; 31.19    (9) documentation that the personal care assistance provider agency and staff have 31.20successfully completed all the training required by this section; 31.21    (10) documentation of the agency's marketing practices; 31.22    (11) disclosure of ownership, leasing, or management of all residential properties 31.23that is used or could be used for providing home care services; and 31.24    (12) documentation that the agency will use the following percentages of revenue 31.25generated from the medical assistance rate paid for personal care assistance services 31.26for employee personal care assistant wages and benefits: 72.5 percent of revenue in the 31.27personal care assistance choice option and 72.5 percent of revenue from other personal 31.28care assistance providers new text begin ; and new text end 31.29     new text begin (13) effective the day following final enactment, documentation that the agency does new text end 31.30 new text begin not burden recipients' free exercise of their right to choose service providers by requiring new text end 31.31 new text begin personal care assistants to sign an agreement not to work with any particular personal new text end 31.32 new text begin care assistance recipient or for another personal care assistance provider agency after new text end 31.33 new text begin leaving the agency and that the agency is not taking action on any such agreements or new text end 31.34 new text begin requirements regardless of the date signed new text end . 31.35    (b) Personal care assistance provider agencies shall provide the information specified 31.36in paragraph (a) to the commissioner at the time the personal care assistance provider 32.1agency enrolls as a vendor or upon request from the commissioner. The commissioner 32.2shall collect the information specified in paragraph (a) from all personal care assistance 32.3providers beginning July 1, 2009. 32.4    (c) All personal care assistance provider agencies shall new text begin require all employees in new text end 32.5 new text begin management and supervisory positions and owners of the agency who are active in the new text end 32.6 new text begin day-to-day management and operations of the agency to new text end complete mandatory training as 32.7determined by the commissioner before enrollment new text begin of the agency new text end as a provider. Personal 32.8care assistance provider agencies are required to send all owners, qualified professionals 32.9employed by the agency, and all other managing employees to the initial and subsequent 32.10trainings. new text begin Employees in management and supervisory positions and owners who are new text end 32.11 new text begin active in the day-to-day operations of an agency who have completed the required training new text end 32.12 new text begin as an employee with a personal care assistance provider agency do not need to repeat new text end 32.13 new text begin the required training if they are hired by another agency, if they have completed the new text end 32.14 new text begin training within the past three years. By September 1, 2010, the required training must be new text end 32.15 new text begin available in languages other than English and to those who need accommodations due new text end 32.16 new text begin to disabilities, online, or by electronic remote connection, and provide for competency new text end 32.17 new text begin testing. new text end Personal care assistance provider agency billing staff shall complete training 32.18about personal care assistance program financial management. This training is effective 32.19July 1, 2009. Any personal care assistance provider agency enrolled before that date 32.20shall, if it has not already, complete the provider training within 18 months of July 1, 32.212009. Any new owners, new qualified professionals, and new managing new text begin or new text end employees new text begin in new text end 32.22 new text begin management and supervisory positions involved in the day-to-day operations new text end are required 32.23to complete mandatory training as a requisite of hiring new text begin working for the agency. Personal new text end 32.24 new text begin care assistance provider agencies certified for participation in Medicare as home health new text end 32.25 new text begin agencies are exempt from the training required in this subdivision new text end . 32.26    Sec. 12. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 24, 32.27is amended to read: 32.28    Subd. 24. Personal care assistance provider agency; general duties. A personal 32.29care assistance provider agency shall: 32.30    (1) enroll as a Medicaid provider meeting all provider standards, including 32.31completion of the required provider training; 32.32    (2) comply with general medical assistance coverage requirements; 32.33    (3) demonstrate compliance with law and policies of the personal care assistance 32.34program to be determined by the commissioner; 32.35    (4) comply with background study requirements; 33.1    (5) verify and keep records of hours worked by the personal care assistant and 33.2qualified professional; 33.3    (6) market agency services only through printed information in brochures and on 33.4Web sites and not engage in any agency-initiated direct contact or marketing in person, by 33.5phone, or other electronic means to potential recipients, guardians, or family members; 33.6    (7) pay the personal care assistant and qualified professional based on actual hours 33.7of services provided; 33.8    (8) withhold and pay all applicable federal and state taxes; 33.9    (9) effective January 1, 2010, document that the agency uses a minimum of 72.5 33.10percent of the revenue generated by the medical assistance rate for personal care assistance 33.11services for employee personal care assistant wages and benefits; 33.12    (10) make the arrangements and pay unemployment insurance, taxes, workers' 33.13compensation, liability insurance, and other benefits, if any; 33.14    (11) enter into a written agreement under subdivision 20 before services are provided; 33.15    (12) report suspected neglect and abuse to the common entry point according to 33.16section 256B.0651; 33.17    (13) provide the recipient with a copy of the home care bill of rights at start of 33.18service; and 33.19    (14) request reassessments at least 60 days prior to the end of the current 33.20authorization for personal care assistance services, on forms provided by the commissioner. 33.21    Sec. 13. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 27, 33.22is amended to read: 33.23    Subd. 27. Personal care assistance provider agency; ventilator training. new text begin (a) new text end The 33.24personal care assistance provider agency is required to provide training for the personal 33.25care assistant responsible for working with a recipient who is ventilator dependent. All 33.26training must be administered by a respiratory therapist, nurse, or physician. Qualified 33.27professional supervision by a nurse must be completed and documented on file in the 33.28personal care assistant's employment record and the recipient's health record. If offering 33.29personal care services to a ventilator-dependent recipient, the personal care assistance 33.30provider agency shall demonstrate new text begin and document new text end the ability to: 33.31    (1) train the personal care assistant; 33.32    (2) supervise the personal care assistant in ventilator operation and maintenance new text begin the new text end 33.33 new text begin care of a ventilator-dependent recipient new text end ; and 33.34    (3) supervise the recipient and responsible party in ventilator operation and 33.35maintenance new text begin the care of a ventilator-dependent recipient; and new text end 34.1     new text begin (4) provide documentation of the training and supervision in clauses (1) to (3) new text end 34.2 new text begin upon request new text end . 34.3     new text begin (b) A personal care assistant shall not undertake any clinical services, patient new text end 34.4 new text begin assessment, patient evaluation, or clinical education regarding the ventilator or the patient new text end 34.5 new text begin on the ventilator. These services may only be provided by health care professionals new text end 34.6 new text begin licensed or registered in this state. new text end 34.7     new text begin (c) A personal care assistant may only perform tasks associated with ventilator new text end 34.8 new text begin maintenance that are approved by the Board of Medical Practice in consultation with the new text end 34.9 new text begin Respiratory Care Practitioner Advisory Council and the Department of Human Services. new text end 34.10    Sec. 14. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 30, 34.11is amended to read: 34.12    Subd. 30. Notice of service changes to recipients. The commissioner must provide: 34.13    (1) by October 31, 2009, information to recipients likely to be affected that (i) 34.14describes the changes to the personal care assistance program that may result in the 34.15loss of access to personal care assistance services, and (ii) includes resources to obtain 34.16further information; and 34.17    (2) notice of changes in medical assistance home care services to each affected 34.18recipient at least 30 days before the effective date of the change. 34.19The notice shall include how to get further information on the changes, how to get help to 34.20obtain other services, a list of community resources, and appeal rights. Notwithstanding 34.21section 256.045, a recipient may request continued services pending appeal within the 34.22time period allowed to request an appeal new text begin ; and new text end 34.23     new text begin (3) a service agreement authorizing personal care assistance hours of service at new text end 34.24 new text begin the previously authorized level, throughout the appeal process period, when a recipient new text end 34.25 new text begin requests services pending an appeal new text end . 34.26    Sec. 15. Minnesota Statutes 2008, section 256B.092, subdivision 4d, is amended to 34.27read: 34.28    Subd. 4d. Medicaid reimbursement; licensed provider; related individuals. The 34.29commissioner shall seek a federal amendment to the home and community-based services 34.30waiver for individuals with developmental disabilities, to allow Medicaid reimbursement 34.31for the provision of supported living services to a related individual new text begin is allowed new text end when the 34.32following conditions have been met: new text begin specified in section 245A.03, subdivision 9, are met. new text end 34.33    (1) the individual is 18 years of age or older; 35.1    (2) the provider is certified initially and annually thereafter, by the county, as 35.2meeting the provider standards established in chapter 245B and the federal waiver plan; 35.3    (3) the provider has been certified by the county as meeting the adult foster care 35.4provider standards established in Minnesota Rules, parts 9555.5105 to 9555.6265; 35.5    (4) the provider is not the legal guardian or conservator of the related individual; and 35.6    (5) the individual's service plan meets the standards of this section and specifies any 35.7special conditions necessary to prevent a conflict of interest for the provider. 35.8    Sec. 16. new text begin REPEALER. new text end 35.9 new text begin Minnesota Statutes 2008, section 256B.0919, subdivision 4, new text end new text begin is repealed. new text end