1.1 	A bill for an act
1.2 	relating to human services; modifying personal care assistant services;
1.3 	amending Minnesota Statutes 2008, sections 144A.071, subdivision 4b; 
1.4 	144A.161, subdivision 1a; 256B.0911, subdivision 4d; Minnesota Statutes 2009 
1.5 	Supplement, sections 256B.0653, subdivision 3; 256B.0659, subdivisions 1, 3, 4, 
1.6 	11, 13, 14, 18, 19, 20, 21, 27, 30; 256B.0911, subdivisions 1a, 2b, 3a.
1.7 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.8 	Section 1. Minnesota Statutes 2008, section 144A.071, subdivision 4b, is amended to 
1.9 	read:
1.10 		Subd. 4b.Licensed beds on layaway status. A licensed and certified nursing 
1.11 	facility may lay away, upon prior written notice to the commissioner of health, up to 50 
1.12 	percent of its licensed and certified beds. A nursing facility may not discharge a resident 
1.13 	in order to lay away a bed. Notice to the commissioner shall be given 60 days prior 
1.14 	to the effective date of the layaway. Beds on layaway shall have the same status as 
1.15 	voluntarily delicensed and decertified beds and shall not be subject to license fees and 
1.16 	license surcharge fees. In addition, beds on layaway may be removed from layaway at any 
1.17 	time on or after one year after the effective date of layaway in the facility of origin, with a 
1.18 	60-day notice to the commissioner. A nursing facility that removes beds from layaway 
1.19 	may not place beds on layaway status for one year after the effective date of the removal 
1.20 	from layaway. The commissioner may approve the immediate removal of beds from 
1.21 	layaway if necessary to provide access to those nursing home beds to residents relocated 
1.22 	from other nursing homes due to emergency situations or closure. In the event approval 
1.23 	is granted, the one-year restriction on placing beds on layaway after a removal of beds 
1.24 	from layaway shall not apply. Beds may remain on layaway for up to five ten years. The 
1.25 	commissioner may approve placing and removing beds on layaway at any time during 
2.1 	renovation or construction related to a moratorium project approved under this section 
2.2 	or section 144A.073.  Nursing facilities are not required to comply with any licensure or 
2.3 	certification requirements for beds on layaway status.

2.4 	Sec. 2. Minnesota Statutes 2008, section 144A.161, subdivision 1a, is amended to read:
2.5 		Subd. 1a.Scope. Where a facility is undertaking closure, curtailment, reduction, or 
2.6 	change in operations, or where a housing with services unit registered under chapter 144D 
2.7 	is closed because the space that it occupies is being replaced by a nursing facility bed that 
2.8 	is being reactivated from layaway status, the facility and the county social services agency 
2.9 	must comply with the requirements of this section.

2.10 	Sec. 3. Minnesota Statutes 2009 Supplement, section 256B.0653, subdivision 3, 
2.11 	is amended to read:
2.12 		Subd. 3.Home health aide visits. (a) Home health aide visits must be provided 
2.13 	by a certified home health aide using a written plan of care that is updated in compliance 
2.14 	with Medicare regulations. A home health aide shall provide hands-on personal care, 
2.15 	perform simple procedures as an extension of therapy or nursing services, and assist in 
2.16 	instrumental activities of daily living as defined in section 256B.0659, including assuring 
2.17 	that the person gets to medical appointments if identified in the written plan of care. Home 
2.18 	health aide visits must be provided in the recipient's home.
2.19 	(b) All home health aide visits must have authorization under section 256B.0652. 
2.20 	The commissioner shall limit home health aide visits to no more than one visit per day 
2.21 	per recipient.
2.22 	(c) Home health aides must be supervised by a registered nurse or an appropriate 
2.23 	therapist when providing services that are an extension of therapy.

2.24 	Sec. 4. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 1, 
2.25 	is amended to read:
2.26 		Subdivision 1.Definitions. (a) For the purposes of this section, the terms defined in 
2.27 	paragraphs (b) to (p) (r) have the meanings given unless otherwise provided in text.
2.28 	(b) "Activities of daily living" means grooming, dressing, bathing, transferring, 
2.29 	mobility, positioning, eating, and toileting.
2.30 	(c) "Behavior," effective January 1, 2010, means a category to determine the home 
2.31 	care rating and is based on the criteria found in this section. "Level I behavior" means 
2.32 	physical aggression towards self, others, or destruction of property that requires the 
2.33 	immediate response of another person.
3.1 	(d) "Complex health-related needs," effective January 1, 2010, means a category to 
3.2 	determine the home care rating and is based on the criteria found in this section.
3.3 	(e) "Critical activities of daily living," effective January 1, 2010, means transferring, 
3.4 	mobility, eating, and toileting.
3.5 	(f) "Dependency in activities of daily living" means a person requires assistance to 
3.6 	begin and complete one or more of the activities of daily living.
3.7 	(g) "Extended personal care assistance service" means personal care assistance 
3.8 	services included in a service plan under one of the home and community-based services 
3.9 	waivers authorized under sections 256B.49, 256B.0915, and 256B.092, subdivision 
3.10 	5, which exceed the amount, duration, and frequency of the state plan personal care 
3.11 	assistance services for participants who:
3.12 	(1) need assistance provided periodically during a week, but less than daily, will 
3.13 	not be able to remain in their home without such assistance, and other replacement 
3.14 	services are more expensive or are not available when personal care assistance services 
3.15 	are to be terminated; or 
3.16 	(2) need additional personal care assistance services beyond the amount authorized 
3.17 	by the state plan personal care assistance assessment in order to assure that their safety, 
3.18 	health, and welfare are provided for in their homes.
3.19 	(h) "Health-related procedures and tasks" means procedures and tasks that can 
3.20 	be delegated or assigned by a licensed health care professional under state law to be 
3.21 	performed by a personal care assistant.
3.22 	(h) (i) "Instrumental activities of daily living" means activities to include meal 
3.23 	planning and preparation; basic assistance with paying bills; shopping for food, clothing, 
3.24 	and other essential items; performing household tasks integral to the personal care 
3.25 	assistance services; communication by telephone and other media; and traveling, including 
3.26 	to medical appointments and to participate in the community.
3.27 	(i) (j) "Managing employee" has the same definition as Code of Federal Regulations, 
3.28 	title 42, section 455.
3.29 	(j) (k) "Qualified professional" means a professional providing supervision of 
3.30 	personal care assistance services and staff as defined in section 256B.0625, subdivision 
3.31 	19c.
3.32 	(k) (l) "Personal care assistance provider agency" means a medical assistance 
3.33 	enrolled provider that provides or assists with providing personal care assistance services 
3.34 	and includes a personal care assistance provider organization, personal care assistance 
3.35 	choice agency, class A licensed nursing agency, and Medicare-certified home health 
3.36 	agency.
4.1 	(l) (m) "Personal care assistant" or "PCA" means an individual employed by a 
4.2 	personal care assistance agency who provides personal care assistance services.
4.3 	(m) (n) "Personal care assistance care plan" means a written description of personal 
4.4 	care assistance services developed by the personal care assistance provider according 
4.5 	to the service plan.
4.6 	(n) (o) "Responsible party" means an individual who is capable of providing the 
4.7 	support necessary to assist the recipient to live in the community.
4.8 	(o) (p) "Self-administered medication" means medication taken orally, by injection 
4.9 	or insertion, or applied topically without the need for assistance.
4.10 	(p) (q) "Service plan" means a written summary of the assessment and description of 
4.11 	the services needed by the recipient.
4.12 	(r) "Wages and benefits" means wages and salaries, the employer's share of FICA 
4.13 	taxes, Medicare taxes, state and federal unemployment taxes, workers' compensation, 
4.14 	mileage reimbursement, health and dental insurance, life insurance, disability insurance, 
4.15 	long-term care insurance, uniform allowance, and contributions to employee retirement 
4.16 	accounts.

4.17 	Sec. 5. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 3, 
4.18 	is amended to read:
4.19 		Subd. 3.Noncovered personal care assistance services. (a) Personal care 
4.20 	assistance services are not eligible for medical assistance payment under this section 
4.21 	when provided:
4.22 	(1) by the recipient's spouse, parent of a recipient under the age of 18, paid legal 
4.23 	guardian, licensed foster provider, except as allowed under section 256B.0651, subdivision 
4.24 	10, or responsible party;
4.25 	(2) in lieu of other staffing options in a residential or child care setting;
4.26 	(3) solely as a child care or babysitting service; or
4.27 	(4) without authorization by the commissioner or the commissioner's designee.
4.28 	(b) The following personal care services are not eligible for medical assistance 
4.29 	payment under this section when provided in residential settings:
4.30 	(1) effective January 1, 2010, when the provider of home care services who is not 
4.31 	related by blood, marriage, or adoption owns or otherwise controls the living arrangement, 
4.32 	including licensed or unlicensed services; or
4.33 	(2) when personal care assistance services are the responsibility of a residential or 
4.34 	program license holder under the terms of a service agreement and administrative rules.
5.1 	(c) Other specific tasks not covered under paragraph (a) or (b) that are not eligible 
5.2 	for medical assistance reimbursement for personal care assistance services under this 
5.3 	section include:
5.4 	(1) sterile procedures;
5.5 	(2) injections of fluids and medications into veins, muscles, or skin;
5.6 	(3) home maintenance or chore services;
5.7 	(4) homemaker services not an integral part of assessed personal care assistance 
5.8 	services needed by a recipient;
5.9 	(5) application of restraints or implementation of procedures under section 245.825;
5.10 	(6) instrumental activities of daily living for children under the age of 18, except 
5.11 	when immediate attention is needed for health or hygiene reasons integral to the personal 
5.12 	care services or when traveling to medical appointments and the need is listed in the 
5.13 	service plan by the assessor; and
5.14 	(7) assessments for personal care assistance services by personal care assistance 
5.15 	provider agencies or by independently enrolled registered nurses.

5.16 	Sec. 6. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 4, 
5.17 	is amended to read:
5.18 		Subd. 4.Assessment for personal care assistance services; limitations. (a) An 
5.19 	assessment as defined in subdivision 3a must be completed for personal care assistance 
5.20 	services.
5.21 	(b) The following limitations apply to the assessment:
5.22 	(1) a person must be assessed as dependent in an activity of daily living based on the 
5.23 	person's ongoing need, on a daily basis, for:
5.24 	(i) cuing and constant supervision to complete the task; or
5.25 	(ii) hands-on assistance to complete the task; and
5.26 	(2) a child may not be found to be dependent in an activity of daily living if because 
5.27 	of the child's age an adult would either perform the activity for the child or assist the child 
5.28 	with the activity. Assistance needed is the assistance appropriate for a typical child of 
5.29 	the same age.
5.30 	(c) Assessment for complex health-related needs must meet the criteria in this 
5.31 	paragraph. During the assessment process, a recipient qualifies as having complex 
5.32 	health-related needs if the recipient has one or more of the interventions that are ordered by 
5.33 	a physician, specified in a personal care assistance care plan, and found in the following:
5.34 	(1) tube feedings requiring:
5.35 	(i) a gastro/jejunostomy tube; or
6.1 	(ii) continuous tube feeding lasting longer than 12 hours per day;
6.2 	(2) wounds described as:
6.3 	(i) stage III or stage IV;
6.4 	(ii) multiple wounds;
6.5 	(iii) requiring sterile or clean dressing changes or a wound vac; or
6.6 	(iv) open lesions such as burns, fistulas, tube sites, or ostomy sites that require 
6.7 	specialized care;
6.8 	(3) parenteral therapy described as:
6.9 	(i) IV therapy more than two times per week lasting longer than four hours for 
6.10 	each treatment; or
6.11 	(ii) total parenteral nutrition (TPN) daily;
6.12 	(4) respiratory interventions including:
6.13 	(i) oxygen required more than eight hours per day;
6.14 	(ii) respiratory vest more than one time per day;
6.15 	(iii) bronchial drainage treatments more than two times per day;
6.16 	(iv) sterile or clean suctioning more than six times per day;
6.17 	(v) dependence on another to apply respiratory ventilation augmentation devices 
6.18 	such as BiPAP and CPAP; and
6.19 	(vi) ventilator dependence under section 256B.0652;
6.20 	(5) insertion and maintenance of catheter including:
6.21 	(i) sterile catheter changes more than one time per month;
6.22 	(ii) clean self-catheterization more than six times per day; or
6.23 	(iii) bladder irrigations;
6.24 	(6) bowel program more than two times per week requiring more than 30 minutes to 
6.25 	perform each time;
6.26 	(7) neurological intervention including:
6.27 	(i) seizures more than two times per week and requiring significant physical 
6.28 	assistance to maintain safety; or
6.29 	(ii) swallowing disorders diagnosed by a physician and requiring specialized 
6.30 	assistance from another on a daily basis; and
6.31 	(8) other congenital or acquired diseases creating a need for significantly increased 
6.32 	direct hands-on assistance and interventions in six to eight activities of daily living.
6.33 	(d) An assessment of behaviors must meet the criteria in this paragraph. A recipient 
6.34 	qualifies as having a need for assistance due to behaviors if the recipient's behavior requires 
6.35 	assistance at least four times per week and shows one or more of the following behaviors:
7.1 	(1) physical aggression towards self or others, or destruction of property that requires 
7.2 	the immediate response of another person;
7.3 	(2) increased vulnerability due to cognitive deficits or socially inappropriate 
7.4 	behavior; or
7.5 	(3) verbally aggressive and resistive to care.

7.6 	Sec. 7. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 11, 
7.7 	is amended to read:
7.8 		Subd. 11.Personal care assistant; requirements. (a) A personal care assistant 
7.9 	must meet the following requirements:
7.10 	(1) be at least 18 years of age with the exception of persons who are 16 or 17 years 
7.11 	of age with these additional requirements:
7.12 	(i) supervision by a qualified professional every 60 days; and
7.13 	(ii) employment by only one personal care assistance provider agency responsible 
7.14 	for compliance with current labor laws;
7.15 	(2) be employed by a personal care assistance provider agency;
7.16 	(3) enroll with the department as a personal care assistant after clearing a background 
7.17 	study. Before a personal care assistant provides services, the personal care assistance 
7.18 	provider agency must initiate a background study on the personal care assistant under 
7.19 	chapter 245C, and the personal care assistance provider agency must have received a 
7.20 	notice from the commissioner that the personal care assistant is:
7.21 	(i) not disqualified under section 245C.14; or
7.22 	(ii) is disqualified, but the personal care assistant has received a set aside of the 
7.23 	disqualification under section 245C.22;
7.24 	(4) be able to effectively communicate with the recipient and personal care 
7.25 	assistance provider agency;
7.26 	(5) be able to provide covered personal care assistance services according to the 
7.27 	recipient's personal care assistance care plan, respond appropriately to recipient needs, 
7.28 	and report changes in the recipient's condition to the supervising qualified professional 
7.29 	or physician;
7.30 	(6) not be a consumer of personal care assistance services;
7.31 	(7) maintain daily written records including, but not limited to, time sheets under 
7.32 	subdivision 12;
7.33 	(8) effective January 1, 2010, complete standardized training as determined 
7.34 	by the commissioner before completing enrollment. The training must be available 
7.35 	in languages other than English and to those who need accommodations due to 
8.1 	disabilities. Personal care assistant training must include successful completion of the 
8.2 	following training components: basic first aid, vulnerable adult, child maltreatment, 
8.3 	OSHA universal precautions, basic roles and responsibilities of personal care assistants 
8.4 	including information about assistance with lifting and transfers for recipients, emergency 
8.5 	preparedness, orientation to positive behavioral practices, fraud issues, and completion of 
8.6 	time sheets. Upon completion of the training components, the personal care assistant must 
8.7 	demonstrate the competency to provide assistance to recipients;
8.8 	(9) complete training and orientation on the needs of the recipient within the first 
8.9 	seven days after the services begin; and
8.10 	(10) be limited to providing and being paid for up to 310 hours per month of personal 
8.11 	care assistance services regardless of the number of recipients being served or the number 
8.12 	of personal care assistance provider agencies enrolled with. The number of hours worked 
8.13 	per day shall not be disallowed by the department unless in violation of the law.
8.14 	(b) A legal guardian may be a personal care assistant if the guardian is not being paid 
8.15 	for the guardian services and meets the criteria for personal care assistants in paragraph (a).
8.16 	(c) Effective January 1, 2010, persons who do not qualify as a personal care assistant 
8.17 	include parents and stepparents of minors, spouses, paid legal guardians, family foster 
8.18 	care providers, except as otherwise allowed in section 256B.0625, subdivision 19a, or 
8.19 	staff of a residential setting.

8.20 	Sec. 8. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 13, 
8.21 	is amended to read:
8.22 		Subd. 13.Qualified professional; qualifications. (a) The qualified professional 
8.23 	must be employed by a personal care assistance provider agency and meet the definition 
8.24 	under section 256B.0625, subdivision 19c. Before a qualified professional provides 
8.25 	services, the personal care assistance provider agency must initiate a background study on 
8.26 	the qualified professional under chapter 245C, and the personal care assistance provider 
8.27 	agency must have received a notice from the commissioner that the qualified professional:
8.28 	(1) is not disqualified under section 245C.14; or
8.29 	(2) is disqualified, but the qualified professional has received a set aside of the 
8.30 	disqualification under section 245C.22.
8.31 	(b) The qualified professional shall perform the duties of training, supervision, and 
8.32 	evaluation of the personal care assistance staff and evaluation of the effectiveness of 
8.33 	personal care assistance services. The qualified professional shall:
8.34 	(1) develop and monitor with the recipient a personal care assistance care plan based 
8.35 	on the service plan and individualized needs of the recipient;
9.1 	(2) develop and monitor with the recipient a monthly plan for the use of personal 
9.2 	care assistance services;
9.3 	(3) review documentation of personal care assistance services provided;
9.4 	(4) provide training and ensure competency for the personal care assistant in the 
9.5 	individual needs of the recipient; and
9.6 	(5) document all training, communication, evaluations, and needed actions to 
9.7 	improve performance of the personal care assistants.
9.8 	(c) Effective January July 1, 2010, the qualified professional shall complete the 
9.9 	provider training with basic information about the personal care assistance program 
9.10 	approved by the commissioner within six months of the date hired by a personal care 
9.11 	assistance provider agency. Qualified professionals who have completed the required 
9.12 	trainings as an employee with a personal care assistance provider agency do not need to 
9.13 	repeat the required trainings if they are hired by another agency, if they have completed the 
9.14 	training within the last three years. The required training shall be available in languages 
9.15 	other than English and to those who need accommodations due to disabilities, shall be 
9.16 	available online or by electronic remote connection, and shall provide for competency 
9.17 	testing to demonstrate an understanding of the content without attending in-person 
9.18 	training. A qualified professional is allowed to be employed and is not subject to the 
9.19 	training requirement until the training is offered online or through remote electronic 
9.20 	connection. A qualified professional employed by a personal care assistance provider 
9.21 	agency certified for participation in Medicare as a home health agency is exempt from 
9.22 	the training required in this subdivision.

9.23 	Sec. 9. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 14, 
9.24 	is amended to read:
9.25 		Subd. 14.Qualified professional; duties. (a) Effective January 1, 2010, all personal 
9.26 	care assistants must be supervised by a qualified professional.
9.27 	(b) Through direct training, observation, return demonstrations, and consultation 
9.28 	with the staff and the recipient, the qualified professional must ensure and document 
9.29 	that the personal care assistant is:
9.30 	(1) capable of providing the required personal care assistance services;
9.31 	(2) knowledgeable about the plan of personal care assistance services before services 
9.32 	are performed; and
9.33 	(3) able to identify conditions that should be immediately brought to the attention of 
9.34 	the qualified professional.
10.1 	(c) The qualified professional shall evaluate the personal care assistant within the first 
10.2 	14 days of starting to provide regularly scheduled services for a recipient except for the 
10.3 	personal care assistance choice option under subdivision 19, paragraph (a), clause (4). For 
10.4 	this initial evaluation, the qualified professional shall evaluate the personal care assistance 
10.5 	services for a recipient through direct observation of a personal care assistant's work. 
10.6 	Subsequent visits to evaluate the personal care assistance services provided to a recipient 
10.7 	do not require direct observation of each personal care assistant's work and shall occur:
10.8 	(1) at least every 90 days thereafter for the first year of a recipient's services; and
10.9 	(2) every 120 days after the first year of a recipient's service or whenever needed for 
10.10 	response to a recipient's request for increased supervision of the personal care assistance 
10.11 	staff.; and
10.12 	(3) after the first 180 days of a recipient's service, supervisory visits may alternate 
10.13 	between unscheduled phone or Internet technology and in-person visits, unless the 
10.14 	in-person visits are needed according to the care plan.
10.15 	(d) Communication with the recipient is a part of the evaluation process of the 
10.16 	personal care assistance staff.
10.17 	(e) At each supervisory visit, the qualified professional shall evaluate personal care 
10.18 	assistance services including the following information:
10.19 	(1) satisfaction level of the recipient with personal care assistance services;
10.20 	(2) review of the month-to-month plan for use of personal care assistance services;
10.21 	(3) review of documentation of personal care assistance services provided;
10.22 	(4) whether the personal care assistance services are meeting the goals of the service 
10.23 	as stated in the personal care assistance care plan and service plan;
10.24 	(5) a written record of the results of the evaluation and actions taken to correct any 
10.25 	deficiencies in the work of a personal care assistant; and
10.26 	(6) revision of the personal care assistance care plan as necessary in consultation 
10.27 	with the recipient or responsible party, to meet the needs of the recipient.
10.28 	(f) The qualified professional shall complete the required documentation in the 
10.29 	agency recipient and employee files and the recipient's home, including the following 
10.30 	documentation:
10.31 	(1) the personal care assistance care plan based on the service plan and individualized 
10.32 	needs of the recipient;
10.33 	(2) a month-to-month plan for use of personal care assistance services;
10.34 	(3) changes in need of the recipient requiring a change to the level of service and the 
10.35 	personal care assistance care plan;
11.1 	(4) evaluation results of supervision visits and identified issues with personal care 
11.2 	assistance staff with actions taken;
11.3 	(5) all communication with the recipient and personal care assistance staff; and
11.4 	(6) hands-on training or individualized training for the care of the recipient.
11.5 	(g) The documentation in paragraph (f) must be done on agency forms.
11.6 	(h) The services that are not eligible for payment as qualified professional services 
11.7 	include:
11.8 	(1) direct professional nursing tasks that could be assessed and authorized as skilled 
11.9 	nursing tasks;
11.10 	(2) supervision of personal care assistance completed by telephone;
11.11 	(3) agency administrative activities;
11.12 	(4) training other than the individualized training required to provide care for a 
11.13 	recipient; and
11.14 	(5) any other activity that is not described in this section.

11.15 	Sec. 10. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 18, 
11.16 	is amended to read:
11.17 		Subd. 18.Personal care assistance choice option; generally. (a) The 
11.18 	commissioner may allow a recipient of personal care assistance services to use a fiscal 
11.19 	intermediary to assist the recipient in paying and accounting for medically necessary 
11.20 	covered personal care assistance services. Unless otherwise provided in this section, all 
11.21 	other statutory and regulatory provisions relating to personal care assistance services apply 
11.22 	to a recipient using the personal care assistance choice option.
11.23 	(b) Personal care assistance choice is an option of the personal care assistance 
11.24 	program that allows the recipient who receives personal care assistance services to be 
11.25 	responsible for the hiring, training, scheduling, and firing of personal care assistants
11.26 	according to the terms of the written agreement with the personal care assistance choice 
11.27 	agency required under subdivision 20, paragraph (a). This program offers greater control 
11.28 	and choice for the recipient in who provides the personal care assistance service and when 
11.29 	the service is scheduled. The recipient or the recipient's responsible party must choose a 
11.30 	personal care assistance choice provider agency as a fiscal intermediary. This personal 
11.31 	care assistance choice provider agency manages payroll, invoices the state, is responsible 
11.32 	for all payroll-related taxes and insurance, and is responsible for providing the consumer 
11.33 	training and support in managing the recipient's personal care assistance services.

12.1 	Sec. 11. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 19, 
12.2 	is amended to read:
12.3 		Subd. 19.Personal care assistance choice option; qualifications; duties. (a) 
12.4 	Under personal care assistance choice, the recipient or responsible party shall:
12.5 	(1) recruit, hire, schedule, and terminate personal care assistants and a qualified 
12.6 	professional according to the terms of the written agreement required under subdivision 
12.7 	20, paragraph (a);
12.8 	(2) develop a personal care assistance care plan based on the assessed needs 
12.9 	and addressing the health and safety of the recipient with the assistance of a qualified 
12.10 	professional as needed;
12.11 	(3) orient and train the personal care assistant with assistance as needed from the 
12.12 	qualified professional;
12.13 	(4) effective January 1, 2010, supervise and evaluate the personal care assistant with 
12.14 	the qualified professional, who is required to visit the recipient at least every 180 days;
12.15 	(5) monitor and verify in writing and report to the personal care assistance choice 
12.16 	agency the number of hours worked by the personal care assistant and the qualified 
12.17 	professional;
12.18 	(6) engage in an annual face-to-face reassessment to determine continuing eligibility 
12.19 	and service authorization; and
12.20 	(7) use the same personal care assistance choice provider agency if shared personal 
12.21 	assistance care is being used.
12.22 	(b) The personal care assistance choice provider agency shall:
12.23 	(1) meet all personal care assistance provider agency standards;
12.24 	(2) enter into a written agreement with the recipient, responsible party, and personal 
12.25 	care assistants;
12.26 	(3) not be related as a parent, child, sibling, or spouse to the recipient, qualified 
12.27 	professional, or the personal care assistant; and
12.28 	(4) ensure arm's-length transactions without undue influence or coercion with the 
12.29 	recipient and personal care assistant.
12.30 	(c) The duties of the personal care assistance choice provider agency are to:
12.31 	(1) be the employer of the personal care assistant and the qualified professional for 
12.32 	employment law and related regulations including, but not limited to, purchasing and 
12.33 	maintaining workers' compensation, unemployment insurance, surety and fidelity bonds, 
12.34 	and liability insurance, and submit any or all necessary documentation including, but not 
12.35 	limited to, workers' compensation and unemployment insurance;
13.1 	(2) bill the medical assistance program for personal care assistance services and 
13.2 	qualified professional services;
13.3 	(3) request and complete background studies that comply with the requirements for 
13.4 	personal care assistants and qualified professionals;
13.5 	(4) pay the personal care assistant and qualified professional based on actual hours 
13.6 	of services provided;
13.7 	(5) withhold and pay all applicable federal and state taxes;
13.8 	(6) verify and keep records of hours worked by the personal care assistant and 
13.9 	qualified professional;
13.10 	(7) make the arrangements and pay taxes and other benefits, if any, and comply with 
13.11 	any legal requirements for a Minnesota employer;
13.12 	(8) enroll in the medical assistance program as a personal care assistance choice 
13.13 	agency; and
13.14 	(9) enter into a written agreement as specified in subdivision 20 before services 
13.15 	are provided.

13.16 	Sec. 12. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 20, 
13.17 	is amended to read:
13.18 		Subd. 20.Personal care assistance choice option; administration. (a) Before 
13.19 	services commence under the personal care assistance choice option, and annually 
13.20 	thereafter, the personal care assistance choice provider agency, recipient, or responsible 
13.21 	party, each personal care assistant, and the qualified professional and the recipient or 
13.22 	responsible party shall enter into a written agreement. The annual agreement must be 
13.23 	provided to the recipient or responsible party, each personal care assistant, and the 
13.24 	qualified professional when completed, and include at a minimum:
13.25 	(1) duties of the recipient, qualified professional, personal care assistant, and 
13.26 	personal care assistance choice provider agency;
13.27 	(2) salary and benefits for the personal care assistant and the qualified professional;
13.28 	(3) administrative fee of the personal care assistance choice provider agency and 
13.29 	services paid for with that fee, including background study fees;
13.30 	(4) grievance procedures to respond to complaints;
13.31 	(5) procedures for hiring and terminating the personal care assistant; and
13.32 	(6) documentation requirements including, but not limited to, time sheets, activity 
13.33 	records, and the personal care assistance care plan.
13.34 	(b) Effective January 1, 2010, except for the administrative fee of the personal care 
13.35 	assistance choice provider agency as reported on the written agreement, the remainder 
14.1 	of the rates paid to the personal care assistance choice provider agency must be used to 
14.2 	pay for the salary and benefits for the personal care assistant or the qualified professional. 
14.3 	The provider agency must use a minimum of 72.5 percent of the revenue generated by 
14.4 	the medical assistance rate for personal care assistance services for employee personal 
14.5 	care assistant wages and benefits.
14.6 	(c) The commissioner shall deny, revoke, or suspend the authorization to use the 
14.7 	personal care assistance choice option if:
14.8 	(1) it has been determined by the qualified professional or public health nurse that 
14.9 	the use of this option jeopardizes the recipient's health and safety;
14.10 	(2) the parties have failed to comply with the written agreement specified in this 
14.11 	subdivision;
14.12 	(3) the use of the option has led to abusive or fraudulent billing for personal care 
14.13 	assistance services; or
14.14 	(4) the department terminates the personal care assistance choice option.
14.15 	(d) The recipient or responsible party may appeal the commissioner's decision in 
14.16 	paragraph (c) according to section 256.045. The denial, revocation, or suspension to 
14.17 	use the personal care assistance choice option must not affect the recipient's authorized 
14.18 	level of personal care assistance services.

14.19 	Sec. 13. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 21, 
14.20 	is amended to read:
14.21 		Subd. 21.Requirements for initial enrollment of personal care assistance 
14.22 	provider agencies. (a) All personal care assistance provider agencies must provide, at the 
14.23 	time of enrollment as a personal care assistance provider agency in a format determined 
14.24 	by the commissioner, information and documentation that includes, but is not limited to, 
14.25 	the following:
14.26 	(1) the personal care assistance provider agency's current contact information 
14.27 	including address, telephone number, and e-mail address;
14.28 	(2) proof of surety bond coverage in the amount of $50,000 or ten percent of the 
14.29 	provider's payments from Medicaid in the previous year, whichever is less;
14.30 	(3) proof of fidelity bond coverage in the amount of $20,000;
14.31 	(4) proof of workers' compensation insurance coverage;
14.32 	(5) a description of the personal care assistance provider agency's organization 
14.33 	identifying the names of all owners, managing employees, staff, board of directors, and 
14.34 	the affiliations of the directors, owners, or staff to other service providers;
15.1 	(6) a copy of the personal care assistance provider agency's written policies and 
15.2 	procedures including: hiring of employees; training requirements; service delivery; 
15.3 	and employee and consumer safety including process for notification and resolution 
15.4 	of consumer grievances, identification and prevention of communicable diseases, and 
15.5 	employee misconduct;
15.6 	(7) copies of all other forms the personal care assistance provider agency uses in 
15.7 	the course of daily business including, but not limited to:
15.8 	(i) a copy of the personal care assistance provider agency's time sheet if the time 
15.9 	sheet varies from the standard time sheet for personal care assistance services approved 
15.10 	by the commissioner, and a letter requesting approval of the personal care assistance 
15.11 	provider agency's nonstandard time sheet;
15.12 	(ii) the personal care assistance provider agency's template for the personal care 
15.13 	assistance care plan; and
15.14 	(iii) the personal care assistance provider agency's template for the written 
15.15 	agreement in subdivision 20 for recipients using the personal care assistance choice 
15.16 	option, if applicable;
15.17 	(8) a list of all trainings and classes that the personal care assistance provider agency 
15.18 	requires of its staff providing personal care assistance services;
15.19 	(9) documentation that the personal care assistance provider agency and staff have 
15.20 	successfully completed all the training required by this section;
15.21 	(10) documentation of the agency's marketing practices;
15.22 	(11) disclosure of ownership, leasing, or management of all residential properties 
15.23 	that is used or could be used for providing home care services; and
15.24 	(12) documentation that the agency will use the following percentages of revenue 
15.25 	generated from the medical assistance rate paid for personal care assistance services 
15.26 	for employee personal care assistant wages and benefits: 72.5 percent of revenue in the 
15.27 	personal care assistance choice option and 72.5 percent of revenue from other personal 
15.28 	care assistance providers; and
15.29 	(13) documentation that the agency does not burden recipients' free exercise of their 
15.30 	right to choose service providers by requiring personal care assistants to sign an agreement 
15.31 	not to work with any particular personal care assistance recipient or for another personal 
15.32 	care assistance provider agency after leaving the agency.
15.33 	(b) Personal care assistance provider agencies shall provide the information specified 
15.34 	in paragraph (a) to the commissioner at the time the personal care assistance provider 
15.35 	agency enrolls as a vendor or upon request from the commissioner. The commissioner 
16.1 	shall collect the information specified in paragraph (a) from all personal care assistance 
16.2 	providers beginning July 1, 2009.
16.3 	(c) All personal care assistance provider agencies shall require all employees in 
16.4 	management and supervisory positions and owners of the agency who are active in the 
16.5 	day-to-day management and operations of the agency to complete mandatory training as 
16.6 	determined by the commissioner before enrollment of the agency as a provider. Personal 
16.7 	care assistance provider agencies are required to send all owners, qualified professionals 
16.8 	employed by the agency, and all other managing employees to the initial and subsequent 
16.9 	trainings. Employees in management and supervisory positions and owners who are active 
16.10 	in the day-to-day operations of an agency who have completed the required training as 
16.11 	an employee with a personal care assistance provider agency do not need to repeat the 
16.12 	required training if they are hired by another agency, if they have completed the training 
16.13 	within the past three years. By September 1, 2010, the required training must be available 
16.14 	online or by electronic remote connection, and provide for competency testing. The 
16.15 	required training must be available in languages other than English and to those who need 
16.16 	accommodations due to disabilities. Personal care assistance provider agency billing staff 
16.17 	shall complete training about personal care assistance program financial management. This 
16.18 	training is effective July 1, 2009. Any personal care assistance provider agency enrolled 
16.19 	before that date shall, if it has not already, complete the provider training within 18 months 
16.20 	of July 1, 2009. Any new owners, new qualified professionals, and new managingor
16.21 	employees in management and supervisory positions involved in the day-to-day operations
16.22 	are required to complete mandatory training as a requisite of hiring working for the 
16.23 	agency. Personal care assistance provider agencies certified for participation in Medicare 
16.24 	as home health agencies are exempt from the training required in this subdivision.

16.25 	Sec. 14. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 27, 
16.26 	is amended to read:
16.27 		Subd. 27.Personal care assistance provider agency; ventilator training. (a) The 
16.28 	personal care assistance provider agency is required to provide training for the personal 
16.29 	care assistant responsible for working with a recipient who is ventilator dependent. All 
16.30 	training must be administered by a respiratory therapist, nurse, or physician. Qualified 
16.31 	professional supervision by a nurse must be completed and documented on file in the 
16.32 	personal care assistant's employment record and the recipient's health record. If offering 
16.33 	personal care services to a ventilator-dependent recipient, the personal care assistance 
16.34 	provider agency shall demonstrate and document the ability to:
16.35 	(1) train the personal care assistant;
17.1 	(2) supervise the personal care assistant in ventilator operation and maintenance the 
17.2 	care of a ventilator-dependent recipient; and
17.3 	(3) supervise the recipient and responsible party in ventilator operation and 
17.4 	maintenance the care of a ventilator-dependent recipient; and
17.5 	(4) provide documentation of training and supervision in clauses (1) to (3) upon 
17.6 	request.
17.7 	(b) A personal care assistant shall not undertake any clinical services, patient 
17.8 	assessment, patient evaluation, or clinical education regarding the ventilator or the patient 
17.9 	on the ventilator. These services may only be provided by health care professionals 
17.10 	licensed or registered in this state.
17.11 	(c) A personal care assistant may only perform tasks associated with ventilator 
17.12 	maintenance that are approved by the Board of Medical Practice in consultation with the 
17.13 	Respiratory Care Practitioner Advisory Council and the Department of Human Services.

17.14 	Sec. 15. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 30, 
17.15 	is amended to read:
17.16 		Subd. 30.Notice of service changes to recipients. The commissioner must provide:
17.17 	(1) by October 31, 2009, information to recipients likely to be affected that (i) 
17.18 	describes the changes to the personal care assistance program that may result in the 
17.19 	loss of access to personal care assistance services, and (ii) includes resources to obtain 
17.20 	further information; and
17.21 	(2) notice of changes in medical assistance home care services to each affected 
17.22 	recipient at least 30 days before the effective date of the change.
17.23 	The notice shall include how to get further information on the changes, how to get help to 
17.24 	obtain other services, a list of community resources, and appeal rights. Notwithstanding 
17.25 	section 256.045, a recipient may request continued services pending appeal within the 
17.26 	time period allowed to request an appeal; and
17.27 	(3) a service agreement authorizing personal care assistance hours of service at 
17.28 	the previously authorized level throughout the appeal process period when a recipient 
17.29 	requests services pending an appeal.

17.30 	Sec. 16. Minnesota Statutes 2009 Supplement, section 256B.0911, subdivision 1a, 
17.31 	is amended to read:
17.32 		Subd. 1a.Definitions. For purposes of this section, the following definitions apply:
17.33 	(a) "Long-term care consultation services" means:
18.1 	(1) assistance in identifying services needed to maintain an individual in the most 
18.2 	inclusive environment;
18.3 	(2) providing recommendations on cost-effective community services that are 
18.4 	available to the individual;
18.5 	(3) development of an individual's person-centered community support plan;
18.6 	(4) providing information regarding eligibility for Minnesota health care programs;
18.7 	(5) face-to-face long-term care consultation assessments, which may be completed 
18.8 	in a hospital, nursing facility, intermediate care facility for persons with developmental 
18.9 	disabilities (ICF/DDs), regional treatment centers, or the person's current or planned 
18.10 	residence;
18.11 	(6) federally mandated screening to determine the need for a institutional level of 
18.12 	care under section 256B.0911, subdivision 4, paragraph (a);
18.13 	(7) determination of home and community-based waiver service eligibility including 
18.14 	level of care determination for individuals who need an institutional level of care as 
18.15 	defined under section 144.0724, subdivision 11, or 256B.092, service eligibility including 
18.16 	state plan home care services identified in section sections256B.0625, subdivisions 6, 
18.17 	7, and 19, paragraphs (a) and (c), and 256B.0657, based on assessment and support 
18.18 	plan development with appropriate referrals, including the option for consumer directed 
18.19 	community supports;
18.20 	(8) providing recommendations for nursing facility placement when there are no 
18.21 	cost-effective community services available; and
18.22 	(9) assistance to transition people back to community settings after facility 
18.23 	admission.
18.24 	(b) "Long-term care options counseling" means the services provided by the linkage 
18.25 	lines as mandated by sections 256.01 and 256.975, subdivision 7, and also includes 
18.26 	telephone assistance and follow up once a long-term care consultation assessment has 
18.27 	been completed.
18.28 	(c) "Minnesota health care programs" means the medical assistance program under 
18.29 	chapter 256B and the alternative care program under section 256B.0913.
18.30 	(d) "Lead agencies" means counties or a collaboration of counties, tribes, and health 
18.31 	plans administering long-term care consultation assessment and support planning services.

18.32 	Sec. 17. Minnesota Statutes 2009 Supplement, section 256B.0911, subdivision 2b, 
18.33 	is amended to read:
18.34 		Subd. 2b.Certified assessors. (a) Beginning January 1, 2011, each lead agency 
18.35 	shall use certified assessors who have completed training and the certification processes 
19.1 	determined by the commissioner in subdivision 2c. Certified assessors shall demonstrate 
19.2 	best practices in assessment and support planning including person-centered planning 
19.3 	principals and have a common set of skills that must ensure consistency and equitable 
19.4 	access to services statewide. Assessors must be part of a multidisciplinary team of 
19.5 	professionals that includes public health nurses, social workers, and other professionals 
19.6 	as defined in paragraph (b). For persons with complex health care needs, a public health 
19.7 	nurse or registered nurse from a multidisciplinary team must be consulted. A lead agency 
19.8 	may choose, in accordance with departmental policies, to contract with a qualified, 
19.9 	certified assessor to conduct assessments and reassessments on behalf of the lead agency.
19.10 	(b) Certified assessors are persons with a minimum of a bachelor's degree in social 
19.11 	work, nursing with a public health nursing certificate, or other closely related field with at 
19.12 	least one year of home and community-based experience or a two-year registered nursing 
19.13 	degree with at least three years of home and community-based experience that have 
19.14 	received training and certification specific to assessment and consultation for long-term 
19.15 	care services in the state.

19.16 	Sec. 18. Minnesota Statutes 2009 Supplement, section 256B.0911, subdivision 3a, 
19.17 	is amended to read:
19.18 		Subd. 3a.Assessment and support planning. (a) Persons requesting assessment, 
19.19 	services planning, or other assistance intended to support community-based living, 
19.20 	including persons who need assessment in order to determine waiver or alternative care 
19.21 	program eligibility, must be visited by a long-term care consultation team within 15 
19.22 	calendar days after the date on which an assessment was requested or recommended. After 
19.23 	January 1, 2011, these requirements also apply to personal care assistance services, private 
19.24 	duty nursing, and home health agency services, on timelines established in subdivision 5. 
19.25 	Face-to-face assessments must be conducted according to paragraphs (b) to (i).
19.26 	(b) The county may utilize a team of either the social worker or public health nurse, 
19.27 	or both. After January 1, 2011, lead agencies shall use certified assessors to conduct the 
19.28 	assessment in a face-to-face interview. The consultation team members must confer 
19.29 	regarding the most appropriate care for each individual screened or assessed.
19.30 	(c) The assessment must be comprehensive and include a person-centered 
19.31 	assessment of the health, psychological, functional, environmental, and social needs of 
19.32 	referred individuals and provide information necessary to develop a support plan that 
19.33 	meets the consumers needs, using an assessment form provided by the commissioner.
19.34 	(d) The assessment must be conducted in a face-to-face interview with the person 
19.35 	being assessed and the person's legal representative, as required by legally executed 
20.1 	documents, and other individuals as requested by the person, who can provide information 
20.2 	on the needs, strengths, and preferences of the person necessary to develop a support plan 
20.3 	that ensures the person's health and safety, but who is not a provider of service or has any 
20.4 	financial interest in the provision of services.
20.5 	(e) The person, or the person's legal representative, must be provided with written 
20.6 	recommendations for community-based services, including consumer directed options,
20.7 	or institutional care that include documentation that the most cost-effective alternatives 
20.8 	available were offered to the individual. For purposes of this requirement, "cost-effective 
20.9 	alternatives" means community services and living arrangements that cost the same as or 
20.10 	less than institutional care.
20.11 	(f) If the person chooses to use community-based services, the person or the person's 
20.12 	legal representative must be provided with a written community support plan, regardless 
20.13 	of whether the individual is eligible for Minnesota health care programs. A person may 
20.14 	request assistance in identifying community supports without participating in a complete 
20.15 	assessment. Upon a request for assistance identifying community support, the person must 
20.16 	be transferred or referred to the services available under sections 256.975, subdivision 7, 
20.17 	and 256.01, subdivision 24, for telephone assistance and follow up.
20.18 	(g) The person has the right to make the final decision between institutional 
20.19 	placement and community placement after the recommendations have been provided, 
20.20 	except as provided in subdivision 4a, paragraph (c).
20.21 	(h) The team must give the person receiving assessment or support planning, or 
20.22 	the person's legal representative, materials, and forms supplied by the commissioner 
20.23 	containing the following information:
20.24 	(1) the need for and purpose of preadmission screening if the person selects nursing 
20.25 	facility placement;
20.26 	(2) the role of the long-term care consultation assessment and support planning in 
20.27 	waiver and alternative care program eligibility determination;
20.28 	(3) information about Minnesota health care programs;
20.29 	(4) the person's freedom to accept or reject the recommendations of the team;
20.30 	(5) the person's right to confidentiality under the Minnesota Government Data 
20.31 	Practices Act, chapter 13;
20.32 	(6) the long-term care consultant's decision regarding the person's need for 
20.33 	institutional level of care as determined under criteria established in section 144.0724, 
20.34 	subdivision 11, or 256B.092; and
21.1 	(7) the person's right to appeal the decision regarding the need for nursing facility 
21.2 	level of care or the county's final decisions regarding public programs eligibility according 
21.3 	to section 256.045, subdivision 3.
21.4 	(i) Face-to-face assessment completed as part of eligibility determination for 
21.5 	the alternative care, elderly waiver, community alternatives for disabled individuals, 
21.6 	community alternative care, and traumatic brain injury waiver programs under sections 
21.7 	256B.0915, 256B.0917, and 256B.49 is valid to establish service eligibility for no more 
21.8 	than 60 calendar days after the date of assessment. The effective eligibility start date 
21.9 	for these programs can never be prior to the date of assessment. If an assessment was 
21.10 	completed more than 60 days before the effective waiver or alternative care program 
21.11 	eligibility start date, assessment and support plan information must be updated in a 
21.12 	face-to-face visit and documented in the department's Medicaid Management Information 
21.13 	System (MMIS). The effective date of program eligibility in this case cannot be prior to 
21.14 	the date the updated assessment is completed.

21.15 	Sec. 19. Minnesota Statutes 2008, section 256B.0911, subdivision 4d, is amended to 
21.16 	read:
21.17 		Subd. 4d.Preadmission screening of individuals under 65 years of age. (a) 
21.18 	It is the policy of the state of Minnesota to ensure that individuals with disabilities or 
21.19 	chronic illness are served in the most integrated setting appropriate to their needs and have 
21.20 	the necessary information to make informed choices about home and community-based 
21.21 	service options.
21.22 	(b) Individuals under 65 years of age who are admitted to a nursing facility from a 
21.23 	hospital must be screened prior to admission as outlined in subdivisions 4a through 4c.
21.24 	(c) Individuals under 65 years of age who are admitted to nursing facilities with 
21.25 	only a telephone screening must receive a face-to-face assessment from the long-term 
21.26 	care consultation team member of the county in which the facility is located or from the 
21.27 	recipient's county case manager within 40 calendar days of admission.
21.28 	(d) Individuals under 65 years of age who are admitted to a nursing facility 
21.29 	without preadmission screening according to the exemption described in subdivision 4b, 
21.30 	paragraph (a), clause (3), and who remain in the facility longer than 30 days must receive 
21.31 	a face-to-face assessment within 40 days of admission.
21.32 	(e) At the face-to-face assessment, the long-term care consultation team member or 
21.33 	county case manager must perform the activities required under subdivision 3b.
22.1 	(f) For individuals under 21 years of age, a screening interview which recommends 
22.2 	nursing facility admission must be face-to-face and approved by the commissioner before 
22.3 	the individual is admitted to the nursing facility.
22.4 	(g) In the event that an individual under 65 years of age is admitted to a nursing 
22.5 	facility on an emergency basis, the county must be notified of the admission on the 
22.6 	next working day, and a face-to-face assessment as described in paragraph (c) must be 
22.7 	conducted within 40 calendar days of admission.
22.8 	(h) At the face-to-face assessment, the long-term care consultation team member or 
22.9 	the case manager must present information about home and community-based options, 
22.10 	including consumer directed options, so the individual can make informed choices. If the 
22.11 	individual chooses home and community-based services, the long-term care consultation 
22.12 	team member or case manager must complete a written relocation plan within 20 working 
22.13 	days of the visit. The plan shall describe the services needed to move out of the facility 
22.14 	and a time line for the move which is designed to ensure a smooth transition to the 
22.15 	individual's home and community.
22.16 	(i) An individual under 65 years of age residing in a nursing facility shall receive a 
22.17 	face-to-face assessment at least every 12 months to review the person's service choices 
22.18 	and available alternatives unless the individual indicates, in writing, that annual visits are 
22.19 	not desired. In this case, the individual must receive a face-to-face assessment at least 
22.20 	once every 36 months for the same purposes.
22.21 	(j) Notwithstanding the provisions of subdivision 6, the commissioner may pay 
22.22 	county agencies directly for face-to-face assessments for individuals under 65 years of age 
22.23 	who are being considered for placement or residing in a nursing facility.

22.24 	Sec. 20. DIRECTION TO COMMISSIONER; CONSULTATION WITH 
22.25 	STAKEHOLDERS.
 22.26 	The commissioner of human services shall consult with stakeholders experienced in 
22.27 	using and providing services through the consumer directed community supports option 
22.28 	during the identification of data to be used in future development of an individualized 
22.29 	budget methodology for the home and community-based waivers under the new 
22.30 	comprehensive assessment.