SF 2933

2nd 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 1.443A.318, subdivision 2; 144A.071, subdivision 4b; 144A.161, subdivision 1.51a; 245A.03, by adding a subdivision; 256B.0911, subdivision 4d; 256B.092, 1.6subdivision 4d; 326B.43, subdivision 2; 626.557, subdivision 9a; Minnesota 1.7Statutes 2009 Supplement, sections 144.0724, subdivision 11; 245A.03, 1.8subdivision 7; 245A.11, subdivision 7b; 256B.0625, subdivision 19c; 256B.0651, 1.9by adding a subdivision; 256B.0652, subdivision 6; 256B.0653, subdivision 1.103; 256B.0659, subdivisions 1, 3, 4, 10, 11, 13, 14, 18, 19, 20, 21, 24, 27, 30, 1.11by adding a subdivision; 256B.0911, subdivisions 1a, 2b, 3a, 3b; 256D.44, 1.12subdivision 5; Laws 2009, chapter 79, article 8, section 81; repealing Minnesota 1.13Statutes 2008, section 256B.0919, subdivision 4. 1.14BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 1.15ARTICLE 1 1.16CONTINUING CARE POLICY 1.17    Section 1. Minnesota Statutes 2008, section 43A.318, subdivision 2, is amended to 1.18read: 1.19    Subd. 2. Program creation; general provisions. (a) The commissioner may 1.20administer a program to make long-term care coverage available to eligible persons. The 1.21commissioner may determine the program's funding arrangements, request bids from 1.22qualified vendors, and negotiate and enter into contracts with qualified vendors. Contracts 1.23are not subject to the requirements of section 16C.16 or 16C.19. Contracts must be for a 1.24uniform term of at least one year, but may be made automatically renewable from term 1.25to term in the absence of notice of termination by either party. The program may not be 1.26self-insured until the commissioner has completed an actuarial study of the program and 2.1reported the results of the study to the legislature and self-insurance has been specifically 2.2authorized by law. 2.3(b) The program may provide coverage for home, community, and institutional 2.4long-term care and any other benefits as determined by the commissioner. Coverage is 2.5optional. The enrolled eligible person must pay the full cost of the coverage. 2.6(c) The commissioner shall promote activities that attempt to raise awareness of 2.7the need for long-term care insurance among residents of the state and encourage the 2.8increased prevalence of long-term care coverage. These activities must include the sharing 2.9of knowledge gained in the development of the program. 2.10(d) The commissioner may employ and contract with persons and other entities to 2.11perform the duties under this section and may determine their duties and compensation 2.12consistent with this chapter. 2.13(e) The benefits provided under this section are not terms and conditions of 2.14employment as defined under section 179A.03, subdivision 19, and are not subject to 2.15collective bargaining. 2.16(f) The commissioner shall establish underwriting criteria for entry of all eligible 2.17persons into the program. Eligible persons who would be immediately eligible for benefits 2.18may not enroll. 2.19(g) Eligible persons who meet underwriting criteria may enroll in the program upon 2.20hiring and at other times established by the commissioner. 2.21(h) An eligible person enrolled in the program may continue to participate in the 2.22program even if an event, such as termination of employment, changes the person's 2.23employment status. 2.24(i) Participating public employee pension plans and public employers may provide 2.25automatic pension or payroll deduction for payment of long-term care insurance premiums 2.26to qualified vendors contracted with under this section. 2.27(j) The premium charged to program enrollees must include an administrative fee to 2.28cover all program expenses incurred in addition to the cost of coverage. All fees collected 2.29are appropriated to the commissioner for the purpose of administrating the program. 2.30 new text begin (k) Public employees of local units of government including but not limited to new text end 2.31 new text begin townships, municipalities, cities, and counties may buy into the long-term care insurance new text end 2.32 new text begin under this section. new text end 2.33    Sec. 2. Minnesota Statutes 2009 Supplement, section 144.0724, subdivision 11, 2.34is amended to read: 3.1    Subd. 11. Nursing facility level of care. (a) For purposes of medical assistance 3.2payment of long-term care services, a recipient must be determined, using assessments 3.3defined in subdivision 4, to meet one of the following nursing facility level of care criteria: 3.4     new text begin (1) the person requires formal clinical monitoring at least once per day; new text end 3.5    (1) new text begin (2) new text end the person needs the assistance of another person or constant supervision to 3.6begin and complete at least four of the following activities of living: bathing, bed mobility, 3.7dressing, eating, grooming, toileting, transferring, and walking; 3.8    (2) new text begin (3) new text end the person needs the assistance of another person or constant supervision 3.9to begin and complete toileting, transferring, or positioning and the assistance cannot 3.10be scheduled; 3.11    (3) new text begin (4) new text end the person has significant difficulty with memory, using information, daily 3.12decision making, or behavioral needs that require intervention; 3.13    (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 3.14     new text begin (6) the person meets the nursing facility level of care criteria determined 90 days new text end 3.15 new text begin after admission or on the first quarterly assessment after admission, whichever is later new text end ; or 3.16    (5) new text begin (7) new text end the person is determined to be at risk for nursing facility admission or 3.17readmission through a face-to-face long-term care consultation assessment as specified 3.18in section 256B.0911, subdivision 3a, 3b, or 4d, by a county, tribe, or managed care 3.19organization under contract with the Department of Human Services. The person is 3.20considered at risk under this clause if the person currently lives alone or will live alone 3.21upon discharge and also meets one of the following criteria: 3.22    (i) the person has experienced a fall resulting in a fracture; 3.23    (ii) the person has been determined to be at risk of maltreatment or neglect, 3.24including self-neglect; or 3.25    (iii) the person has a sensory impairment that substantially impacts functional ability 3.26and maintenance of a community residence. 3.27    (b) The assessment used to establish medical assistance payment for nursing facility 3.28services must be the most recent assessment performed under subdivision 4, paragraph 3.29(b), that occurred no more than 90 calendar days before the effective date of medical 3.30assistance eligibility for payment of long-term care services. In no case shall medical 3.31assistance payment for long-term care services occur prior to the date of the determination 3.32of nursing facility level of care. 3.33    (c) The assessment used to establish medical assistance payment for long-term care 3.34services provided under sections 256B.0915 and 256B.49 and alternative care payment 3.35for services provided under section 256B.0913 must be the most recent face-to-face 3.36assessment performed under section 256B.0911, subdivision 3a, 3b, or 4d, that occurred 4.1no more than 60 calendar days before the effective date of medical assistance eligibility 4.2for payment of long-term care services. 4.3    Sec. 3. Minnesota Statutes 2008, section 144A.071, subdivision 4b, is amended to read: 4.4    Subd. 4b. Licensed beds on layaway status. A licensed and certified nursing 4.5facility may lay away, upon prior written notice to the commissioner of health, up to 50 4.6percent of its licensed and certified beds. A nursing facility may not discharge a resident 4.7in order to lay away a bed. Notice to the commissioner shall be given 60 days prior 4.8to the effective date of the layaway. Beds on layaway shall have the same status as 4.9voluntarily delicensed and decertified beds and shall not be subject to license fees and 4.10license surcharge fees. In addition, beds on layaway may be removed from layaway at any 4.11time on or after one year after the effective date of layaway in the facility of origin, with a 4.1260-day notice to the commissioner. A nursing facility that removes beds from layaway 4.13may not place beds on layaway status for one year after the effective date of the removal 4.14from layaway. The commissioner may approve the immediate removal of beds from 4.15layaway if necessary to provide access to those nursing home beds to residents relocated 4.16from other nursing homes due to emergency situations or closure. In the event approval 4.17is granted, the one-year restriction on placing beds on layaway after a removal of beds 4.18from layaway shall not apply. Beds may remain on layaway for up to five new text begin ten new text end years. The 4.19commissioner may approve placing and removing beds on layaway at any time during 4.20renovation or construction related to a moratorium project approved under this section 4.21or section 144A.073. new text begin Nursing facilities are not required to comply with any licensure or new text end 4.22 new text begin certification requirements for beds on layaway status. new text end 4.23    Sec. 4. Minnesota Statutes 2008, section 144A.161, subdivision 1a, is amended to read: 4.24    Subd. 1a. Scope. Where a facility is undertaking closure, curtailment, reduction, or 4.25change in operations, new text begin or where a housing with services unit registered under chapter 144D new text end 4.26 new text begin is closed because the space that it occupies is being replaced by a nursing facility bed that new text end 4.27 new text begin is being reactivated from layaway status, new text end the facility and the county social services agency 4.28must comply with the requirements of this section. 4.29    Sec. 5. Minnesota Statutes 2009 Supplement, section 245A.03, subdivision 7, is 4.30amended to read: 4.31    Subd. 7. Licensing moratorium. (a) The commissioner shall not issue an 4.32initial license for child foster care licensed under Minnesota Rules, parts 2960.3000 to 4.332960.3340, or adult foster care licensed under Minnesota Rules, parts 9555.5105 to 5.19555.6265, under this chapter for a physical location that will not be the primary residence 5.2of the license holder for the entire period of licensure. If a license is issued during this 5.3moratorium, and the license holder changes the license holder's primary residence away 5.4from the physical location of the foster care license, the commissioner shall revoke the 5.5license according to section 245A.07. Exceptions to the moratorium include: 5.6(1) foster care settings that are required to be registered under chapter 144D; 5.7(2) foster care licenses replacing foster care licenses in existence on May 15, 2009, 5.8and determined to be needed by the commissioner under paragraph (b); 5.9(3) new foster care licenses determined to be needed by the commissioner under 5.10paragraph (b) for the closure of a nursing facility, ICF/MR, or regional treatment center; 5.11(4) new foster care licenses determined to be needed by the commissioner under 5.12paragraph (b) for persons requiring hospital level care; or 5.13(5) new foster care licenses determined to be needed by the commissioner for the 5.14transition of people from personal care assistance to the home and community-based 5.15services. 5.16(b) The commissioner shall determine the need for newly licensed foster care homes 5.17as defined under this subdivision. As part of the determination, the commissioner shall 5.18consider the availability of foster care capacity in the area in which the licensee seeks to 5.19operate, and the recommendation of the local county board. The determination by the 5.20commissioner must be final. A determination of need is not required for a change in 5.21ownership at the same address. 5.22    (c) Residential settings that would otherwise be subject to the moratorium established 5.23in paragraph (a), that are in the process of receiving an adult or child foster care license as 5.24of July 1, 2009, shall be allowed to continue to complete the process of receiving an adult 5.25or child foster care license. For this paragraph, all of the following conditions must be met 5.26to be considered in the process of receiving an adult or child foster care license: 5.27    (1) participants have made decisions to move into the residential setting, including 5.28documentation in each participant's care plan; 5.29    (2) the provider has purchased housing or has made a financial investment in the 5.30property; 5.31    (3) the lead agency has approved the plans, including costs for the residential setting 5.32for each individual; 5.33    (4) the completion of the licensing process, including all necessary inspections, is 5.34the only remaining component prior to being able to provide services; and 5.35    (5) the needs of the individuals cannot be met within the existing capacity in that 5.36county. 6.1To qualify for the process under this paragraph, the lead agency must submit 6.2documentation to the commissioner by August 1, 2009, that all of the above criteria are 6.3met. 6.4(d) The commissioner shall study the effects of the license moratorium under this 6.5subdivision and shall report back to the legislature by January 15, 2011. new text begin This study shall new text end 6.6 new text begin include, but is not limited to the following: new text end 6.7 new text begin (1) the overall capacity and utilization of foster care beds where the physical location new text end 6.8 new text begin is not the primary residence of the license holder prior to and after implementation new text end 6.9 new text begin of the moratorium; new text end 6.10 new text begin (2) the overall capacity and utilization of foster care beds where the physical new text end 6.11 new text begin location is the primary residence of the license holder prior to and after implementation new text end 6.12 new text begin of the moratorium; and new text end 6.13 new text begin (3) the number of licensed and occupied ICF/MR beds prior to and after new text end 6.14 new text begin implementation of the moratorium. new text end 6.15    Sec. 6. Minnesota Statutes 2008, section 245A.03, is amended by adding a subdivision 6.16to read: 6.17     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 6.18 new text begin subdivision 2, paragraph (a), clause (1), and subdivision 7, an individual who is related to a new text end 6.19 new text begin person receiving supported living services may provide licensed services to that person if: new text end 6.20     new text begin (1) the person who receives supported living services received these services in a new text end 6.21 new text begin residential site on July 1, 2005; new text end 6.22     new text begin (2) the services under clause (1) were provided in a corporate foster care setting for new text end 6.23 new text begin adults and were funded by the developmental disabilities home and community-based new text end 6.24 new text begin services waiver defined in section 256B.092; new text end 6.25     new text begin (3) the individual who is related obtains and maintains both a license under new text end 6.26 new text begin chapter 245B and an adult foster care license under Minnesota Rules, parts 9555.5105 new text end 6.27 new text begin to 9555.6265; and new text end 6.28     new text begin (4) the individual who is related is not the guardian of the person receiving supported new text end 6.29 new text begin living services. new text end 6.30 new text begin EFFECTIVE DATE. new text end new text begin This section is effective the day following final enactment. new text end 6.31    Sec. 7. Minnesota Statutes 2009 Supplement, section 245A.11, subdivision 7b, is 6.32amended to read: 6.33    Subd. 7b. Adult foster care data privacy and security. (a) An adult foster 6.34care license holder who creates, collects, records, maintains, stores, or discloses any 7.1individually identifiable recipient data, whether in an electronic or any other format, 7.2must comply with the privacy and security provisions of applicable privacy laws and 7.3regulations, including: 7.4(1) the federal Health Insurance Portability and Accountability Act of 1996 7.5(HIPAA), Public Law 104-1; and the HIPAA Privacy Rule, Code of Federal Regulations, 7.6title 45, part 160, and subparts A and E of part 164; and 7.7(2) the Minnesota Government Data Practices Act as codified in chapter 13. 7.8(b) For purposes of licensure, the license holder shall be monitored for compliance 7.9with the following data privacy and security provisions: 7.10(1) the license holder must control access to data on foster care recipients according 7.11to the definitions of public and private data on individuals under section 13.02; 7.12classification of the data on individuals as private under section 13.46, subdivision 2; 7.13and control over the collection, storage, use, access, protection, and contracting related 7.14to data according to section 13.05, in which the license holder is assigned the duties 7.15of a government entity; 7.16(2) the license holder must provide each foster care recipient with a notice that 7.17meets the requirements under section 13.04, in which the license holder is assigned the 7.18duties of the government entity, and that meets the requirements of Code of Federal 7.19Regulations, title 45, part 164.52. The notice shall describe the purpose for collection of 7.20the data, and to whom and why it may be disclosed pursuant to law. The notice must 7.21inform the recipient that the license holder uses electronic monitoring and, if applicable, 7.22that recording technology is used; 7.23(3) the license holder must not install monitoring cameras in bathrooms; 7.24(4) electronic monitoring cameras must not be concealed from the foster care 7.25recipients; and 7.26(5) electronic video and audio recordings of foster care recipients shall not be 7.27stored by the license holder for more than five days new text begin unless: (i) a foster care recipient or new text end 7.28 new text begin legal representative requests that the recording be held longer based on a specific report new text end 7.29 new text begin of alleged maltreatment; or (ii) the recording captures an incident or event of alleged new text end 7.30 new text begin maltreatment under section 626.556 or 626.557 or a crime under chapter 609. When new text end 7.31 new text begin requested by a recipient or when a recording captures an incident or event of alleged new text end 7.32 new text begin maltreatment or a crime, the license holder must maintain the recording in a secured area new text end 7.33 new text begin for no longer than 30 days to give the investigating agency an opportunity to make a copy new text end 7.34 new text begin of the recording. The investigating agency will maintain the electronic video or audio new text end 7.35 new text begin recordings as required in section 626.557, subdivision 12b new text end . 8.1(c) The commissioner shall develop, and make available to license holders and 8.2county licensing workers, a checklist of the data privacy provisions to be monitored 8.3for purposes of licensure. 8.4    Sec. 8. Minnesota Statutes 2009 Supplement, section 256B.0625, subdivision 19c, 8.5is amended to read: 8.6    Subd. 19c. Personal care. Medical assistance covers personal care assistance 8.7services provided by an individual who is qualified to provide the services according to 8.8subdivision 19a and sections 256B.0651 to 256B.0656, provided in accordance with a 8.9plan, and supervised by a qualified professional. 8.10"Qualified professional" means a mental health professional as defined in section 245.462, 8.11subdivision 18 , or 245.4871, subdivision 27; or a registered nurse as defined in sections 8.12148.171 to 148.285, a licensed social worker as defined in section new text begin sections new text end 8.13 new text begin 148D.010 and 148D.055 new text end , or a qualified developmental disabilities specialist under section 8.14245B.07, subdivision 4 . The qualified professional shall perform the duties required in 8.15section 256B.0659. 8.16    Sec. 9. Minnesota Statutes 2009 Supplement, section 256B.0651, is amended by 8.17adding a subdivision to read: 8.18     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 8.19 new text begin each recipient with a copy of the home care bill of rights under section 144A.44 at new text end 8.20 new text begin least 30 days prior to terminating services to a recipient, if the termination results from new text end 8.21 new text begin provider sanctions under section 256B.064, such as a payment withhold, a suspension of new text end 8.22 new text begin participation, or a termination of participation. If a home care provider determines it is new text end 8.23 new text begin unable to continue providing services to a recipient, the provider must notify the recipient, new text end 8.24 new text begin the recipient's responsible party, and the commissioner 30 days prior to terminating new text end 8.25 new text begin services to the recipient because of an action under section 256B.064, and must assist the new text end 8.26 new text begin commissioner and lead agency in supporting the recipient in transitioning to another new text end 8.27 new text begin home care provider of the recipient's choice. new text end 8.28     new text begin (b) In the event of a payment withhold from a home care provider, a suspension of new text end 8.29 new text begin participation, or a termination of participation of a home care provider under section new text end 8.30 new text begin 256B.064, the commissioner may inform the Office of Ombudsman for Long-Term Care new text end 8.31 new text begin and the lead agencies for all recipients with active service agreements with the provider. new text end 8.32 new text begin At the commissioner's request, the lead agencies must contact recipients to ensure that the new text end 8.33 new text begin recipients are continuing to receive needed care, and that the recipients have been given new text end 8.34 new text begin free choice of provider if they transfer to another home care provider. In addition, the new text end 9.1 new text begin commissioner or the commissioner's delegate may directly notify recipients who receive new text end 9.2 new text begin care from the provider that payments have been withheld or that the provider's participation new text end 9.3 new text begin in medical assistance has been suspended or terminated, if the commissioner determines new text end 9.4 new text begin that notification is necessary to protect the welfare of the recipients. For purposes of this new text end 9.5 new text begin subdivision, "lead agencies" means counties, tribes, and managed care organizations. new text end 9.6    Sec. 10. Minnesota Statutes 2009 Supplement, section 256B.0652, subdivision 6, 9.7is amended to read: 9.8    Subd. 6. Authorization; personal care assistance and qualified professional. 9.9    (a) All personal care assistance services, supervision by a qualified professional, and 9.10additional services beyond the limits established in subdivision 11, must be authorized 9.11by the commissioner or the commissioner's designee before services begin except for the 9.12assessments established in subdivision 11 and section 256B.0911. The authorization for 9.13personal care assistance and qualified professional services under section 256B.0659 must 9.14be completed within 30 days after receiving a complete request. 9.15    (b) The amount of personal care assistance services authorized must be based 9.16on the recipient's home care rating. The home care rating shall be determined by the 9.17commissioner or the commissioner's designee based on information submitted to the 9.18commissioner identifying the following: 9.19    (1) total number of dependencies of activities of daily living as defined in section 9.20256B.0659 ; 9.21    (2) number new text begin presence new text end of complex health-related needs as defined in section 9.22256B.0659 ; and 9.23    (3) number new text begin presence new text end of new text begin Level I new text end behavior descriptions as defined in section 9.24256B.0659 . 9.25    (c) The methodology to determine total time for personal care assistance services for 9.26each home care rating is based on the median paid units per day for each home care rating 9.27from fiscal year 2007 data for the personal care assistance program. Each home care rating 9.28has a base level of hours assigned. Additional time is added through the assessment and 9.29identification of the following: 9.30    (1) 30 additional minutes per day for a dependency in each critical activity of daily 9.31living as defined in section 256B.0659; 9.32    (2) 30 additional minutes per day for each complex health-related function as 9.33defined in section 256B.0659; and 9.34    (3) 30 additional minutes per day for each behavior issue as defined in section 9.35256B.0659 new text begin , subdivision 4, paragraph (d) new text end . 10.1    (d) A limit of 96 units of qualified professional supervision may be authorized for 10.2each recipient receiving personal care assistance services. A request to the commissioner 10.3to exceed this total in a calendar year must be requested by the personal care provider 10.4agency on a form approved by the commissioner. 10.5    Sec. 11. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 10, 10.6is amended to read: 10.7    Subd. 10. Responsible party; duties; delegation. (a) A responsible party shall 10.8enter into a written agreement with a personal care assistance provider agency, on a form 10.9determined by the commissioner, to perform the following duties: 10.10    (1) be available while care is provided in a method agreed upon by the individual 10.11or the individual's legal representative and documented in the recipient's personal care 10.12assistance care plan; 10.13    (2) monitor personal care assistance services to ensure the recipient's personal care 10.14assistance care plan is being followed; and 10.15    (3) review and sign personal care assistance time sheets after services are provided 10.16to provide verification of the personal care assistance services. 10.17Failure to provide the support required by the recipient must result in a referral to the 10.18county common entry point. 10.19    (b) Responsible parties who are parents of minors or guardians of minors or 10.20incapacitated persons may delegate the responsibility to another adult who is not the 10.21personal care assistant during a temporary absence of at least 24 hours but not more 10.22than six months. The person delegated as a responsible party must be able to meet the 10.23definition of the responsible party. The responsible party must ensure that the delegate 10.24performs the functions of the responsible party, is identified at the time of the assessment, 10.25and is listed on the personal care assistance care plan. The responsible party must 10.26communicate to the personal care assistance provider agency about the need for a delegate new text begin new text end 10.27 new text begin delegated new text end responsible party, including the name of the delegated responsible party, dates 10.28the delegated responsible party will be living with the recipient, and contact numbers. 10.29    Sec. 12. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 11, 10.30is amended to read: 10.31    Subd. 11. Personal care assistant; requirements. (a) A personal care assistant 10.32must meet the following requirements: 10.33    (1) be at least 18 years of age with the exception of persons who are 16 or 17 years 10.34of age with these additional requirements: 11.1    (i) supervision by a qualified professional every 60 days; and 11.2    (ii) employment by only one personal care assistance provider agency responsible 11.3for compliance with current labor laws; 11.4    (2) be employed by a personal care assistance provider agency; 11.5    (3) enroll with the department as a personal care assistant after clearing a background 11.6study. new text begin Except as provided in subdivision 11a, new text end before a personal care assistant provides 11.7services, the personal care assistance provider agency must initiate a background study on 11.8the personal care assistant under chapter 245C, and the personal care assistance provider 11.9agency must have received a notice from the commissioner that the personal care assistant 11.10is: 11.11    (i) not disqualified under section 245C.14; or 11.12    (ii) is disqualified, but the personal care assistant has received a set aside of the 11.13disqualification under section 245C.22; 11.14    (4) be able to effectively communicate with the recipient and personal care 11.15assistance provider agency; 11.16    (5) be able to provide covered personal care assistance services according to the 11.17recipient's personal care assistance care plan, respond appropriately to recipient needs, 11.18and report changes in the recipient's condition to the supervising qualified professional 11.19or physician; 11.20    (6) not be a consumer of personal care assistance services; 11.21    (7) maintain daily written records including, but not limited to, time sheets under 11.22subdivision 12; 11.23    (8) effective January 1, 2010, complete standardized training as determined by the 11.24commissioner before completing enrollment. Personal care assistant training must include 11.25successful completion of the following training components: basic first aid, vulnerable 11.26adult, child maltreatment, OSHA universal precautions, basic roles and responsibilities of 11.27personal care assistants including information about assistance with lifting and transfers 11.28for recipients, emergency preparedness, orientation to positive behavioral practices, fraud 11.29issues, and completion of time sheets. Upon completion of the training components, 11.30the personal care assistant must demonstrate the competency to provide assistance to 11.31recipients; 11.32    (9) complete training and orientation on the needs of the recipient within the first 11.33seven days after the services begin; and 11.34    (10) be limited to providing and being paid for up to 310 hours per month of personal 11.35care assistance services regardless of the number of recipients being served or the number 11.36of personal care assistance provider agencies enrolled with. 12.1    (b) A legal guardian may be a personal care assistant if the guardian is not being paid 12.2for the guardian services and meets the criteria for personal care assistants in paragraph (a). 12.3    (c) Effective January 1, 2010, persons who do not qualify as a personal care assistant 12.4include parents and stepparents of minors, spouses, paid legal guardians, family foster 12.5care providers, except as otherwise allowed in section 256B.0625, subdivision 19a, or 12.6staff of a residential setting. 12.7 new text begin EFFECTIVE DATE. new text end new text begin This section is effective retroactively from July 1, 2009. new text end 12.8    Sec. 13. Minnesota Statutes 2009 Supplement, section 256B.0659, is amended by 12.9adding a subdivision to read: 12.10     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 12.11 new text begin assistant for a recipient may be allowed to enroll with a different personal care assistant new text end 12.12 new text begin provider agency upon initiation of a new background study according to chapter 245C, if new text end 12.13 new text begin all of the following are met: new text end 12.14     new text begin (1) the commissioner determines that a change in enrollment or affiliation of the new text end 12.15 new text begin personal care assistant is needed in order to ensure continuity of services and protect the new text end 12.16 new text begin health and safety of the recipient; new text end 12.17     new text begin (2) the chosen agency has been continuously enrolled as a personal care assistance new text end 12.18 new text begin provider agency for at least two years; new text end 12.19     new text begin (3) the recipient chooses to transfer to the personal care assistance provider agency; new text end 12.20     new text begin (4) the personal care assistant has been continuously enrolled with the former new text end 12.21 new text begin personal care assistance provider agency since the last background study was completed; new text end 12.22 new text begin and new text end 12.23     new text begin (5) the personal care assistant continues to meet requirements of subdivision 11, new text end 12.24 new text begin excluding paragraph (a), clause (3). new text end 12.25 new text begin EFFECTIVE DATE. new text end new text begin This section is effective retroactively from July 1, 2009. new text end 12.26    Sec. 14. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 13, 12.27is amended to read: 12.28    Subd. 13. Qualified professional; qualifications. (a) The qualified professional 12.29must be employed by new text begin work for new text end a personal care assistance provider agency and meet the 12.30definition under section 256B.0625, subdivision 19c. Before a qualified professional 12.31provides services, the personal care assistance provider agency must initiate a background 12.32study on the qualified professional under chapter 245C, and the personal care assistance 13.1provider agency must have received a notice from the commissioner that the qualified 13.2professional: 13.3    (1) is not disqualified under section 245C.14; or 13.4    (2) is disqualified, but the qualified professional has received a set aside of the 13.5disqualification under section 245C.22. 13.6    (b) The qualified professional shall perform the duties of training, supervision, and 13.7evaluation of the personal care assistance staff and evaluation of the effectiveness of 13.8personal care assistance services. The qualified professional shall: 13.9    (1) develop and monitor with the recipient a personal care assistance care plan based 13.10on the service plan and individualized needs of the recipient; 13.11    (2) develop and monitor with the recipient a monthly plan for the use of personal 13.12care assistance services; 13.13    (3) review documentation of personal care assistance services provided; 13.14    (4) provide training and ensure competency for the personal care assistant in the 13.15individual needs of the recipient; and 13.16    (5) document all training, communication, evaluations, and needed actions to 13.17improve performance of the personal care assistants. 13.18    (c) Effective January 1, 2010, the qualified professional shall complete the provider 13.19training with basic information about the personal care assistance program approved 13.20by the commissioner within six months of the date hired by a personal care assistance 13.21provider agency. Qualified professionals who have completed the required trainings new text begin new text end 13.22 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 13.23not need to repeat the required trainings new text begin training new text end if they are hired by another agency, if 13.24they have completed the training within the last three years. 13.25    Sec. 15. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 21, 13.26is amended to read: 13.27    Subd. 21. Requirements for initial enrollment of personal care assistance 13.28provider agencies. (a) All personal care assistance provider agencies must provide, at the 13.29time of enrollment as a personal care assistance provider agency in a format determined 13.30by the commissioner, information and documentation that includes, but is not limited to, 13.31the following: 13.32    (1) the personal care assistance provider agency's current contact information 13.33including address, telephone number, and e-mail address; 13.34    (2) proof of surety bond coverage in the amount of $50,000 or ten percent of the 13.35provider's payments from Medicaid in the previous year, whichever is less; 14.1    (3) proof of fidelity bond coverage in the amount of $20,000; 14.2    (4) proof of workers' compensation insurance coverage; 14.3     new text begin (5) proof of liability insurance; new text end 14.4    (5) new text begin (6) new text end a description of the personal care assistance provider agency's organization 14.5identifying the names of all owners, managing employees, staff, board of directors, and 14.6the affiliations of the directors, owners, or staff to other service providers; 14.7    (6) new text begin (7) new text end a copy of the personal care assistance provider agency's written policies 14.8and procedures including: hiring of employees; training requirements; service delivery; 14.9and employee and consumer safety including process for notification and resolution 14.10of consumer grievances, identification and prevention of communicable diseases, and 14.11employee misconduct; 14.12    (7) new text begin (8) new text end copies of all other forms the personal care assistance provider agency uses in 14.13the course of daily business including, but not limited to: 14.14    (i) a copy of the personal care assistance provider agency's time sheet if the time 14.15sheet varies from the standard time sheet for personal care assistance services approved 14.16by the commissioner, and a letter requesting approval of the personal care assistance 14.17provider agency's nonstandard time sheet; 14.18    (ii) the personal care assistance provider agency's template for the personal care 14.19assistance care plan; and 14.20    (iii) the personal care assistance provider agency's template for the written 14.21agreement in subdivision 20 for recipients using the personal care assistance choice 14.22option, if applicable; 14.23    (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 14.24provider agency requires of its staff providing personal care assistance services; 14.25    (9) new text begin (10) new text end documentation that the personal care assistance provider agency and staff 14.26have successfully completed all the training required by this section; 14.27    (10) new text begin (11) new text end documentation of the agency's marketing practices; 14.28    (11) new text begin (12) new text end disclosure of ownership, leasing, or management of all residential 14.29properties that is used or could be used for providing home care services; and 14.30    (12) new text begin (13) new text end documentation that the agency will use the following percentages of 14.31revenue generated from the medical assistance rate paid for personal care assistance 14.32services for employee personal care assistant wages and benefits: 72.5 percent of revenue 14.33in the personal care assistance choice option and 72.5 percent of revenue from other 14.34personal care assistance providers. 14.35    (b) Personal care assistance provider agencies shall provide the information specified 14.36in paragraph (a) to the commissioner at the time the personal care assistance provider 15.1agency enrolls as a vendor or upon request from the commissioner. The commissioner 15.2shall collect the information specified in paragraph (a) from all personal care assistance 15.3providers beginning July 1, 2009. 15.4    (c) All personal care assistance provider agencies shall complete mandatory training 15.5as determined by the commissioner before enrollment as a provider. Personal care 15.6assistance provider agencies are required to send all owners, qualified professionals 15.7employed by the agency, and all other managing employees to the initial and subsequent 15.8trainings new text begin training new text end . Personal care assistance provider agency billing staff shall complete 15.9training about personal care assistance program financial management. This training is 15.10effective July 1, 2009. Any personal care assistance provider agency enrolled before that 15.11date shall, if it has not already, complete the provider training within 18 months of July 1, 15.122009. Any new owners, new qualified professionals, and new managing employees are 15.13required to complete mandatory training as a requisite of hiring. 15.14    Sec. 16. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 30, 15.15is amended to read: 15.16    Subd. 30. Notice of service changes to recipients. The commissioner must provide: 15.17    (1) by October 31, 2009, information to recipients likely to be affected that (i) 15.18describes the changes to the personal care assistance program that may result in the 15.19loss of access to personal care assistance services, and (ii) includes resources to obtain 15.20further information; and 15.21    (2) notice of changes in medical assistance home care new text begin personal care assistant new text end services 15.22to each affected recipient at least 30 days before the effective date of the change. 15.23The notice shall include how to get further information on the changes, how to get help to 15.24obtain other services, a list of community resources, and appeal rights. Notwithstanding 15.25section 256.045, a recipient may request continued services pending appeal within the 15.26time period allowed to request an appeal. 15.27    Sec. 17. Minnesota Statutes 2009 Supplement, section 256B.0911, subdivision 1a, 15.28is amended to read: 15.29    Subd. 1a. Definitions. For purposes of this section, the following definitions apply: 15.30    (a) "Long-term care consultation services" means: 15.31    (1) assistance in identifying services needed to maintain an individual in the most 15.32inclusive environment; 15.33    (2) providing recommendations on cost-effective community services that are 15.34available to the individual; 16.1    (3) development of an individual's person-centered community support plan; 16.2    (4) providing information regarding eligibility for Minnesota health care programs; 16.3    (5) face-to-face long-term care consultation assessments, which may be completed 16.4in a hospital, nursing facility, intermediate care facility for persons with developmental 16.5disabilities (ICF/DDs), regional treatment centers, or the person's current or planned 16.6residence; 16.7    (6) federally mandated screening to determine the need for a institutional level of 16.8care under section 256B.0911, subdivision 4, paragraph (a); 16.9    (7) determination of home and community-based waiver service eligibility including 16.10level of care determination for individuals who need an institutional level of care as 16.11defined under section 144.0724, subdivision 11, or 256B.092, service eligibility including 16.12state plan home care services identified in section new text begin sections new text end 256B.0625, subdivisions 6, 16.137, and 19, paragraphs (a) and (c), new text begin and 256B.0657, new text end based on assessment and support plan 16.14development with appropriate referrals new text begin , including the option for consumer-directed new text end 16.15 new text begin community supports new text end ; 16.16    (8) providing recommendations for nursing facility placement when there are no 16.17cost-effective community services available; and 16.18    (9) assistance to transition people back to community settings after facility 16.19admission. 16.20    (b) "Long-term care options counseling" means the services provided by the linkage 16.21lines as mandated by sections 256.01 and 256.975, subdivision 7, and also includes 16.22telephone assistance and follow up once a long-term care consultation assessment has 16.23been completed. 16.24    (c) "Minnesota health care programs" means the medical assistance program under 16.25chapter 256B and the alternative care program under section 256B.0913. 16.26    (d) "Lead agencies" means counties or a collaboration of counties, tribes, and health 16.27plans administering long-term care consultation assessment and support planning services. 16.28    Sec. 18. Minnesota Statutes 2009 Supplement, section 256B.0911, subdivision 2b, 16.29is amended to read: 16.30    Subd. 2b. Certified assessors. (a) Beginning January 1, 2011, each lead agency 16.31shall use certified assessors who have completed training and the certification processes 16.32determined by the commissioner in subdivision 2c. Certified assessors shall demonstrate 16.33best practices in assessment and support planning including person-centered planning 16.34principals and have a common set of skills that must ensure consistency and equitable 16.35access to services statewide. Assessors must be part of a multidisciplinary team of 17.1professionals that includes public health nurses, social workers, and other professionals 17.2as defined in paragraph (b). For persons with complex health care needs, a public health 17.3nurse or registered nurse from a multidisciplinary team must be consulted. new text begin A lead agency new text end 17.4 new text begin may choose, according to departmental policies, to contract with a qualified, certified new text end 17.5 new text begin assessor to conduct assessments and reassessments on behalf of the lead agency. new text end 17.6    (b) Certified assessors are persons with a minimum of a bachelor's degree in social 17.7work, nursing with a public health nursing certificate, or other closely related field with at 17.8least one year of home and community-based experience or a two-year registered nursing 17.9degree with at least three years of home and community-based experience that have 17.10received training and certification specific to assessment and consultation for long-term 17.11care services in the state. 17.12    Sec. 19. Minnesota Statutes 2009 Supplement, section 256B.0911, subdivision 3a, 17.13is amended to read: 17.14    Subd. 3a. Assessment and support planning. (a) Persons requesting assessment, 17.15services planning, or other assistance intended to support community-based living, 17.16including persons who need assessment in order to determine waiver or alternative care 17.17program eligibility, must be visited by a long-term care consultation team within 15 17.18calendar days after the date on which an assessment was requested or recommended. After 17.19January 1, 2011, these requirements also apply to personal care assistance services, private 17.20duty nursing, and home health agency services, on timelines established in subdivision 5. 17.21Face-to-face assessments must be conducted according to paragraphs (b) to (i). 17.22    (b) The county may utilize a team of either the social worker or public health nurse, 17.23or both. After January 1, 2011, lead agencies shall use certified assessors to conduct the 17.24assessment in a face-to-face interview. The consultation team members must confer 17.25regarding the most appropriate care for each individual screened or assessed. 17.26    (c) The assessment must be comprehensive and include a person-centered 17.27assessment of the health, psychological, functional, environmental, and social needs of 17.28referred individuals and provide information necessary to develop a support plan that 17.29meets the consumers needs, using an assessment form provided by the commissioner. 17.30    (d) The assessment must be conducted in a face-to-face interview with the person 17.31being assessed and the person's legal representative, as required by legally executed 17.32documents, and other individuals as requested by the person, who can provide information 17.33on the needs, strengths, and preferences of the person necessary to develop a support plan 17.34that ensures the person's health and safety, but who is not a provider of service or has any 17.35financial interest in the provision of services. 18.1    (e) The person, or the person's legal representative, must be provided with written 18.2recommendations for community-based services new text begin , including consumer-directed options, new text end 18.3or institutional care that include documentation that the most cost-effective alternatives 18.4available were offered to the individual. For purposes of this requirement, "cost-effective 18.5alternatives" means community services and living arrangements that cost the same as or 18.6less than institutional care. 18.7    (f) If the person chooses to use community-based services, the person or the person's 18.8legal representative must be provided with a written community support plan, regardless 18.9of whether the individual is eligible for Minnesota health care programs. A person may 18.10request assistance in identifying community supports without participating in a complete 18.11assessment. Upon a request for assistance identifying community support, the person must 18.12be transferred or referred to the services available under sections 256.975, subdivision 7, 18.13and 256.01, subdivision 24, for telephone assistance and follow up. 18.14    (g) The person has the right to make the final decision between institutional 18.15placement and community placement after the recommendations have been provided, 18.16except as provided in subdivision 4a, paragraph (c). 18.17    (h) The team must give the person receiving assessment or support planning, or 18.18the person's legal representative, materials, and forms supplied by the commissioner 18.19containing the following information: 18.20    (1) the need for and purpose of preadmission screening if the person selects nursing 18.21facility placement; 18.22    (2) the role of the long-term care consultation assessment and support planning in 18.23waiver and alternative care program eligibility determination; 18.24    (3) information about Minnesota health care programs; 18.25    (4) the person's freedom to accept or reject the recommendations of the team; 18.26    (5) the person's right to confidentiality under the Minnesota Government Data 18.27Practices Act, chapter 13; 18.28    (6) the long-term care consultant's decision regarding the person's need for 18.29institutional level of care as determined under criteria established in section 144.0724, 18.30subdivision 11 , or 256B.092; and 18.31    (7) the person's right to appeal the decision regarding the need for nursing facility 18.32level of care or the county's final decisions regarding public programs eligibility according 18.33to section 256.045, subdivision 3. 18.34    (i) Face-to-face assessment completed as part of eligibility determination for 18.35the alternative care, elderly waiver, community alternatives for disabled individuals, 18.36community alternative care, and traumatic brain injury waiver programs under sections 19.1256B.0915 , 256B.0917, and 256B.49 is valid to establish service eligibility for no more 19.2than 60 calendar days after the date of assessment. The effective eligibility start date 19.3for these programs can never be prior to the date of assessment. If an assessment was 19.4completed more than 60 days before the effective waiver or alternative care program 19.5eligibility start date, assessment and support plan information must be updated in a 19.6face-to-face visit and documented in the department's Medicaid Management Information 19.7System (MMIS). The effective date of program eligibility in this case cannot be prior to 19.8the date the updated assessment is completed. 19.9    Sec. 20. Minnesota Statutes 2009 Supplement, section 256B.0911, subdivision 3b, 19.10is amended to read: 19.11    Subd. 3b. Transition assistance. (a) A long-term care consultation team shall 19.12provide assistance to persons residing in a nursing facility, hospital, regional treatment 19.13center, or intermediate care facility for persons with developmental disabilities who 19.14request or are referred for assistance. Transition assistance must include assessment, 19.15community support plan development, referrals to long-term care options counseling 19.16under section 256B.975, subdivision 10, for community support plan implementation 19.17and to Minnesota health care programs, new text begin including home and community-based waiver new text end 19.18 new text begin services and consumer-directed options through the waivers, new text end and referrals to programs 19.19that provide assistance with housing. Transition assistance must also include information 19.20about the Centers for Independent Living and the Senior LinkAge Line, and about other 19.21organizations that can provide assistance with relocation efforts, and information about 19.22contacting these organizations to obtain their assistance and support. 19.23    (b) The county shall develop transition processes with institutional social workers 19.24and discharge planners to ensure that: 19.25    (1) persons admitted to facilities receive information about transition assistance 19.26that is available; 19.27    (2) the assessment is completed for persons within ten working days of the date of 19.28request or recommendation for assessment; and 19.29    (3) there is a plan for transition and follow-up for the individual's return to the 19.30community. The plan must require notification of other local agencies when a person 19.31who may require assistance is screened by one county for admission to a facility located 19.32in another county. 19.33    (c) If a person who is eligible for a Minnesota health care program is admitted to a 19.34nursing facility, the nursing facility must include a consultation team member or the case 19.35manager in the discharge planning process. 20.1    Sec. 21. Minnesota Statutes 2008, section 256B.0911, subdivision 4d, is amended to 20.2read: 20.3    Subd. 4d. Preadmission screening of individuals under 65 years of age. (a) 20.4It is the policy of the state of Minnesota to ensure that individuals with disabilities or 20.5chronic illness are served in the most integrated setting appropriate to their needs and have 20.6the necessary information to make informed choices about home and community-based 20.7service options. 20.8    (b) Individuals under 65 years of age who are admitted to a nursing facility from a 20.9hospital must be screened prior to admission as outlined in subdivisions 4a through 4c. 20.10    (c) Individuals under 65 years of age who are admitted to nursing facilities with 20.11only a telephone screening must receive a face-to-face assessment from the long-term 20.12care consultation team member of the county in which the facility is located or from the 20.13recipient's county case manager within 40 calendar days of admission. 20.14    (d) Individuals under 65 years of age who are admitted to a nursing facility 20.15without preadmission screening according to the exemption described in subdivision 4b, 20.16paragraph (a), clause (3), and who remain in the facility longer than 30 days must receive 20.17a face-to-face assessment within 40 days of admission. 20.18    (e) At the face-to-face assessment, the long-term care consultation team member or 20.19county case manager must perform the activities required under subdivision 3b. 20.20    (f) For individuals under 21 years of age, a screening interview which recommends 20.21nursing facility admission must be face-to-face and approved by the commissioner before 20.22the individual is admitted to the nursing facility. 20.23    (g) In the event that an individual under 65 years of age is admitted to a nursing 20.24facility on an emergency basis, the county must be notified of the admission on the 20.25next working day, and a face-to-face assessment as described in paragraph (c) must be 20.26conducted within 40 calendar days of admission. 20.27    (h) At the face-to-face assessment, the long-term care consultation team member or 20.28the case manager must present information about home and community-based options new text begin , new text end 20.29 new text begin including consumer-directed options, new text end so the individual can make informed choices. If the 20.30individual chooses home and community-based services, the long-term care consultation 20.31team member or case manager must complete a written relocation plan within 20 working 20.32days of the visit. The plan shall describe the services needed to move out of the facility 20.33and a time line for the move which is designed to ensure a smooth transition to the 20.34individual's home and community. 20.35    (i) An individual under 65 years of age residing in a nursing facility shall receive a 20.36face-to-face assessment at least every 12 months to review the person's service choices 21.1and available alternatives unless the individual indicates, in writing, that annual visits are 21.2not desired. In this case, the individual must receive a face-to-face assessment at least 21.3once every 36 months for the same purposes. 21.4    (j) Notwithstanding the provisions of subdivision 6, the commissioner may pay 21.5county agencies directly for face-to-face assessments for individuals under 65 years of age 21.6who are being considered for placement or residing in a nursing facility. 21.7    Sec. 22. Minnesota Statutes 2009 Supplement, section 256D.44, subdivision 5, is 21.8amended to read: 21.9    Subd. 5. Special needs. In addition to the state standards of assistance established in 21.10subdivisions 1 to 4, payments are allowed for the following special needs of recipients of 21.11Minnesota supplemental aid who are not residents of a nursing home, a regional treatment 21.12center, or a group residential housing facility. 21.13    (a) The county agency shall pay a monthly allowance for medically prescribed 21.14diets if the cost of those additional dietary needs cannot be met through some other 21.15maintenance benefit. The need for special diets or dietary items must be prescribed by 21.16a licensed physician. Costs for special diets shall be determined as percentages of the 21.17allotment for a one-person household under the thrifty food plan as defined by the United 21.18States Department of Agriculture. The types of diets and the percentages of the thrifty 21.19food plan that are covered are as follows: 21.20    (1) high protein diet, at least 80 grams daily, 25 percent of thrifty food plan; 21.21    (2) controlled protein diet, 40 to 60 grams and requires special products, 100 percent 21.22of thrifty food plan; 21.23    (3) controlled protein diet, less than 40 grams and requires special products, 125 21.24percent of thrifty food plan; 21.25    (4) low cholesterol diet, 25 percent of thrifty food plan; 21.26    (5) high residue diet, 20 percent of thrifty food plan; 21.27    (6) pregnancy and lactation diet, 35 percent of thrifty food plan; 21.28    (7) gluten-free diet, 25 percent of thrifty food plan; 21.29    (8) lactose-free diet, 25 percent of thrifty food plan; 21.30    (9) antidumping diet, 15 percent of thrifty food plan; 21.31    (10) hypoglycemic diet, 15 percent of thrifty food plan; or 21.32    (11) ketogenic diet, 25 percent of thrifty food plan. 21.33    (b) Payment for nonrecurring special needs must be allowed for necessary home 21.34repairs or necessary repairs or replacement of household furniture and appliances using 22.1the payment standard of the AFDC program in effect on July 16, 1996, for these expenses, 22.2as long as other funding sources are not available. 22.3    (c) A fee for guardian or conservator service is allowed at a reasonable rate 22.4negotiated by the county or approved by the court. This rate shall not exceed five percent 22.5of the assistance unit's gross monthly income up to a maximum of $100 per month. If the 22.6guardian or conservator is a member of the county agency staff, no fee is allowed. 22.7    (d) The county agency shall continue to pay a monthly allowance of $68 for 22.8restaurant meals for a person who was receiving a restaurant meal allowance on June 1, 22.91990, and who eats two or more meals in a restaurant daily. The allowance must continue 22.10until the person has not received Minnesota supplemental aid for one full calendar month 22.11or until the person's living arrangement changes and the person no longer meets the criteria 22.12for the restaurant meal allowance, whichever occurs first. 22.13    (e) A fee of ten percent of the recipient's gross income or $25, whichever is less, 22.14is allowed for representative payee services provided by an agency that meets the 22.15requirements under SSI regulations to charge a fee for representative payee services. This 22.16special need is available to all recipients of Minnesota supplemental aid regardless of 22.17their living arrangement. 22.18    (f)(1) Notwithstanding the language in this subdivision, an amount equal to the 22.19maximum allotment authorized by the federal Food Stamp Program for a single individual 22.20which is in effect on the first day of July of each year will be added to the standards of 22.21assistance established in subdivisions 1 to 4 for adults under the age of 65 who qualify 22.22as shelter needy and are: (i) relocating from an institution, or an adult mental health 22.23residential treatment program under section 256B.0622; (ii) eligible for the self-directed 22.24supports option as defined under section 256B.0657, subdivision 2; or (iii) home and 22.25community-based waiver recipients living in their own home or rented or leased apartment 22.26which is not owned, operated, or controlled by a provider of service not related by blood 22.27or marriage new text begin , unless allowed under paragraph (g) new text end . 22.28    (2) Notwithstanding subdivision 3, paragraph (c), an individual eligible for the 22.29shelter needy benefit under this paragraph is considered a household of one. An eligible 22.30individual who receives this benefit prior to age 65 may continue to receive the benefit 22.31after the age of 65. 22.32    (3) "Shelter needy" means that the assistance unit incurs monthly shelter costs that 22.33exceed 40 percent of the assistance unit's gross income before the application of this 22.34special needs standard. "Gross income" for the purposes of this section is the applicant's or 22.35recipient's income as defined in section 256D.35, subdivision 10, or the standard specified 22.36in subdivision 3, paragraph (a) or (b), whichever is greater. A recipient of a federal or 23.1state housing subsidy, that limits shelter costs to a percentage of gross income, shall not be 23.2considered shelter needy for purposes of this paragraph. 23.3(g) Notwithstanding this subdivision, to access housing and services as provided 23.4in paragraph (f), the recipient may choose housing that may or may not be owned, 23.5operated, or controlled by the recipient's service provider if the housing is located in a 23.6multifamily building of six or more units. new text begin In a multifamily building of four or more units, new text end 23.7the maximum number of units new text begin apartments new text end that may be used by recipients of this program 23.8shall be 50 percent of the units in a building. The department shall develop an exception 23.9process to the 50 percent maximum. This paragraph expires on June 30, 2011 new text begin 2012 new text end . 23.10    Sec. 23. Minnesota Statutes 2008, section 326B.43, subdivision 2, is amended to read: 23.11    Subd. 2. Agreement with municipality. The commissioner may enter into an 23.12agreement with a municipality, in which the municipality agrees to perform plan and 23.13specification reviews required to be performed by the commissioner under Minnesota 23.14Rules, part 4715.3130, if: 23.15    (a) the municipality has adopted: 23.16    (1) the plumbing code; 23.17    (2) an ordinance that requires plumbing plans and specifications to be submitted to, 23.18reviewed, and approved by the municipality, except as provided in paragraph (n); 23.19    (3) an ordinance that authorizes the municipality to perform inspections required by 23.20the plumbing code; and 23.21    (4) an ordinance that authorizes the municipality to enforce the plumbing code in its 23.22entirety, except as provided in paragraph (p); 23.23    (b) the municipality agrees to review plumbing plans and specifications for all 23.24construction for which the plumbing code requires the review of plumbing plans and 23.25specifications, except as provided in paragraph (n); 23.26    (c) the municipality agrees that, when it reviews plumbing plans and specifications 23.27under paragraph (b), the review will: 23.28    (1) reflect the degree to which the plans and specifications affect the public health 23.29and conform to the provisions of the plumbing code; 23.30    (2) ensure that there is no physical connection between water supply systems that 23.31are safe for domestic use and those that are unsafe for domestic use; and 23.32    (3) ensure that there is no apparatus through which unsafe water may be discharged 23.33or drawn into a safe water supply system; 24.1    (d) the municipality agrees to perform all inspections required by the plumbing 24.2code in connection with projects for which the municipality reviews plumbing plans and 24.3specifications under paragraph (b); 24.4    (e) the commissioner determines that the individuals who will conduct the 24.5inspections and the plumbing plan and specification reviews for the municipality do not 24.6have any conflict of interest in conducting the inspections and the plan and specification 24.7reviews; 24.8    (f) individuals who will conduct the plumbing plan and specification reviews for 24.9the municipality are: 24.10    (1) licensed master plumbers; 24.11    (2) licensed professional engineers; or 24.12    (3) individuals who are working under the supervision of a licensed professional 24.13engineer or licensed master plumber and who are licensed master or journeyman plumbers 24.14or hold a postsecondary degree in engineering; 24.15    (g) individuals who will conduct the plumbing plan and specification reviews for 24.16the municipality have passed a competency assessment required by the commissioner to 24.17assess the individual's competency at reviewing plumbing plans and specifications; 24.18    (h) individuals who will conduct the plumbing inspections for the municipality 24.19are licensed master or journeyman plumbers, or inspectors meeting the competency 24.20requirements established in rules adopted under section 326B.135; 24.21    (i) the municipality agrees to enforce in its entirety the plumbing code on all 24.22projects, except as provided in paragraph (p); 24.23    (j) the municipality agrees to keep official records of all documents received, 24.24including plans, specifications, surveys, and plot plans, and of all plan reviews, permits 24.25and certificates issued, reports of inspections, and notices issued in connection with 24.26plumbing inspections and the review of plumbing plans and specifications; 24.27    (k) the municipality agrees to maintain the records described in paragraph (j) in the 24.28official records of the municipality for the period required for the retention of public 24.29records under section 138.17, and shall make these records readily available for review at 24.30the request of the commissioner; 24.31    (l) the municipality and the commissioner agree that if at any time during the 24.32agreement the municipality does not have in effect the plumbing code or any of ordinances 24.33described in paragraph (a), or if the commissioner determines that the municipality is not 24.34properly administering and enforcing the plumbing code or is otherwise not complying 24.35with the agreement: 25.1    (1) the commissioner may, effective 14 days after the municipality's receipt of 25.2written notice, terminate the agreement; 25.3    (2) the municipality may challenge the termination in a contested case before the 25.4commissioner pursuant to the Administrative Procedure Act; and 25.5    (3) while any challenge is pending under clause (2), the commissioner shall perform 25.6plan and specification reviews within the municipality under Minnesota Rules, part 25.74715.3130; 25.8    (m) the municipality and the commissioner agree that the municipality may terminate 25.9the agreement with or without cause on 90 days' written notice to the commissioner; 25.10    (n) the municipality and the commissioner agree that the municipality shall forward 25.11to the state for review all plumbing plans and specifications for the following types of 25.12projects within the municipality: 25.13    (1) hospitals, nursing homes, supervised living facilities new text begin licensed for eight or new text end 25.14 new text begin more individuals new text end , and similar health-care-related facilities regulated by the Minnesota 25.15Department of Health; 25.16    (2) buildings owned by the federal or state government; and 25.17    (3) projects of a special nature for which department review is requested by either 25.18the municipality or the state; 25.19    (o) where the municipality forwards to the state for review plumbing plans and 25.20specifications, as provided in paragraph (n), the municipality shall not collect any fee for 25.21plan review, and the commissioner shall collect all applicable fees for plan review; and 25.22    (p) no municipality shall revoke, suspend, or place restrictions on any plumbing 25.23license issued by the state. 25.24    Sec. 24. Minnesota Statutes 2008, section 626.557, subdivision 9a, is amended to read: 25.25    Subd. 9a. Evaluation and referral of reports made to common entry point unit. 25.26    The common entry point must screen the reports of alleged or suspected maltreatment for 25.27immediate risk and make all necessary referrals as follows: 25.28    (1) if the common entry point determines that there is an immediate need for 25.29adult protective services, the common entry point agency shall immediately notify the 25.30appropriate county agency; 25.31    (2) if the report contains suspected criminal activity against a vulnerable adult, the 25.32common entry point shall immediately notify the appropriate law enforcement agency; 25.33    (3) if the report references alleged or suspected maltreatment and there is no 25.34immediate need for adult protective services, the common entry point shall notify new text begin refer all new text end 26.1 new text begin reports of alleged or suspected maltreatment to new text end the appropriate lead agency as soon as 26.2possible, but in any event no longer than two working days; new text begin and new text end 26.3    (4) if the report does not reference alleged or suspected maltreatment, the common 26.4entry point may determine whether the information will be referred; and 26.5    (5) new text begin (4) new text end if the report contains information about a suspicious death, the common entry 26.6point shall immediately notify the appropriate law enforcement agencies, the local medical 26.7examiner, and the ombudsman established under section 245.92. Law enforcement 26.8agencies shall coordinate with the local medical examiner and the ombudsman as provided 26.9by law. 26.10    Sec. 25. Laws 2009, chapter 79, article 8, section 81, is amended to read: 26.11    Sec. 81. ESTABLISHING A SINGLE SET OF STANDARDS. 26.12(a) The commissioner of human services shall consult with disability service 26.13providers, advocates, counties, and consumer families to develop a single set of standards new text begin , new text end 26.14 new text begin to be referred to as "quality outcome standards," new text end governing services for people with 26.15disabilities receiving services under the home and community-based waiver services 26.16program to replace all or portions of existing laws and rules including, but not limited 26.17to, data practices, licensure of facilities and providers, background studies, reporting 26.18of maltreatment of minors, reporting of maltreatment of vulnerable adults, and the 26.19psychotropic medication checklist. The standards must: 26.20(1) enable optimum consumer choice; 26.21(2) be consumer driven; 26.22(3) link services to individual needs and life goals; 26.23(4) be based on quality assurance and individual outcomes; 26.24(5) utilize the people closest to the recipient, who may include family, friends, and 26.25health and service providers, in conjunction with the recipient's risk management plan to 26.26assist the recipient or the recipient's guardian in making decisions that meet the recipient's 26.27needs in a cost-effective manner and assure the recipient's health and safety; 26.28(6) utilize person-centered planning; and 26.29(7) maximize federal financial participation. 26.30(b) The commissioner may consult with existing stakeholder groups convened under 26.31the commissioner's authority, including the home and community-based expert services 26.32panel established by the commissioner in 2008, to meet all or some of the requirements 26.33of this section. 27.1(c) The commissioner shall provide the reports and plans required by this section to 27.2the legislative committees and budget divisions with jurisdiction over health and human 27.3services policy and finance by January 15, 2012. 27.4    Sec. 26. new text begin ELDERLY WAIVER CONVERSION. new text end 27.5     new text begin Notwithstanding Minnesota Statutes, section 256B.0915, subdivision 3b, a person new text end 27.6 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 27.7 new text begin waiver program and shall be considered a conversion for purposes of accessing monthly new text end 27.8 new text begin budget caps equal to no more than the person's monthly spending under the personal care new text end 27.9 new text begin assistance program on January 1, 2010. new text end 27.10    Sec. 27. new text begin DIRECTION TO COMMISSIONER; CONSULTATION WITH new text end 27.11 new text begin STAKEHOLDERS. new text end 27.12     new text begin The commissioner shall consult with stakeholders experienced in using and new text end 27.13 new text begin providing services through the consumer-directed community supports option during new text end 27.14 new text begin the identification of data to be used in future development of an individualized budget new text end 27.15 new text begin methodology for the home and community-based waivers for individuals with disabilities new text end 27.16 new text begin under the new comprehensive assessment. new text end 27.17    Sec. 28. new text begin CASE MANAGEMENT REFORM. new text end 27.18 new text begin (a) By February 1, 2011, the commissioner of human services shall provide specific new text end 27.19 new text begin recommendations and language for proposed legislation to: new text end 27.20 new text begin (1) define the administrative and the service functions of case management and make new text end 27.21 new text begin changes to improve the funding for administrative functions; new text end 27.22 new text begin (2) standardize and simplify processes, standards, and timelines for administrative new text end 27.23 new text begin functions of case management within the Department of Human Services, Disability new text end 27.24 new text begin Services Division, including eligibility determinations, resource allocation, management new text end 27.25 new text begin of dollars, provision for assignment of one case manager at a time per person, waiting lists, new text end 27.26 new text begin quality assurance, host county concurrence requirements, county of financial responsibility new text end 27.27 new text begin provisions, and waiver compliance; and new text end 27.28 new text begin (3) increase opportunities for consumer choice of case management functions new text end 27.29 new text begin involving service coordination. new text end 27.30 new text begin (b) In developing these recommendations, the commissioner shall consider the new text end 27.31 new text begin recommendations of the 2007 Redesigning Case Management Services for Persons new text end 27.32 new text begin with Disabilities report and consult with existing stakeholder groups, which include new text end 28.1 new text begin representatives of counties, disability and senior advocacy groups, service providers, and new text end 28.2 new text begin representatives of agencies which provide contracted case management. new text end 28.3 new text begin EFFECTIVE DATE. new text end new text begin This section is effective the day following final enactment. new text end 28.4ARTICLE 2 28.5PERSONAL CARE ASSISTANT SERVICES 28.6    Section 1. Minnesota Statutes 2009 Supplement, section 256B.0653, subdivision 3, 28.7is amended to read: 28.8    Subd. 3. Home health aide visits. (a) Home health aide visits must be provided 28.9by a certified home health aide using a written plan of care that is updated in compliance 28.10with Medicare regulations. A home health aide shall provide hands-on personal care, 28.11perform simple procedures as an extension of therapy or nursing services, and assist in 28.12instrumental activities of daily living as defined in section 256B.0659 new text begin , including assuring new text end 28.13 new text begin that the person gets to medical appointments if identified in the written plan of care new text end . Home 28.14health aide visits must be provided in the recipient's home. 28.15    (b) All home health aide visits must have authorization under section 256B.0652. 28.16The commissioner shall limit home health aide visits to no more than one visit per day 28.17per recipient. 28.18    (c) Home health aides must be supervised by a registered nurse or an appropriate 28.19therapist when providing services that are an extension of therapy. 28.20    Sec. 2. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 1, 28.21is amended to read: 28.22    Subdivision 1. Definitions. (a) For the purposes of this section, the terms defined in 28.23paragraphs (b) to (p) new text begin (r) new text end have the meanings given unless otherwise provided in text. 28.24    (b) "Activities of daily living" means grooming, dressing, bathing, transferring, 28.25mobility, positioning, eating, and toileting. 28.26    (c) "Behavior," effective January 1, 2010, means a category to determine the home 28.27care rating and is based on the criteria found in this section. "Level I behavior" means 28.28physical aggression towards self, others, or destruction of property that requires the 28.29immediate response of another person. 28.30    (d) "Complex health-related needs," effective January 1, 2010, means a category to 28.31determine the home care rating and is based on the criteria found in this section. 28.32    (e) "Critical activities of daily living," effective January 1, 2010, means transferring, 28.33mobility, eating, and toileting. 29.1    (f) "Dependency in activities of daily living" means a person requires assistance to 29.2begin and complete one or more of the activities of daily living. 29.3    (g) new text begin "Extended personal care assistance service" means personal care assistance new text end 29.4 new text begin services included in a service plan under one of the home and community-based services new text end 29.5 new text begin waivers authorized under sections 256B.49, 256B.0915, and 256B.092, subdivision new text end 29.6 new text begin 5, which exceed the amount, duration, and frequency of the state plan personal care new text end 29.7 new text begin assistance services for participants who: new text end 29.8     new text begin (1) need assistance provided periodically during a week, but less than daily will not new text end 29.9 new text begin be able to remain in their home without the assistance, and other replacement services new text end 29.10 new text begin are more expensive or are not available when personal care assistance services are to be new text end 29.11 new text begin terminated; or new text end 29.12     new text begin (2) need additional personal care assistance services beyond the amount authorized new text end 29.13 new text begin by the state plan personal care assistance assessment in order to ensure that their safety, new text end 29.14 new text begin health, and welfare are provided for in their homes. new text end 29.15     new text begin (h) new text end "Health-related procedures and tasks" means procedures and tasks that can 29.16be delegated or assigned by a licensed health care professional under state law to be 29.17performed by a personal care assistant. 29.18    (h) new text begin (i) new text end "Instrumental activities of daily living" means activities to include meal 29.19planning and preparation; basic assistance with paying bills; shopping for food, clothing, 29.20and other essential items; performing household tasks integral to the personal care 29.21assistance services; communication by telephone and other media; and traveling, including 29.22to medical appointments and to participate in the community. 29.23    (i) new text begin (j) new text end "Managing employee" has the same definition as Code of Federal Regulations, 29.24title 42, section 455. 29.25    (j) new text begin (k) new text end "Qualified professional" means a professional providing supervision of 29.26personal care assistance services and staff as defined in section 256B.0625, subdivision 29.2719c . 29.28    (k) new text begin (l) new text end "Personal care assistance provider agency" means a medical assistance 29.29enrolled provider that provides or assists with providing personal care assistance services 29.30and includes a personal care assistance provider organization, personal care assistance 29.31choice agency, class A licensed nursing agency, and Medicare-certified home health 29.32agency. 29.33    (l) new text begin (m) new text end "Personal care assistant" or "PCA" means an individual employed by a 29.34personal care assistance agency who provides personal care assistance services. 30.1    (m) new text begin (n) new text end "Personal care assistance care plan" means a written description of personal 30.2care assistance services developed by the personal care assistance provider according 30.3to the service plan. 30.4    (n) new text begin (o) new text end "Responsible party" means an individual who is capable of providing the 30.5support necessary to assist the recipient to live in the community. 30.6    (o) new text begin (p) new text end "Self-administered medication" means medication taken orally, by injection 30.7or insertion, or applied topically without the need for assistance. 30.8    (p) new text begin (q) new text end "Service plan" means a written summary of the assessment and description of 30.9the services needed by the recipient. 30.10     new text begin (r) "Wages and benefits" means wages and salaries, the employer's share of FICA new text end 30.11 new text begin taxes, Medicare taxes, state and federal unemployment taxes, workers' compensation, new text end 30.12 new text begin mileage reimbursement, health and dental insurance, life insurance, disability insurance, new text end 30.13 new text begin long-term care insurance, uniform allowance, and contributions to employee retirement new text end 30.14 new text begin accounts. new text end 30.15    Sec. 3. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 3, 30.16is amended to read: 30.17    Subd. 3. Noncovered personal care assistance services. (a) Personal care 30.18assistance services are not eligible for medical assistance payment under this section 30.19when provided: 30.20    (1) by the recipient's spouse, parent of a recipient under the age of 18, paid legal 30.21guardian, licensed foster provider, except as allowed under section 256B.0651, subdivision 30.2210 , or responsible party; 30.23    (2) in lieu of other staffing options in a residential or child care setting; 30.24    (3) solely as a child care or babysitting service; or 30.25    (4) without authorization by the commissioner or the commissioner's designee. 30.26    (b) The following personal care services are not eligible for medical assistance 30.27payment under this section when provided in residential settings: 30.28    (1) effective January 1, 2010, when the provider of home care services who is not 30.29related by blood, marriage, or adoption owns or otherwise controls the living arrangement, 30.30including licensed or unlicensed services; or 30.31    (2) when personal care assistance services are the responsibility of a residential or 30.32program license holder under the terms of a service agreement and administrative rules. 30.33    (c) Other specific tasks not covered under paragraph (a) or (b) that are not eligible 30.34for medical assistance reimbursement for personal care assistance services under this 30.35section include: 31.1    (1) sterile procedures; 31.2    (2) injections of fluids and medications into veins, muscles, or skin; 31.3    (3) home maintenance or chore services; 31.4    (4) homemaker services not an integral part of assessed personal care assistance 31.5services needed by a recipient; 31.6    (5) application of restraints or implementation of procedures under section 245.825; 31.7    (6) instrumental activities of daily living for children under the age of 18 new text begin , except new text end 31.8 new text begin when immediate attention is needed for health or hygiene reasons integral to the personal new text end 31.9 new text begin care services and the need is listed in the service plan by the assessor new text end ; and 31.10    (7) assessments for personal care assistance services by personal care assistance 31.11provider agencies or by independently enrolled registered nurses. 31.12    Sec. 4. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 4, 31.13is amended to read: 31.14    Subd. 4. Assessment for personal care assistance services; limitations. (a) An 31.15assessment as defined in subdivision 3a must be completed for personal care assistance 31.16services. 31.17    (b) The following limitations apply to the assessment: 31.18    (1) a person must be assessed as dependent in an activity of daily living based on 31.19the 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 , 31.20on a daily basis, for: 31.21    (i) cuing and constant supervision to complete the task; or 31.22    (ii) hands-on assistance to complete the task; and 31.23    (2) a child may not be found to be dependent in an activity of daily living if because 31.24of the child's age an adult would either perform the activity for the child or assist the child 31.25with the activity. Assistance needed is the assistance appropriate for a typical child of 31.26the same age. 31.27    (c) Assessment for complex health-related needs must meet the criteria in this 31.28paragraph. During the assessment process, a recipient qualifies as having complex 31.29health-related needs if the recipient has one or more of the interventions that are ordered by 31.30a physician, specified in a personal care assistance care plan, and found in the following: 31.31    (1) tube feedings requiring: 31.32    (i) a gastro/jejunostomy new text begin gastrojejunostomy new text end tube; or 31.33    (ii) continuous tube feeding lasting longer than 12 hours per day; 31.34    (2) wounds described as: 31.35    (i) stage III or stage IV; 32.1    (ii) multiple wounds; 32.2    (iii) requiring sterile or clean dressing changes or a wound vac; or 32.3    (iv) open lesions such as burns, fistulas, tube sites, or ostomy sites that require 32.4specialized care; 32.5    (3) parenteral therapy described as: 32.6    (i) IV therapy more than two times per week lasting longer than four hours for 32.7each treatment; or 32.8    (ii) total parenteral nutrition (TPN) daily; 32.9    (4) respiratory interventions including: 32.10    (i) oxygen required more than eight hours per day; 32.11    (ii) respiratory vest more than one time per day; 32.12    (iii) bronchial drainage treatments more than two times per day; 32.13    (iv) sterile or clean suctioning more than six times per day; 32.14    (v) dependence on another to apply respiratory ventilation augmentation devices 32.15such as BiPAP and CPAP; and 32.16    (vi) ventilator dependence under section 256B.0652; 32.17    (5) insertion and maintenance of catheter including: 32.18    (i) sterile catheter changes more than one time per month; 32.19    (ii) clean self-catheterization more than six times per day; or 32.20    (iii) bladder irrigations; 32.21    (6) bowel program more than two times per week requiring more than 30 minutes to 32.22perform each time; 32.23    (7) neurological intervention including: 32.24    (i) seizures more than two times per week and requiring significant physical 32.25assistance to maintain safety; or 32.26    (ii) swallowing disorders diagnosed by a physician and requiring specialized 32.27assistance from another on a daily basis; and 32.28    (8) other congenital or acquired diseases creating a need for significantly increased 32.29direct hands-on assistance and interventions in six to eight activities of daily living. 32.30    (d) An assessment of behaviors must meet the criteria in this paragraph. A recipient 32.31qualifies as having a need for assistance due to behaviors if the recipient's behavior requires 32.32assistance at least four times per week and shows one or more of the following behaviors: 32.33    (1) physical aggression towards self or others, or destruction of property that requires 32.34the immediate response of another person; 32.35    (2) increased vulnerability due to cognitive deficits or socially inappropriate 32.36behavior; or 33.1    (3) verbally aggressive and resistive to care. 33.2    Sec. 5. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 11, 33.3is amended to read: 33.4    Subd. 11. Personal care assistant; requirements. (a) A personal care assistant 33.5must meet the following requirements: 33.6    (1) be at least 18 years of age with the exception of persons who are 16 or 17 years 33.7of age with these additional requirements: 33.8    (i) supervision by a qualified professional every 60 days; and 33.9    (ii) employment by only one personal care assistance provider agency responsible 33.10for compliance with current labor laws; 33.11    (2) be employed by a personal care assistance provider agency; 33.12    (3) enroll with the department as a personal care assistant after clearing a background 33.13study. Before a personal care assistant provides services, the personal care assistance 33.14provider agency must initiate a background study on the personal care assistant under 33.15chapter 245C, and the personal care assistance provider agency must have received a 33.16notice from the commissioner that the personal care assistant is: 33.17    (i) not disqualified under section 245C.14; or 33.18    (ii) is disqualified, but the personal care assistant has received a set aside of the 33.19disqualification under section 245C.22; 33.20    (4) be able to effectively communicate with the recipient and personal care 33.21assistance provider agency; 33.22    (5) be able to provide covered personal care assistance services according to the 33.23recipient's personal care assistance care plan, respond appropriately to recipient needs, 33.24and report changes in the recipient's condition to the supervising qualified professional 33.25or physician; 33.26    (6) not be a consumer of personal care assistance services; 33.27    (7) maintain daily written records including, but not limited to, time sheets under 33.28subdivision 12; 33.29    (8) effective January 1, 2010, complete standardized training as determined 33.30by the commissioner before completing enrollment. new text begin The training must be available new text end 33.31 new text begin in languages other than English and to those who need accommodations due to new text end 33.32 new text begin disabilities. new text end Personal care assistant training must include successful completion of the 33.33following training components: basic first aid, vulnerable adult, child maltreatment, 33.34OSHA universal precautions, basic roles and responsibilities of personal care assistants 33.35including information about assistance with lifting and transfers for recipients, emergency 34.1preparedness, orientation to positive behavioral practices, fraud issues, and completion of 34.2time sheets. Upon completion of the training components, the personal care assistant must 34.3demonstrate the competency to provide assistance to recipients; 34.4    (9) complete training and orientation on the needs of the recipient within the first 34.5seven days after the services begin; and 34.6    (10) be limited to providing and being paid for up to 310 hours per month of personal 34.7care assistance services regardless of the number of recipients being served or the number 34.8of personal care assistance provider agencies enrolled with. new text begin The number of hours worked new text end 34.9 new text begin per day shall not be disallowed by the department unless in violation of the law. new text end 34.10    (b) A legal guardian may be a personal care assistant if the guardian is not being paid 34.11for the guardian services and meets the criteria for personal care assistants in paragraph (a). 34.12    (c) Effective January 1, 2010, persons who do not qualify as a personal care assistant 34.13include parents and stepparents of minors, spouses, paid legal guardians, family foster 34.14care providers, except as otherwise allowed in section 256B.0625, subdivision 19a, or 34.15staff of a residential setting. 34.16    Sec. 6. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 13, 34.17is amended to read: 34.18    Subd. 13. Qualified professional; qualifications. (a) The qualified professional 34.19must be employed by a personal care assistance provider agency and meet the definition 34.20under section 256B.0625, subdivision 19c. Before a qualified professional provides 34.21services, the personal care assistance provider agency must initiate a background study on 34.22the qualified professional under chapter 245C, and the personal care assistance provider 34.23agency must have received a notice from the commissioner that the qualified professional: 34.24    (1) is not disqualified under section 245C.14; or 34.25    (2) is disqualified, but the qualified professional has received a set aside of the 34.26disqualification under section 245C.22. 34.27    (b) The qualified professional shall perform the duties of training, supervision, and 34.28evaluation of the personal care assistance staff and evaluation of the effectiveness of 34.29personal care assistance services. The qualified professional shall: 34.30    (1) develop and monitor with the recipient a personal care assistance care plan based 34.31on the service plan and individualized needs of the recipient; 34.32    (2) develop and monitor with the recipient a monthly plan for the use of personal 34.33care assistance services; 34.34    (3) review documentation of personal care assistance services provided; 35.1    (4) provide training and ensure competency for the personal care assistant in the 35.2individual needs of the recipient; and 35.3    (5) document all training, communication, evaluations, and needed actions to 35.4improve performance of the personal care assistants. 35.5    (c) Effective January new text begin July new text end 1, 2010, the qualified professional shall complete the 35.6provider training with basic information about the personal care assistance program 35.7approved by the commissioner within six months of the date hired by a personal care 35.8assistance provider agency. Qualified professionals who have completed the required 35.9trainings as an employee with a personal care assistance provider agency do not need to 35.10repeat the required trainings if they are hired by another agency, if they have completed the 35.11training within the last three years. new text begin The required training shall be available in languages new text end 35.12 new text begin other than English and to those who need accommodations due to disabilities, online, or new text end 35.13 new text begin by electronic remote connection, and provide for competency testing to demonstrate an new text end 35.14 new text begin understanding of the content without attending in-person training. A qualified professional new text end 35.15 new text begin is allowed to be employed and is not subject to the training requirement until the training is new text end 35.16 new text begin offered online or through remote electronic connection. A qualified professional employed new text end 35.17 new text begin by a personal care assistance provider agency certified for participation in Medicare as new text end 35.18 new text begin a home health agency is exempt from the training required in this subdivision. The new text end 35.19 new text begin commissioner shall ensure there is a mechanism in place to verify the identity of persons new text end 35.20 new text begin completing the competency testing electronically. new text end 35.21    Sec. 7. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 14, 35.22is amended to read: 35.23    Subd. 14. Qualified professional; duties. (a) Effective January 1, 2010, all personal 35.24care assistants must be supervised by a qualified professional. 35.25    (b) Through direct training, observation, return demonstrations, and consultation 35.26with the staff and the recipient, the qualified professional must ensure and document 35.27that the personal care assistant is: 35.28    (1) capable of providing the required personal care assistance services; 35.29    (2) knowledgeable about the plan of personal care assistance services before services 35.30are performed; and 35.31    (3) able to identify conditions that should be immediately brought to the attention of 35.32the qualified professional. 35.33    (c) The qualified professional shall evaluate the personal care assistant within the first 35.3414 days of starting to provide new text begin regularly scheduled new text end services for a recipient except for the 35.35personal care assistance choice option under subdivision 19, paragraph (a), clause (4). new text begin For new text end 36.1 new text begin the initial evaluation, new text end the qualified professional shall evaluate the personal care assistance 36.2services for a recipient through direct observation of a personal care assistant's work new text begin . new text end 36.3 new text begin Subsequent visits to evaluate the personal care assistance services provided to a recipient new text end 36.4 new text begin do not require direct observation of each personal care assistant's work and shall occur new text end : 36.5    (1) at least every 90 days thereafter for the first year of a recipient's services; and 36.6    (2) every 120 days after the first year of a recipient's service or whenever needed for 36.7response to a recipient's request for increased supervision of the personal care assistance 36.8staff new text begin ; and new text end 36.9     new text begin (3) after the first 180 days of a recipient's service, supervisory visits may alternate new text end 36.10 new text begin between unscheduled phone or Internet technology and in-person visits, unless the new text end 36.11 new text begin in-person visits are needed according to the care plan new text end . 36.12    (d) Communication with the recipient is a part of the evaluation process of the 36.13personal care assistance staff. 36.14    (e) At each supervisory visit, the qualified professional shall evaluate personal care 36.15assistance services including the following information: 36.16    (1) satisfaction level of the recipient with personal care assistance services; 36.17    (2) review of the month-to-month plan for use of personal care assistance services; 36.18    (3) review of documentation of personal care assistance services provided; 36.19    (4) whether the personal care assistance services are meeting the goals of the service 36.20as stated in the personal care assistance care plan and service plan; 36.21    (5) a written record of the results of the evaluation and actions taken to correct any 36.22deficiencies in the work of a personal care assistant; and 36.23    (6) revision of the personal care assistance care plan as necessary in consultation 36.24with the recipient or responsible party, to meet the needs of the recipient. 36.25    (f) The qualified professional shall complete the required documentation in the 36.26agency recipient and employee files and the recipient's home, including the following 36.27documentation: 36.28    (1) the personal care assistance care plan based on the service plan and individualized 36.29needs of the recipient; 36.30    (2) a month-to-month plan for use of personal care assistance services; 36.31    (3) changes in need of the recipient requiring a change to the level of service and the 36.32personal care assistance care plan; 36.33    (4) evaluation results of supervision visits and identified issues with personal care 36.34assistance staff with actions taken; 36.35    (5) all communication with the recipient and personal care assistance staff; and 36.36    (6) hands-on training or individualized training for the care of the recipient. 37.1    (g) The documentation in paragraph (f) must be done on agency forms. 37.2    (h) The services that are not eligible for payment as qualified professional services 37.3include: 37.4    (1) direct professional nursing tasks that could be assessed and authorized as skilled 37.5nursing tasks; 37.6    (2) supervision of personal care assistance completed by telephone; 37.7    (3) agency administrative activities; 37.8    (4) training other than the individualized training required to provide care for a 37.9recipient; and 37.10    (5) any other activity that is not described in this section. 37.11    Sec. 8. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 18, 37.12is amended to read: 37.13    Subd. 18. Personal care assistance choice option; generally. (a) The 37.14commissioner may allow a recipient of personal care assistance services to use a fiscal 37.15intermediary to assist the recipient in paying and accounting for medically necessary 37.16covered personal care assistance services. Unless otherwise provided in this section, all 37.17other statutory and regulatory provisions relating to personal care assistance services apply 37.18to a recipient using the personal care assistance choice option. 37.19    (b) Personal care assistance choice is an option of the personal care assistance 37.20program that allows the recipient who receives personal care assistance services to be 37.21responsible for the hiring, training, scheduling, and firing of personal care assistants new text begin new text end 37.22 new text begin according to the terms of the written agreement with the personal care assistance choice new text end 37.23 new text begin agency required under subdivision 20, paragraph (a) new text end . This program offers greater control 37.24and choice for the recipient in who provides the personal care assistance service and when 37.25the service is scheduled. The recipient or the recipient's responsible party must choose a 37.26personal care assistance choice provider agency as a fiscal intermediary. This personal 37.27care assistance choice provider agency manages payroll, invoices the state, is responsible 37.28for all payroll-related taxes and insurance, and is responsible for providing the consumer 37.29training and support in managing the recipient's personal care assistance services. 37.30    Sec. 9. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 19, 37.31is amended to read: 37.32    Subd. 19. Personal care assistance choice option; qualifications; duties. (a) 37.33Under personal care assistance choice, the recipient or responsible party shall: 38.1    (1) recruit, hire, schedule, and terminate personal care assistants and a qualified 38.2professional new text begin according to the terms of the written agreement required under subdivision new text end 38.3 new text begin 20, paragraph (a) new text end ; 38.4    (2) develop a personal care assistance care plan based on the assessed needs 38.5and addressing the health and safety of the recipient with the assistance of a qualified 38.6professional as needed; 38.7    (3) orient and train the personal care assistant with assistance as needed from the 38.8qualified professional; 38.9    (4) effective January 1, 2010, supervise and evaluate the personal care assistant with 38.10the qualified professional, who is required to visit the recipient at least every 180 days; 38.11    (5) monitor and verify in writing and report to the personal care assistance choice 38.12agency the number of hours worked by the personal care assistant and the qualified 38.13professional; 38.14    (6) engage in an annual face-to-face reassessment to determine continuing eligibility 38.15and service authorization; and 38.16    (7) use the same personal care assistance choice provider agency if shared personal 38.17assistance care is being used. 38.18    (b) The personal care assistance choice provider agency shall: 38.19    (1) meet all personal care assistance provider agency standards; 38.20    (2) enter into a written agreement with the recipient, responsible party, and personal 38.21care assistants; 38.22    (3) not be related as a parent, child, sibling, or spouse to the recipient, qualified 38.23professional, or the personal care assistant; and 38.24    (4) ensure arm's-length transactions without undue influence or coercion with the 38.25recipient and personal care assistant. 38.26    (c) The duties of the personal care assistance choice provider agency are to: 38.27    (1) be the employer of the personal care assistant and the qualified professional for 38.28employment law and related regulations including, but not limited to, purchasing and 38.29maintaining workers' compensation, unemployment insurance, surety and fidelity bonds, 38.30and liability insurance, and submit any or all necessary documentation including, but not 38.31limited to, workers' compensation and unemployment insurance; 38.32    (2) bill the medical assistance program for personal care assistance services and 38.33qualified professional services; 38.34    (3) request and complete background studies that comply with the requirements for 38.35personal care assistants and qualified professionals; 39.1    (4) pay the personal care assistant and qualified professional based on actual hours 39.2of services provided; 39.3    (5) withhold and pay all applicable federal and state taxes; 39.4    (6) verify and keep records of hours worked by the personal care assistant and 39.5qualified professional; 39.6    (7) make the arrangements and pay taxes and other benefits, if any, and comply with 39.7any legal requirements for a Minnesota employer; 39.8    (8) enroll in the medical assistance program as a personal care assistance choice 39.9agency; and 39.10    (9) enter into a written agreement as specified in subdivision 20 before services 39.11are provided. 39.12    Sec. 10. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 20, 39.13is amended to read: 39.14    Subd. 20. Personal care assistance choice option; administration. (a) Before 39.15services commence under the personal care assistance choice option, and annually 39.16thereafter, the personal care assistance choice provider agency, recipient, or responsible 39.17party, each personal care assistant, and the qualified professional new text begin and the recipient or new text end 39.18 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 39.19 new text begin provided to the recipient or responsible party, each personal care assistant, and the new text end 39.20 new text begin qualified professional when completed, and new text end include at a minimum: 39.21    (1) duties of the recipient, qualified professional, personal care assistant, and 39.22personal care assistance choice provider agency; 39.23    (2) salary and benefits for the personal care assistant and the qualified professional; 39.24    (3) administrative fee of the personal care assistance choice provider agency and 39.25services paid for with that fee, including background study fees; 39.26    (4) grievance procedures to respond to complaints; 39.27    (5) procedures for hiring and terminating the personal care assistant; and 39.28    (6) documentation requirements including, but not limited to, time sheets, activity 39.29records, and the personal care assistance care plan. 39.30    (b) Effective January 1, 2010, except for the administrative fee of the personal care 39.31assistance choice provider agency as reported on the written agreement, the remainder 39.32of the rates paid to the personal care assistance choice provider agency must be used to 39.33pay for the salary and benefits for the personal care assistant or the qualified professional. 39.34The provider agency must use a minimum of 72.5 percent of the revenue generated by 40.1the medical assistance rate for personal care assistance services for employee personal 40.2care assistant wages and benefits. 40.3    (c) The commissioner shall deny, revoke, or suspend the authorization to use the 40.4personal care assistance choice option if: 40.5    (1) it has been determined by the qualified professional or public health nurse that 40.6the use of this option jeopardizes the recipient's health and safety; 40.7    (2) the parties have failed to comply with the written agreement specified in this 40.8subdivision; 40.9    (3) the use of the option has led to abusive or fraudulent billing for personal care 40.10assistance services; or 40.11    (4) the department terminates the personal care assistance choice option. 40.12    (d) The recipient or responsible party may appeal the commissioner's decision in 40.13paragraph (c) according to section 256.045. The denial, revocation, or suspension to 40.14use the personal care assistance choice option must not affect the recipient's authorized 40.15level of personal care assistance services. 40.16    Sec. 11. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 21, 40.17is amended to read: 40.18    Subd. 21. Requirements for initial enrollment of personal care assistance 40.19provider agencies. (a) All personal care assistance provider agencies must provide, at the 40.20time of enrollment as a personal care assistance provider agency in a format determined 40.21by the commissioner, information and documentation that includes, but is not limited to, 40.22the following: 40.23    (1) the personal care assistance provider agency's current contact information 40.24including address, telephone number, and e-mail address; 40.25    (2) proof of surety bond coverage in the amount of $50,000 or ten percent of the 40.26provider's payments from Medicaid in the previous year, whichever is less; 40.27    (3) proof of fidelity bond coverage in the amount of $20,000; 40.28    (4) proof of workers' compensation insurance coverage; 40.29    (5) a description of the personal care assistance provider agency's organization 40.30identifying the names of all owners, managing employees, staff, board of directors, and 40.31the affiliations of the directors, owners, or staff to other service providers; 40.32    (6) a copy of the personal care assistance provider agency's written policies and 40.33procedures including: hiring of employees; training requirements; service delivery; 40.34and employee and consumer safety including process for notification and resolution 41.1of consumer grievances, identification and prevention of communicable diseases, and 41.2employee misconduct; 41.3    (7) copies of all other forms the personal care assistance provider agency uses in 41.4the course of daily business including, but not limited to: 41.5    (i) a copy of the personal care assistance provider agency's time sheet if the time 41.6sheet varies from the standard time sheet for personal care assistance services approved 41.7by the commissioner, and a letter requesting approval of the personal care assistance 41.8provider agency's nonstandard time sheet; 41.9    (ii) the personal care assistance provider agency's template for the personal care 41.10assistance care plan; and 41.11    (iii) the personal care assistance provider agency's template for the written 41.12agreement in subdivision 20 for recipients using the personal care assistance choice 41.13option, if applicable; 41.14    (8) a list of all trainings and classes that the personal care assistance provider agency 41.15requires of its staff providing personal care assistance services; 41.16    (9) documentation that the personal care assistance provider agency and staff have 41.17successfully completed all the training required by this section; 41.18    (10) documentation of the agency's marketing practices; 41.19    (11) disclosure of ownership, leasing, or management of all residential properties 41.20that is used or could be used for providing home care services; and 41.21    (12) documentation that the agency will use the following percentages of revenue 41.22generated from the medical assistance rate paid for personal care assistance services 41.23for employee personal care assistant wages and benefits: 72.5 percent of revenue in the 41.24personal care assistance choice option and 72.5 percent of revenue from other personal 41.25care assistance providers new text begin ; and new text end 41.26     new text begin (13) effective the day following final enactment, documentation that the agency does new text end 41.27 new text begin not burden recipients' free exercise of their right to choose service providers by requiring new text end 41.28 new text begin personal care assistants to sign an agreement not to work with any particular personal new text end 41.29 new text begin care assistance recipient or for another personal care assistance provider agency after new text end 41.30 new text begin leaving the agency and that the agency is not taking action on any such agreements or new text end 41.31 new text begin requirements regardless of the date signed new text end . 41.32    (b) Personal care assistance provider agencies shall provide the information specified 41.33in paragraph (a) to the commissioner at the time the personal care assistance provider 41.34agency enrolls as a vendor or upon request from the commissioner. The commissioner 41.35shall collect the information specified in paragraph (a) from all personal care assistance 41.36providers beginning July 1, 2009. 42.1    (c) All personal care assistance provider agencies shall new text begin require all employees in new text end 42.2 new text begin management and supervisory positions and owners of the agency who are active in the new text end 42.3 new text begin day-to-day management and operations of the agency to new text end complete mandatory training as 42.4determined by the commissioner before enrollment new text begin of the agency new text end as a provider. Personal 42.5care assistance provider agencies are required to send all owners, qualified professionals 42.6employed by the agency, and all other managing employees to the initial and subsequent 42.7trainings. new text begin Employees in management and supervisory positions and owners who are new text end 42.8 new text begin active in the day-to-day operations of an agency who have completed the required training new text end 42.9 new text begin as an employee with a personal care assistance provider agency do not need to repeat new text end 42.10 new text begin the required training if they are hired by another agency, if they have completed the new text end 42.11 new text begin training within the past three years. By September 1, 2010, the required training must be new text end 42.12 new text begin available in languages other than English and to those who need accommodations due new text end 42.13 new text begin to disabilities, online, or by electronic remote connection, and provide for competency new text end 42.14 new text begin testing. new text end Personal care assistance provider agency billing staff shall complete training 42.15about personal care assistance program financial management. This training is effective 42.16July 1, 2009. Any personal care assistance provider agency enrolled before that date 42.17shall, if it has not already, complete the provider training within 18 months of July 1, 42.182009. Any new owners, new qualified professionals, and new managing new text begin or new text end employees new text begin in new text end 42.19 new text begin management and supervisory positions involved in the day-to-day operations new text end are required 42.20to complete mandatory training as a requisite of hiring new text begin working for the agency. Personal new text end 42.21 new text begin care assistance provider agencies certified for participation in Medicare as home health new text end 42.22 new text begin agencies are exempt from the training required in this subdivision new text end . 42.23    Sec. 12. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 24, 42.24is amended to read: 42.25    Subd. 24. Personal care assistance provider agency; general duties. A personal 42.26care assistance provider agency shall: 42.27    (1) enroll as a Medicaid provider meeting all provider standards, including 42.28completion of the required provider training; 42.29    (2) comply with general medical assistance coverage requirements; 42.30    (3) demonstrate compliance with law and policies of the personal care assistance 42.31program to be determined by the commissioner; 42.32    (4) comply with background study requirements; 42.33    (5) verify and keep records of hours worked by the personal care assistant and 42.34qualified professional; 43.1    (6) market agency services only through printed information in brochures and on 43.2Web sites and not engage in any agency-initiated direct contact or marketing in person, by 43.3phone, or other electronic means to potential recipients, guardians, or family members; 43.4    (7) pay the personal care assistant and qualified professional based on actual hours 43.5of services provided; 43.6    (8) withhold and pay all applicable federal and state taxes; 43.7    (9) effective January 1, 2010, document that the agency uses a minimum of 72.5 43.8percent of the revenue generated by the medical assistance rate for personal care assistance 43.9services for employee personal care assistant wages and benefits; 43.10    (10) make the arrangements and pay unemployment insurance, taxes, workers' 43.11compensation, liability insurance, and other benefits, if any; 43.12    (11) enter into a written agreement under subdivision 20 before services are provided; 43.13    (12) report suspected neglect and abuse to the common entry point according to 43.14section 256B.0651; 43.15    (13) provide the recipient with a copy of the home care bill of rights at start of 43.16service; and 43.17    (14) request reassessments at least 60 days prior to the end of the current 43.18authorization for personal care assistance services, on forms provided by the commissioner. 43.19    Sec. 13. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 27, 43.20is amended to read: 43.21    Subd. 27. Personal care assistance provider agency; ventilator training. new text begin (a) new text end The 43.22personal care assistance provider agency is required to provide training for the personal 43.23care assistant responsible for working with a recipient who is ventilator dependent. All 43.24training must be administered by a respiratory therapist, nurse, or physician. Qualified 43.25professional supervision by a nurse must be completed and documented on file in the 43.26personal care assistant's employment record and the recipient's health record. If offering 43.27personal care services to a ventilator-dependent recipient, the personal care assistance 43.28provider agency shall demonstrate new text begin and document new text end the ability to: 43.29    (1) train the personal care assistant; 43.30    (2) supervise the personal care assistant in ventilator operation and maintenance new text begin the new text end 43.31 new text begin care of a ventilator-dependent recipient new text end ; and 43.32    (3) supervise the recipient and responsible party in ventilator operation and 43.33maintenance new text begin the care of a ventilator-dependent recipient; and new text end 43.34     new text begin (4) provide documentation of the training and supervision in clauses (1) to (3) new text end 43.35 new text begin upon request new text end . 44.1     new text begin (b) A personal care assistant shall not undertake any clinical services, patient new text end 44.2 new text begin assessment, patient evaluation, or clinical education regarding the ventilator or the patient new text end 44.3 new text begin on the ventilator. These services may only be provided by health care professionals new text end 44.4 new text begin licensed or registered in this state. new text end 44.5     new text begin (c) A personal care assistant may only perform tasks associated with ventilator new text end 44.6 new text begin maintenance that are approved by the Board of Medical Practice in consultation with the new text end 44.7 new text begin Respiratory Care Practitioner Advisory Council and the Department of Human Services. new text end 44.8    Sec. 14. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 30, 44.9is amended to read: 44.10    Subd. 30. Notice of service changes to recipients. The commissioner must provide: 44.11    (1) by October 31, 2009, information to recipients likely to be affected that (i) 44.12describes the changes to the personal care assistance program that may result in the 44.13loss of access to personal care assistance services, and (ii) includes resources to obtain 44.14further information; and 44.15    (2) notice of changes in medical assistance home care services to each affected 44.16recipient at least 30 days before the effective date of the change. 44.17The notice shall include how to get further information on the changes, how to get help to 44.18obtain other services, a list of community resources, and appeal rights. Notwithstanding 44.19section 256.045, a recipient may request continued services pending appeal within the 44.20time period allowed to request an appeal new text begin ; and new text end 44.21     new text begin (3) a service agreement authorizing personal care assistance hours of service at new text end 44.22 new text begin the previously authorized level, throughout the appeal process period, when a recipient new text end 44.23 new text begin requests services pending an appeal new text end . 44.24    Sec. 15. Minnesota Statutes 2008, section 256B.092, subdivision 4d, is amended to 44.25read: 44.26    Subd. 4d. Medicaid reimbursement; licensed provider; related individuals. The 44.27commissioner shall seek a federal amendment to the home and community-based services 44.28waiver for individuals with developmental disabilities, to allow Medicaid reimbursement 44.29for the provision of supported living services to a related individual new text begin is allowed new text end when the 44.30following conditions have been met: new text begin specified in section 245A.03, subdivision 9, are met. new text end 44.31    (1) the individual is 18 years of age or older; 44.32    (2) the provider is certified initially and annually thereafter, by the county, as 44.33meeting the provider standards established in chapter 245B and the federal waiver plan; 45.1    (3) the provider has been certified by the county as meeting the adult foster care 45.2provider standards established in Minnesota Rules, parts 9555.5105 to 9555.6265; 45.3    (4) the provider is not the legal guardian or conservator of the related individual; and 45.4    (5) the individual's service plan meets the standards of this section and specifies any 45.5special conditions necessary to prevent a conflict of interest for the provider. 45.6    Sec. 16. new text begin REPEALER. new text end 45.7 new text begin Minnesota Statutes 2008, section 256B.0919, subdivision 4, new text end new text begin is repealed. new text end