1.1 	A bill for an act
1.2 	relating to human services; amending continuing care policy provisions; making 
1.3 	changes to the telephone equipment program; making changes to disability 
1.4 	services provisions; reforming comprehensive assessments and case management 
1.5 	services; making changes to nursing facility provisions; making technical and 
1.6 	conforming changes; providing for rulemaking authority; requiring reports;
1.7 	amending Minnesota Statutes 2010, sections 144A.071, subdivisions 3, 4a, 5a; 
1.8 	144A.073, subdivision 3c, by adding a subdivision; 144D.08; 237.50; 237.51; 
1.9 	237.52; 237.53; 237.54; 237.55; 237.56; 245A.03, subdivision 7; 245A.11, 
1.10 	subdivision 8; 252.32, subdivision 1a; 252A.21, subdivision 2; 256.476, 
1.11 	subdivision 11; 256B.0625, subdivision 19c; 256B.0659, subdivisions 1, 2, 3, 
1.12 	3a, 4, 9, 11, 13, 14, 19, 21, 30; 256B.0911, subdivisions 1, 1a, 2b, 2c, 3, 3a, 3b, 
1.13 	3c, 4a, 4c, 6; 256B.0913, subdivisions 7, 8; 256B.0915, subdivisions 1a, 1b, 3c, 
1.14 	6, 10; 256B.0916, subdivision 7; 256B.092, subdivisions 1, 1a, 1b, 1e, 1g, 2, 3, 
1.15 	5, 7, 8, 8a, 9, 11; 256B.096, subdivision 5; 256B.19, subdivision 1e; 256B.431, 
1.16 	subdivisions 2t, 26; 256B.438, subdivisions 1, 3, 4, by adding a subdivision; 
1.17 	256B.441, subdivision 55a, by adding a subdivision; 256B.49, subdivisions 13, 
1.18 	14, 15, 21; 256B.4912; 256G.02, subdivision 6; proposing coding for new law 
1.19 	in Minnesota Statutes, chapter 252; repealing Minnesota Statutes 2010, section 
1.20 	144A.073, subdivisions 4, 5.
1.21 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.22 	ARTICLE 1
1.23 	TELEPHONE EQUIPMENT PROGRAM

1.24 	Section 1. Minnesota Statutes 2010, section 237.50, is amended to read:
1.25 	237.50 DEFINITIONS.
1.26 		Subdivision 1.Scope. The terms used in sections 237.50 to 237.56 have the 
1.27 	meanings given them in this section. 
1.28 		Subd. 3.Communication impaired disability. "Communication impaired
1.29 	disability" means certified as deaf, severely hearing impaired, hard-of-hearing having 
1.30 	a hearing loss, speech impaired, deaf and blind disability, or mobility impaired if the 
2.1 	mobility impairment significantly impedes the ability physical disability that makes it 
2.2 	difficult or impossible to use standard customer premises telecommunications services 
2.3 	and equipment.
2.4 		Subd. 4.Communication device. "Communication device" means a device that 
2.5 	when connected to a telephone enables a communication-impaired person to communicate 
2.6 	with another person utilizing the telephone system. A "communication device" includes a 
2.7 	ring signaler, an amplification device, a telephone device for the deaf, a Brailling device 
2.8 	for use with a telephone, and any other device the Department of Human Services deems 
2.9 	necessary.
2.10 		Subd. 4a.Deaf. "Deaf" means a hearing impairment loss of such severity that the 
2.11 	individual must depend primarily upon visual communication such as writing, lip reading, 
2.12 	manual communication sign language, and gestures.
2.13 		Subd. 4b.Deafblind. "Deafblind" means any combination of vision and hearing 
2.14 	loss that interferes with acquiring information from the environment to the extent that 
2.15 	compensatory strategies and skills are necessary to access that or other information.
2.16 		Subd. 5.Exchange. "Exchange" means a unit area established and described by the 
2.17 	tariff of a telephone company for the administration of telephone service in a specified 
2.18 	geographical area, usually embracing a city, town, or village and its environs, and served 
2.19 	by one or more central offices, together with associated facilities used in providing 
2.20 	service within that area.
2.21 		Subd. 6.Fund. "Fund" means the telecommunications access Minnesota fund 
2.22 	established in section 237.52. 
2.23 		Subd. 6a.Hard-of-hearing. "Hard-of-hearing" means a hearing impairment loss
2.24 	resulting in a functional loss limitation, but not to the extent that the individual must 
2.25 	depend primarily upon visual communication.
2.26 		Subd. 7.Interexchange service. "Interexchange service" means telephone service 
2.27 	between points in two or more exchanges.
2.28 		Subd. 8.Inter-LATA interexchange service. "Inter-LATA interexchange service" 
2.29 	means interexchange service originating and terminating in different LATAs.
2.30 		Subd. 9.Local access and transport area. "Local access and transport area 
2.31 	(LATA)" means a geographical area designated by the Modification of Final Judgment 
2.32 	in U.S. v. Western Electric Co., Inc., 552 F. Supp. 131 (D.D.C. 1982), including 
2.33 	modifications in effect on the effective date of sections 237.51 to 237.54.
2.34 		Subd. 10.Local exchange service. "Local exchange service" means telephone 
2.35 	service between points within an exchange.
3.1 		Subd. 10a.Telecommunications device. "Telecommunications device" means 
3.2 	a device that (1) allows a person with a communication disability to have access to 
3.3 	telecommunications services as defined in subdivision 13, and (2) is specifically 
3.4 	selected by the Department of Human Services for its capacity to allow persons with 
3.5 	communication disabilities to use telecommunications services in a manner that is 
3.6 	functionally equivalent to the ability of an individual who does not have a communication 
3.7 	disability. A telecommunications device may include a ring signaler, an amplified 
3.8 	telephone, a hands-free telephone, a text telephone, a captioned telephone, a wireless 
3.9 	device, a device that produces Braille output for use with a telephone, and any other 
3.10 	device the Department of Human Services deems appropriate.
3.11 		Subd. 11.Telecommunication Telecommunications Relay service Services.
 3.12 	"Telecommunication Telecommunications Relay service Services" or "TRS" means 
3.13 	a central statewide service through which a communication-impaired person, 
3.14 	using a communication device, may send and receive messages to and from a 
3.15 	non-communication-impaired person whose telephone is not equipped with a 
3.16 	communication device and through which a non-communication-impaired person 
3.17 	may, by using voice communication, send and receive messages to and from a 
3.18 	communication-impaired person the telecommunications transmission services required 
3.19 	under Federal Communications Commission (FCC) regulations at Code of Federal 
3.20 	Regulations, title 47, sections 64.604 to 64.606. TRS allows an individual who has 
3.21 	a communication disability to use telecommunications services in a manner that is 
3.22 	functionally equivalent to the ability of an individual who does not have a communication 
3.23 	disability.
3.24 		Subd. 12.Telecommunications. "Telecommunications" means the transmission, 
3.25 	between or among points specified by the user, of information of the user's choosing, 
3.26 	without change in the form or content of the information as sent and received.
3.27 		Subd. 13.Telecommunications services. "Telecommunications services" means 
3.28 	the offering of telecommunications for fee directly to the public, or to such classes of users 
3.29 	as to be effectively available to the public, regardless of the facilities used.

3.30 	Sec. 2. Minnesota Statutes 2010, section 237.51, is amended to read:
3.31 	237.51 TELECOMMUNICATIONS ACCESS MINNESOTA PROGRAM 
3.32 	ADMINISTRATION.
3.33 		Subdivision 1.Creation. The commissioner of commerce shall:
4.1 	(1) administer through interagency agreement with the commissioner of human 
4.2 	services a program to distribute communication telecommunications devices to eligible 
4.3 	communication-impaired persons who have communication disabilities; and
4.4 	(2) contract with a one or more  qualified vendor vendors  that serves 
4.5 	communication-impaired serve persons who have communication disabilities to create 
4.6 	and maintain a telecommunication provide telecommunications relay service services.
4.7 	For purposes of sections 237.51 to 237.56, the Department of Commerce and any 
4.8 	organization with which it contracts pursuant to this section or section 237.54, subdivision 
4.9 	2, are not telephone companies or telecommunications carriers as defined in section 
4.10 	237.01. 
4.11 		Subd. 5.Commissioner of commerce duties. In addition to any duties specified 
4.12 	elsewhere in sections 237.51 to 237.56, the commissioner of commerce shall: 
4.13 	(1) prepare the reports required by section 237.55; 
4.14 	(2) administer the fund created in section 237.52; and 
4.15 	(3) adopt rules under chapter 14 to implement the provisions of sections 237.50
4.16 	to 237.56. 
4.17 		Subd. 5a.Department Commissioner of human services duties. (a) In addition to 
4.18 	any duties specified elsewhere in sections 237.51 to 237.56, the commissioner of human 
4.19 	services shall: 
4.20 	(1) define economic hardship, special needs, and household criteria so as to 
4.21 	determine the priority of eligible applicants for initial distribution of devices and to 
4.22 	determine circumstances necessitating provision of more than one communication
4.23 	telecommunications device per household;
4.24 	(2) establish a method to verify eligibility requirements;
4.25 	(3) establish specifications for communication telecommunications devices to be 
4.26 	purchased provided under section 237.53, subdivision 3; and
4.27 	(4) inform the public and specifically the community of communication-impaired
4.28 	persons who have communication disabilities of the program.; and
4.29 	(5) provide devices based on the assessed need of eligible applicants. 
4.30 	(b) The commissioner may establish an advisory board to advise the department 
4.31 	in carrying out the duties specified in this section and to advise the commissioner of 
4.32 	commerce in carrying out duties under section 237.54. If so established, the advisory 
4.33 	board must include, at a minimum, the following communication-impaired persons: 
4.34 	(1) at least one member who is deaf;
4.35 	(2) at least one member who is has a speech impaired disability;
5.1 	(3) at least one member who is mobility impaired has a physical disability that 
5.2 	makes it difficult or impossible for the person to access telecommunications services; and
5.3 	(4) at least one member who is hard-of-hearing.
5.4 	The membership terms, compensation, and removal of members and the filling of 
5.5 	membership vacancies are governed by section 15.059. Advisory board meetings shall be 
5.6 	held at the discretion of the commissioner. 

5.7 	Sec. 3. Minnesota Statutes 2010, section 237.52, is amended to read:
5.8 	237.52 TELECOMMUNICATIONS ACCESS MINNESOTA FUND.
5.9 		Subdivision 1.Fund established. A telecommunications access Minnesota fund is 
5.10 	established as an account in the state treasury. Earnings, such as interest, dividends, and 
5.11 	any other earnings arising from fund assets, must be credited to the fund.
5.12 		Subd. 2.Assessment. (a) The commissioner of commerce, the commissioner 
5.13 	of employment and economic development, and the commissioner of human services 
5.14 	shall annually recommend to the Public Utilities Commission (PUC) an adequate and 
5.15 	appropriate surcharge and budget to implement sections 237.50 to 237.56, 248.062, 
5.16 	and 256C.30, respectively. The maximum annual budget for section 248.062 must not 
5.17 	exceed $100,000 and for section 256C.30 must not exceed $300,000. The Public Utilities 
5.18 	Commission shall review the budgets for reasonableness and may modify the budget 
5.19 	to the extent it is unreasonable. The commission shall annually determine the funding 
5.20 	mechanism to be used within 60 days of receipt of the recommendation of the departments 
5.21 	and shall order the imposition of surcharges effective on the earliest practicable date. The 
5.22 	commission shall establish a monthly charge no greater than 20 cents for each customer 
5.23 	access line, including trunk equivalents as designated by the commission pursuant to 
5.24 	section 403.11, subdivision 1.
5.25 	(b) If the fund balance falls below a level capable of fully supporting all programs 
5.26 	eligible under subdivision 5 and sections 248.062 and 256C.30, expenditures under 
5.27 	sections 248.062 and 256C.30 shall be reduced on a pro rata basis and expenditures under 
5.28 	sections 237.53 and 237.54 shall be fully funded. Expenditures under sections 248.062
5.29 	and 256C.30 shall resume at fully funded levels when the commissioner of commerce 
5.30 	determines there is a sufficient fund balance to fully fund those expenditures.
5.31 		Subd. 3.Collection. Every telephone company or communications carrier that 
5.32 	provides service provider of services capable of originating a telecommunications relay
5.33 	TRS call, including cellular communications and other nonwire access services, in this 
5.34 	state shall collect the charges established by the commission under subdivision 2 and 
5.35 	transfer amounts collected to the commissioner of public safety in the same manner as 
6.1 	provided in section 403.11, subdivision 1, paragraph (d). The commissioner of public 
6.2 	safety must deposit the receipts in the fund established in subdivision 1. 
6.3 		Subd. 4.Appropriation. Money in the fund is appropriated to the commissioner of 
6.4 	commerce to implement sections 237.51 to 237.56, to the commissioner of employment 
6.5 	and economic development to implement section 248.062, and to the commissioner of 
6.6 	human services to implement section 256C.30.
6.7 		Subd. 5.Expenditures. (a) Money in the fund may only be used for:
6.8 	(1) expenses of the Department of Commerce, including personnel cost, public 
6.9 	relations, advisory board members' expenses, preparation of reports, and other reasonable 
6.10 	expenses not to exceed ten percent of total program expenditures;
6.11 	(2) reimbursing the commissioner of human services for purchases made or services 
6.12 	provided pursuant to section 237.53; 
6.13 	(3) reimbursing telephone companies for purchases made or services provided 
6.14 	under section 237.53, subdivision 5; and 
6.15 	(4) contracting for establishment and operation of the telecommunication relay 
6.16 	service the provision of TRS required by section 237.54. 
6.17 	(b) All costs directly associated with the establishment of the program, the purchase 
6.18 	and distribution of communication telecommunications devices, and the establishment 
6.19 	and operation of the telecommunication relay service provision of TRS are either 
6.20 	reimbursable or directly payable from the fund after authorization by the commissioner 
6.21 	of commerce. The commissioner of commerce shall contract with the message relay 
6.22 	service operator one or more TRS providers to indemnify the local exchange carriers of 
6.23 	the relay telecommunications service providers for any fines imposed by the Federal 
6.24 	Communications Commission related to the failure of the relay service to comply with 
6.25 	federal service standards. Notwithstanding section 16A.41, the commissioner may 
6.26 	advance money to the contractor of the telecommunication relay service TRS providers if 
6.27 	the contractor establishesproviders establish to the commissioner's satisfaction that the 
6.28 	advance payment is necessary for the operation provision of the service. The advance 
6.29 	payment may be used only for working capital reserve for the operation of the service. 
6.30 	The advance payment must be offset or repaid by the end of the contract fiscal year 
6.31 	together with interest accrued from the date of payment. 

6.32 	Sec. 4. Minnesota Statutes 2010, section 237.53, is amended to read:
6.33 	237.53 COMMUNICATION TELECOMMUNICATIONS DEVICE.
7.1 		Subdivision 1.Application. A person applying for a communication
7.2 	telecommunications device under this section must apply to the program administrator on 
7.3 	a form prescribed by the Department of Human Services.
7.4 		Subd. 2.Eligibility. To be eligible to obtain a communication telecommunications
7.5 	device under this section, a person must be:
7.6 	(1) be able to benefit from and use the equipment for its intended purpose;
7.7 	(2) have a communication impaired disability;
7.8 	(3) be a resident of the state;
7.9 	(4) be a resident in a household that has a median income at or below the applicable 
7.10 	median household income in the state, except a deaf and blind person who is deafblind
7.11 	applying for a telebraille unit Braille device may reside in a household that has a median 
7.12 	income no more than 150 percent of the applicable median household income in the 
7.13 	state; and
7.14 	(5) be a resident in a household that has telephone telecommunications service 
7.15 	or that has made application for service and has been assigned a telephone number; or 
7.16 	a resident in a residential care facility, such as a nursing home or group home where 
7.17 	telephone telecommunications service is not included as part of overall service provision.
7.18 		Subd. 3.Distribution. The commissioner of human services shall purchase and 
7.19 	distribute a sufficient number of communication telecommunications devices so that each 
7.20 	eligible household receives an appropriate device devices as determined under section 
7.21 	237.51, subdivision 5a. The commissioner of human services shall distribute the devices 
7.22 	to eligible households in each service area free of charge as determined under section 
7.23 	237.51, subdivision 5a. 
7.24 		Subd. 4.Training; maintenance. The commissioner of human services shall 
7.25 	maintain the communication telecommunications devices until the warranty period 
7.26 	expires, and provide training, without charge, to first-time users of the devices.
7.27 		Subd. 5.Wiring installation. If acommunication-impaired person is not served by 
7.28 	telephone service and is subject to economic hardship as determined by the Department 
7.29 	of Human Services, the telephone company providing local serviceshall at the direction 
7.30 	of the administrator of the program install necessary outside wiring without charge to 
7.31 	the household.
7.32 		Subd. 6.Ownership. All communication Telecommunications devices purchased 
7.33 	pursuant to subdivision 3 will become are the property of the state of Minnesota. Policies 
7.34 	and procedures for the return of devices from individuals who withdraw from the program 
7.35 	or whose eligibility status changes shall be determined by the commissioner of human 
7.36 	services.
8.1 		Subd. 7.Standards. The communication telecommunications devices distributed 
8.2 	under this section must comply with the electronic industries association alliance standards 
8.3 	and be approved by the Federal Communications Commission. The commissioner of 
8.4 	human services must provide each eligible person a choice of several models of devices, 
8.5 	the retail value of which may not exceed $600 for a communication device for the deaf
8.6 	text telephone, and a retail value of $7,000 for a telebraille Braille device, or an amount 
8.7 	authorized by the Department of Human Services for a telephone device for the deaf with 
8.8 	auxiliary equipment all other telecommunications devices and auxiliary equipment it 
8.9 	deems cost-effective and appropriate to distribute according to sections 237.51 to 237.56.

8.10 	Sec. 5. Minnesota Statutes 2010, section 237.54, is amended to read:
8.11 	237.54 TELECOMMUNICATION TELECOMMUNICATIONS RELAY 
8.12 	SERVICE SERVICES (TRS).
8.13 		Subd. 2.Operation. (a) The commissioner of commerce shall contract with 
8.14 	a one or more  qualified vendor vendors for the operation and maintenance of the 
8.15 	telecommunication relay system provision of Telecommunications Relay Services (TRS).
8.16 	(b) The telecommunication relay service provider TRS providers shall operate the 
8.17 	relay service within the state of Minnesota. The operator of the system TRS providers
8.18 	shall keep all messages confidential, shall train personnel in the unique needs of 
8.19 	communication-impaired people, and shall inform communication-impaired persons 
8.20 	and the public of the availability and use of the system. Except in the case of a speech- 
8.21 	or mobility-impaired person, the operator shall not relay a message unless it originates 
8.22 	or terminates through a communication device for the deaf or a Brailling device for use 
8.23 	with a telephone comply with all current and subsequent FCC regulations at Code of 
8.24 	Federal Regulations, title 47, sections 64.601 to 64.606, and shall inform persons who 
8.25 	have communication disabilities and the public of the availability and use of TRS.

8.26 	Sec. 6. Minnesota Statutes 2010, section 237.55, is amended to read:
8.27 	237.55 ANNUAL REPORT ON COMMUNICATION
8.28 	TELECOMMUNICATIONS ACCESS.
8.29 	The commissioner of commerce must prepare a report for presentation to the Public 
8.30 	Utilities Commission by January 31 of each year. Each report must review the accessibility 
8.31 	of the telephone system to communication-impaired persons, review the ability of 
8.32 	non-communication-impaired persons to communicate with communication-impaired 
8.33 	persons via the telephone system telecommunications services to persons who have 
8.34 	communication disabilities, describe services provided, account for money received and 
9.1 	disbursed annually annual revenues and expenditures for each aspect of the program fund
9.2 	to date, and include predicted program future operation.

9.3 	Sec. 7. Minnesota Statutes 2010, section 237.56, is amended to read:
9.4 	237.56 ADEQUATE SERVICE ENFORCEMENT.
9.5 	The services required to be provided under sections 237.50 to 237.55 may be 
9.6 	enforced under section 237.081 upon a complaint of at least two communication-impaired
9.7 	persons within the service area of any one telephone company telecommunications 
9.8 	service provider, provided that if only one person within the service area of a company 
9.9 	is receiving service under sections 237.50 to 237.55, the commission Public Utilities 
9.10 	Commission may proceed upon a complaint from that person. 

9.11 	ARTICLE 2
9.12 	DISABILITY SERVICES

9.13 	Section 1. Minnesota Statutes 2010, section 245A.03, subdivision 7, is amended to 
9.14 	read:
9.15 		Subd. 7.Licensing moratorium. (a) The commissioner shall not issue an 
9.16 	initial license for child foster care licensed under Minnesota Rules, parts 2960.3000 to 
9.17 	2960.3340, or adult foster care licensed under Minnesota Rules, parts 9555.5105 to 
9.18 	9555.6265, under this chapter for a physical location that will not be the primary residence 
9.19 	of the license holder for the entire period of licensure. If a license is issued during this 
9.20 	moratorium, and the license holder changes the license holder's primary residence away 
9.21 	from the physical location of the foster care license, the commissioner shall revoke the 
9.22 	license according to section 245A.07. Exceptions to the moratorium include:
9.23 	(1) foster care settings that are required to be registered under chapter 144D;
9.24 	(2) foster care licenses replacing foster care licenses in existence on May 15, 2009, 
9.25 	and determined to be needed by the commissioner under paragraph (b);
9.26 	(3) new foster care licenses determined to be needed by the commissioner under 
9.27 	paragraph (b) for the closure or downsizing of a nursing facility, ICF/MR, or regional 
9.28 	treatment center;
9.29 	(4) new foster care licenses determined to be needed by the commissioner under 
9.30 	paragraph (b) for persons requiring hospital level care; or
9.31 	(5) new foster care licenses determined to be needed by the commissioner for the 
9.32 	transition of people from personal care assistance to the home and community-based 
9.33 	services.
10.1 	(b) The commissioner shall determine the need for newly licensed foster care homes 
10.2 	as defined under this subdivision. As part of the determination, the commissioner shall 
10.3 	consider the availability of foster care capacity in the area in which the licensee seeks to 
10.4 	operate, and the recommendation of the local county board. The determination by the 
10.5 	commissioner must be final. A determination of need is not required for a change in 
10.6 	ownership at the same address.
10.7 	(c) Residential settings that would otherwise be subject to the moratorium established 
10.8 	in paragraph (a), that are in the process of receiving an adult or child foster care license as 
10.9 	of July 1, 2009, shall be allowed to continue to complete the process of receiving an adult 
10.10 	or child foster care license. For this paragraph, all of the following conditions must be met 
10.11 	to be considered in the process of receiving an adult or child foster care license:
10.12 	(1) participants have made decisions to move into the residential setting, including 
10.13 	documentation in each participant's care plan;
10.14 	(2) the provider has purchased housing or has made a financial investment in the 
10.15 	property;
10.16 	(3) the lead agency has approved the plans, including costs for the residential setting 
10.17 	for each individual;
10.18 	(4) the completion of the licensing process, including all necessary inspections, is 
10.19 	the only remaining component prior to being able to provide services; and
10.20 	(5) the needs of the individuals cannot be met within the existing capacity in that 
10.21 	county.
10.22 	To qualify for the process under this paragraph, the lead agency must submit 
10.23 	documentation to the commissioner by August 1, 2009, that all of the above criteria are 
10.24 	met.
10.25 	(d) (c) The commissioner shall study the effects of the license moratorium under this 
10.26 	subdivision and shall report back to the legislature by January 15, 2011. This study shall 
10.27 	include, but is not limited to the following:
10.28 	(1) the overall capacity and utilization of foster care beds where the physical location 
10.29 	is not the primary residence of the license holder prior to and after implementation 
10.30 	of the moratorium;
10.31 	(2) the overall capacity and utilization of foster care beds where the physical 
10.32 	location is the primary residence of the license holder prior to and after implementation 
10.33 	of the moratorium; and
10.34 	(3) the number of licensed and occupied ICF/MR beds prior to and after 
10.35 	implementation of the moratorium.
11.1 	(d) At the time of application and reapplication for licensure, the applicant and the 
11.2 	license holder that are subject to the moratorium or an exclusion established in paragraph 
11.3 	(a) are required to inform the commissioner whether the physical location where the foster 
11.4 	care will be provided is or will be the primary residence of the license holder for the entire 
11.5 	period of licensure. If the primary residence of the applicant or license holder changes, the 
11.6 	applicant or license holder must notify the commissioner immediately. The commissioner 
11.7 	shall print on the foster care license certificate whether or not the physical location is the 
11.8 	primary residence of the license holder.
11.9 	(e) License holders of foster care homes identified under paragraph (e) that are not 
11.10 	the primary residence of the license holder and that also provide services in the foster care 
11.11 	home that are covered by a federally approved home and community-based services 
11.12 	waiver, as authorized under section 256B.0915, 256B.092, or 256B.49 must inform the 
11.13 	human services licensing division that the license holder provides or intends to provide 
11.14 	these waiver-funded services. These license holders must be considered registered under 
11.15 	section 256B.092, subdivision 11, paragraph (c), and this registration status must be 
11.16 	identified on their license certificates.

11.17 	Sec. 2. Minnesota Statutes 2010, section 245A.11, subdivision 8, is amended to read:
11.18 		Subd. 8.Community residential setting license. (a) The commissioner shall 
11.19 	establish provider standards for residential support services that integrate service standards 
11.20 	and the residential setting under one license. The commissioner shall propose statutory 
11.21 	language and an implementation plan for licensing requirements for residential support 
11.22 	services to the legislature by January 15, 2011 2012, as a component of the quality outcome 
11.23 	standards recommendations required by Laws 2010, chapter 352, article 1, section 24.
11.24 	(b) Providers licensed under chapter 245B, and providing, contracting, or arranging 
11.25 	for services in settings licensed as adult foster care under Minnesota Rules, parts 
11.26 	9555.5105 to 9555.6265, or child foster care under Minnesota Rules, parts 2960.3000 to 
11.27 	2960.3340; and meeting the provisions of section 256B.092, subdivision 11, paragraph 
11.28 	(b), must be required to obtain a community residential setting license.

11.29 	Sec. 3. Minnesota Statutes 2010, section 252.32, subdivision 1a, is amended to read:
11.30 		Subd. 1a.Support grants. (a) Provision of support grants must be limited to 
11.31 	families who require support and whose dependents are under the age of 21 and who 
11.32 	have been certified disabled under section 256B.055, subdivision 12, paragraphs (a), 
11.33 	(b), (c), (d), and (e). Families who are receiving: home and community-based waivered 
11.34 	services for persons with developmental disabilities authorized under section 256B.092 or 
12.1 	256B.49; personal care assistance under section 256B.0652; or a consumer support grant 
12.2 	under section 256.476 are not eligible for support grants.
12.3 	Families whose annual adjusted gross income is $60,000 or more are not eligible for 
12.4 	support grants except in cases where extreme hardship is demonstrated. Beginning in state 
12.5 	fiscal year 1994, the commissioner shall adjust the income ceiling annually to reflect the 
12.6 	projected change in the average value in the United States Department of Labor Bureau of 
12.7 	Labor Statistics Consumer Price Index (all urban) for that year.
12.8 	(b) Support grants may be made available as monthly subsidy grants and lump-sum 
12.9 	grants.
12.10 	(c) Support grants may be issued in the form of cash, voucher, and direct county 
12.11 	payment to a vendor.
12.12 	(d) Applications for the support grant shall be made by the legal guardian to the 
12.13 	county social service agency. The application shall specify the needs of the families, the 
12.14 	form of the grant requested by the families, and the items and services to be reimbursed.

12.15 	Sec. 4. [252.34] REPORT BY COMMISSIONER.
12.16 	Beginning January 1, 2013, the commissioner shall provide a biennial report to the 
12.17 	chairs of the legislative committees with jurisdiction over health and human services 
12.18 	policy and funding. The report must provide a summary of overarching goals and priorities 
12.19 	for persons with disabilities, including the status of how each of the following programs 
12.20 	administered by the commissioner is supporting the overarching goals and priorities:
12.21 	(1) home and community-based services waivers for persons with disabilities under 
12.22 	sections 256B.092 and 256B.49;
12.23 	(2) home care services under section 256B.0652; and
12.24 	(3) other relevant programs and services as determined by the commissioner.

12.25 	Sec. 5. Minnesota Statutes 2010, section 252A.21, subdivision 2, is amended to read:
12.26 		Subd. 2.Rules. The commissioner shall adopt rules to implement this chapter. 
12.27 	The rules must include standards for performance of guardianship or conservatorship 
12.28 	duties including, but not limited to: twice a year visits with the ward; quarterly reviews 
12.29 	of records from day, residential, and support services; a requirement that the duties of 
12.30 	guardianship or conservatorship and case management not be performed by the same 
12.31 	person; specific standards for action on "do not resuscitate" orders, sterilization requests, 
12.32 	and the use of psychotropic medication and aversive procedures.

12.33 	Sec. 6. Minnesota Statutes 2010, section 256.476, subdivision 11, is amended to read:
13.1 		Subd. 11.Consumer support grant program after July 1, 2001.  Effective 
13.2 	July 1, 2001, the commissioner shall allocate consumer support grant resources to 
13.3 	serve additional individuals based on a review of Medicaid authorization and payment 
13.4 	information of persons eligible for a consumer support grant from the most recent fiscal 
13.5 	year. The commissioner shall use the following methodology to calculate maximum 
13.6 	allowable monthly consumer support grant levels:
13.7 	(1) For individuals whose program of origination is medical assistance home care 
13.8 	under sections 256B.0651 and 256B.0653 to 256B.0656, the maximum allowable monthly 
13.9 	grant levels are calculated by:
13.10 	(i) determining 50 percent of the averagethe service authorization for each 
13.11 	individual based on the individual's home care rating assessment;
13.12 	(ii) calculating the overall ratio of actual payments to service authorizations by 
13.13 	program;
13.14 	(iii) applying the overall ratio to the average50 percent of the service authorization 
13.15 	level of each home care rating; and
13.16 	(iv) adjusting the result for any authorized rate increaseschanges provided by the 
13.17 	legislature; and.
13.18 	(v) adjusting the result for the average monthly utilization per recipient.
13.19 	(2) The commissioner may review and evaluateshall ensure the methodology to 
13.20 	reflect changes inis consistent with the home care programs.

13.21 	Sec. 7. Minnesota Statutes 2010, section 256B.0625, subdivision 19c, is amended to 
13.22 	read:
13.23 		Subd. 19c.Personal care. Medical assistance covers personal care assistance 
13.24 	services provided by an individual who is qualified to provide the services according to 
13.25 	subdivision 19a and sections 256B.0651 to 256B.0656, provided in accordance with a 
13.26 	plan, and supervised by a qualified professional.
13.27 	"Qualified professional" means a mental health professional as defined in section 
13.28 	245.462, subdivision 18, clauses (1) to (6), or 245.4871, subdivision 27, clauses (1) to (6); 
13.29 	or a registered nurse as defined in sections 148.171 to 148.285, a licensed social worker 
13.30 	as defined in sections 148D.010 and 148D.055, or a qualified developmental disabilities 
13.31 	specialist under section 245B.07, subdivision 4. The qualified professional shall perform 
13.32 	the duties required in section 256B.0659.

13.33 	Sec. 8. Minnesota Statutes 2010, section 256B.0659, subdivision 1, is amended to read:
14.1 		Subdivision 1.Definitions. (a) For the purposes of this section, the terms defined in 
14.2 	paragraphs (b) to (r) have the meanings given unless otherwise provided in text.
14.3 	(b) "Activities of daily living" means grooming, dressing, bathing, transferring, 
14.4 	mobility, positioning, eating, and toileting.
14.5 	(c) "Behavior," effective January 1, 2010, means a category to determine the home 
14.6 	care rating and is based on the criteria found in this section. "Level I behavior" means 
14.7 	physical aggression towards self, others, or destruction of property that requires the 
14.8 	immediate response of another person.
14.9 	(d) "Complex health-related needs," effective January 1, 2010, means a category to 
14.10 	determine the home care rating and is based on the criteria found in this section.
14.11 	(e) "Critical activities of daily living," effective January 1, 2010, means transferring, 
14.12 	mobility, eating, and toileting.
14.13 	(f) "Dependency in activities of daily living" means a person requires assistance to 
14.14 	begin and complete one or more of the activities of daily living.
14.15 	(g) "Extended personal care assistance service" means personal care assistance 
14.16 	services included in a service plan under one of the home and community-based services 
14.17 	waivers authorized under sections 256B.0915, 256B.092, subdivision 5, and 256B.49, 
14.18 	which exceed the amount, duration, and frequency of the state plan personal care 
14.19 	assistance services for participants who:
14.20 	(1) need assistance provided periodically during a week, but less than daily will not 
14.21 	be able to remain in their homes without the assistance, and other replacement services 
14.22 	are more expensive or are not available when personal care assistance services are to 
14.23 	be terminated reduced; or
14.24 	(2) need additional personal care assistance services beyond the amount authorized 
14.25 	by the state plan personal care assistance assessment in order to ensure that their safety, 
14.26 	health, and welfare are provided for in their homes.
14.27 	(h) "Health-related procedures and tasks" means procedures and tasks that can 
14.28 	be delegated or assigned by a licensed health care professional under state law to be 
14.29 	performed by a personal care assistant.
14.30 	(i) "Instrumental activities of daily living" means activities to include meal planning 
14.31 	and preparation; basic assistance with paying bills; shopping for food, clothing, and other 
14.32 	essential items; performing household tasks integral to the personal care assistance 
14.33 	services; communication by telephone and other media; and traveling, including to 
14.34 	medical appointments and to participate in the community.
14.35 	(j) "Managing employee" has the same definition as Code of Federal Regulations, 
14.36 	title 42, section 455.
15.1 	(k) "Qualified professional" means a professional providing supervision of personal 
15.2 	care assistance services and staff as defined in section 256B.0625, subdivision 19c.
15.3 	(l) "Personal care assistance provider agency" means a medical assistance enrolled 
15.4 	provider that provides or assists with providing personal care assistance services and 
15.5 	includes a personal care assistance provider organization, personal care assistance choice 
15.6 	agency, class A licensed nursing agency, and Medicare-certified home health agency.
15.7 	(m) "Personal care assistant" or "PCA" means an individual employed by a personal 
15.8 	care assistance agency who provides personal care assistance services.
15.9 	(n) "Personal care assistance care plan" means a written description of personal 
15.10 	care assistance services developed by the personal care assistance provider according 
15.11 	to the service plan.
15.12 	(o) "Responsible party" means an individual who is capable of providing the support 
15.13 	necessary to assist the recipient to live in the community.
15.14 	(p) "Self-administered medication" means medication taken orally, by injection or 
15.15 	insertion, or applied topically without the need for assistance.
15.16 	(q) "Service plan" means a written summary of the assessment and description of the 
15.17 	services needed by the recipient.
15.18 	(r) "Wages and benefits" means wages and salaries, the employer's share of FICA 
15.19 	taxes, Medicare taxes, state and federal unemployment taxes, workers' compensation, 
15.20 	mileage reimbursement, health and dental insurance, life insurance, disability insurance, 
15.21 	long-term care insurance, uniform allowance, and contributions to employee retirement 
15.22 	accounts.

15.23 	Sec. 9. Minnesota Statutes 2010, section 256B.0659, subdivision 3, is amended to read:
15.24 		Subd. 3.Noncovered personal care assistance services. (a) Personal care 
15.25 	assistance services are not eligible for medical assistance payment under this section 
15.26 	when provided:
15.27 	(1) by the recipient's spouse, parent of a recipient under the age of 18, paid legal 
15.28 	guardian, licensed foster provider, except as allowed under section 256B.0652, subdivision 
15.29 	10, or responsible party;
15.30 	(2) in lieu of other staffing options order to meet staffing or license requirements in a 
15.31 	residential or child care setting;
15.32 	(3) solely as a child care or babysitting service; or
15.33 	(4) without authorization by the commissioner or the commissioner's designee.
15.34 	(b) The following personal care services are not eligible for medical assistance 
15.35 	payment under this section when provided in residential settings:
16.1 	(1) effective January 1, 2010, when the provider of home care services who is not 
16.2 	related by blood, marriage, or adoption owns or otherwise controls the living arrangement, 
16.3 	including licensed or unlicensed services; or
16.4 	(2) when personal care assistance services are the responsibility of a residential or 
16.5 	program license holder under the terms of a service agreement and administrative rules.
16.6 	(c) Other specific tasks not covered under paragraph (a) or (b) that are not eligible 
16.7 	for medical assistance reimbursement for personal care assistance services under this 
16.8 	section include:
16.9 	(1) sterile procedures;
16.10 	(2) injections of fluids and medications into veins, muscles, or skin;
16.11 	(3) home maintenance or chore services;
16.12 	(4) homemaker services not an integral part of assessed personal care assistance 
16.13 	services needed by a recipient;
16.14 	(5) application of restraints or implementation of procedures under section 245.825;
16.15 	(6) instrumental activities of daily living for children under the age of 18, except 
16.16 	when immediate attention is needed for health or hygiene reasons integral to the personal 
16.17 	care services and the need is listed in the service plan by the assessor; and
16.18 	(7) assessments for personal care assistance services by personal care assistance 
16.19 	provider agencies or by independently enrolled registered nurses.

16.20 	Sec. 10. Minnesota Statutes 2010, section 256B.0659, subdivision 9, is amended to 
16.21 	read:
16.22 		Subd. 9.Responsible party; generally. (a) "Responsible party" means an 
16.23 	individual who is capable of providing the support necessary to assist the recipient to live 
16.24 	in the community.
16.25 	(b) A responsible party must be 18 years of age, actively participate in planning and 
16.26 	directing of personal care assistance services, and attend all assessments for the recipient.
16.27 	(c) A responsible party must not be the:
16.28 	(1) personal care assistant;
16.29 	(2) qualified professional;
16.30 	(3) home care provider agency owner or staff manager; or
16.31 	(4) home care provider agency staff unless staff who are not listed in clauses (1) to 
16.32 	(3) are related to the recipient by blood, marriage, or adoption; or
16.33 	(3) (5) county staff acting as part of employment.
17.1 	(d) A licensed family foster parent who lives with the recipient may be the 
17.2 	responsible party as long as the family foster parent meets the other responsible party 
17.3 	requirements.
17.4 	(e) A responsible party is required when:
17.5 	(1) the person is a minor according to section 524.5-102, subdivision 10;
17.6 	(2) the person is an incapacitated adult according to section 524.5-102, subdivision 
17.7 	6, resulting in a court-appointed guardian; or
17.8 	(3) the assessment according to subdivision 3a determines that the recipient is in 
17.9 	need of a responsible party to direct the recipient's care.
17.10 	(f) There may be two persons designated as the responsible party for reasons such 
17.11 	as divided households and court-ordered custodies. Each person named as responsible 
17.12 	party must meet the program criteria and responsibilities.
17.13 	(g) The recipient or the recipient's legal representative shall appoint a responsible 
17.14 	party if necessary to direct and supervise the care provided to the recipient. The 
17.15 	responsible party must be identified at the time of assessment and listed on the recipient's 
17.16 	service agreement and personal care assistance care plan.

17.17 	Sec. 11. Minnesota Statutes 2010, section 256B.0659, subdivision 11, is amended to 
17.18 	read:
17.19 		Subd. 11.Personal care assistant; requirements. (a) A personal care assistant 
17.20 	must meet the following requirements:
17.21 	(1) be at least 18 years of age with the exception of persons who are 16 or 17 years 
17.22 	of age with these additional requirements:
17.23 	(i) supervision by a qualified professional every 60 days; and
17.24 	(ii) employment by only one personal care assistance provider agency responsible 
17.25 	for compliance with current labor laws;
17.26 	(2) be employed by a personal care assistance provider agency;
17.27 	(3) enroll with the department as a personal care assistant after clearing a background 
17.28 	study. Except as provided in subdivision 11a, before a personal care assistant provides 
17.29 	services, the personal care assistance provider agency must initiate a background study on 
17.30 	the personal care assistant under chapter 245C, and the personal care assistance provider 
17.31 	agency must have received a notice from the commissioner that the personal care assistant 
17.32 	is:
17.33 	(i) not disqualified under section 245C.14; or
17.34 	(ii) is disqualified, but the personal care assistant has received a set aside of the 
17.35 	disqualification under section 245C.22;
18.1 	(4) be able to effectively communicate with the recipient and personal care 
18.2 	assistance provider agency;
18.3 	(5) be able to provide covered personal care assistance services according to the 
18.4 	recipient's personal care assistance care plan, respond appropriately to recipient needs, 
18.5 	and report changes in the recipient's condition to the supervising qualified professional 
18.6 	or physician;
18.7 	(6) not be a consumer of personal care assistance services;
18.8 	(7) maintain daily written records including, but not limited to, time sheets under 
18.9 	subdivision 12;
18.10 	(8) effective January 1, 2010, complete standardized training as determined 
18.11 	by the commissioner before completing enrollment. The training must be available 
18.12 	in languages other than English and to those who need accommodations due to 
18.13 	disabilities. Personal care assistant training must include successful completion of the 
18.14 	following training components: basic first aid, vulnerable adult, child maltreatment, 
18.15 	OSHA universal precautions, basic roles and responsibilities of personal care assistants 
18.16 	including information about assistance with lifting and transfers for recipients, emergency 
18.17 	preparedness, orientation to positive behavioral practices, fraud issues, and completion of 
18.18 	time sheets. Upon completion of the training components, the personal care assistant must 
18.19 	demonstrate the competency to provide assistance to recipients;
18.20 	(9) complete training and orientation on the needs of the recipient within the first
18.21 	seven days after the services begin; and
18.22 	(10) be limited to providing and being paid for up to 275 hours per month, except 
18.23 	that this limit shall be 275 hours per month for the period July 1, 2009, through June 30, 
18.24 	2011, of personal care assistance services regardless of the number of recipients being 
18.25 	served or the number of personal care assistance provider agencies enrolled with. The 
18.26 	number of hours worked per day shall not be disallowed by the department unless in 
18.27 	violation of the law.
18.28 	(b) A legal guardian may be a personal care assistant if the guardian is not being paid 
18.29 	for the guardian services and meets the criteria for personal care assistants in paragraph (a).
18.30 	(c) Effective January 1, 2010, Persons who do not qualify as a personal care assistant 
18.31 	include parents, and stepparents, and legal guardians of minors,; spouses,; paid legal 
18.32 	guardians, of adults; family foster care providers, except as otherwise allowed in section 
18.33 	256B.0625, subdivision 19a, or; and staff of a residential setting.

18.34 	Sec. 12. Minnesota Statutes 2010, section 256B.0659, subdivision 13, is amended to 
18.35 	read:
19.1 		Subd. 13.Qualified professional; qualifications. (a) The qualified professional 
19.2 	must work for a personal care assistance provider agency and meet the definition under 
19.3 	section 256B.0625, subdivision 19c. Before a qualified professional provides services, the 
19.4 	personal care assistance provider agency must initiate a background study on the qualified 
19.5 	professional under chapter 245C, and the personal care assistance provider agency must 
19.6 	have received a notice from the commissioner that the qualified professional:
19.7 	(1) is not disqualified under section 245C.14; or
19.8 	(2) is disqualified, but the qualified professional has received a set aside of the 
19.9 	disqualification under section 245C.22.
19.10 	(b) The qualified professional shall perform the duties of training, supervision, and 
19.11 	evaluation of the personal care assistance staff and evaluation of the effectiveness of 
19.12 	personal care assistance services. The qualified professional shall:
19.13 	(1) develop and monitor with the recipient a personal care assistance care plan based 
19.14 	on the service plan and individualized needs of the recipient;
19.15 	(2) develop and monitor with the recipient a monthly plan for the use of personal 
19.16 	care assistance services;
19.17 	(3) review documentation of personal care assistance services provided;
19.18 	(4) provide training and ensure competency for the personal care assistant in the 
19.19 	individual needs of the recipient; and
19.20 	(5) document all training, communication, evaluations, and needed actions to 
19.21 	improve performance of the personal care assistants.
19.22 	(c) Effective July 1, 2010 2011, the qualified professional shall complete the provider 
19.23 	training with basic information about the personal care assistance program approved by 
19.24 	the commissioner. Newly hired qualified professionals must complete the training within 
19.25 	six months of the date hired by a personal care assistance provider agency. Qualified 
19.26 	professionals who have completed the required training as a worker from a personal care 
19.27 	assistance provider agency do not need to repeat the required training if they are hired 
19.28 	by another agency, if they have completed the training within the last three years. The 
19.29 	required training shall must be available in languages other than English and to those who 
19.30 	need accommodations due to disabilities,with meaningful access according to title VI of 
19.31 	the Civil Rights Act and federal regulations adopted under that law or any guidance from 
19.32 	the United States Health and Human Services Department. The required training must 
19.33 	be available online, or by electronic remote connection, and. The required training must
19.34 	provide for competency testing to demonstrate an understanding of the content without 
19.35 	attending in-person training. A qualified professional is allowed to be employed and is not 
19.36 	subject to the training requirement until the training is offered online or through remote 
20.1 	electronic connection. A qualified professional employed by a personal care assistance 
20.2 	provider agency certified for participation in Medicare as a home health agency is exempt 
20.3 	from the training required in this subdivision. When available, the qualified professional 
20.4 	working for a Medicare-certified home health agency must successfully complete the 
20.5 	competency test. The commissioner shall ensure there is a mechanism in place to verify 
20.6 	the identity of persons completing the competency testing electronically.

20.7 	Sec. 13. Minnesota Statutes 2010, section 256B.0659, subdivision 14, is amended to 
20.8 	read:
20.9 		Subd. 14.Qualified professional; duties. (a) Effective January 1, 2010, all personal 
20.10 	care assistants must be supervised by a qualified professional.
20.11 	(b) Through direct training, observation, return demonstrations, and consultation 
20.12 	with the staff and the recipient, the qualified professional must ensure and document 
20.13 	that the personal care assistant is:
20.14 	(1) capable of providing the required personal care assistance services;
20.15 	(2) knowledgeable about the plan of personal care assistance services before services 
20.16 	are performed; and
20.17 	(3) able to identify conditions that should be immediately brought to the attention of 
20.18 	the qualified professional.
20.19 	(c) The qualified professional shall evaluate the personal care assistant within the 
20.20 	first 14 days of starting to provide regularly scheduled services for a recipient, or sooner as 
20.21 	determined by the qualified professional, except for the personal care assistance choice 
20.22 	option under subdivision 19, paragraph (a), clause (4). For the initial evaluation, the 
20.23 	qualified professional shall evaluate the personal care assistance services for a recipient 
20.24 	through direct observation of a personal care assistant's work. The qualified professional 
20.25 	may conduct additional training and evaluation visits, based upon the needs of the 
20.26 	recipient and the personal care assistant's ability to meet those needs. Subsequent visits to 
20.27 	evaluate the personal care assistance services provided to a recipient do not require direct 
20.28 	observation of each personal care assistant's work and shall occur:
20.29 	(1) at least every 90 days thereafter for the first year of a recipient's services;
20.30 	(2) every 120 days after the first year of a recipient's service or whenever needed for 
20.31 	response to a recipient's request for increased supervision of the personal care assistance 
20.32 	staff; and
20.33 	(3) after the first 180 days of a recipient's service, supervisory visits may alternate 
20.34 	between unscheduled phone or Internet technology and in-person visits, unless the 
20.35 	in-person visits are needed according to the care plan.
21.1 	(d) Communication with the recipient is a part of the evaluation process of the 
21.2 	personal care assistance staff.
21.3 	(e) At each supervisory visit, the qualified professional shall evaluate personal care 
21.4 	assistance services including the following information:
21.5 	(1) satisfaction level of the recipient with personal care assistance services;
21.6 	(2) review of the month-to-month plan for use of personal care assistance services;
21.7 	(3) review of documentation of personal care assistance services provided;
21.8 	(4) whether the personal care assistance services are meeting the goals of the service 
21.9 	as stated in the personal care assistance care plan and service plan;
21.10 	(5) a written record of the results of the evaluation and actions taken to correct any 
21.11 	deficiencies in the work of a personal care assistant; and
21.12 	(6) revision of the personal care assistance care plan as necessary in consultation 
21.13 	with the recipient or responsible party, to meet the needs of the recipient.
21.14 	(f) The qualified professional shall complete the required documentation in the 
21.15 	agency recipient and employee files and the recipient's home, including the following 
21.16 	documentation:
21.17 	(1) the personal care assistance care plan based on the service plan and individualized 
21.18 	needs of the recipient;
21.19 	(2) a month-to-month plan for use of personal care assistance services;
21.20 	(3) changes in need of the recipient requiring a change to the level of service and the 
21.21 	personal care assistance care plan;
21.22 	(4) evaluation results of supervision visits and identified issues with personal care 
21.23 	assistance staff with actions taken;
21.24 	(5) all communication with the recipient and personal care assistance staff; and
21.25 	(6) hands-on training or individualized training for the care of the recipient.
21.26 	(g) The documentation in paragraph (f) must be done on agency forms templates.
21.27 	(h) The services that are not eligible for payment as qualified professional services 
21.28 	include:
21.29 	(1) direct professional nursing tasks that could be assessed and authorized as skilled 
21.30 	nursing tasks;
21.31 	(2) supervision of personal care assistance completed by telephone;
21.32 	(3) (2) agency administrative activities;
21.33 	(4) (3) training other than the individualized training required to provide care for a 
21.34 	recipient; and
21.35 	(5) (4) any other activity that is not described in this section.

22.1 	Sec. 14. Minnesota Statutes 2010, section 256B.0659, subdivision 19, is amended to 
22.2 	read:
22.3 		Subd. 19.Personal care assistance choice option; qualifications; duties. (a) 
22.4 	Under personal care assistance choice, the recipient or responsible party shall:
22.5 	(1) recruit, hire, schedule, and terminate personal care assistants according to the 
22.6 	terms of the written agreement required under subdivision 20, paragraph (a);
22.7 	(2) develop a personal care assistance care plan based on the assessed needs 
22.8 	and addressing the health and safety of the recipient with the assistance of a qualified 
22.9 	professional as needed;
22.10 	(3) orient and train the personal care assistant with assistance as needed from the 
22.11 	qualified professional;
22.12 	(4) effective January 1, 2010, supervise and evaluate the personal care assistant with 
22.13 	the qualified professional, who is required to visit the recipient at least every 180 days;
22.14 	(5) monitor and verify in writing and report to the personal care assistance choice 
22.15 	agency the number of hours worked by the personal care assistant and the qualified 
22.16 	professional;
22.17 	(6) engage in an annual face-to-face reassessment to determine continuing eligibility 
22.18 	and service authorization; and
22.19 	(7) use the same personal care assistance choice provider agency if shared personal 
22.20 	assistance care is being used.
22.21 	(b) The personal care assistance choice provider agency shall:
22.22 	(1) meet all personal care assistance provider agency standards;
22.23 	(2) enter into a written agreement with the recipient, responsible party, and personal 
22.24 	care assistants;
22.25 	(3) not be related as a parent, child, sibling, or spouse to the recipient, qualified 
22.26 	professional, or the personal care assistant; and
22.27 	(4) ensure arm's-length transactions without undue influence or coercion with the 
22.28 	recipient and personal care assistant.
22.29 	(c) The duties of the personal care assistance choice provider agency are to:
22.30 	(1) be the employer of the personal care assistant and the qualified professional for 
22.31 	employment law and related regulations including, but not limited to, purchasing and 
22.32 	maintaining workers' compensation, unemployment insurance, surety and fidelity bonds, 
22.33 	and liability insurance, and submit any or all necessary documentation including, but not 
22.34 	limited to, workers' compensation and unemployment insurance;
22.35 	(2) bill the medical assistance program for personal care assistance services and 
22.36 	qualified professional services;
23.1 	(3) request and complete background studies that comply with the requirements for 
23.2 	personal care assistants and qualified professionals;
23.3 	(4) pay the personal care assistant and qualified professional based on actual hours 
23.4 	of services provided;
23.5 	(5) withhold and pay all applicable federal and state taxes;
23.6 	(6) verify and keep records of hours worked by the personal care assistant and 
23.7 	qualified professional;
23.8 	(7) make the arrangements and pay taxes and other benefits, if any, and comply with 
23.9 	any legal requirements for a Minnesota employer;
23.10 	(8) enroll in the medical assistance program as a personal care assistance choice 
23.11 	agency; and
23.12 	(9) enter into a written agreement as specified in subdivision 20 before services 
23.13 	are provided.

23.14 	Sec. 15. Minnesota Statutes 2010, section 256B.0659, subdivision 21, is amended to 
23.15 	read:
23.16 		Subd. 21.Requirements for initial enrollment of personal care assistance 
23.17 	provider agencies. (a) All personal care assistance provider agencies must provide, at the 
23.18 	time of enrollment as a personal care assistance provider agency in a format determined 
23.19 	by the commissioner, information and documentation that includes, but is not limited to, 
23.20 	the following:
23.21 	(1) the personal care assistance provider agency's current contact information 
23.22 	including address, telephone number, and e-mail address;
23.23 	(2) proof of surety bond coverage in the amount of $50,000 or ten percent of the 
23.24 	provider's payments from Medicaid in the previous year, whichever is less;
23.25 	(3) proof of fidelity bond coverage in the amount of $20,000;
23.26 	(4) proof of workers' compensation insurance coverage;
23.27 	(5) proof of liability insurance;
23.28 	(6) a description of the personal care assistance provider agency's organization 
23.29 	identifying the names of all owners, managing employees, staff, board of directors, and 
23.30 	the affiliations of the directors, owners, or staff to other service providers;
23.31 	(7) a copy of the personal care assistance provider agency's written policies and 
23.32 	procedures including: hiring of employees; training requirements; service delivery; 
23.33 	and employee and consumer safety including process for notification and resolution 
23.34 	of consumer grievances, identification and prevention of communicable diseases, and 
23.35 	employee misconduct;
24.1 	(8) copies of all other forms the personal care assistance provider agency uses in 
24.2 	the course of daily business including, but not limited to:
24.3 	(i) a copy of the personal care assistance provider agency's time sheet if the time 
24.4 	sheet varies from the standard time sheet for personal care assistance services approved 
24.5 	by the commissioner, and a letter requesting approval of the personal care assistance 
24.6 	provider agency's nonstandard time sheet;
24.7 	(ii) the personal care assistance provider agency's template for the personal care 
24.8 	assistance care plan; and
24.9 	(iii) the personal care assistance provider agency's template for the written 
24.10 	agreement in subdivision 20 for recipients using the personal care assistance choice 
24.11 	option, if applicable;
24.12 	(9) a list of all training and classes that the personal care assistance provider agency 
24.13 	requires of its staff providing personal care assistance services;
24.14 	(10) documentation that the personal care assistance provider agency and staff have 
24.15 	successfully completed all the training required by this section;
24.16 	(11) documentation of the agency's marketing practices;
24.17 	(12) disclosure of ownership, leasing, or management of all residential properties 
24.18 	that is used or could be used for providing home care services;
24.19 	(13) documentation that the agency will use the following percentages of revenue 
24.20 	generated from the medical assistance rate paid for personal care assistance services 
24.21 	for employee personal care assistant wages and benefits: 72.5 percent of revenue in the 
24.22 	personal care assistance choice option and 72.5 percent of revenue from other personal 
24.23 	care assistance providers; and
24.24 	(14) effective May 15, 2010, documentation that the agency does not burden 
24.25 	recipients' free exercise of their right to choose service providers by requiring personal 
24.26 	care assistants to sign an agreement not to work with any particular personal care 
24.27 	assistance recipient or for another personal care assistance provider agency after leaving 
24.28 	the agency and that the agency is not taking action on any such agreements or requirements 
24.29 	regardless of the date signed.
24.30 	(b) Personal care assistance provider agencies shall provide the information specified 
24.31 	in paragraph (a) to the commissioner at the time the personal care assistance provider 
24.32 	agency enrolls as a vendor or upon request from the commissioner. The commissioner 
24.33 	shall collect the information specified in paragraph (a) from all personal care assistance 
24.34 	providers beginning July 1, 2009.
24.35 	(c) All personal care assistance provider agencies shall require all employees in 
24.36 	management and supervisory positions and owners of the agency who are active in the 
25.1 	day-to-day management and operations of the agency to complete mandatory training 
25.2 	as determined by the commissioner before enrollment of the agency as a provider. 
25.3 	Employees in management and supervisory positions and owners who are active in 
25.4 	the day-to-day operations of an agency who have completed the required training as 
25.5 	an employee with a personal care assistance provider agency do not need to repeat 
25.6 	the required training if they are hired by another agency, if they have completed the 
25.7 	training within the past three years. By September 1, 2010, the required training must be 
25.8 	available in languages other than English and to those who need accommodations due 
25.9 	to disabilities,with meaningful access according to title VI of the Civil Rights Act and 
25.10 	federal regulations adopted under that law or any guidance from the United States Health 
25.11 	and Human Services Department. The required training must be available online, or by 
25.12 	electronic remote connection, and. The required training must provide for competency 
25.13 	testing. Personal care assistance provider agency billing staff shall complete training about 
25.14 	personal care assistance program financial management. This training is effective July 1, 
25.15 	2009. Any personal care assistance provider agency enrolled before that date shall, if it 
25.16 	has not already, complete the provider training within 18 months of July 1, 2009. Any new 
25.17 	owners or employees in management and supervisory positions involved in the day-to-day 
25.18 	operations are required to complete mandatory training as a requisite of working for the 
25.19 	agency. Personal care assistance provider agencies certified for participation in Medicare 
25.20 	as home health agencies are exempt from the training required in this subdivision. When 
25.21 	available, Medicare-certified home health agency owners, supervisors, or managers must 
25.22 	successfully complete the competency test.

25.23 	Sec. 16. Minnesota Statutes 2010, section 256B.0659, subdivision 30, is amended to 
25.24 	read:
25.25 		Subd. 30.Notice of service changes to recipients. The commissioner must provide:
25.26 	(1) by October 31, 2009, information to recipients likely to be affected that (i) 
25.27 	describes the changes to the personal care assistance program that may result in the 
25.28 	loss of access to personal care assistance services, and (ii) includes resources to obtain 
25.29 	further information;
25.30 	(2) effective through January 1, 2012, notice of changes in medical assistance 
25.31 	personal care assistance services to each affected recipient at least 30 days before the 
25.32 	effective date of the change.
25.33 	The notice shall include how to get further information on the changes, how to get help to 
25.34 	obtain other services, a list of community resources, and appeal rights. Notwithstanding 
26.1 	section 256.045, a recipient may request continued services pending appeal within the 
26.2 	time period allowed to request an appeal; and
26.3 	(3) a service agreement authorizing personal care assistance hours of service at 
26.4 	the previously authorized level, throughout the appeal process period, when a recipient 
26.5 	requests services pending an appeal.

26.6 	Sec. 17. Minnesota Statutes 2010, section 256B.0916, subdivision 7, is amended to 
26.7 	read:
26.8 		Subd. 7.Annual report by commissioner. (a) Beginning November 1, 2001, and 
26.9 	each November 1 thereafter, the commissioner shall issue an annual report on county and 
26.10 	state use of available resources for the home and community-based waiver for persons with 
26.11 	developmental disabilities. For each county or county partnership, the report shall include:
26.12 	(1) the amount of funds allocated but not used;
26.13 	(2) the county specific allowed reserve amount approved and used;
26.14 	(3) the number, ages, and living situations of individuals screened and waiting for 
26.15 	services;
26.16 	(4) the urgency of need for services to begin within one, two, or more than two 
26.17 	years for each individual;
26.18 	(5) the services needed;
26.19 	(6) the number of additional persons served by approval of increased capacity within 
26.20 	existing allocations;
26.21 	(7) results of action by the commissioner to streamline administrative requirements 
26.22 	and improve county resource management; and
26.23 	(8) additional action that would decrease the number of those eligible and waiting 
26.24 	for waivered services.
26.25 	The commissioner shall specify intended outcomes for the program and the degree to 
26.26 	which these specified outcomes are attained.
26.27 	(b) This subdivision expires January 1, 2012.

26.28 	Sec. 18. Minnesota Statutes 2010, section 256B.092, subdivision 11, is amended to 
26.29 	read:
26.30 		Subd. 11.Residential support services. (a) Upon federal approval, there is 
26.31 	established a new service called residential support that is available on the community 
26.32 	alternative care, community alternatives for disabled individuals, developmental 
26.33 	disabilities, and traumatic brain injury waivers. Existing waiver service descriptions 
26.34 	must be modified to the extent necessary to ensure there is no duplication between 
27.1 	other services. Residential support services must be provided by vendors licensed as a 
27.2 	community residential setting as defined in section 245A.11, subdivision 8.
27.3 	(b) Residential support services must meet the following criteria:
27.4 	(1) providers of residential support services must own or control the residential site;
27.5 	(2) the residential site must not be the primary residence of the license holder;
27.6 	(3) the residential site must have a designated program supervisor responsible for 
27.7 	program oversight, development, and implementation of policies and procedures;
27.8 	(4) the provider of residential support services must provide supervision, training, 
27.9 	and assistance as described in the person's community support plan; and
27.10 	(5) the provider of residential support services must meet the requirements of 
27.11 	licensure and additional requirements of the person's community support plan.
27.12 	(c) Providers of residential support services that meet the definition in paragraph 
27.13 	(a) must be registered using a process determined by the commissioner beginning July 
27.14 	1, 2009. Providers licensed to provide child foster care under Minnesota Rules, parts 
27.15 	2960.3000 to 2960.3340, or adult foster care licensed under Minnesota Rules, parts 
27.16 	9555.5105 to 9555.6265, and that meet the requirements in section 245A.03, subdivision 
27.17 	7, paragraph (e), are considered registered under this section.

27.18 	Sec. 19. Minnesota Statutes 2010, section 256B.096, subdivision 5, is amended to read:
27.19 		Subd. 5.Biennial report. (a) The commissioner shall provide a biennial report to 
27.20 	the chairs of the legislative committees with jurisdiction over health and human services 
27.21 	policy and funding beginning January 15, 2009, on the development and activities of the 
27.22 	quality management, assurance, and improvement system designed to meet the federal 
27.23 	requirements under the home and community-based services waiver programs for persons 
27.24 	with disabilities. By January 15, 2008, the commissioner shall provide a preliminary 
27.25 	report on priorities for meeting the federal requirements, progress on development and 
27.26 	field testing of the annual survey, appropriations necessary to implement an annual survey 
27.27 	of service recipients once field testing is completed, recommendations for improvements 
27.28 	in the incident reporting system, and a plan for incorporating quality assurance efforts 
27.29 	under section 256B.095 and other regional efforts into the statewide system.
27.30 	(b) This subdivision expires January 1, 2012.

27.31 	Sec. 20. Minnesota Statutes 2010, section 256B.49, subdivision 21, is amended to read:
27.32 		Subd. 21.Report. (a) The commissioner shall expand on the annual report required 
27.33 	under section 256B.0916, subdivision 7, to include information on the county of residence 
28.1 	and financial responsibility, age, and major diagnoses for persons eligible for the home 
28.2 	and community-based waivers authorized under subdivision 11 who are:
28.3 	(1) receiving those services;
28.4 	(2) screened and waiting for waiver services; and
28.5 	(3) residing in nursing facilities and are under age 65.
28.6 	(b) This subdivision expires January 1, 2012.

28.7 	Sec. 21. Minnesota Statutes 2010, section 256B.4912, is amended to read:
28.8 	256B.4912 HOME AND COMMUNITY-BASED WAIVERS; PROVIDERS 
28.9 	AND PAYMENT.
28.10 		Subdivision 1.Provider qualifications. For the home and community-based 
28.11 	waivers providing services to seniors and individuals with disabilities, the commissioner 
28.12 	shall establish:
28.13 	(1) agreements with enrolled waiver service providers to ensure providers meet 
28.14 	qualifications defined in the waiver plans Minnesota health care program requirements;
28.15 	(2) regular reviews of provider qualifications, and including requests of proof of 
28.16 	documentation; and
28.17 	(3) processes to gather the necessary information to determine provider 
28.18 	qualifications.
28.19 	By July 2010,Beginning July 2011, staff that provide direct contact, as defined 
28.20 	in section 245C.02, subdivision 11, that are employees of waiver service providers for 
28.21 	services specified in the federally approved waiver plans must meet the requirements 
28.22 	of chapter 245C prior to providing waiver services and as part of ongoing enrollment. 
28.23 	Beginning July 2012, service owners and managerial officials overseeing the management 
28.24 	or policies of services that provide direct contact as specified in the federally approved 
28.25 	waiver plans must meet the requirements of chapter 245C prior to reenrollment or, for new 
28.26 	providers, prior to initial enrollment. Upon federal approval, this requirement must also 
28.27 	apply to consumer-directed community supports.
28.28 		Subd. 1a.Definitions. For the purposes of this section, the following definitions 
28.29 	apply.
28.30 	(a) "Home and community-based service providers" means approved vendors who 
28.31 	provide community services and long-term supports under medical assistance programs 
28.32 	that include waiver programs as defined in sections 245B.092, 256B.0915, and 256B.49, 
28.33 	and state plan home care services as defined in section 256B.0651.
29.1 	(b) "Home and community-based service administrators" means counties and tribes 
29.2 	that, individually or collaboratively, administer home and community-based waiver 
29.3 	services delivery in a consistent manner under a state agency directive.
29.4 		Subd. 2.Rate-setting methodologies. The commissioner shall establish 
29.5 	statewide rate-setting methodologies that meet federal waiver requirements for home 
29.6 	and community-based waiver services for individuals with disabilities. The rate-setting 
29.7 	methodologies must abide by the principles of transparency and equitability across the 
29.8 	state. The methodologies must involve a uniform process of structuring rates for each 
29.9 	service and must promote quality and participant choice.
29.10 		Subd. 3.Payment rate criteria. (a) The payment structures and methodologies 
29.11 	under this section shall reflect the payment rate criteria in paragraphs (b) and (c).
29.12 	(b) Payment rates must be based on reasonable costs that are ordinary, necessary, 
29.13 	and related to delivery of authorized client services.
29.14 	(c) The commissioner must not reimburse:
29.15 	(1) unauthorized service delivery;
29.16 	(2) services provided under a receipt of a special grant;
29.17 	(3) services provided under contract to a local school district;
29.18 	(4) extended employment services under Minnesota Rules, parts 3300.2005 to 
29.19 	3300.3100, or vocational rehabilitation services provided under the federal Rehabilitation 
29.20 	Act, as amended, Title I, section 110, or Title VI-C, and not through use of medical 
29.21 	assistance or county social service funds; or
29.22 	(5) services provided to a client by a licensed medical, therapeutic, or rehabilitation 
29.23 	practitioner or any other vendor of medical care which are billed separately on a 
29.24 	fee-for-service basis.
29.25 		Subd. 4.Rate exception process. The payment structures and methodologies 
29.26 	under this section must include procedures to seek authorization from the commissioner 
29.27 	for exceptions for very dependent persons with special needs to the rates in excess of the 
29.28 	amounts as determined utilizing individualized payment structures and methodologies 
29.29 	established by the commissioner under subdivision 2.
29.30 		Subd. 5.Shared service limits. The commissioner retains authority to limit the 
29.31 	number of people that share waiver and day services. Individualized payment structures 
29.32 	and methodologies established by the commissioner under subdivision 2 must reflect the 
29.33 	option to share services within the limits established by the commissioner.
29.34 		Subd. 6.Home and community-based service administrator roles and 
29.35 	responsibilities. The commissioner shall define roles and responsibilities of home and 
29.36 	community-based service administrators to include:
30.1 	(1) certification functions to include monitoring and review of waiver home and 
30.2 	community-based service providers in compliance with federal requirements; and
30.3 	(2) assessment of home and community-based waiver service capacity and 
30.4 	development to address identified service gaps.
30.5 		Subd. 7.Recommendations to the legislature. The commissioner shall consult 
30.6 	with existing advisory groups on rate-setting methodologies, provider qualifications, and 
30.7 	home and community-based service administrator roles and responsibilities to develop 
30.8 	and test processes, roles, and rate-setting methodologies described in this section. The 
30.9 	commissioner shall recommend by January 15, 2012, to the chairs of the legislative 
30.10 	committees with jurisdiction over health and human services policy and funding, 
30.11 	statutory changes that define the processes, roles, and rate-setting methodologies for 
30.12 	full implementation by January 1, 2013.

30.13 	Sec. 22. STREAMLINE CONSUMER-DIRECTED SERVICES.
 30.14 	The commissioner of human services shall prepare and provide recommendations 
30.15 	for streamlining administrative oversight, financial management, and payment protocols 
30.16 	for consumer-directed services administered through the commissioner, including 
30.17 	consumer-directed community supports, under Minnesota Statutes, sections 256B.49, 
30.18 	subdivision 16, and 256B.0916, subdivision 6a; consumer support grants, under Minnesota 
30.19 	Statutes, section 256.476; family support grants, under Minnesota Statutes, section 252.32; 
30.20 	and any other consumer directed service options identified by the commissioner. The 
30.21 	commissioner shall report to the legislature by January 15, 2012, with recommendations 
30.22 	prepared under this section.

30.23 	ARTICLE 3
30.24 	COMPREHENSIVE ASSESSMENT AND CASE MANAGEMENT REFORM

30.25 	Section 1. Minnesota Statutes 2010, section 256B.0659, subdivision 1, is amended to 
30.26 	read:
30.27 		Subdivision 1.Definitions. (a) For the purposes of this section, the terms defined in 
30.28 	paragraphs (b) to (r) have the meanings given unless otherwise provided in text.
30.29 	(b) "Activities of daily living" means grooming, dressing, bathing, transferring, 
30.30 	mobility, positioning, eating, and toileting.
30.31 	(c) "Level I behavior," effective January 1, 2010, means a category to determine 
30.32 	the home care rating and is based on the criteria found in this section. "Level I behavior" 
30.33 	means and is defined as physical aggression towards self, others, or destruction of property 
30.34 	that requires the immediate response of another person and either:
31.1 	(1) has occurred within 30 days prior to the assessment; or
31.2 	(2) there is objective evidence that, without intervention, it would have occurred 
31.3 	30 days prior to the assessment. Objective evidence includes logs of intervention kept 
31.4 	by the family or provider.
31.5 	(d) "Complex health-related needs," effective January 1, 2010, means a category to 
31.6 	determine the home care rating and is based on the criteria found in this section.
31.7 	(e) "Critical activities of daily living," effective January 1, 2010, means transferring, 
31.8 	mobility, eating, and toileting.
31.9 	(f) "Dependency in activities of daily living" means a person requires assistance to 
31.10 	begin and complete one or more of the activities of daily living.
31.11 	(g) "Extended personal care assistance service" means personal care assistance 
31.12 	services included in a service plan under one of the home and community-based services 
31.13 	waivers authorized under sections 256B.0915, 256B.092, subdivision 5, and 256B.49, 
31.14 	which exceed the amount, duration, and frequency of the state plan personal care 
31.15 	assistance services for participants who:
31.16 	(1) need assistance provided periodically during a week, but less than daily will not 
31.17 	be able to remain in their homes without the assistance, and other replacement services 
31.18 	are more expensive or are not available when personal care assistance services are to be 
31.19 	terminated; or
31.20 	(2) need additional personal care assistance services beyond the amount authorized 
31.21 	by the state plan personal care assistance assessment in order to ensure that their safety, 
31.22 	health, and welfare are provided for in their homes.
31.23 	(h) "Health-related procedures and tasks" means procedures and tasks that can 
31.24 	be delegated or assigned by a licensed health care professional under state law to be 
31.25 	performed by a personal care assistant.
31.26 	(i) "Instrumental activities of daily living" means activities to include meal planning 
31.27 	and preparation; basic assistance with paying bills; shopping for food, clothing, and other 
31.28 	essential items; performing household tasks integral to the personal care assistance 
31.29 	services; communication by telephone and other media; and traveling, including to 
31.30 	medical appointments and to participate in the community.
31.31 	(j) "Managing employee" has the same definition as Code of Federal Regulations, 
31.32 	title 42, section 455.
31.33 	(k) "Qualified professional" means a professional providing supervision of personal 
31.34 	care assistance services and staff as defined in section 256B.0625, subdivision 19c.
31.35 	(l) "Personal care assistance provider agency" means a medical assistance enrolled 
31.36 	provider that provides or assists with providing personal care assistance services and 
32.1 	includes a personal care assistance provider organization, personal care assistance choice 
32.2 	agency, class A licensed nursing agency, and Medicare-certified home health agency.
32.3 	(m) "Personal care assistant" or "PCA" means an individual employed by a personal 
32.4 	care assistance agency who provides personal care assistance services.
32.5 	(n) "Personal care assistance care plan" means a written description of personal 
32.6 	care assistance services developed by the personal care assistance provider according 
32.7 	to the service plan.
32.8 	(o) "Responsible party" means an individual who is capable of providing the support 
32.9 	necessary to assist the recipient to live in the community.
32.10 	(p) "Self-administered medication" means medication taken orally, by injection, 
32.11 	nebulizer, or insertion, or applied topically without the need for assistance.
32.12 	(q) "Service plan" means a written summary of the assessment and description of the 
32.13 	services needed by the recipient.
32.14 	(r) "Wages and benefits" means wages and salaries, the employer's share of FICA 
32.15 	taxes, Medicare taxes, state and federal unemployment taxes, workers' compensation, 
32.16 	mileage reimbursement, health and dental insurance, life insurance, disability insurance, 
32.17 	long-term care insurance, uniform allowance, and contributions to employee retirement 
32.18 	accounts.

32.19 	Sec. 2. Minnesota Statutes 2010, section 256B.0659, subdivision 2, is amended to read:
32.20 		Subd. 2.Personal care assistance services; covered services. (a) The personal 
32.21 	care assistance services eligible for payment include services and supports furnished 
32.22 	to an individual, as needed, to assist in:
32.23 	(1) activities of daily living;
32.24 	(2) health-related procedures and tasks;
32.25 	(3) observation and redirection of behaviors; and
32.26 	(4) instrumental activities of daily living.
32.27 	(b) Activities of daily living include the following covered services:
32.28 	(1) dressing, including assistance with choosing, application, and changing of 
32.29 	clothing and application of special appliances, wraps, or clothing;
32.30 	(2) grooming, including assistance with basic hair care, oral care, shaving, applying 
32.31 	cosmetics and deodorant, and care of eyeglasses and hearing aids. Nail care is included, 
32.32 	except for recipients who are diabetic or have poor circulation;
32.33 	(3) bathing, including assistance with basic personal hygiene, and inspection of the 
32.34 	skin and skin care;
33.1 	(4) eating, including and assistance with hand washing and application of orthotics 
33.2 	required for eating, transfers, and feeding;
33.3 	(5) transfers, including assistance with transferring the recipient from one seating or 
33.4 	reclining area to another;
33.5 	(6) mobility, including assistance with ambulation, including use of a wheelchair. 
33.6 	Mobility does not include providing transportation for a recipient;
33.7 	(7) positioning, including assistance with positioning or turning a recipient for 
33.8 	necessary care and comfort; and
33.9 	(8) toileting, including assistance with helping recipient with bowel or bladder 
33.10 	elimination and care including transfers, mobility, positioning, feminine hygiene, use of 
33.11 	toileting equipment or supplies, cleansing the perineal area, inspection of the skin, and 
33.12 	adjusting clothing.
33.13 	(c) Health-related procedures and tasks include the following covered services:
33.14 	(1) range of motion and passive exercise to maintain a recipient's strength and 
33.15 	muscle functioning;
33.16 	(2) assistance with self-administered medication as defined by this section, including. 
33.17 	The personal care assistant must not determine the medication dose or time for the 
33.18 	medication. Assistance with medications includes reminders to take medication, bringing 
33.19 	medication to the recipient, and assistance with opening medication under the direction of 
33.20 	the recipient or responsible party, including medications given through a nebulizer;
33.21 	(3) interventions for seizure disorders, including monitoring and observation; and
33.22 	(4) other activities considered within the scope of the personal care service and 
33.23 	meeting the definition of health-related procedures and tasks under this section.
33.24 	(d) A personal care assistant may provide health-related procedures and tasks 
33.25 	associated with the complex health-related needs of a recipient if the procedures and 
33.26 	tasks meet the definition of health-related procedures and tasks under this section and the 
33.27 	personal care assistant is trained by a qualified professional and demonstrates competency 
33.28 	to safely complete the procedures and tasks. Delegation of health-related procedures and 
33.29 	tasks and all training must be documented in the personal care assistance care plan and the 
33.30 	recipient's and personal care assistant's files.
33.31 	(e) Effective January 1, 2010, for a personal care assistant to provide the 
33.32 	health-related procedures and tasks of tracheostomy suctioning and services to recipients 
33.33 	on ventilator support there must be:
33.34 	(1) delegation and training by a registered nurse, certified or licensed respiratory 
33.35 	therapist, or a physician;
33.36 	(2) utilization of clean rather than sterile procedure;
34.1 	(3) specialized training about the health-related procedures and tasks and equipment, 
34.2 	including ventilator operation and maintenance;
34.3 	(4) individualized training regarding the needs of the recipient; and
34.4 	(5) supervision by a qualified professional who is a registered nurse.
34.5 	(f) Effective January 1, 2010, a personal care assistant may observe and redirect the 
34.6 	recipient for episodes where there is a need for redirection due to behaviors. Training of 
34.7 	the personal care assistant must occur based on the needs of the recipient, the personal 
34.8 	care assistance care plan, and any other support services provided.
34.9 	(g) Instrumental activities of daily living under subdivision 1, paragraph (i).

34.10 	Sec. 3. Minnesota Statutes 2010, section 256B.0659, subdivision 3a, is amended to 
34.11 	read:
34.12 		Subd. 3a.Assessment; defined. This subdivision is effective until notification 
34.13 	is given by the commissioner as described under section 256B.0911, subdivision 3a. 
34.14 	"Assessment" means a review and evaluation of a recipient's need for home personal care 
34.15 	assistance services conducted in person. Assessments for personal care assistance services 
34.16 	shall be conducted by the county public health nurse or a certified public health nurse under 
34.17 	contract with the county except when a long-term care consultation is being conducted 
34.18 	for the purposes of determining a person's eligibility for home and community-based 
34.19 	waiver services according to section 256B.0911 and the support plan may include personal 
34.20 	care assistance services. An in-person assessment must include: documentation of 
34.21 	health status, determination of need, evaluation of service effectiveness, identification of 
34.22 	appropriate services, service plan development or modification, coordination of services, 
34.23 	referrals and follow-up to appropriate payers and community resources, completion of 
34.24 	required reports, recommendation of service authorization, and consumer education. 
34.25 	Once the need for personal care assistance services is determined under this section or 
34.26 	sections 256B.0651, 256B.0653, 256B.0654, and 256B.0656, the county public health 
34.27 	nurse or certified public health nurse under contract with the county is responsible for 
34.28 	communicating this recommendation to the commissioner and the recipient. An in-person 
34.29 	assessment must occur at least annually or when there is a significant change in the 
34.30 	recipient's condition or when there is a change in the need for personal care assistance 
34.31 	services. A service update may substitute for the annual face-to-face assessment when 
34.32 	there is not a significant change in recipient condition or a change in the need for 
34.33 	personal care assistance service. A service update may be completed by telephone, used 
34.34 	when there is no need for an increase in personal care assistance services, and used 
34.35 	for two consecutive assessments if followed by a face-to-face assessment. A service 
35.1 	update must be completed on a form approved by the commissioner. A service update 
35.2 	or review for temporary increase includes a review of initial baseline data, evaluation of 
35.3 	service effectiveness, redetermination of service need, modification of service plan and 
35.4 	appropriate referrals, update of initial forms, obtaining service authorization, and on going 
35.5 	consumer education. Assessments or reassessments must be completed on forms provided 
35.6 	by the commissioner within 30 20 days of a request for home care services by a recipient 
35.7 	or responsible party or personal care provider agency.

35.8 	Sec. 4. Minnesota Statutes 2010, section 256B.0659, subdivision 4, is amended to read:
35.9 		Subd. 4.Assessment for personal care assistance services; limitations. (a) An 
35.10 	assessment as defined in subdivision 3a must be completed for personal care assistance 
35.11 	services.
35.12 	(b) The following limitations apply to the assessment:
35.13 	(1) a person must be assessed as dependent in an activity of daily living based on the 
35.14 	person's daily need or need on the days during the week the activity is completed for:
35.15 	(i) cuing and constant supervision to complete the task; or
35.16 	(ii) hands-on assistance to complete the task; and
35.17 	(2) a child may not be found to be dependent in an activity of daily living if because 
35.18 	of the child's age an adult would either perform the activity for the child or assist the child 
35.19 	with the activity. Assistance needed is the assistance appropriate for a typical child of 
35.20 	the same age.
35.21 	(c) Assessment for complex health-related needs must meet the criteria in this 
35.22 	paragraph. During the assessment process, a recipient qualifies as having complex 
35.23 	health-related needs if the recipient has one or more of the interventions that are ordered by 
35.24 	a physician, specified in a personal care assistance care plan, and found in the following:
35.25 	(1) tube feedings requiring:
35.26 	(i) a gastrojejunostomy tube; or
35.27 	(ii) continuous tube feeding lasting longer than 12 hours per day;
35.28 	(2) wounds described as:
35.29 	(i) stage III or stage IV;
35.30 	(ii) multiple wounds;
35.31 	(iii) requiring sterile or clean dressing changes or a wound vac; or
35.32 	(iv) open lesions such as burns, fistulas, tube sites, or ostomy sites that require 
35.33 	specialized care;
35.34 	(3) parenteral therapy described as:
36.1 	(i) IV therapy more than two times per week lasting longer than four hours for 
36.2 	each treatment; or
36.3 	(ii) total parenteral nutrition (TPN) daily;
36.4 	(4) respiratory interventions, including:
36.5 	(i) oxygen required more than eight hours per day;
36.6 	(ii) respiratory vest more than one time per day;
36.7 	(iii) bronchial drainage treatments more than two times per day;
36.8 	(iv) sterile or clean suctioning more than six times per day;
36.9 	(v) dependence on another to apply respiratory ventilation augmentation devices 
36.10 	such as BiPAP and CPAP; and
36.11 	(vi) ventilator dependence under section 256B.0652;
36.12 	(5) insertion and maintenance of catheter, including:
36.13 	(i) sterile catheter changes more than one time per month;
36.14 	(ii) clean intermittent catheterization, and including self-catheterization more than 
36.15 	six times per day; or
36.16 	(iii) bladder irrigations;
36.17 	(6) bowel program more than two times per week requiring more than 30 minutes to 
36.18 	perform each time;
36.19 	(7) neurological intervention, including:
36.20 	(i) seizures more than two times per week and requiring significant physical 
36.21 	assistance to maintain safety; or
36.22 	(ii) swallowing disorders diagnosed by a physician and requiring specialized 
36.23 	assistance from another on a daily basis; and
36.24 	(8) other congenital or acquired diseases creating a need for significantly increased 
36.25 	direct hands-on assistance and interventions in six to eight activities of daily living.
36.26 	(d) An assessment of behaviors must meet the criteria in this paragraph. A recipient 
36.27 	qualifies as having a need for assistance due to behaviors if the recipient's behavior requires 
36.28 	assistance at least four times per week and shows one or more of the following behaviors:
36.29 	(1) physical aggression towards self or others, or destruction of property that requires 
36.30 	the immediate response of another person;
36.31 	(2) increased vulnerability due to cognitive deficits or socially inappropriate 
36.32 	behavior; or
36.33 	(3) increased need for assistance for recipients who are verbally aggressive and or 
36.34 	 resistive to care such that the time needed to perform activities of daily living is increased.

36.35 	Sec. 5. Minnesota Statutes 2010, section 256B.0911, subdivision 1, is amended to read:
37.1 		Subdivision 1.Purpose and goal. (a) The purpose of long-term care consultation 
37.2 	services is to assist persons with long-term or chronic care needs in making long-term care 
37.3 	decisions and selecting support and service options that meet their needs and reflect their 
37.4 	preferences. The availability of, and access to, information and other types of assistance, 
37.5 	including assessment and support planning, is also intended to prevent or delay certified 
37.6 	nursing facility institutional placements and to provide access to transition assistance 
37.7 	after admission. Further, the goal of these services is to contain costs associated with 
37.8 	unnecessary certified nursing facility institutional admissions. Long-term consultation 
37.9 	services must be available to any person regardless of public program eligibility. The 
37.10 	commissioner of human services shall seek to maximize use of available federal and state 
37.11 	funds and establish the broadest program possible within the funding available.
37.12 	(b) These services must be coordinated with long-term care options counseling 
37.13 	provided under section 256.975, subdivision 7, and section 256.01, subdivision 24, for 
37.14 	telephone assistance and follow up and to offer a variety of cost-effective alternatives 
37.15 	to persons with disabilities and elderly persons. The county or tribal lead agency or 
37.16 	managed care plan providing long-term care consultation services shall encourage the use 
37.17 	of volunteers from families, religious organizations, social clubs, and similar civic and 
37.18 	service organizations to provide community-based services.

37.19 	Sec. 6. Minnesota Statutes 2010, section 256B.0911, subdivision 1a, is amended to 
37.20 	read:
37.21 		Subd. 1a.Definitions. For purposes of this section, the following definitions apply:
37.22 	(a) "Long-term care consultation services" means:
37.23 	(1) intake for and access to assistance in identifying services needed to maintain an 
37.24 	individual in the most inclusive environment;
37.25 	(2) providing recommendations on for and referrals to cost-effective community 
37.26 	services that are available to the individual;
37.27 	(3) development of an individual's person-centered community support plan;
37.28 	(4) providing information regarding eligibility for Minnesota health care programs;
37.29 	(5) face-to-face long-term care consultation assessments, which may be completed 
37.30 	in a hospital, nursing facility, intermediate care facility for persons with developmental 
37.31 	disabilities (ICF/DDs), regional treatment centers, or the person's current or planned 
37.32 	residence;
37.33 	(6) federally mandated preadmission screening to determine the need for an 
37.34 	institutional level of care activities described under subdivision subdivisions 4a and 4b;
38.1 	(7) determination of home and community-based waiver and other service eligibility
38.2 	as required under sections 256B.0913, 256B.0915, and 256B.49, including level of care 
38.3 	determination for individuals who need an institutional level of care as defined under 
38.4 	section 144.0724, subdivision 11, or 256B.092, service eligibility including state plan 
38.5 	home care services identified in sections 256B.0625, subdivisions 6, 7, and 19, paragraphs 
38.6 	(a) and (c), and 256B.0657, based on assessment and community support plan development 
38.7 	with, appropriate referrals to obtain necessary diagnostic information, and including the 
38.8 	option an eligibility determination for consumer-directed community supports;
38.9 	(8) providing recommendations for nursing facility institutional placement when 
38.10 	there are no cost-effective community services available; and
38.11 	(9) providing access to assistance to transition people back to community settings 
38.12 	after facility institutional admission.
38.13 	(b) Upon statewide implementation of lead agency requirements in subdivisions 2b, 
38.14 	2c, and 3a, "long-term care consultation services" also means:
38.15 	(1) service eligibility determination for state plan home care services identified in:
38.16 	(i) section 256B.0625, subdivisions 7, 19a, and 19c;
38.17 	(ii) section 256B.0657; or
38.18 	(iii) consumer support grants under section 256.476;
38.19 	(2) notwithstanding provisions in Minnesota Rules, parts 9525.0004 to 9525.0024, 
38.20 	determination of eligibility for case management services available under sections 
38.21 	256B.0621, subdivision 2, paragraph (4), and 256B.0924 and Minnesota Rules, part 
38.22 	9525.0016, and also includes obtaining necessary diagnostic information;
38.23 	(3) determination of institutional level of care, waiver, and other service eligibility 
38.24 	as required under section 256B.092, determination of eligibility for family support grants 
38.25 	under section 252.32, semi-independent living services under section 252.275 and day 
38.26 	training and habilitation services under section 256B.092;
38.27 	(8) (4) providing recommendations for nursing facilityinstitutional placement when 
38.28 	there are no cost-effective community services available; and
38.29 	(9) (5) providing access to assistance to transition people back to community settings 
38.30 	after facility institutional admission.
38.31 	(b) (c) "Long-term care options counseling" means the services provided by the 
38.32 	linkage lines as mandated by sections 256.01 and 256.975, subdivision 7, and also 
38.33 	includes telephone assistance and follow up once a long-term care consultation assessment 
38.34 	has been completed.
38.35 	(c) (d) "Minnesota health care programs" means the medical assistance program 
38.36 	under chapter 256B and the alternative care program under section 256B.0913.
39.1 	(d) (e) "Lead agencies" means counties administering or a collaboration of counties,
39.2 	tribes, and health plans administering under contract with the commissioner to administer
39.3 	long-term care consultation assessment and support planning services.

39.4 	Sec. 7. Minnesota Statutes 2010, section 256B.0911, subdivision 2b, is amended to 
39.5 	read:
39.6 		Subd. 2b.Certified assessors. (a) Beginning January 1, 2011, This section is 
39.7 	effective upon completion of the training and certification process identified in subdivision 
39.8 	2c. Each lead agency shall use certified assessors who have completed training and the 
39.9 	certification processes determined by the commissioner in subdivision 2c. Certified 
39.10 	assessors shall demonstrate best practices in assessment and support planning including 
39.11 	person-centered planning principals and have a common set of skills that must ensure 
39.12 	consistency and equitable access to services statewide. Assessors must be part of a 
39.13 	multidisciplinary team of professionals that includes public health nurses, social workers, 
39.14 	and other professionals as defined in paragraph (b). For persons with complex health care 
39.15 	needs, a public health nurse or registered nurse from a multidisciplinary team must be 
39.16 	consulted. A lead agency may choose, according to departmental policies, to contract 
39.17 	with a qualified, certified assessor to conduct assessments and reassessments on behalf 
39.18 	of the lead agency.
39.19 	(b) Certified assessors are persons with a minimum of a bachelor's degree in social 
39.20 	work, nursing with a public health nursing certificate, or other closely related field with at 
39.21 	least one year of home and community-based experience or a two-year registered nursing 
39.22 	degree with at least three years of home and community-based experience that have 
39.23 	received training and certification specific to assessment and consultation for long-term 
39.24 	care services in the state.

39.25 	Sec. 8. Minnesota Statutes 2010, section 256B.0911, subdivision 2c, is amended to 
39.26 	read:
39.27 		Subd. 2c.Assessor training and certification. The commissioner shall develop 
39.28 	and implement a curriculum and an assessor certification process to begin no later than 
39.29 	January 1, 2010. All existing lead agency staff designated to provide the services defined 
39.30 	in subdivision 1a must be certified within timelines specified by the commissioner, but 
39.31 	no sooner than six months after statewide availability of the training and certification 
39.32 	process. The commissioner must establish the timelines for training and certification in 
39.33 	such a manner that allows lead agencies to most efficiently adopt the automated process 
39.34 	established in subdivision 5by December 30, 2010. Each lead agency is required to ensure 
40.1 	that they have sufficient numbers of certified assessors to provide long-term consultation 
40.2 	assessment and support planning within the timelines and parameters of the service by 
40.3 	January 1, 2011. Certified assessors are required to be recertified every three years.

40.4 	Sec. 9. Minnesota Statutes 2010, section 256B.0911, subdivision 3, is amended to read:
40.5 		Subd. 3.Long-term care consultation team. (a) Until January 1, 2011, A long-term 
40.6 	care consultation team shall be established by the county board of commissioners. Each 
40.7 	local consultation team shall consist of at least one social worker and at least one public 
40.8 	health nurse from their respective county agencies. The board may designate public 
40.9 	health or social services as the lead agency for long-term care consultation services. If a 
40.10 	county does not have a public health nurse available, it may request approval from the 
40.11 	commissioner to assign a county registered nurse with at least one year experience in 
40.12 	home care to participate on the team. Two or more counties may collaborate to establish 
40.13 	a joint local consultation team or teams.
40.14 	(b) Certified assessors must be part of a multidisciplinary team of professionals 
40.15 	that includes public health nurses, social workers, and other professionals as defined in 
40.16 	subdivision 2b, paragraph (b). The team is responsible for providing long-term care 
40.17 	consultation services to all persons located in the county who request the services, 
40.18 	regardless of eligibility for Minnesota health care programs.
40.19 	(c) The commissioner shall allow arrangements and make recommendations that 
40.20 	encourage counties and tribes to collaborate to establish joint local long-term care 
40.21 	consultation teams to ensure that long-term care consultations are done within the 
40.22 	timelines and parameters of the service. This includes integrated service models as 
40.23 	required in subdivision 1, paragraph (b).
40.24 	(d) Tribes and health plans under contract with the commissioner must provide 
40.25 	long-term care consultation services as specified in the contract.

40.26 	Sec. 10. Minnesota Statutes 2010, section 256B.0911, subdivision 3a, is amended to 
40.27 	read:
40.28 		Subd. 3a.Assessment and support planning. (a) Persons requesting assessment, 
40.29 	services planning, or other assistance intended to support community-based living, 
40.30 	including persons who need assessment in order to determine waiver or alternative care 
40.31 	program eligibility, must be visited by a long-term care consultation team within 15 20
40.32 	calendar days after the date on which an assessment was requested or recommended. 
40.33 	After January 1, 2011 Upon statewide implementation of subdivisions 2b, 2c, and 5, 
40.34 	these requirements this requirement also apply applies to assessment of persons requesting
41.1 	personal care assistance services, and private duty nursing, and home health agency 
41.2 	services, on timelines established in subdivision 5. The commissioner shall provide at 
41.3 	least a 90-day notice to lead agencies prior to the effective date of this requirement.
41.4 	Face-to-face assessments must be conducted according to paragraphs (b) to (i).
41.5 	(b) The county may utilize a team of either the social worker or public health nurse, 
41.6 	or both. After January 1, 2011 Upon implementation of subdivisions 2b, 2c, and 5, lead 
41.7 	agencies shall use certified assessors to conduct the assessment in a face-to-face interview
41.8 	assessments. The consultation team members must confer regarding the most appropriate 
41.9 	care for each individual screened or assessed. For persons with complex health care needs, 
41.10 	a public health or registered nurse from the team must be consulted.
41.11 	(c) The assessment must be comprehensive and include a person-centered assessment 
41.12 	of the health, psychological, functional, environmental, and social needs of referred 
41.13 	individuals and provide information necessary to develop a community support plan that 
41.14 	meets the consumers needs, using an assessment form provided by the commissioner.
41.15 	(d) The assessment must be conducted in a face-to-face interview with the person 
41.16 	being assessed and the person's legal representative, as required by legally executed 
41.17 	documents, and other individuals as requested by the person, who can provide information 
41.18 	on the needs, strengths, and preferences of the person necessary to develop a community 
41.19 	support plan that ensures the person's health and safety, but who is not a provider of 
41.20 	service or has any financial interest in the provision of services.
41.21 	(e) The person, or the person's legal representative, must be provided with written 
41.22 	recommendations for community-based services, including consumer-directed options, 
41.23 	or institutional care that include documentation that the most cost-effective alternatives 
41.24 	available were offered to the individual. For purposes of this requirement, "cost-effective 
41.25 	alternatives" means community services and living arrangements that cost the same as or 
41.26 	less than institutional care.
41.27 	(f) (e) If the person chooses to use community-based services, the person or the 
41.28 	person's legal representative must be provided with a written community support plan
41.29 	within 40 calendar days of the assessment visit, regardless of whether the individual 
41.30 	is eligible for Minnesota health care programs. The written community support plan 
41.31 	must include:
41.32 	(1) a summary of assessed needs as defined in paragraphs (c) and (d);
41.33 	(2) the individual's options and choices to meet identified needs, including all 
41.34 	available options for case management services and providers;
41.35 	(3) identification of health and safety risks and how those risks will be addressed, 
41.36 	including personal risk management strategies;
42.1 	(4) referral information; and
42.2 	(5) informal caregiver supports, if applicable.
42.3 	For persons determined eligible for services defined under subdivision 1a, paragraph 
42.4 	(a), clause (7), and paragraph (b), the community support plan must also include the 
42.5 	estimated annual and monthly budget amount for those services. In addition, for persons 
42.6 	determined eligible for state plan home care under subdivision 1a, paragraph (b), clause 
42.7 	(1), the person or person's representative must also receive a copy of the home care service 
42.8 	plan developed by the certified assessor.
42.9 	(f) A person may request assistance in identifying community supports without 
42.10 	participating in a complete assessment. Upon a request for assistance identifying 
42.11 	community support, the person must be transferred or referred to the long-term care 
42.12 	options counseling services available under sections 256.975, subdivision 7, and 256.01, 
42.13 	subdivision 24, for telephone assistance and follow up.
42.14 	(g) The person has the right to make the final decision between institutional 
42.15 	placement and community placement after the recommendations have been provided, 
42.16 	except as provided in subdivision 4a, paragraph (c).
42.17 	(h) The team lead agency must give the person receiving assessment or support 
42.18 	planning, or the person's legal representative, materials, and forms supplied by the 
42.19 	commissioner containing the following information:
42.20 	(1) written recommendations for community-based services and consumer-directed 
42.21 	options;
42.22 	(2) documentation that the most cost-effective alternatives available were offered to 
42.23 	the individual. For purposes of this clause, "cost-effective" means community services 
42.24 	and living arrangements that cost the same as or less than institutional care;
42.25 	(3) the need for and purpose of preadmission screening if the person selects nursing 
42.26 	facility placement;
42.27 	(2) (4) the role of the long-term care consultation assessment and support planning 
42.28 	in waiver and alternative care program eligibility determination for waiver and alternative 
42.29 	care programs, and state plan home care, case management, and other services as defined 
42.30 	in subdivision 1a, paragraph (a), clause (7), and paragraph (b);
42.31 	(3) (5) information about Minnesota health care programs;
42.32 	(4) (6) the person's freedom to accept or reject the recommendations of the team;
42.33 	(5) (7) the person's right to confidentiality under the Minnesota Government Data 
42.34 	Practices Act, chapter 13;
42.35 	(6) (8) the long-term care consultant's certified assessor's decision regarding the 
42.36 	person's need for institutional level of care as determined under criteria established 
43.1 	in section 144.0724, subdivision 11, or 256B.092 	 and the certified assessor's decision 
43.2 	regarding eligibility for all services and programs as defined in subdivision 1a, paragraph 
43.3 	(a), clause (7) , and paragraph (b)
; and
43.4 	(7) (9) the person's right to appeal any certified assessor's decision regarding 
43.5 	eligibility for all services and programs as defined in subdivision 1a, paragraph (a), clause 
43.6 	(7), and paragraph (b), and incorporating the decision regarding the need for nursing 
43.7 	facility institutional level of care or the county's lead agency's final decisions regarding 
43.8 	public programs eligibility according to section 256.045, subdivision 3.
43.9 	(i) Face-to-face assessment completed as part of eligibility determination for 
43.10 	the alternative care, elderly waiver, community alternatives for disabled individuals, 
43.11 	community alternative care, and traumatic brain injury waiver programs under sections 
43.12 	256B.0913, 256B.0915, 256B.0917, and 256B.49 is valid to establish service eligibility 
43.13 	for no more than 60 calendar days after the date of assessment. The effective eligibility 
43.14 	start date for these programs can never be prior to the date of assessment. If an assessment 
43.15 	was completed more than 60 days before the effective waiver or alternative care program 
43.16 	eligibility start date, assessment and support plan information must be updated in a 
43.17 	face-to-face visit and documented in the department's Medicaid Management Information 
43.18 	System (MMIS). Notwithstanding retroactive medical assistance coverage of state plan 
43.19 	services, the effective date of program eligibility in this case for programs included in this 
43.20 	item cannot be prior to the date the most recent updated assessment is completed.

43.21 	Sec. 11. Minnesota Statutes 2010, section 256B.0911, subdivision 3b, is amended to 
43.22 	read:
43.23 		Subd. 3b.Transition assistance. (a) A long-term care consultation team Lead 
43.24 	agency certified assessors shall provide assistance to persons residing in a nursing 
43.25 	facility, hospital, regional treatment center, or intermediate care facility for persons with 
43.26 	developmental disabilities who request or are referred for assistance. Transition assistance 
43.27 	must include assessment, community support plan development, referrals to long-term 
43.28 	care options counseling under section 256B.975 256.975, subdivision 10 7, for community 
43.29 	support plan implementation and to Minnesota health care programs, including home and 
43.30 	community-based waiver services and consumer-directed options through the waivers, 
43.31 	and referrals to programs that provide assistance with housing. Transition assistance 
43.32 	must also include information about the Centers for Independent Living and the Senior 
43.33 	LinkAge Line, Disability Linkage Line, and about other organizations that can provide 
43.34 	assistance with relocation efforts, and information about contacting these organizations to 
43.35 	obtain their assistance and support.
44.1 	(b) The county lead agency shall develop transition processes with institutional 
44.2 	social workers and discharge planners to ensure that:
44.3 	(1) referrals for in-person assessments are taken from long-term care options 
44.4 	counselors as provided for in section 256.975, subdivision 7, paragraph (b), clause (11);
44.5 	(2) persons admitted to facilitiesassessed in institutions receive information about 
44.6 	transition assistance that is available;
44.7 	(2) (3) the assessment is completed for persons within ten working 20 calendar days 
44.8 	of the date of request or recommendation for assessment; and
44.9 	(3) (4) there is a plan for transition and follow-up for the individual's return to the 
44.10 	community. The plan must require, including notification of other local agencies when a 
44.11 	person who may require assistance is screened by one county for admission to a facility
44.12 	from agencies located in another county.; and
44.13 	(5) relocation targeted case management as defined in section 256B.0621, 
44.14 	subdivision 2, clause (4), is authorized for an eligible medical assistance recipient.
44.15 	(c) If a person who is eligible for a Minnesota health care program is admitted to a 
44.16 	nursing facility, the nursing facility must include a consultation team member or the case 
44.17 	manager in the discharge planning process.

44.18 	Sec. 12. Minnesota Statutes 2010, section 256B.0911, subdivision 3c, is amended to 
44.19 	read:
44.20 		Subd. 3c.Transition to housing with services. (a) Housing with services 
44.21 	establishments offering or providing assisted living under chapter 144G shall inform 
44.22 	all prospective residents of the availability of and contact information for transitional 
44.23 	consultation services under this subdivision prior to executing a lease or contract with the 
44.24 	prospective resident. The purpose of transitional long-term care consultation is to support 
44.25 	persons with current or anticipated long-term care needs in making informed choices 
44.26 	among options that include the most cost-effective and least restrictive settings, and to 
44.27 	delay spenddown to eligibility for publicly funded programs by connecting people to 
44.28 	alternative services in their homes before transition to housing with services. Regardless 
44.29 	of the consultation, prospective residents maintain the right to choose housing with 
44.30 	services or assisted living if that option is their preference.
44.31 	(b) Transitional consultation services are provided as determined by the 
44.32 	commissioner of human services in partnership with county long-term care consultation 
44.33 	units, and the Area Agencies on Aging, and are a combination of telephone-based 
44.34 	and in-person assistance provided under models developed by the commissioner. The 
44.35 	consultation shall be performed in a manner that provides objective and complete 
45.1 	information. Transitional consultation must be provided within five working days of the 
45.2 	request of the prospective resident as follows:
45.3 	(1) the consultation must be provided by a qualified professional as determined by 
45.4 	the commissioner;
45.5 	(2) the consultation must include a review of the prospective resident's reasons for 
45.6 	considering assisted living, the prospective resident's personal goals, a discussion of the 
45.7 	prospective resident's immediate and projected long-term care needs, and alternative 
45.8 	community services or assisted living settings that may meet the prospective resident's 
45.9 	needs; and
45.10 	(3) the prospective resident shall be informed of the availability of long-term care 
45.11 	consultation services described in subdivision 3a that are available at no charge to the 
45.12 	prospective resident to assist the prospective resident in assessment and planning to meet 
45.13 	the prospective resident's long-term care needs. The Senior LinkAge Line and long-term 
45.14 	care consultation team shall give the highest priority to referrals of individuals who are at 
45.15 	highest risk of nursing facility placement or as needed for determining eligibility.

45.16 	Sec. 13. Minnesota Statutes 2010, section 256B.0911, subdivision 4a, is amended to 
45.17 	read:
45.18 		Subd. 4a.Preadmission screening activities related to nursing facility 
45.19 	admissions. (a) All applicants to Medicaid certified nursing facilities, including certified 
45.20 	boarding care facilities, must be screened prior to admission regardless of income, assets, 
45.21 	or funding sources for nursing facility care, except as described in subdivision 4b. The 
45.22 	purpose of the screening is to determine the need for nursing facility level of care as 
45.23 	described in paragraph (d) and to complete activities required under federal law related to 
45.24 	mental illness and developmental disability as outlined in paragraph (b).
45.25 	(b) A person who has a diagnosis or possible diagnosis of mental illness or 
45.26 	developmental disability must receive a preadmission screening before admission 
45.27 	regardless of the exemptions outlined in subdivision 4b, paragraph (b), to identify the need 
45.28 	for further evaluation and specialized services, unless the admission prior to screening is 
45.29 	authorized by the local mental health authority or the local developmental disabilities case 
45.30 	manager, or unless authorized by the county agency according to Public Law 101-508.
45.31 	The following criteria apply to the preadmission screening:
45.32 	(1) the county lead agency must use forms and criteria developed by the 
45.33 	commissioner to identify persons who require referral for further evaluation and 
45.34 	determination of the need for specialized services; and
46.1 	(2) the evaluation and determination of the need for specialized services must be 
46.2 	done by:
46.3 	(i) a qualified independent mental health professional, for persons with a primary or 
46.4 	secondary diagnosis of a serious mental illness; or
46.5 	(ii) a qualified developmental disability professional, for persons with a primary or 
46.6 	secondary diagnosis of developmental disability. For purposes of this requirement, a 
46.7 	qualified developmental disability professional must meet the standards for a qualified 
46.8 	developmental disability professional under Code of Federal Regulations, title 42, section 
46.9 	483.430.
46.10 	(c) The local county mental health authority or the state developmental disability 
46.11 	authority under Public Law Numbers 100-203 and 101-508 may prohibit admission to a 
46.12 	nursing facility if the individual does not meet the nursing facility level of care criteria or 
46.13 	needs specialized services as defined in Public Law Numbers 100-203 and 101-508. For 
46.14 	purposes of this section, "specialized services" for a person with developmental disability 
46.15 	means active treatment as that term is defined under Code of Federal Regulations, title 
46.16 	42, section 483.440 (a)(1).
46.17 	(d) The determination of the need for nursing facility level of care must be made 
46.18 	according to criteria established in section 144.0724, subdivision 11, and 256B.092, 
46.19 	using forms developed by the commissioner. In assessing a person's needs, consultation 
46.20 	team members shall have a physician available for consultation and shall consider the 
46.21 	assessment of the individual's attending physician, if any. The individual's physician must 
46.22 	be included if the physician chooses to participate. Other personnel may be included on 
46.23 	the team as deemed appropriate by the county lead agency.

46.24 	Sec. 14. Minnesota Statutes 2010, section 256B.0911, subdivision 4c, is amended to 
46.25 	read:
46.26 		Subd. 4c.Screening requirements. (a) A person may be screened for nursing 
46.27 	facility admission by telephone or in a face-to-face screening interview. Consultation team 
46.28 	members Certified assessors shall identify each individual's needs using the following 
46.29 	categories:
46.30 	(1) the person needs no face-to-face screening interview to determine the need 
46.31 	for nursing facility level of care based on information obtained from other health care 
46.32 	professionals;
46.33 	(2) the person needs an immediate face-to-face screening interview to determine the 
46.34 	need for nursing facility level of care and complete activities required under subdivision 
46.35 	4a; or
47.1 	(3) the person may be exempt from screening requirements as outlined in subdivision 
47.2 	4b, but will need transitional assistance after admission or in-person follow-along after 
47.3 	a return home.
47.4 	(b) Persons admitted on a nonemergency basis to a Medicaid-certified nursing 
47.5 	facility must be screened prior to admission.
47.6 	(c) The county lead agency screening or intake activity must include processes to 
47.7 	identify persons who may require transition assistance as described in subdivision 3b.

47.8 	Sec. 15. Minnesota Statutes 2010, section 256B.0911, subdivision 6, is amended to 
47.9 	read:
47.10 		Subd. 6.Payment for long-term care consultation services. (a) The total payment 
47.11 	for each county must be paid monthly by certified nursing facilities in the county. The 
47.12 	monthly amount to be paid by each nursing facility for each fiscal year must be determined 
47.13 	by dividing the county's annual allocation for long-term care consultation services by 12 
47.14 	to determine the monthly payment and allocating the monthly payment to each nursing 
47.15 	facility based on the number of licensed beds in the nursing facility. Payments to counties 
47.16 	in which there is no certified nursing facility must be made by increasing the payment 
47.17 	rate of the two facilities located nearest to the county seat.
47.18 	(b) The commissioner shall include the total annual payment determined under 
47.19 	paragraph (a) for each nursing facility reimbursed under section 256B.431or,256B.434, 
47.20 	or 256B.441according to section 256B.431, subdivision 2b, paragraph (g).
47.21 	(c) In the event of the layaway, delicensure and decertification, or removal from 
47.22 	layaway of 25 percent or more of the beds in a facility, the commissioner may adjust 
47.23 	the per diem payment amount in paragraph (b) and may adjust the monthly payment 
47.24 	amount in paragraph (a). The effective date of an adjustment made under this paragraph 
47.25 	shall be on or after the first day of the month following the effective date of the layaway, 
47.26 	delicensure and decertification, or removal from layaway.
47.27 	(d) Payments for long-term care consultation services are available to the county 
47.28 	or counties to cover staff salaries and expenses to provide the services described in 
47.29 	subdivision 1a. The county shall employ, or contract with other agencies to employ, within 
47.30 	the limits of available funding, sufficient personnel to provide long-term care consultation 
47.31 	services while meeting the state's long-term care outcomes and objectives as defined in 
47.32 	section 256B.0917, subdivision 1. The county shall be accountable for meeting local 
47.33 	objectives as approved by the commissioner in the biennial home and community-based 
47.34 	services quality assurance plan on a form provided by the commissioner.
48.1 	(e) Notwithstanding section 256B.0641, overpayments attributable to payment of the 
48.2 	screening costs under the medical assistance program may not be recovered from a facility.
48.3 	(f) The commissioner of human services shall amend the Minnesota medical 
48.4 	assistance plan to include reimbursement for the local consultation teams.
48.5 	(g) Until the alternative payment methodology in paragraph (h) is implemented, 
48.6 	the county may bill, as case management services, assessments, support planning, and 
48.7 	follow-along provided to persons determined to be eligible for case management under 
48.8 	Minnesota health care programs. No individual or family member shall be charged for an 
48.9 	initial assessment or initial support plan development provided under subdivision 3a or 3b.
48.10 	(h) The commissioner shall develop an alternative payment methodology for 
48.11 	long-term care consultation services that includes the funding available under this 
48.12 	subdivision, and sections 256B.092 and 256B.0659. In developing the new payment 
48.13 	methodology, the commissioner shall consider the maximization of other funding sources, 
48.14 	including federal funding, for this all long-term care consultation and preadmission 
48.15 	screening activity.

48.16 	Sec. 16. Minnesota Statutes 2010, section 256B.0913, subdivision 7, is amended to 
48.17 	read:
48.18 		Subd. 7.Case management. (a) The provision of case management under the 
48.19 	alternative care program is governed by requirements in section 256B.0915, subdivisions 
48.20 	1a and 1b.
48.21 	(b) The case manager must not approve alternative care funding for a client in any 
48.22 	setting in which the case manager cannot reasonably ensure the client's health and safety. 
48.23 	(c) The case manager is responsible for the cost-effectiveness of the alternative care 
48.24 	individual care coordinated services and support plan and must not approve any care plan 
48.25 	in which the cost of services funded by alternative care and client contributions exceeds 
48.26 	the limit specified in section 256B.0915, subdivision 3, paragraph (b).
48.27 	(d) Case manager responsibilities include those in section 256B.0915, subdivision 
48.28 	1a, paragraph (g).

48.29 	Sec. 17. Minnesota Statutes 2010, section 256B.0913, subdivision 8, is amended to 
48.30 	read:
48.31 		Subd. 8.Requirements for individual care coordinated services and support
48.32 	plan. (a) The case manager shall implement the coordinated services and support plan of 
48.33 	care for each alternative care client and ensure that a client's service needs and eligibility 
48.34 	are reassessed at least every 12 months. The  coordinated services and support plan must 
49.1 	meet the requirements in section 256B.0915, subdivision 6. The plan shall include any 
49.2 	services prescribed by the individual's attending physician as necessary to allow the 
49.3 	individual to remain in a community setting. In developing the individual's care plan, the 
49.4 	case manager should include the use of volunteers from families and neighbors, religious 
49.5 	organizations, social clubs, and civic and service organizations to support the formal home 
49.6 	care services. The lead agency shall be held harmless for damages or injuries sustained 
49.7 	through the use of volunteers under this subdivision including workers' compensation 
49.8 	liability. The case manager shall provide documentation in each individual's plan of care
49.9 	and, if requested, to the commissioner that the most cost-effective alternatives available 
49.10 	have been offered to the individual and that the individual was free to choose among 
49.11 	available qualified providers, both public and private, including qualified case management 
49.12 	or service coordination providers other than those employed by any county; however, the 
49.13 	county or tribe maintains responsibility for prior authorizing services in accordance with 
49.14 	statutory and administrative requirements. The case manager must give the individual a 
49.15 	ten-day written notice of any denial, termination, or reduction of alternative care services.
49.16 	(b) The county of service or tribe must provide access to and arrange for case 
49.17 	management services, including assuring implementation of the coordinated services 
49.18 	and support plan. "County of service" has the meaning given it in Minnesota Rules, 
49.19 	part 9505.0015, subpart 11. The county of service must notify the county of financial 
49.20 	responsibility of the approved care plan and the amount of encumbered funds.

49.21 	Sec. 18. Minnesota Statutes 2010, section 256B.0915, subdivision 1a, is amended to 
49.22 	read:
49.23 		Subd. 1a.Elderly waiver case management services. (a) Elderly Except 
49.24 	as provided to individuals under prepaid medical assistance programs as described 
49.25 	in paragraph (h), case management services under the home and community-based 
49.26 	services waiver for elderly individuals are available from providers meeting qualification 
49.27 	requirements and the standards specified in subdivision 1b. Eligible recipients may choose 
49.28 	any qualified provider of elderly case management services.
49.29 	(b) Case management services assist individuals who receive waiver services in 
49.30 	gaining access to needed waiver and other state plan services, and assist individuals in 
49.31 	appeals under section 256.045, as well as needed medical, social, educational, and other 
49.32 	services regardless of the funding source for the services to which access is gained. Case 
49.33 	managers shall collaborate with consumers, families, legal representatives, and relevant 
49.34 	medical experts and service providers in the development and periodic review of the 
49.35 	coordinated services and support plan.
50.1 	(c) A case aide shall provide assistance to the case manager in carrying out 
50.2 	administrative activities of the case management function. The case aide may not assume 
50.3 	responsibilities that require professional judgment including assessments, reassessments, 
50.4 	and care plan development. The case manager is responsible for providing oversight of 
50.5 	the case aide.
50.6 	(d) Case managers shall be responsible for ongoing monitoring of the provision of 
50.7 	services included in the individual's plan of care. Case managers shall initiate and oversee
50.8 	the process of assessment and reassessment of the individual's care coordinated services 
50.9 	and support plan as defined in subdivision 6 and review the plan of care at intervals 
50.10 	specified in the federally approved waiver plan.
50.11 	(e) The county of service or tribe must provide access to and arrange for case 
50.12 	management services. County of service has the meaning given it in Minnesota Rules, 
50.13 	part 9505.0015, subpart 11.
50.14 	(f) Except as described in paragraph (h), case management services must be provided 
50.15 	by a public or private agency that is enrolled as a medical assistance provider determined 
50.16 	by the commissioner to meet all of the requirements in subdivision 1b. Case management 
50.17 	services must not be provided to a recipient by a private agency that has a financial interest 
50.18 	in the provision of any other services included in the recipient's coordinated service and 
50.19 	support plan. For purposes of this section, "private agency" means any agency that is not 
50.20 	identified as a lead agency under section 256B.0911, subdivision 1a, paragraph (e).
50.21 	(g) Case management service activities provided to or arranged for a person include:
50.22 	(1) development of the coordinated services and support plan under subdivision 6;
50.23 	(2) informing the individual or the individual's legal guardian or conservator of 
50.24 	service options, and options for case management services and providers;
50.25 	(3) consulting with relevant medical experts or service providers;
50.26 	(4) assisting the person in the identification of potential providers;
50.27 	(5) assisting the person to access services;
50.28 	(6) coordination of services; and
50.29 	(7) evaluation and monitoring of the services identified in the plan, including at least 
50.30 	one annual face-to-face visit by the case manager with each person.
50.31 	(h) For individuals enrolled in prepaid medical assistance programs under section 
50.32 	256B.69, subdivisions 6b and 23, the health plan will provide or arrange to provide elderly 
50.33 	waiver case management services in paragraph (g), as part of an integrated delivery system 
50.34 	in accordance with contract requirements established by the commissioner.

51.1 	Sec. 19. Minnesota Statutes 2010, section 256B.0915, subdivision 1b, is amended to 
51.2 	read:
51.3 		Subd. 1b.Provider qualifications and standards. (a) The commissioner must 
51.4 	enroll qualified providers of elderly case management services under the home and 
51.5 	community-based waiver for the elderly under section 1915(c) of the Social Security 
51.6 	Act. The enrollment process shall ensure the provider's ability to meet the qualification 
51.7 	requirements and standards in this subdivision and other federal and state requirements 
51.8 	of this service. An elderly A case management provider is an enrolled medical 
51.9 	assistance provider who is determined by the commissioner to have all of the following 
51.10 	characteristics:
51.11 	(1) the demonstrated capacity and experience to provide the components of 
51.12 	case management to coordinate and link community resources needed by the eligible 
51.13 	population;
51.14 	(2) administrative capacity and experience in serving the target population for 
51.15 	whom it will provide services and in ensuring quality of services under state and federal 
51.16 	requirements;
51.17 	(3) a financial management system that provides accurate documentation of services 
51.18 	and costs under state and federal requirements;
51.19 	(4) the capacity to document and maintain individual case records under state and 
51.20 	federal requirements; and
51.21 	(5) the lead agency may allow a case manager employed by the lead agency to 
51.22 	delegate certain aspects of the case management activity to another individual employed 
51.23 	by the lead agency provided there is oversight of the individual by the case manager. 
51.24 	The case manager may not delegate those aspects which require professional judgment 
51.25 	including assessments, reassessments, and care coordinated services and support plan 
51.26 	development. Lead agencies include counties, health plans, and federally recognized 
51.27 	tribes who authorize services under this section.
51.28 	(b) The health plan shall provide or arrange to provide elderly waiver case 
51.29 	management services in subdivision 1a, paragraph (g), as part of an integrated delivery 
51.30 	system in accordance with contract requirements established by the commissioner related 
51.31 	to provider standards and qualifications.

51.32 	Sec. 20. Minnesota Statutes 2010, section 256B.0915, subdivision 3c, is amended to 
51.33 	read:
51.34 		Subd. 3c.Service approval and contracting provisions. (a) Medical assistance 
51.35 	funding for skilled nursing services, private duty nursing, home health aide, and personal 
52.1 	care services for waiver recipients must be approved by the case manager and included in 
52.2 	the individual care coordinated services and support plan.
52.3 	(b) A lead agency is not required to contract with a provider of supplies and 
52.4 	equipment if the monthly cost of the supplies and equipment is less than $250.

52.5 	Sec. 21. Minnesota Statutes 2010, section 256B.0915, subdivision 6, is amended to 
52.6 	read:
52.7 		Subd. 6.Implementation of care coordinated services and support plan. (a) 
52.8 	Each elderly waiver client shall be provided a copy of a written care coordinated services 
52.9 	and support plan that meets the requirements outlined in section 256B.0913, subdivision 8. 
52.10 	The care plan must be implemented by the county of service when it is different than the 
52.11 	county of financial responsibility. The county of service administering waivered services 
52.12 	must notify the county of financial responsibility of the approved care plan. that:
52.13 	(1) is developed and signed by the recipient within ten working days after the case 
52.14 	manager receives the community support plan from the certified assessor;
52.15 	(2) includes the results of the assessment information on the person's need for 
52.16 	service and identification of service needs that will be or that are met by the person's 
52.17 	relatives, friends, and others, as well as community services used by the general public;
52.18 	(3) reasonably ensures the health and safety of the recipient;
52.19 	(4) identifies the person's preferences for services as stated by the person or the 
52.20 	person's legal guardian or conservator;
52.21 	(5) reflects the person's informed choice between institutional and community-based 
52.22 	services, as well as choice of services, supports, and providers, including available case 
52.23 	manager providers;
52.24 	(6) identifies long and short-range goals for the person;
52.25 	(7) identifies specific services and the amount, frequency, duration, and cost of the 
52.26 	services to be provided to the person based on assessed needs, preferences, and available 
52.27 	resources; and
52.28 	(8) includes information about the right to appeal decisions under section 256.045;
52.29 	(b) In developing the coordinated services and support plan, the case manager should 
52.30 	also include the use of volunteers, religious organizations, social clubs, and civic and 
52.31 	service organizations to support the individual in the community. The lead agency must be 
52.32 	held harmless for damages or injuries sustained through the use of volunteers and agencies 
52.33 	under this paragraph, including workers' compensation liability.

53.1 	Sec. 22. Minnesota Statutes 2010, section 256B.0915, subdivision 10, is amended to 
53.2 	read:
53.3 		Subd. 10.Waiver payment rates; managed care organizations. The 
53.4 	commissioner shall adjust the elderly waiver capitation payment rates for managed 
53.5 	care organizations paid under section 256B.69, subdivisions 6a 6b and 23, to reflect the 
53.6 	maximum service rate limits for customized living services and 24-hour customized 
53.7 	living services under subdivisions 3e and 3h for the contract period beginning October 
53.8 	1, 2009. Medical assistance rates paid to customized living providers by managed 
53.9 	care organizations under this section shall not exceed the maximum service rate limits 
53.10 	determined by the commissioner under subdivisions 3e and 3h.

53.11 	Sec. 23. Minnesota Statutes 2010, section 256B.092, subdivision 1, is amended to read:
53.12 		Subdivision 1.County of financial responsibility; duties. Before any services 
53.13 	shall be rendered to persons with developmental disabilities who are in need of social 
53.14 	service and medical assistance, the county of financial responsibility shall conduct or 
53.15 	arrange for a diagnostic evaluation in order to determine whether the person has or may 
53.16 	have a developmental disability or has or may have a related condition. If the county 
53.17 	of financial responsibility determines that the person has a developmental disability, 
53.18 	the county shall inform the person of case management services available under this 
53.19 	section. Except as provided in subdivision 1g or 4b, if a person is diagnosed as having a 
53.20 	developmental disability, the county of financial responsibility shall conduct or arrange for 
53.21 	a needs assessment by a certified assessor, and develop or arrange for an individual service
53.22 	a community support plan according to section 256B.0911, provide or arrange for ongoing 
53.23 	case management services at the level identified in the individual service plan, provide 
53.24 	or arrange for case management administration, and authorize services identified in the 
53.25 	person's individual service coordinated services and support plan developed according to 
53.26 	subdivision 1b. Diagnostic information, obtained by other providers or agencies, may be 
53.27 	used by the county agency in determining eligibility for case management. Nothing in this 
53.28 	section shall be construed as requiring: (1) assessment in areas agreed to as unnecessary 
53.29 	by the case manager a certified assessor and the person, or the person's legal guardian or 
53.30 	conservator, or the parent if the person is a minor, or (2) assessments in areas where there 
53.31 	has been a functional assessment completed in the previous 12 months for which the 
53.32 	case manager certified assessor and the person or person's guardian or conservator, or the 
53.33 	parent if the person is a minor, agree that further assessment is not necessary. For persons 
53.34 	under state guardianship, the case manager certified assessor shall seek authorization from 
53.35 	the public guardianship office for waiving any assessment requirements. Assessments 
54.1 	related to health, safety, and protection of the person for the purpose of identifying service 
54.2 	type, amount, and frequency or assessments required to authorize services may not be 
54.3 	waived. To the extent possible, for wards of the commissioner the county shall consider 
54.4 	the opinions of the parent of the person with a developmental disability when developing 
54.5 	the person's individual service community support plan and coordinated services and 
54.6 	support plan.

54.7 	Sec. 24. Minnesota Statutes 2010, section 256B.092, subdivision 1a, is amended to 
54.8 	read:
54.9 		Subd. 1a.Case management administration and services. (a) The administrative 
54.10 	functions of case management provided to or arranged for a person include: Each recipient 
54.11 	of a home and community-based waiver shall be provided case management services by 
54.12 	qualified vendors as described in the federally approved waiver application.
54.13 	(1) review of eligibility for services;
54.14 	(2) screening;
54.15 	(3) intake;
54.16 	(4) diagnosis;
54.17 	(5) the review and authorization of services based upon an individualized service 
54.18 	plan; and
54.19 	(6) responding to requests for conciliation conferences and appeals according to 
54.20 	section 256.045 made by the person, the person's legal guardian or conservator, or the 
54.21 	parent if the person is a minor.
54.22 	(b) Case management service activities provided to or arranged for a person include:
54.23 	(1) development of the individual service coordinated services and support plan
54.24 	under subdivision 1b;
54.25 	(2) informing the individual or the individual's legal guardian or conservator, or 
54.26 	parent if the person is a minor, of service options;
54.27 	(3) consulting with relevant medical experts or service providers;
54.28 	(4) assisting the person in the identification of potential providers;
54.29 	(5) assisting the person to access services and assisting in appeals under section 
54.30 	256.045;
54.31 	(6) coordination of services, if coordination is not provided by another service 
54.32 	provider;
54.33 	(7) evaluation and monitoring of the services identified in the coordinated services 
54.34 	and support plan, which must incorporate at least one annual face-to-face visit by the case 
54.35 	manager with each person; and
55.1 	(8) annual reviews of service plans and services provided review and provide the 
55.2 	lead agency with recommendations for service authorization based upon the individual's 
55.3 	needs identified in the coordinated services and support plan.
55.4 	(c) Case management administration and service activities that are provided to the 
55.5 	person with a developmental disability shall be provided directly by county agencies or 
55.6 	under contract. Case management services must be provided by a public or private agency 
55.7 	that is enrolled as a medical assistance provider determined by the commissioner to meet 
55.8 	all of the requirements in the approved federal waiver plans. Case management services 
55.9 	must not be provided to a recipient by a private agency that has a financial interest in the 
55.10 	provision of any other services included in the recipient's coordinated services and support 
55.11 	plan. For purposes of this section, "private agency" means any agency that is not identified 
55.12 	as a lead agency under section 256B.0911, subdivision 1a, paragraph (d).
55.13 	(d) Case managers are responsible for the administrative duties and service 
55.14 	provisions listed in paragraphs (a) and (b). Case managers shall collaborate with 
55.15 	consumers, families, legal representatives, and relevant medical experts and service 
55.16 	providers in the development and annual review of the individualized service coordinated 
55.17 	services and support plan and habilitation plans plan.
55.18 	(e) The Department of Human Services shall offer ongoing education in case 
55.19 	management to case managers. Case managers shall receive no less than ten hours of case 
55.20 	management education and disability-related training each year.

55.21 	Sec. 25. Minnesota Statutes 2010, section 256B.092, subdivision 1b, is amended to 
55.22 	read:
55.23 		Subd. 1b.Individual Coordinated service and support plan. The individual 
55.24 	service plan must (a) Each recipient of home and community-based waivered services 
55.25 	shall be provided a copy of the written coordinated service and support plan which:
55.26 	(1) is developed and signed by the recipient within ten working days after the case 
55.27 	manager receives the community support plan from the certified assessor;
55.28 	(1) include (2) includes the results of the assessment information on the person's 
55.29 	need for service, including identification of service needs that will be or that are met 
55.30 	by the person's relatives, friends, and others, as well as community services used by 
55.31 	the general public;
55.32 	(3) reasonably ensures the health and safety of the recipient;
55.33 	(2) identify (4) identifies the person's preferences for services as stated by the person, 
55.34 	the person's legal guardian or conservator, or the parent if the person is a minor;
56.1 	(5) provides for an informed choice, as defined in section 256B.77, subdivision 2, 
56.2 	paragraph (o), of service and support providers, and identifies all available options for 
56.3 	case management services and providers;
56.4 	(3) identify (6) identifies long- and short-range goals for the person;
56.5 	(4) identify (7) identifies specific services and the amount and frequency of the 
56.6 	services to be provided to the person based on assessed needs, preferences, and available 
56.7 	resources. The individual service coordinated service and support plan shall also specify 
56.8 	other services the person needs that are not available;
56.9 	(5) identify (8) identifies the need for an individual program plan to be developed 
56.10 	by the provider according to the respective state and federal licensing and certification 
56.11 	standards, and additional assessments to be completed or arranged by the provider after 
56.12 	service initiation;
56.13 	(6) identify (9) identifies provider responsibilities to implement and make 
56.14 	recommendations for modification to the individual service coordinated service and 
56.15 	support plan;
56.16 	(7) include (10) includes notice of the right to request a conciliation conference or a 
56.17 	hearing under section 256.045;
56.18 	(8) be (11) is agreed upon and signed by the person, the person's legal guardian 
56.19 	or conservator, or the parent if the person is a minor, and the authorized county 
56.20 	representative; and
56.21 	(9) be (12) is reviewed by a health professional if the person has overriding medical 
56.22 	needs that impact the delivery of services.
56.23 	Service planning formats developed for interagency planning such as transition, 
56.24 	vocational, and individual family service plans may be substituted for service planning 
56.25 	formats developed by county agencies.
56.26 	(b) In developing the coordinated services and support plan, the case manager is 
56.27 	encouraged to include the use of volunteers, religious organizations, social clubs, and civic 
56.28 	and service organizations to support the individual in the community. The lead agency 
56.29 	must be held harmless for damages or injuries sustained through the use of volunteers and 
56.30 	agencies under this paragraph, including workers' compensation liability.

56.31 	Sec. 26. Minnesota Statutes 2010, section 256B.092, subdivision 1e, is amended to 
56.32 	read:
56.33 		Subd. 1e.Coordination, evaluation, and monitoring of services. (a) If the 
56.34 	individual service coordinated service and support plan identifies the need for individual 
56.35 	program plans for authorized services, the case manager shall assure that individual 
57.1 	program plans are developed by the providers according to clauses (2) to (5). The 
57.2 	providers shall assure that the individual program plans:
57.3 	(1) are developed according to the respective state and federal licensing and 
57.4 	certification requirements;
57.5 	(2) are designed to achieve the goals of the individual service coordinated service 
57.6 	and support plan;
57.7 	(3) are consistent with other aspects of the individual service coordinated service 
57.8 	and support plan;
57.9 	(4) assure the health and safety of the person; and
57.10 	(5) are developed with consistent and coordinated approaches to services among the 
57.11 	various service providers.
57.12 	(b) The case manager shall monitor the provision of services:
57.13 	(1) to assure that the individual service coordinated service and support plan is 
57.14 	being followed according to paragraph (a);
57.15 	(2) to identify any changes or modifications that might be needed in the individual 
57.16 	service coordinated service and support plan, including changes resulting from 
57.17 	recommendations of current service providers;
57.18 	(3) to determine if the person's legal rights are protected, and if not, notify the 
57.19 	person's legal guardian or conservator, or the parent if the person is a minor, protection 
57.20 	services, or licensing agencies as appropriate; and
57.21 	(4) to determine if the person, the person's legal guardian or conservator, or the 
57.22 	parent if the person is a minor, is satisfied with the services provided.
57.23 	(c) If the provider fails to develop or carry out the individual program plan according 
57.24 	to paragraph (a), the case manager shall notify the person's legal guardian or conservator, 
57.25 	or the parent if the person is a minor, the provider, the respective licensing and certification 
57.26 	agencies, and the county board where the services are being provided. In addition, the 
57.27 	case manager shall identify other steps needed to assure the person receives the services 
57.28 	identified in the individual service coordinated service and support plan.

57.29 	Sec. 27. Minnesota Statutes 2010, section 256B.092, subdivision 1g, is amended to 
57.30 	read:
57.31 		Subd. 1g.Conditions not requiring development of individual service
57.32 	coordinated service and support plan. Unless otherwise required by federal law, the 
57.33 	county agency is not required to complete an individual service a coordinated service and 
57.34 	support plan as defined in subdivision 1b for:
58.1 	(1) persons whose families are requesting respite care for their family member who 
58.2 	resides with them, or whose families are requesting a family support grant and are not 
58.3 	requesting purchase or arrangement of habilitative services; and
58.4 	(2) persons with developmental disabilities, living independently without authorized 
58.5 	services or receiving funding for services at a rehabilitation facility as defined in section 
58.6 	268A.01, subdivision 6, and not in need of or requesting additional services.

58.7 	Sec. 28. Minnesota Statutes 2010, section 256B.092, subdivision 2, is amended to read:
58.8 		Subd. 2.Medical assistance. To assure quality case management to those persons 
58.9 	who are eligible for medical assistance, the commissioner shall, upon request:
58.10 	(1) provide consultation on the case management process;
58.11 	(2) assist county agencies in the screening and annual reviews of clients review 
58.12 	process to assure that appropriate levels of service are provided to persons;
58.13 	(3) provide consultation on service planning and development of services with 
58.14 	appropriate options;
58.15 	(4) provide training and technical assistance to county case managers; and
58.16 	(5) authorize payment for medical assistance services according to this chapter 
58.17 	and rules implementing it.

58.18 	Sec. 29. Minnesota Statutes 2010, section 256B.092, subdivision 3, is amended to read:
58.19 		Subd. 3.Authorization and termination of services. County agency case 
58.20 	managers, under rules of the commissioner, shall authorize and terminate services of 
58.21 	community and regional treatment center providers according to individual service
58.22 	support plans. Services provided to persons with developmental disabilities may only be 
58.23 	authorized and terminated by case managers or certified assessors according to (1) rules of 
58.24 	the commissioner and (2) the individual service support plan as defined in subdivision 
58.25 	1b and section 256B.0911. Medical assistance services not needed shall not be authorized 
58.26 	by county agencies or funded by the commissioner. When purchasing or arranging for 
58.27 	unlicensed respite care services for persons with overriding health needs, the county 
58.28 	agency shall seek the advice of a health care professional in assessing provider staff 
58.29 	training needs and skills necessary to meet the medical needs of the person.

58.30 	Sec. 30. Minnesota Statutes 2010, section 256B.092, subdivision 5, is amended to read:
58.31 		Subd. 5.Federal waivers. (a) The commissioner shall apply for any federal 
58.32 	waivers necessary to secure, to the extent allowed by law, federal financial participation 
58.33 	under United States Code, title 42, sections 1396 et seq., as amended, for the provision 
59.1 	of services to persons who, in the absence of the services, would need the level of care 
59.2 	provided in a regional treatment center or a community intermediate care facility for 
59.3 	persons with developmental disabilities. The commissioner may seek amendments to the 
59.4 	waivers or apply for additional waivers under United States Code, title 42, sections 1396 
59.5 	et seq., as amended, to contain costs. The commissioner shall ensure that payment for 
59.6 	the cost of providing home and community-based alternative services under the federal 
59.7 	waiver plan shall not exceed the cost of intermediate care services including day training 
59.8 	and habilitation services that would have been provided without the waivered services.
59.9 	The commissioner shall seek an amendment to the 1915c home and 
59.10 	community-based waiver to allow properly licensed adult foster care homes to provide 
59.11 	residential services to up to five individuals with developmental disabilities. If the 
59.12 	amendment to the waiver is approved, adult foster care providers that can accommodate 
59.13 	five individuals shall increase their capacity to five beds, provided the providers continue 
59.14 	to meet all applicable licensing requirements.
59.15 	(b) The commissioner, in administering home and community-based waivers for 
59.16 	persons with developmental disabilities, shall ensure that day services for eligible persons 
59.17 	are not provided by the person's residential service provider, unless the person or the 
59.18 	person's legal representative is offered a choice of providers and agrees in writing to 
59.19 	provision of day services by the residential service provider. The individual service
59.20 	coordinated service and support plan for individuals who choose to have their residential 
59.21 	service provider provide their day services must describe how health, safety, protection, 
59.22 	and habilitation needs will be met, including how frequent and regular contact with 
59.23 	persons other than the residential service provider will occur. The individualized service
59.24 	coordinated service and support plan must address the provision of services during the 
59.25 	day outside the residence on weekdays.
59.26 	(c) When a county lead agency is evaluating denials, reductions, or terminations 
59.27 	of home and community-based services under section 256B.0916 for an individual, the 
59.28 	case manager lead agency shall offer to meet with the individual or the individual's 
59.29 	guardian in order to discuss the prioritization of service needs within the individualized 
59.30 	service coordinated service and support plan. The reduction in the authorized services 
59.31 	for an individual due to changes in funding for waivered services may not exceed the 
59.32 	amount needed to ensure medically necessary services to meet the individual's health, 
59.33 	safety, and welfare.

59.34 	Sec. 31. Minnesota Statutes 2010, section 256B.092, subdivision 7, is amended to read:
60.1 		Subd. 7.Screening teams Assessments. (a) Assessments and reassessments shall 
60.2 	be conducted by certified assessors according to section 256B.0911, and must incorporate 
60.3 	appropriate referrals to determine eligibility for case management under subdivision 1a.
60.4 	(b) For persons with developmental disabilities, screening teams shall be established 
60.5 	which a certified assessor shall evaluate the need for the level of care provided by 
60.6 	residential-based habilitation services, residential services, training and habilitation 
60.7 	services, and nursing facility services. The evaluation assessment shall address whether 
60.8 	home and community-based services are appropriate for persons who are at risk of 
60.9 	placement in an intermediate care facility for persons with developmental disabilities, or 
60.10 	for whom there is reasonable indication that they might require this level of care. The 
60.11 	screening team certified assessor shall make an evaluation of need within 60 working 
60.12 	days of a request for service by a person with a developmental disability, and within 
60.13 	five working days of an emergency admission of a person to an intermediate care 
60.14 	facility for persons with developmental disabilities. The screening team shall consist of 
60.15 	the case manager for persons with developmental disabilities, the person, the person's 
60.16 	legal guardian or conservator, or the parent if the person is a minor, and a qualified 
60.17 	developmental disability professional, as defined in the Code of Federal Regulations, 
60.18 	title 42, section 483.430, as amended through June 3, 1988. The case manager may also 
60.19 	act as the qualified developmental disability professional if the case manager meets 
60.20 	the federal definition. County social service agencies may contract with a public or 
60.21 	private agency or individual who is not a service provider for the person for the public 
60.22 	guardianship representation required by the screening or individual service planning 
60.23 	process. The contract shall be limited to public guardianship representation for the 
60.24 	screening and individual service planning activities. The contract shall require compliance 
60.25 	with the commissioner's instructions and may be for paid or voluntary services. For 
60.26 	persons determined to have overriding health care needs and are seeking admission to a 
60.27 	nursing facility or an ICF/MR, or seeking access to home and community-based waivered 
60.28 	services, a registered nurse must be designated as either the case manager or the qualified 
60.29 	developmental disability professional. For persons under the jurisdiction of a correctional 
60.30 	agency, the case manager must consult with the corrections administrator regarding 
60.31 	additional health, safety, and supervision needs. The case manager, with the concurrence 
60.32 	of the person, the person's legal guardian or conservator, or the parent if the person is a 
60.33 	minor, may invite other individuals to attend meetings of the screening team. No member 
60.34 	of the screening team shall have any direct or indirect service provider interest in the case. 
60.35 	Nothing in this section shall be construed as requiring the screening team meeting to be 
60.36 	separate from the service planning meeting.

61.1 	Sec. 32. Minnesota Statutes 2010, section 256B.092, subdivision 8, is amended to read:
61.2 		Subd. 8.Screening team Additional certified assessor duties. In addition to the 
61.3 	responsibilities of certified assessors described in section 256B.0911, for persons with 
61.4 	developmental disabilities, the screening team certified assessor shall:
61.5 	(1) review diagnostic data;
61.6 	(2) review health, social, and developmental assessment data using a uniform 
61.7 	screening tool specified by the commissioner;
61.8 	(3) identify the level of services appropriate to maintain the person in the most 
61.9 	normal and least restrictive setting that is consistent with the person's treatment needs;
61.10 	(4) (1) identify other noninstitutional public assistance or social service that may 
61.11 	prevent or delay long-term residential placement;
61.12 	(5) (2) assess whether a person is in need of long-term residential care;
61.13 	(6) (3) make recommendations regarding placement and payment for: (i) social 
61.14 	service or public assistance support, or both, to maintain a person in the person's own home 
61.15 	or other place of residence; (ii) training and habilitation service, vocational rehabilitation, 
61.16 	and employment training activities; (iii) community residential placement; (iv) regional 
61.17 	treatment center placement; or (v) a home and community-based service alternative to 
61.18 	community residential placement or regional treatment center placement;
61.19 	(7) (4) evaluate the availability, location, and quality of the services listed in clause 
61.20 	(6) (3), including the impact of placement alternatives on the person's ability to maintain 
61.21 	or improve existing patterns of contact and involvement with parents and other family 
61.22 	members;
61.23 	(8) (5) identify the cost implications of recommendations in clause (6) (3); and
61.24 	(9) (6) make recommendations to a court as may be needed to assist the court in 
61.25 	making decisions regarding commitment of persons with developmental disabilities; and
61.26 	(10) inform the person and the person's legal guardian or conservator, or the parent if 
61.27 	the person is a minor, that appeal may be made to the commissioner pursuant to section 
61.28 	256.045.

61.29 	Sec. 33. Minnesota Statutes 2010, section 256B.092, subdivision 8a, is amended to 
61.30 	read:
61.31 		Subd. 8a.County concurrence notification. (a) If the county of financial 
61.32 	responsibility wishes to place a person in another county for services, the county of 
61.33 	financial responsibility shall seek concurrence from notify the proposed county of service 
61.34 	and the placement shall be made cooperatively between the two counties. Arrangements 
61.35 	shall be made between the two counties for ongoing social service, including annual 
62.1 	reviews of the person's individual service coordinated service and support plan. The county 
62.2 	where services are provided may not make changes in the person's service coordinated 
62.3 	service and support plan without approval by the county of financial responsibility.
62.4 	(b) When a person has been screened and authorized for services in an intermediate 
62.5 	care facility for persons with developmental disabilities or for home and community-based 
62.6 	services for persons with developmental disabilities, the case manager shall assist that 
62.7 	person in identifying a service provider who is able to meet the needs of the person 
62.8 	according to the person's individual service plan. If the identified service is to be provided 
62.9 	in a county other than the county of financial responsibility, the county of financial 
62.10 	responsibility shall request concurrence of the county where the person is requesting to 
62.11 	receive the identified services. The county of service may refuse to concur shall notify 
62.12 	the county of financial responsibility if:
62.13 	(1) it can demonstrate that the provider is unable to provide the services identified in 
62.14 	the person's individual service plan as services that are needed and are to be provided; or
62.15 	(2), in the case of an intermediate care facility for persons with developmental 
62.16 	disabilities, there has been no authorization for admission by the admission review team 
62.17 	as required in section 256B.0926.
62.18 	(c) The county of service shall notify the county of financial responsibility of 
62.19 	concurrence or refusal to concur any concerns about the chosen provider's capacity to 
62.20 	meet the needs of the person seeking to move to residential services in another county no 
62.21 	later than 20 working days following receipt of the written request notification. Unless 
62.22 	other mutually acceptable arrangements are made by the involved county agencies, the 
62.23 	county of financial responsibility is responsible for costs of social services and the costs 
62.24 	associated with the development and maintenance of the placement. The county of 
62.25 	service may request that the county of financial responsibility purchase case management 
62.26 	services from the county of service or from a contracted provider of case management 
62.27 	when the county of financial responsibility is not providing case management as defined 
62.28 	in this section and rules adopted under this section, unless other mutually acceptable 
62.29 	arrangements are made by the involved county agencies. Standards for payment limits 
62.30 	under this section may be established by the commissioner. Financial disputes between 
62.31 	counties shall be resolved as provided in section 256G.09. This subdivision also applies to 
62.32 	home and community-based waiver services provided under section 256B.49.

62.33 	Sec. 34. Minnesota Statutes 2010, section 256B.092, subdivision 9, is amended to read:
62.34 		Subd. 9.Reimbursement. Payment for services shall not be provided to a 
62.35 	service provider for any person placed in an intermediate care facility for persons with 
63.1 	developmental disabilities prior to the person being screened by the screening team
63.2 	receiving an assessment by a certified assessor. The commissioner shall not deny 
63.3 	reimbursement for: (1) a person admitted to an intermediate care facility for persons 
63.4 	with developmental disabilities who is assessed to need long-term supportive services, 
63.5 	if long-term supportive services other than intermediate care are not available in that 
63.6 	community; (2) any person admitted to an intermediate care facility for persons with 
63.7 	developmental disabilities under emergency circumstances; (3) any eligible person placed 
63.8 	in the intermediate care facility for persons with developmental disabilities pending an 
63.9 	appeal of the screening team's certified assessor's decision; or (4) any medical assistance 
63.10 	recipient when, after full discussion of all appropriate alternatives including those that 
63.11 	are expected to be less costly than intermediate care for persons with developmental 
63.12 	disabilities, the person or the person's legal guardian or conservator, or the parent if the 
63.13 	person is a minor, insists on intermediate care placement. The screening team certified 
63.14 	assessor shall provide documentation that the most cost-effective alternatives available 
63.15 	were offered to this individual or the individual's legal guardian or conservator.

63.16 	Sec. 35. Minnesota Statutes 2010, section 256B.092, subdivision 11, is amended to 
63.17 	read:
63.18 		Subd. 11.Residential support services. (a) Upon federal approval, there is 
63.19 	established a new service called residential support that is available on the community 
63.20 	alternative care, community alternatives for disabled individuals, developmental 
63.21 	disabilities, and traumatic brain injury waivers. Existing waiver service descriptions 
63.22 	must be modified to the extent necessary to ensure there is no duplication between 
63.23 	other services. Residential support services must be provided by vendors licensed as a 
63.24 	community residential setting as defined in section 245A.11, subdivision 8.
63.25 	(b) Residential support services must meet the following criteria:
63.26 	(1) providers of residential support services must own or control the residential site;
63.27 	(2) the residential site must not be the primary residence of the license holder;
63.28 	(3) the residential site must have a designated program supervisor responsible for 
63.29 	program oversight, development, and implementation of policies and procedures;
63.30 	(4) the provider of residential support services must provide supervision, training, 
63.31 	and assistance as described in the person's community coordinated services and support 
63.32 	plan; and
63.33 	(5) the provider of residential support services must meet the requirements of 
63.34 	licensure and additional requirements of the person's community coordinated services and
63.35 	support plan.
64.1 	(c) Providers of residential support services that meet the definition in paragraph 
64.2 	(a) must be registered using a process determined by the commissioner beginning July 
64.3 	1, 2009.

64.4 	Sec. 36. Minnesota Statutes 2010, section 256B.49, subdivision 13, is amended to read:
64.5 		Subd. 13.Case management. (a) Each recipient of a home and community-based 
64.6 	waiver shall be provided case management services by qualified vendors as described 
64.7 	in the federally approved waiver application. The case management service activities 
64.8 	provided will must include:
64.9 	(1) assessing the needs of the individual within 20 working days of a recipient's 
64.10 	request;
64.11 	(2) developing (1) finalizing the written individual service coordinated service and 
64.12 	support plan within ten working days after the assessment is completed case manager 
64.13 	receives the plan from the certified assessor;
64.14 	(3) (2) informing the recipient or the recipient's legal guardian or conservator 
64.15 	of service options;
64.16 	(4) (3) assisting the recipient in the identification of potential service providers and 
64.17 	available options for case management service and providers;
64.18 	(5) (4) assisting the recipient to access services and assisting with appeals under 
64.19 	section 256.045; and
64.20 	(6) (5) coordinating, evaluating, and monitoring of the services identified in the 
64.21 	service plan;.
64.22 	(7) completing the annual reviews of the service plan; and
64.23 	(8) informing the recipient or legal representative of the right to have assessments 
64.24 	completed and service plans developed within specified time periods, and to appeal county 
64.25 	action or inaction under section 256.045, subdivision 3, including the determination of 
64.26 	nursing facility level of care.
64.27 	(b) The case manager may delegate certain aspects of the case management service 
64.28 	activities to another individual provided there is oversight by the case manager. The case 
64.29 	manager may not delegate those aspects which require professional judgment including 
64.30 	assessments, reassessments, and care plan development.:
64.31 	(1) finalizing the coordinated service and support plan;
64.32 	(2) ongoing assessment and monitoring of the person's needs and adequacy of the 
64.33 	approved coordinated service and support plan; and
64.34 	(3) adjustments to the coordinated service and support plan.
65.1 	(c) Case management services must be provided by a public or private agency that 
65.2 	is enrolled as a medical assistance provider determined by the commissioner to meet all 
65.3 	of the requirements in the approved federal waiver plans. Case management services 
65.4 	must not be provided to a recipient by a private agency that has any financial interest in 
65.5 	the provision of any other services included in the recipient's coordinated services and 
65.6 	support plan. For purposes of this section, "private agency" means any agency that is not 
65.7 	identified as a lead agency under section 256B.0911, subdivision 1a, paragraph (d).

65.8 	Sec. 37. Minnesota Statutes 2010, section 256B.49, subdivision 14, is amended to read:
65.9 		Subd. 14.Assessment and reassessment. (a) Assessments of each recipient's 
65.10 	strengths, informal support systems, and need for services shall be completed within 
65.11 	20 working days of the recipient's request. Reassessment of each recipient's strengths, 
65.12 	support systems, and need for services shall be conducted at least every 12 months and at 
65.13 	other times when there has been a significant change in the recipient's functioning and 
65.14 	reassessments shall be conducted by certified assessors according to section 256B.0911, 
65.15 	subdivision 2b.
65.16 	(b) There must be a determination that the client requires a hospital level of care or a 
65.17 	nursing facility level of care as defined in section 144.0724, subdivision 11, at initial and 
65.18 	subsequent assessments to initiate and maintain participation in the waiver program.
65.19 	(c) Regardless of other assessments identified in section 144.0724, subdivision 4, as 
65.20 	appropriate to determine nursing facility level of care for purposes of medical assistance 
65.21 	payment for nursing facility services, only face-to-face assessments conducted according 
65.22 	to section 256B.0911, subdivisions 3a, 3b, and 4d, that result in a hospital level of care 
65.23 	determination or a nursing facility level of care determination must be accepted for 
65.24 	purposes of initial and ongoing access to waiver services payment.
65.25 	(d) Persons with developmental disabilities who apply for services under the nursing 
65.26 	facility level waiver programs shall be screened for the appropriate level of care according 
65.27 	to section 256B.092.
65.28 	(e) (d) Recipients who are found eligible for home and community-based services 
65.29 	under this section before their 65th birthday may remain eligible for these services after 
65.30 	their 65th birthday if they continue to meet all other eligibility factors.

65.31 	Sec. 38. Minnesota Statutes 2010, section 256B.49, subdivision 15, is amended to read:
65.32 		Subd. 15.IndividualizedCoordinated service and support plan. (a) Each 
65.33 	recipient of home and community-based waivered services shall be provided a copy of the 
65.34 	written servicecoordinated service and support plan which:
66.1 	(1) is developed and signed by the recipient within ten working days of the 
66.2 	completion of the assessment;
66.3 	(2) meets the assessed needs of the recipient;
66.4 	(3) reasonably ensures the health and safety of the recipient;
66.5 	(4) promotes independence;
66.6 	(5) allows for services to be provided in the most integrated settings; and
66.7 	(6) provides for an informed choice, as defined in section 256B.77, subdivision 
66.8 	2, paragraph (p), of service and support providers meets the requirements in section 
66.9 	256B.092, subdivision 1b.
66.10 	(b) When a county is evaluating denials, reductions, or terminations of home and 
66.11 	community-based services under section 256B.49 for an individual, the case manager 
66.12 	shall offer to meet with the individual or the individual's guardian in order to discuss the 
66.13 	prioritization of service needs within the individualized service coordinated services and 
66.14 	support plan. The reduction in the authorized services for an individual due to changes 
66.15 	in funding for waivered services may not exceed the amount needed to ensure medically 
66.16 	necessary services to meet the individual's health, safety, and welfare.

66.17 	Sec. 39. Minnesota Statutes 2010, section 256G.02, subdivision 6, is amended to read:
66.18 		Subd. 6.Excluded time. "Excluded time" means:
66.19 	(a) (1) any period an applicant spends in a hospital, sanitarium, nursing home, 
66.20 	shelter other than an emergency shelter, halfway house, foster home, semi-independent 
66.21 	living domicile or services program, residential facility offering care, board and lodging 
66.22 	facility or other institution for the hospitalization or care of human beings, as defined in 
66.23 	section 144.50, 144A.01, or 245A.02, subdivision 14; maternity home, battered women's 
66.24 	shelter, or correctional facility; or any facility based on an emergency hold under sections 
66.25 	253B.05, subdivisions 1 and 2, and 253B.07, subdivision 6;
66.26 	(b) (2) any period an applicant spends on a placement basis in a training and 
66.27 	habilitation program, including: a rehabilitation facility or work or employment program 
66.28 	as defined in section 268A.01; or receiving personal care assistance services pursuant to 
66.29 	section 256B.0659; semi-independent living services provided under section 252.275, and 
66.30 	Minnesota Rules, parts 9525.0500 to 9525.0660; or day training and habilitation programs 
66.31 	and assisted living services; and
66.32 	(c) (3) any placement for a person with an indeterminate commitment, including 
66.33 	independent living.

67.1 	Sec. 40. RECOMMENDATIONS FOR FURTHER CASE MANAGEMENT 
67.2 	REDESIGN.
 67.3 	By February 1, 2012, the commissioner of human services shall develop a legislative 
67.4 	report with specific recommendations and language for proposed legislation to be effective 
67.5 	July 1, 2012, for the following:
67.6 	(a) definitions of service and consolidation of standards and rates to the extent 
67.7 	appropriate for all types of medical assistance case management service services, including 
67.8 	targeted case management under Minnesota Statutes, sections 256B.0621, 256B.0924, and 
67.9 	256B.094, and all types of home and community-based waiver case management and case 
67.10 	management under Minnesota Rules, parts 9525.0004 to 9525.0036. This work must be 
67.11 	completed in collaboration with efforts under Minnesota Statutes, section 256B.4912;
67.12 	(b) recommendations on county of financial responsibility requirements and quality 
67.13 	assurance measures for case management; and
67.14 	(c) identification of county administrative functions that may remain entwined in 
67.15 	case management service delivery models.

67.16 	ARTICLE 4
67.17 	NURSING FACILITIES

67.18 	Section 1. Minnesota Statutes 2010, section 144A.071, subdivision 3, is amended to 
67.19 	read:
67.20 		Subd. 3.Exceptions authorizing increase in beds; hardship areas. (a) The 
67.21 	commissioner of health, in coordination with the commissioner of human services, may 
67.22 	approve the addition of a new certified bed or the addition of a new licensed and Medicare 
67.23 	and Medicaid-certified nursing home bed beds, under using the following conditions:
67.24 	criteria and process in this subdivision.
67.25 	(a) to license or certify a new bed in place of one decertified after July 1, 1993, as 
67.26 	long as the number of certified plus newly certified or recertified beds does not exceed the 
67.27 	number of beds licensed or certified on July 1, 1993, or to address an extreme hardship 
67.28 	situation, in a particular county that, together with all contiguous Minnesota counties, has 
67.29 	fewer nursing home beds per 1,000 elderly than the number that is ten percent higher than 
67.30 	the national average of nursing home beds per 1,000 elderly individuals. For the purposes 
67.31 	of this section, the national average of nursing home beds shall be the most recent figure 
67.32 	that can be supplied by the federal Centers for Medicare and Medicaid Services and the 
67.33 	number of elderly in the county or the nation shall be determined by the most recent 
67.34 	federal census or the most recent estimate of the state demographer as of July 1, of each 
67.35 	year of persons age 65 and older, whichever is the most recent at the time of the request for 
68.1 	replacement. An extreme hardship situation can only be found after the county documents 
68.2 	the existence of unmet medical needs that cannot be addressed by any other alternatives;
68.3 	(b) The commissioner, in cooperation with the commissioner of human services, 
68.4 	shall consider the following criteria when determining that an area of the state is a 
68.5 	hardship area with regard to access to nursing facility services:
68.6 	(1) a low number of beds per 1,000 in a specified area using as a standard beds 
68.7 	per 1,000 persons age 65 and older, in five-year age groups, using data from the most 
68.8 	recent census and population projections, weighted by each group's most recent nursing 
68.9 	home utilization, of the county at the 20th percentile, as determined by the commissioner 
68.10 	of human services;
68.11 	(2) a high level of out-migration for nursing facility services associated with a 
68.12 	described area from the county or counties of residence to other Minnesota counties, as 
68.13 	determined by the commissioner of human services, using as a standard an amount greater 
68.14 	than the out-migration of the county ranked at the 50th percentile;
68.15 	(3) an adequate level of availability of noninstitutional long-term care services 
68.16 	measured as public spending for home and community-based long-term care services per 
68.17 	individual age 65 and older, in five-year age groups, using data from the most recent 
68.18 	census and population projections, weighted by each group's most recent nursing home 
68.19 	utilization, as determined by the commissioner of human services, using as a standard an 
68.20 	amount greater than the 50th percentile of counties; 
68.21 	(4) there must be a declaration of hardship resulting from insufficient access to 
68.22 	nursing home beds by local county agencies and area agencies on aging; and
68.23 	(5) other factors that may demonstrate the need to add new nursing facility beds.
68.24 	(c) On August 15 of odd-numbered years, the commissioner, in cooperation with 
68.25 	the commissioner of human services, may publish in the State Register a request for 
68.26 	information in which interested parties, using the data provided under section 144A.351, 
68.27 	along with any other relevant data, demonstrate that a specified area is a hardship area 
68.28 	with regard to access to nursing facility services. For a response to be considered, the 
68.29 	commissioner must receive it by November 15. The commissioner shall make responses 
68.30 	to the request for information available to the public and shall allow 30 days for comment. 
68.31 	The commissioner shall review responses and comments and determine if any areas of 
68.32 	the state are to be declared hardship areas. 
68.33 	(d) For each designated hardship area determined in paragraph (c), the commissioner 
68.34 	shall publish a request for proposals in accordance with section 144A.073 and Minnesota 
68.35 	Rules, parts 4655.1070 to 4655.1098. The request for proposals must be published in the 
68.36 	State Register by March 15 following receipt of responses to the request for information. 
69.1 	The request for proposals must specify the number of new beds which may be added 
69.2 	in the designated hardship area, which must not exceed the number which, if added to 
69.3 	the existing number of beds in the area, including beds in layaway status, would have 
69.4 	prevented it from being determined to be a hardship area under paragraph (b), clause 
69.5 	(1). Beginning July 1, 2011, the number of new beds approved must not exceed 200 
69.6 	beds statewide per biennium. After June 30, 2019, the number of new beds that may be 
69.7 	approved in a biennium must not exceed 300 statewide. For a proposal to be considered, 
69.8 	the commissioner must receive it within six months of the publication of the request for 
69.9 	proposals. The commissioner shall review responses to the request for proposals and 
69.10 	shall approve or disapprove each proposal by the following July 15, in accordance with 
69.11 	section 144A.073 and Minnesota Rules, parts 4655.1070 to 4655.1098. The commissioner 
69.12 	shall base approvals or disapprovals on a comparison and ranking of proposals using 
69.13 	only the criteria in subdivision 4a. Approval of a proposal expires after 18 months 
69.14 	unless the facility has added the new beds using existing space, subject to approval 
69.15 	by the commissioner, or has commenced construction as defined in section 144A.071, 
69.16 	subdivision 1a, paragraph (d). If fewer than 50 percent of the beds in a facility are newly 
69.17 	licensed, after the beds have been added, the operating payment rates previously in effect 
69.18 	shall remain. If 50 percent or more of the beds in a facility are newly licensed after the 
69.19 	approved beds have been added, then determination of operating payment rates shall 
69.20 	be done according to Minnesota Rules, part 9549.0057, using limits determined under 
69.21 	section 256B.441. Determination of external fixed payment rates must be done according 
69.22 	to section 256B.441, subdivision 53. Determinations of property payment rates for 
69.23 	facilities with beds added under this subdivision must be done in the same manner as rate 
69.24 	determinations resulting from projects approved and completed under section 144A.073. 
69.25 	(b) to (e) The commissioner may:
69.26 	(1) certify or license new beds in a new facility that is to be operated by the 
69.27 	commissioner of veterans affairs or when the costs of constructing and operating the new 
69.28 	beds are to be reimbursed by the commissioner of veterans affairs or the United States 
69.29 	Veterans Administration; and
69.30 	(c) to (2) license or certify beds in a facility that has been involuntarily delicensed or 
69.31 	decertified for participation in the medical assistance program, provided that an application 
69.32 	for relicensure or recertification is submitted to the commissioner by an organization that 
69.33 	is not a related organization as defined in section 256B.441, subdivision 34, to the prior 
69.34 	licensee within 120 days after delicensure or decertification;.
70.1 	(d) to certify two existing beds in a facility with 66 licensed beds on January 1, 1994, 
70.2 	that had an average occupancy rate of 98 percent or higher in both calendar years 1992 and 
70.3 	1993, and which began construction of four attached assisted living units in April 1993; or
70.4 	(e) to certify four existing beds in a facility in Winona with 139 beds, of which 129 
70.5 	beds are certified.

70.6 	Sec. 2. Minnesota Statutes 2010, section 144A.073, subdivision 3c, is amended to read:
70.7 		Subd. 3c.Cost neutral relocation projects. (a) Notwithstanding subdivision 3, the 
70.8 	commissioner may at any time accept proposals, or amendments to proposals previously 
70.9 	approved under this section, for relocations that are cost neutral with respect to state costs 
70.10 	as defined in section 144A.071, subdivision 5a. The commissioner, in consultation with 
70.11 	the commissioner of human services, shall evaluate proposals according to subdivision 
70.12 	4 4a, clauses (1), (2), (3), and (9) (4), (5), (6), and (8), and other criteria established in 
70.13 	rule.or law. The commissioner of human services shall determine the allowable payment 
70.14 	rates of the facility receiving the beds in accordance with section 256B.441, subdivision 
70.15 	60. The commissioner shall approve or disapprove a project within 90 days. Proposals 
70.16 	and amendments approved under this subdivision are not subject to the six-mile limit 
70.17 	in subdivision 5, paragraph (e).
70.18 	(b) For the purposes of paragraph (a), cost neutrality shall be measured over the first 
70.19 	three 12-month periods of operation after completion of the project.

70.20 	Sec. 3. Minnesota Statutes 2010, section 144A.073, is amended by adding a 
70.21 	subdivision to read:
70.22 		Subd. 4a.Criteria for review. In reviewing the application materials and submitted 
70.23 	costs by an applicant to the moratorium process, the review panel shall consider the 
70.24 	following criteria in recommending proposals:
70.25 	(1) the extent to which the proposed nursing home project is integrated with other 
70.26 	health and long-term care services for older adults;
70.27 	(2) the extent to which the project provides for the complete replacement of an 
70.28 	outdated physical plant;
70.29 	(3) the extent to which the project results in a reduction of nursing facility beds in an 
70.30 	area that has a relatively high number of beds per thousand occupied by persons age 85 
70.31 	and over;
70.32 	(4) the extent to which the project produces improvements in health, safety 
70.33 	(including life safety code corrections), quality of life, and privacy of residents;
71.1 	(5) the extent to which, under the current facility ownership and management, the 
71.2 	provider has shown the ability to provide good quality of care based on health-related 
71.3 	findings on certification surveys, quality indicator scores, and quality-of-life scores, 
71.4 	including those from the Minnesota nursing home report card;
71.5 	(6) the extent to which the project integrates the latest technology and design 
71.6 	features in a way that improves the resident experience and improves the working 
71.7 	environment for employees;
71.8 	(7) the extent to which the sustainability of the nursing facility can be demonstrated 
71.9 	based on the need for services in the area and the proposed financing of the project; and
71.10 	(8) the extent to which the project provides or maintains access to nursing facility 
71.11 	services needed in the community.

71.12 	Sec. 4. Minnesota Statutes 2010, section 144D.08, is amended to read:
71.13 	144D.08 UNIFORM CONSUMER INFORMATION GUIDE.
71.14 	All housing with services establishments shall make available to all prospective 
71.15 	and current residents information consistent with the uniform format and the required 
71.16 	components adopted by the commissioner under section 144G.06. This section does not 
71.17 	apply to an establishment registered under section 144D.025, serving the homeless.

71.18 	Sec. 5. Minnesota Statutes 2010, section 256B.19, subdivision 1e, is amended to read:
71.19 		Subd. 1e.Additional local share of certain nursing facility costs. Beginning on 
71.20 	the latter of January 1, 2011, or the first day of the month beginning no less than 45 days 
71.21 	following federal approval, local government entities that own the physical plant or are 
71.22 	the license holders of nursing facilities receiving rate adjustments under section 256B.441, 
71.23 	subdivision 55a, shall be responsible for paying the portion of nonfederal costs calculated 
71.24 	under section 256B.441, subdivision 55a, paragraph (d). This responsibility remains in 
71.25 	effect through the day before the phase-in under section 256B.441, subdivision 55, is 
71.26 	complete. Beginning the day when the phase-in under section 256B.441, subdivision 55, 
71.27 	is complete, local government entities that own the physical plant or are the license holders 
71.28 	of nursing facilities receiving rate adjustments under section 256B.441, subdivision 55a, 
71.29 	shall be responsible for paying the portion of nonfederal costs calculated under section 
71.30 	256B.441, subdivision 55a, paragraph (e). Payments of the nonfederal share shall be 
71.31 	made monthly to the commissioner in amounts determined in accordance with section 
71.32 	256B.441, subdivision 55a, paragraph (d) (e). Payments for each month beginning in 
71.33 	January 2011 through September 2015 on the effective date of the rate adjustment  shall be 
71.34 	due by the 15th day of the following month. If any provider obligated to pay an amount 
72.1 	under this subdivision is more than two months 30 days delinquent in the timely payment 
72.2 	of the monthly installment, the commissioner may withhold payments, penalties, and 
72.3 	interest in accordance with the methods outlined in section 256.9657, subdivision 7a
72.4 	revoke participation under this subdivision and end payments determined under section 
72.5 	256B.441, subdivision 55a, to the participating nursing facility effective on the first day 
72.6 	of the month following the month in which such notice was mailed. In the event of 
72.7 	revocation, any amounts paid by private residents under this subdivision for days of 
72.8 	service on or after the first day of the month following the month in which such notice was 
72.9 	mailed must be refunded.

72.10 	Sec. 6. Minnesota Statutes 2010, section 256B.431, subdivision 2t, is amended to read:
72.11 		Subd. 2t.Payment limitation. For services rendered on or after July 1, 2003, 
72.12 	for facilities reimbursed under this section or section 256B.434 chapter, the Medicaid 
72.13 	program shall only pay a co-payment during a Medicare-covered skilled nursing facility 
72.14 	stay if the Medicare rate less the resident's co-payment responsibility is less than the 
72.15 	Medicaid RUG-III case-mix payment rate, or, beginning January 1, 2012, the Medicaid 
72.16 	RUG-IV case-mix payment rate. The amount that shall be paid by the Medicaid program 
72.17 	is equal to the amount by which the Medicaid RUG-III or RUG-IV case-mix payment 
72.18 	rate exceeds the Medicare rate less the co-payment responsibility. Health plans paying 
72.19 	for nursing home services under section 256B.69, subdivision 6a, may limit payments as 
72.20 	allowed under this subdivision.

72.21 	Sec. 7. Minnesota Statutes 2010, section 256B.438, subdivision 1, is amended to read:
72.22 		Subdivision 1.Scope. This section establishes the method and criteria used to 
72.23 	determine resident reimbursement classifications based upon the assessments of residents 
72.24 	of nursing homes and boarding care homes whose payment rates are established under 
72.25 	section 256B.431, 256B.434, or 256B.435256B.441 or any other section. Resident 
72.26 	reimbursement classifications shall be established according to the 34 group, resource 
72.27 	utilization groups, version III or RUG-III model as described in section 144.0724. 
72.28 	Reimbursement classifications established under this section shall be implemented 
72.29 	after June 30, 2002, but no later than January 1, 2003. Reimbursement classifications 
72.30 	established under this section shall be implemented no earlier than six weeks after the 
72.31 	commissioner mails notices of payment rates to the facilities. Effective January 1, 2012, 
72.32 	resident reimbursement classifications shall be established according to the 48 group, 
72.33 	resource utilization groups, RUG-IV model under section 144.0724.

73.1 	Sec. 8. Minnesota Statutes 2010, section 256B.438, subdivision 3, is amended to read:
73.2 		Subd. 3.Case mix indices. (a) The commissioner of human services shall assign a 
73.3 	case mix index to each resident class based on the Centers for Medicare and Medicaid 
73.4 	Services staff time measurement study and adjusted for Minnesota-specific wage indices. 
73.5 	The case mix indices assigned to each resident class shall be published in the Minnesota 
73.6 	State Register at least 120 days prior to the implementation of the 34 group, RUG-III 
73.7 	resident classification system.
73.8 	(b) An index maximization approach shall be used to classify residents.
73.9 	(c) After implementation of the revised case mix system, the commissioner of 
73.10 	human services may annually rebase case mix indices and base rates using more current 
73.11 	data on average wage rates and staff time measurement studies. This rebasing shall be 
73.12 	calculated under subdivision 7, paragraph (b). The commissioner shall publish in the 
73.13 	Minnesota State Register adjusted case mix indices at least 45 days prior to the effective 
73.14 	date of the adjusted case mix indices.
73.15 	(d) Upon implementation of the 48-group RUG-IV resident classification system, the 
73.16 	commissioner of human services shall assign a case mix index to each resident class based 
73.17 	on the Centers for Medicare and Medicaid Services staff time measurement study. The 
73.18 	case mix indices assigned to each resident class shall be published in the State Register at 
73.19 	least 120 days prior to the implementation of the RUG-IV resident classification system.

73.20 	Sec. 9. Minnesota Statutes 2010, section 256B.438, subdivision 4, is amended to read:
73.21 		Subd. 4.Resident assessment schedule. (a) Nursing facilities shall conduct and 
73.22 	submit case mix assessments according to the schedule established by the commissioner 
73.23 	of health under section 144.0724, subdivisions 4 and 5.
73.24 	(b) The resident reimbursement classifications established under section 144.0724, 
73.25 	subdivision 3, shall be effective the day of admission for new admission assessments. 
73.26 	The effective date for significant change assessments shall be the assessment reference 
73.27 	date. The effective date for annual and quarterly assessments shall be the first day of the 
73.28 	month following assessment reference date.
73.29 	(c) Effective October 1, 2006, the commissioner shall rebase payment rates 
73.30 	to account for the change in the resident assessment schedule in section 144.0724, 
73.31 	subdivision 4, paragraph (b), clause (4), in a facility specific budget neutral manner, 
73.32 	according to subdivision 7, paragraph (b).
73.33 	(d) Effective January 1, 2012, the commissioner shall determine payment rates 
73.34 	to account for the transition to RUG-IV, in a facility-specific, revenue-neutral manner, 
73.35 	according to subdivision 8, paragraph (b).

74.1 	Sec. 10. Minnesota Statutes 2010, section 256B.438, is amended by adding a 
74.2 	subdivision to read:
74.3 		Subd. 8.Rate determination upon transition to RUG-IV payment rates. (a) The 
74.4 	commissioner of human services shall determine payment rates at the time of transition 
74.5 	to the RUG-IV-based payment model in a facility-specific, revenue-neutral manner. To 
74.6 	transition from the current calculation methodology to the RUG-IV-based methodology, 
74.7 	nursing facilities shall report to the commissioner of human services the private pay 
74.8 	and Medicaid resident days classified according to the categories defined in subdivision 
74.9 	3, paragraphs (a) and (d), for the six-month reporting period ending June 30, 2011. This 
74.10 	report must be submitted to the commissioner, in a form prescribed by the commissioner, 
74.11 	by August 15, 2011. The commissioner of human services shall use this data to compute 
74.12 	the standardized days for the RUG-III and RUG-IV classification systems.
74.13 	(b) The commissioner of human services shall determine the case mix adjusted 
74.14 	component for the January 1, 2012, rate as follows:
74.15 	(1) using the September 30, 2010, cost report, determine the case mix portion of the 
74.16 	operating cost for each facility;
74.17 	(2) multiply the 36 operating payment rates in effect on December 31, 2011, by the 
74.18 	number of private pay and Medicaid resident days assigned to each group for the reporting 
74.19 	period ending June 30, 2011, and compute the total;
74.20 	(3) compute the product of the amounts in clauses (1) and (2);
74.21 	(4) determine the private pay and Medicaid RUG standardized days for the reporting 
74.22 	period ending June 30, 2011, using the new indices calculated under subdivision 3, 
74.23 	paragraph (d);
74.24 	(5) divide the amount determined in clause (3) by the amount in clause (4), which 
74.25 	shall be the default rate (DDF) unadjusted case mix component of the rate under the 
74.26 	RUG-IV method; and
74.27 	(6) determine the case mix adjusted component of each operating rate by multiplying 
74.28 	the default rate (DDF) unadjusted case mix component by the case mix weight in 
74.29 	subdivision 3, paragraph (d), for each RUG-IV group.
74.30 	(c) The noncase mix components will be allocated to each RUG group as a constant 
74.31 	amount to determine the operating payment rate.

74.32 	Sec. 11. Minnesota Statutes 2010, section 256B.441, subdivision 55a, is amended to 
74.33 	read:
74.34 		Subd. 55a.Alternative to phase-in for publicly owned nursing facilities. (a) For 
74.35 	operating payment rates implemented between January 1, 2011, and September 30, 2015,
75.1 	 the first day of the month beginning no less than 45 days following federal approval, 
75.2 	and the day before the phase-in under subdivision 55 is complete, the commissioner 
75.3 	shall allow nursing facilities whose physical plant is owned or whose license is held by a 
75.4 	city, county, or hospital district to apply for a higher payment rate under this section if 
75.5 	the local government entity agrees to pay a specified portion of the nonfederal share 
75.6 	of medical assistance costs. Nursing facilities that apply shall be eligible to select an 
75.7 	operating payment rate, with a weight of 1.00, up to the rate calculated in subdivision 54, 
75.8 	without application of the phase-in under subdivision 55. The rates for the other RUG's 
75.9 	levels RUGS shall be computed as provided under subdivision 54.
75.10 	(b) For operating payment rates implemented beginning the day when the phase-in 
75.11 	under subdivision 55 is complete, the commissioner shall allow nursing facilities whose 
75.12 	physical plant is owned or whose license is held by a city, county, or hospital district to 
75.13 	apply for a higher payment rate under this section if the local government entity agrees 
75.14 	to pay a specified portion of the nonfederal share of medical assistance costs. Nursing 
75.15 	facilities that apply are eligible to select an operating payment rate, with a weight of 1.00, 
75.16 	up to an amount determined by the commissioner to be allowable under the Medicare upper 
75.17 	payment limit test. The rates for the other RUGS shall be computed under subdivision 54.
75.18 	(b) (c) Rates determined under this subdivision shall take effect beginning on the 
75.19 	latter of January 1, 2011, or the first day of the month beginning no less than 45 days 
75.20 	following federal approval, based on cost reports for the rate year ending September 30, 
75.21 	2009, and in future rate years, rates determined for nursing facilities participating under 
75.22 	this subdivision shall take effect on October 1 of each year, based on the most recent 
75.23 	available cost report.
75.24 	(c) (d) Eligible nursing facilities that wish to participate under this subdivision shall 
75.25 	make an application to the commissioner by September 30, 2010, or by June 30 of any 
75.26 	subsequent year. Participation under this subdivision is irrevocable. If paragraph (a) does 
75.27 	not result in a rate greater than what would have been provided without application of this 
75.28 	subdivision, a facility's rates shall be calculated as otherwise provided and no payment by 
75.29 	the local government entity shall be required under paragraph (d).
75.30 	(d)(e) For each participating nursing facility, the public entity that owns the physical 
75.31 	plant or is the license holder of the nursing facility shall pay to the state the entire 
75.32 	nonfederal share of medical assistance payments received as a result of the difference 
75.33 	between the nursing facility's payment rate under subdivision 54, paragraph (a) or (b), 
75.34 	and the rates that the nursing facility would otherwise be paid without application of this 
75.35 	subdivision under subdivision 54 or 55 as determined by the commissioner.
76.1 	(e)(f) The commissioner may, at any time, reduce the payments under this 
76.2 	subdivision based on the commissioner's determination that the payments shall cause 
76.3 	nursing facility rates to exceed the state's Medicare upper payment limit or any other 
76.4 	federal limitation. If the commissioner determines a reduction is necessary, the 
76.5 	commissioner shall reduce all payment rates for participating nursing facilities by a 
76.6 	percentage applied to the amount of increase they would otherwise receive under this 
76.7 	subdivision and shall notify participating facilities of the reductions. If payments to a 
76.8 	nursing facility are reduced, payments under section 256B.19, subdivision 1e, shall be 
76.9 	reduced accordingly.

76.10 	Sec. 12. Minnesota Statutes 2010, section 256B.441, is amended by adding a 
76.11 	subdivision to read:
76.12 		Subd. 60.Method for determining budget-neutral nursing facility rates for 
76.13 	relocated beds. (a) Nursing facility rates for bed relocations must be calculated by 
76.14 	comparing the estimated medical assistance costs prior to and after the proposed bed 
76.15 	relocation using the calculations in this subdivision. All payment rates are based on a 1.0 
76.16 	case mix level, with other case mix rates determined accordingly. Nursing facility beds 
76.17 	on layaway status that are being moved must be included in the calculation for both the 
76.18 	originating and receiving facility and treated as though they were in active status with the 
76.19 	occupancy characteristics of the active beds of the originating facility.
76.20 	(b) Medical assistance costs of the beds in the originating nursing facilities must 
76.21 	be calculated as follows:
76.22 	(1) multiply each originating facility's total payment rate for a RUGS weight of 1.0 
76.23 	by the facility's percentage of medical assistance days on its most recent available cost 
76.24 	report;
76.25 	(2) take the products in clause (1) and multiply by each facility's average case mix 
76.26 	score for medical assistance residents on its most recent available cost report;
76.27 	(3) take the products in clause (2) and multiply by the number of beds being 
76.28 	relocated, times 365; and
76.29 	(4) calculate the sum of the amounts determined in clause (3).
76.30 	(c) Medical assistance costs in the receiving facility, prior to the bed relocation, must 
76.31 	be calculated as follows:
76.32 	(1) multiply the facility's total payment rate for a RUGS weight of 1.0 by the medical 
76.33 	assistance days on the most recent cost report; and
76.34 	(2) multiply the product in clause (1) by the average case mix weight of medical 
76.35 	assistance residents on the most recent cost report.
77.1 	(d) The commissioner shall determine the medical assistance costs prior to the bed 
77.2 	relocation which must be the sum of the amounts determined in paragraphs (b) and (c).
77.3 	(e) The commissioner shall estimate the medical assistance costs after the bed 
77.4 	relocation as follows:
77.5 	(1) estimate the medical assistance days in the receiving facility after the bed 
77.6 	relocation. The commissioner may use the current medical assistance portion, or if data 
77.7 	does not exist, may use the statewide average, or may use the provider's estimate of the 
77.8 	medical assistance utilization of the relocated beds;
77.9 	(2) estimate the average case mix weight of medical assistance residents in the 
77.10 	receiving facility after the bed relocation. The commissioner may use current average 
77.11 	case mix weight or, if data does not exist, may use the statewide average, or may use the 
77.12 	provider's estimate of the average case mix weight; and
77.13 	(3) multiply the amount determined in clause (1) by the amount determined in 
77.14 	clause (2) by the total payment rate for a RUGS weight of 1.0 that is the highest rate of 
77.15 	the facilities from which the relocated beds either originate or to which they are being 
77.16 	relocated so long as that rate is associated with ten percent or more of the total number of 
77.17 	beds to be in the receiving facility after the bed relocation.
77.18 	(f) If the amount determined in paragraph (e) is less than or equal to the amount 
77.19 	determined in paragraph (d), the commissioner shall allow a total payment rate equal to 
77.20 	the amount used in paragraph (e), clause (3).
77.21 	(g) If the amount determined in paragraph (e) is greater than the amount determined 
77.22 	in paragraph (d), the commissioner shall allow a rate with a RUGS weight of 1.0 that 
77.23 	when used in paragraph (e), clause (3), results in the amount determined in paragraph (e) 
77.24 	being equal to the amount determined in paragraph (d).
77.25 	(h) If the commissioner relies upon provider estimates in paragraph (e), clause (1) 
77.26 	or (2), then annually, for three years after the rates determined in this subdivision take 
77.27 	effect, the commissioner shall determine the accuracy of the alternative factors of medical 
77.28 	assistance case load and RUGS weight used in this subdivision and shall reduce the total 
77.29 	payment rate for a RUGS weight of 1.0 if the factors used result in medical assistance 
77.30 	costs exceeding the amount in paragraph (d). If the actual medical assistance costs exceed 
77.31 	the estimates by more than five percent, the commissioner shall also recover the difference 
77.32 	between the estimated costs in paragraph (e) and the actual costs according to section 
77.33 	256B.0641. The commissioner may require submission of data from the receiving facility 
77.34 	needed to implement this paragraph.
78.1 	(i) When beds approved for relocation are put into active service at the destination 
78.2 	facility, rates determined in this subdivision must be adjusted by any adjustment amounts 
78.3 	that were implemented after the date of the letter of approval.

78.4 	Sec. 13.  REPEALER.
 78.5 	Minnesota Statutes 2010, section 144A.073, subdivisions 4 and 5, are repealed.

78.6 	ARTICLE 5
78.7 	TECHNICAL

78.8 	Section 1. Minnesota Statutes 2010, section 144A.071, subdivision 4a, is amended to 
78.9 	read:
78.10 		Subd. 4a.Exceptions for replacement beds.  It is in the best interest of the state 
78.11 	to ensure that nursing homes and boarding care homes continue to meet the physical 
78.12 	plant licensing and certification requirements by permitting certain construction projects. 
78.13 	Facilities should be maintained in condition to satisfy the physical and emotional needs 
78.14 	of residents while allowing the state to maintain control over nursing home expenditure 
78.15 	growth.
78.16 	The commissioner of health in coordination with the commissioner of human 
78.17 	services, may approve the renovation, replacement, upgrading, or relocation of a nursing 
78.18 	home or boarding care home, under the following conditions:
78.19 	(a) to license or certify beds in a new facility constructed to replace a facility or to 
78.20 	make repairs in an existing facility that was destroyed or damaged after June 30, 1987, by 
78.21 	fire, lightning, or other hazard provided:
78.22 	(i) destruction was not caused by the intentional act of or at the direction of a 
78.23 	controlling person of the facility;
78.24 	(ii) at the time the facility was destroyed or damaged the controlling persons of the 
78.25 	facility maintained insurance coverage for the type of hazard that occurred in an amount 
78.26 	that a reasonable person would conclude was adequate;
78.27 	(iii) the net proceeds from an insurance settlement for the damages caused by the 
78.28 	hazard are applied to the cost of the new facility or repairs;
78.29 	(iv) the new facility is constructed on the same site as the destroyed facility or on 
78.30 	another site subject to the restrictions in section 144A.073, subdivision 5;
78.31 	(v) (iv) the number of licensed and certified beds in the new facility does not exceed 
78.32 	the number of licensed and certified beds in the destroyed facility; and
78.33 	(vi) (v) the commissioner determines that the replacement beds are needed to 
78.34 	prevent an inadequate supply of beds.
79.1 	Project construction costs incurred for repairs authorized under this clause shall not be 
79.2 	considered in the dollar threshold amount defined in subdivision 2;
79.3 	(b) to license or certify beds that are moved from one location to another within a 
79.4 	nursing home facility, provided the total costs of remodeling performed in conjunction 
79.5 	with the relocation of beds does not exceed $1,000,000;
79.6 	(c) to license or certify beds in a project recommended for approval under section 
79.7 	144A.073;
79.8 	(d) to license or certify beds that are moved from an existing state nursing home to 
79.9 	a different state facility, provided there is no net increase in the number of state nursing 
79.10 	home beds;
79.11 	(e) to certify and license as nursing home beds boarding care beds in a certified 
79.12 	boarding care facility if the beds meet the standards for nursing home licensure, or in a 
79.13 	facility that was granted an exception to the moratorium under section 144A.073, and if 
79.14 	the cost of any remodeling of the facility does not exceed $1,000,000. If boarding care 
79.15 	beds are licensed as nursing home beds, the number of boarding care beds in the facility 
79.16 	must not increase beyond the number remaining at the time of the upgrade in licensure. 
79.17 	The provisions contained in section 144A.073 regarding the upgrading of the facilities 
79.18 	do not apply to facilities that satisfy these requirements;
79.19 	(f) to license and certify up to 40 beds transferred from an existing facility owned and 
79.20 	operated by the Amherst H. Wilder Foundation in the city of St. Paul to a new unit at the 
79.21 	same location as the existing facility that will serve persons with Alzheimer's disease and 
79.22 	other related disorders. The transfer of beds may occur gradually or in stages, provided 
79.23 	the total number of beds transferred does not exceed 40. At the time of licensure and 
79.24 	certification of a bed or beds in the new unit, the commissioner of health shall delicense 
79.25 	and decertify the same number of beds in the existing facility. As a condition of receiving 
79.26 	a license or certification under this clause, the facility must make a written commitment 
79.27 	to the commissioner of human services that it will not seek to receive an increase in its 
79.28 	property-related payment rate as a result of the transfers allowed under this paragraph;
79.29 	(g) to license and certify nursing home beds to replace currently licensed and certified 
79.30 	boarding care beds which may be located either in a remodeled or renovated boarding care 
79.31 	or nursing home facility or in a remodeled, renovated, newly constructed, or replacement 
79.32 	nursing home facility within the identifiable complex of health care facilities in which the 
79.33 	currently licensed boarding care beds are presently located, provided that the number of 
79.34 	boarding care beds in the facility or complex are decreased by the number to be licensed 
79.35 	as nursing home beds and further provided that, if the total costs of new construction, 
79.36 	replacement, remodeling, or renovation exceed ten percent of the appraised value of 
80.1 	the facility or $200,000, whichever is less, the facility makes a written commitment to 
80.2 	the commissioner of human services that it will not seek to receive an increase in its 
80.3 	property-related payment rate by reason of the new construction, replacement, remodeling, 
80.4 	or renovation. The provisions contained in section 144A.073 regarding the upgrading of 
80.5 	facilities do not apply to facilities that satisfy these requirements;
80.6 	(h) to license as a nursing home and certify as a nursing facility a facility that is 
80.7 	licensed as a boarding care facility but not certified under the medical assistance program, 
80.8 	but only if the commissioner of human services certifies to the commissioner of health that 
80.9 	licensing the facility as a nursing home and certifying the facility as a nursing facility will 
80.10 	result in a net annual savings to the state general fund of $200,000 or more;
80.11 	(i) to certify, after September 30, 1992, and prior to July 1, 1993, existing nursing 
80.12 	home beds in a facility that was licensed and in operation prior to January 1, 1992;
80.13 	(j) to license and certify new nursing home beds to replace beds in a facility acquired 
80.14 	by the Minneapolis Community Development Agency as part of redevelopment activities 
80.15 	in a city of the first class, provided the new facility is located within three miles of the site 
80.16 	of the old facility. Operating and property costs for the new facility must be determined 
80.17 	and allowed under section 256B.431 or 256B.434;
80.18 	(k) to license and certify up to 20 new nursing home beds in a community-operated 
80.19 	hospital and attached convalescent and nursing care facility with 40 beds on April 21, 
80.20 	1991, that suspended operation of the hospital in April 1986. The commissioner of human 
80.21 	services shall provide the facility with the same per diem property-related payment rate 
80.22 	for each additional licensed and certified bed as it will receive for its existing 40 beds;
80.23 	(l) to license or certify beds in renovation, replacement, or upgrading projects as 
80.24 	defined in section 144A.073, subdivision 1, so long as the cumulative total costs of the 
80.25 	facility's remodeling projects do not exceed $1,000,000;
80.26 	(m) to license and certify beds that are moved from one location to another for the 
80.27 	purposes of converting up to five four-bed wards to single or double occupancy rooms 
80.28 	in a nursing home that, as of January 1, 1993, was county-owned and had a licensed 
80.29 	capacity of 115 beds;
80.30 	(n) to allow a facility that on April 16, 1993, was a 106-bed licensed and certified 
80.31 	nursing facility located in Minneapolis to layaway all of its licensed and certified nursing 
80.32 	home beds. These beds may be relicensed and recertified in a newly constructed teaching 
80.33 	nursing home facility affiliated with a teaching hospital upon approval by the legislature. 
80.34 	The proposal must be developed in consultation with the interagency committee on 
80.35 	long-term care planning. The beds on layaway status shall have the same status as 
81.1 	voluntarily delicensed and decertified beds, except that beds on layaway status remain 
81.2 	subject to the surcharge in section 256.9657. This layaway provision expires July 1, 1998;
81.3 	(o) to allow a project which will be completed in conjunction with an approved 
81.4 	moratorium exception project for a nursing home in southern Cass County and which is 
81.5 	directly related to that portion of the facility that must be repaired, renovated, or replaced, 
81.6 	to correct an emergency plumbing problem for which a state correction order has been 
81.7 	issued and which must be corrected by August 31, 1993;
81.8 	(p) to allow a facility that on April 16, 1993, was a 368-bed licensed and certified 
81.9 	nursing facility located in Minneapolis to layaway, upon 30 days prior written notice to 
81.10 	the commissioner, up to 30 of the facility's licensed and certified beds by converting 
81.11 	three-bed wards to single or double occupancy. Beds on layaway status shall have the 
81.12 	same status as voluntarily delicensed and decertified beds except that beds on layaway 
81.13 	status remain subject to the surcharge in section 256.9657, remain subject to the license 
81.14 	application and renewal fees under section 144A.07 and shall be subject to a $100 per bed 
81.15 	reactivation fee. In addition, at any time within three years of the effective date of the 
81.16 	layaway, the beds on layaway status may be:
81.17 	(1) relicensed and recertified upon relocation and reactivation of some or all of 
81.18 	the beds to an existing licensed and certified facility or facilities located in Pine River, 
81.19 	Brainerd, or International Falls; provided that the total project construction costs related to 
81.20 	the relocation of beds from layaway status for any facility receiving relocated beds may 
81.21 	not exceed the dollar threshold provided in subdivision 2 unless the construction project 
81.22 	has been approved through the moratorium exception process under section 144A.073;
81.23 	(2) relicensed and recertified, upon reactivation of some or all of the beds within the 
81.24 	facility which placed the beds in layaway status, if the commissioner has determined a 
81.25 	need for the reactivation of the beds on layaway status.
81.26 	The property-related payment rate of a facility placing beds on layaway status 
81.27 	must be adjusted by the incremental change in its rental per diem after recalculating the 
81.28 	rental per diem as provided in section 256B.431, subdivision 3a, paragraph (c). The 
81.29 	property-related payment rate for a facility relicensing and recertifying beds from layaway 
81.30 	status must be adjusted by the incremental change in its rental per diem after recalculating 
81.31 	its rental per diem using the number of beds after the relicensing to establish the facility's 
81.32 	capacity day divisor, which shall be effective the first day of the month following the 
81.33 	month in which the relicensing and recertification became effective. Any beds remaining 
81.34 	on layaway status more than three years after the date the layaway status became effective 
81.35 	must be removed from layaway status and immediately delicensed and decertified;
82.1 	(q) to license and certify beds in a renovation and remodeling project to convert 12 
82.2 	four-bed wards into 24 two-bed rooms, expand space, and add improvements in a nursing 
82.3 	home that, as of January 1, 1994, met the following conditions: the nursing home was 
82.4 	located in Ramsey County; had a licensed capacity of 154 beds; and had been ranked 
82.5 	among the top 15 applicants by the 1993 moratorium exceptions advisory review panel. 
82.6 	The total project construction cost estimate for this project must not exceed the cost 
82.7 	estimate submitted in connection with the 1993 moratorium exception process;
82.8 	(r) to license and certify up to 117 beds that are relocated from a licensed and 
82.9 	certified 138-bed nursing facility located in St. Paul to a hospital with 130 licensed 
82.10 	hospital beds located in South St. Paul, provided that the nursing facility and hospital are 
82.11 	owned by the same or a related organization and that prior to the date the relocation is 
82.12 	completed the hospital ceases operation of its inpatient hospital services at that hospital. 
82.13 	After relocation, the nursing facility's status under section 256B.431, subdivision 2j, shall 
82.14 	be the same as it was prior to relocation. The nursing facility's property-related payment 
82.15 	rate resulting from the project authorized in this paragraph shall become effective no 
82.16 	earlier than April 1, 1996. For purposes of calculating the incremental change in the 
82.17 	facility's rental per diem resulting from this project, the allowable appraised value of 
82.18 	the nursing facility portion of the existing health care facility physical plant prior to the 
82.19 	renovation and relocation may not exceed $2,490,000;
82.20 	(s) to license and certify two beds in a facility to replace beds that were voluntarily 
82.21 	delicensed and decertified on June 28, 1991;
82.22 	(t) to allow 16 licensed and certified beds located on July 1, 1994, in a 142-bed 
82.23 	nursing home and 21-bed boarding care home facility in Minneapolis, notwithstanding 
82.24 	the licensure and certification after July 1, 1995, of the Minneapolis facility as a 147-bed 
82.25 	nursing home facility after completion of a construction project approved in 1993 under 
82.26 	section 144A.073, to be laid away upon 30 days' prior written notice to the commissioner. 
82.27 	Beds on layaway status shall have the same status as voluntarily delicensed or decertified 
82.28 	beds except that they shall remain subject to the surcharge in section 256.9657. The 
82.29 	16 beds on layaway status may be relicensed as nursing home beds and recertified at 
82.30 	any time within five years of the effective date of the layaway upon relocation of some 
82.31 	or all of the beds to a licensed and certified facility located in Watertown, provided that 
82.32 	the total project construction costs related to the relocation of beds from layaway status 
82.33 	for the Watertown facility may not exceed the dollar threshold provided in subdivision 
82.34 	2 unless the construction project has been approved through the moratorium exception 
82.35 	process under section 144A.073.
83.1 	The property-related payment rate of the facility placing beds on layaway status 
83.2 	must be adjusted by the incremental change in its rental per diem after recalculating the 
83.3 	rental per diem as provided in section 256B.431, subdivision 3a, paragraph (c). The 
83.4 	property-related payment rate for the facility relicensing and recertifying beds from 
83.5 	layaway status must be adjusted by the incremental change in its rental per diem after 
83.6 	recalculating its rental per diem using the number of beds after the relicensing to establish 
83.7 	the facility's capacity day divisor, which shall be effective the first day of the month 
83.8 	following the month in which the relicensing and recertification became effective. Any 
83.9 	beds remaining on layaway status more than five years after the date the layaway status 
83.10 	became effective must be removed from layaway status and immediately delicensed 
83.11 	and decertified;
83.12 	(u) to license and certify beds that are moved within an existing area of a facility or 
83.13 	to a newly constructed addition which is built for the purpose of eliminating three- and 
83.14 	four-bed rooms and adding space for dining, lounge areas, bathing rooms, and ancillary 
83.15 	service areas in a nursing home that, as of January 1, 1995, was located in Fridley and had 
83.16 	a licensed capacity of 129 beds;
83.17 	(v) to relocate 36 beds in Crow Wing County and four beds from Hennepin County 
83.18 	to a 160-bed facility in Crow Wing County, provided all the affected beds are under 
83.19 	common ownership;
83.20 	(w) to license and certify a total replacement project of up to 49 beds located in 
83.21 	Norman County that are relocated from a nursing home destroyed by flood and whose 
83.22 	residents were relocated to other nursing homes. The operating cost payment rates for 
83.23 	the new nursing facility shall be determined based on the interim and settle-up payment 
83.24 	provisions of Minnesota Rules, part 9549.0057, and the reimbursement provisions of 
83.25 	section 256B.431, except that subdivision 26, paragraphs (a) and (b), shall not apply until 
83.26 	the second rate year after the settle-up cost report is filed. Property-related reimbursement 
83.27 	rates shall be determined under section 256B.431, taking into account any federal or state 
83.28 	flood-related loans or grants provided to the facility;
83.29 	(x) to license and certify a total replacement project of up to 129 beds located 
83.30 	in Polk County that are relocated from a nursing home destroyed by flood and whose 
83.31 	residents were relocated to other nursing homes. The operating cost payment rates for 
83.32 	the new nursing facility shall be determined based on the interim and settle-up payment 
83.33 	provisions of Minnesota Rules, part 9549.0057, and the reimbursement provisions of 
83.34 	section 256B.431, except that subdivision 26, paragraphs (a) and (b), shall not apply until 
83.35 	the second rate year after the settle-up cost report is filed. Property-related reimbursement 
84.1 	rates shall be determined under section 256B.431, taking into account any federal or state 
84.2 	flood-related loans or grants provided to the facility;
84.3 	(y) to license and certify beds in a renovation and remodeling project to convert 13 
84.4 	three-bed wards into 13 two-bed rooms and 13 single-bed rooms, expand space, and 
84.5 	add improvements in a nursing home that, as of January 1, 1994, met the following 
84.6 	conditions: the nursing home was located in Ramsey County, was not owned by a hospital 
84.7 	corporation, had a licensed capacity of 64 beds, and had been ranked among the top 15 
84.8 	applicants by the 1993 moratorium exceptions advisory review panel. The total project 
84.9 	construction cost estimate for this project must not exceed the cost estimate submitted in 
84.10 	connection with the 1993 moratorium exception process;
84.11 	(z) to license and certify up to 150 nursing home beds to replace an existing 285 
84.12 	bed nursing facility located in St. Paul. The replacement project shall include both the 
84.13 	renovation of existing buildings and the construction of new facilities at the existing 
84.14 	site. The reduction in the licensed capacity of the existing facility shall occur during the 
84.15 	construction project as beds are taken out of service due to the construction process. Prior 
84.16 	to the start of the construction process, the facility shall provide written information to the 
84.17 	commissioner of health describing the process for bed reduction, plans for the relocation 
84.18 	of residents, and the estimated construction schedule. The relocation of residents shall be 
84.19 	in accordance with the provisions of law and rule;
84.20 	(aa) to allow the commissioner of human services to license an additional 36 beds 
84.21 	to provide residential services for the physically disabled under Minnesota Rules, parts 
84.22 	9570.2000 to 9570.3400, in a 198-bed nursing home located in Red Wing, provided that 
84.23 	the total number of licensed and certified beds at the facility does not increase;
84.24 	(bb) to license and certify a new facility in St. Louis County with 44 beds 
84.25 	constructed to replace an existing facility in St. Louis County with 31 beds, which has 
84.26 	resident rooms on two separate floors and an antiquated elevator that creates safety 
84.27 	concerns for residents and prevents nonambulatory residents from residing on the second 
84.28 	floor. The project shall include the elimination of three- and four-bed rooms;
84.29 	(cc) to license and certify four beds in a 16-bed certified boarding care home in 
84.30 	Minneapolis to replace beds that were voluntarily delicensed and decertified on or 
84.31 	before March 31, 1992. The licensure and certification is conditional upon the facility 
84.32 	periodically assessing and adjusting its resident mix and other factors which may 
84.33 	contribute to a potential institution for mental disease declaration. The commissioner of 
84.34 	human services shall retain the authority to audit the facility at any time and shall require 
84.35 	the facility to comply with any requirements necessary to prevent an institution for mental 
84.36 	disease declaration, including delicensure and decertification of beds, if necessary;
85.1 	(dd) to license and certify 72 beds in an existing facility in Mille Lacs County with 
85.2 	80 beds as part of a renovation project. The renovation must include construction of 
85.3 	an addition to accommodate ten residents with beginning and midstage dementia in a 
85.4 	self-contained living unit; creation of three resident households where dining, activities, 
85.5 	and support spaces are located near resident living quarters; designation of four beds 
85.6 	for rehabilitation in a self-contained area; designation of 30 private rooms; and other 
85.7 	improvements;
85.8 	(ee) to license and certify beds in a facility that has undergone replacement or 
85.9 	remodeling as part of a planned closure under section 256B.437;
85.10 	(ff) to license and certify a total replacement project of up to 124 beds located 
85.11 	in Wilkin County that are in need of relocation from a nursing home significantly 
85.12 	damaged by flood. The operating cost payment rates for the new nursing facility shall 
85.13 	be determined based on the interim and settle-up payment provisions of Minnesota 
85.14 	Rules, part 9549.0057, and the reimbursement provisions of section 256B.431, except 
85.15 	that section 256B.431, subdivision 26, paragraphs (a) and (b), shall not apply until the 
85.16 	second rate year after the settle-up cost report is filed. Property-related reimbursement 
85.17 	rates shall be determined under section 256B.431, taking into account any federal or state 
85.18 	flood-related loans or grants provided to the facility;
85.19 	(gg) to allow the commissioner of human services to license an additional nine beds 
85.20 	to provide residential services for the physically disabled under Minnesota Rules, parts 
85.21 	9570.2000 to 9570.3400, in a 240-bed nursing home located in Duluth, provided that the 
85.22 	total number of licensed and certified beds at the facility does not increase;
85.23 	(hh) to license and certify up to 120 new nursing facility beds to replace beds in a 
85.24 	facility in Anoka County, which was licensed for 98 beds as of July 1, 2000, provided the 
85.25 	new facility is located within four miles of the existing facility and is in Anoka County. 
85.26 	Operating and property rates shall be determined and allowed under section 256B.431 and 
85.27 	Minnesota Rules, parts 9549.0010 to 9549.0080, or section 256B.434 or 256B.435. The 
85.28 	provisions of section 256B.431, subdivision 26, paragraphs (a) and (b), do not apply until 
85.29 	the second rate year following settle-up; or
85.30 	(ii) to transfer up to 98 beds of a 129-licensed bed facility located in Anoka County 
85.31 	that, as of March 25, 2001, is in the active process of closing, to a 122-licensed bed 
85.32 	nonprofit nursing facility located in the city of Columbia Heights or its affiliate. The 
85.33 	transfer is effective when the receiving facility notifies the commissioner in writing of the 
85.34 	number of beds accepted. The commissioner shall place all transferred beds on layaway 
85.35 	status held in the name of the receiving facility. The layaway adjustment provisions of 
85.36 	section 256B.431, subdivision 30, do not apply to this layaway. The receiving facility 
86.1 	may only remove the beds from layaway for recertification and relicensure at the receiving 
86.2 	facility's current site, or at a newly constructed facility located in Anoka County. The 
86.3 	receiving facility must receive statutory authorization before removing these beds from 
86.4 	layaway status, or may remove these beds from layaway status if removal from layaway 
86.5 	status is part of a moratorium exception project approved by the commissioner under 
86.6 	section 144A.073.

86.7 	Sec. 2. Minnesota Statutes 2010, section 144A.071, subdivision 5a, is amended to read:
86.8 		Subd. 5a.Cost estimate of a moratorium exception project. (a) For the 
86.9 	purposes of this section and section 144A.073, the cost estimate of a moratorium 
86.10 	exception project shall include the effects of the proposed project on the costs of the state 
86.11 	subsidy for community-based services, nursing services, and housing in institutional 
86.12 	and noninstitutional settings. The commissioner of health, in cooperation with the 
86.13 	commissioner of human services, shall define the method for estimating these costs in the 
86.14 	permanent rule implementing section 144A.073. The commissioner of human services 
86.15 	shall prepare an estimate of the total state annual long-term costs of each moratorium 
86.16 	exception proposal.
86.17 	(b) The interest rate to be used for estimating the cost of each moratorium exception 
86.18 	project proposal shall be the lesser of either the prime rate plus two percentage points, or 
86.19 	the posted yield for standard conventional fixed rate mortgages of the Federal Home Loan 
86.20 	Mortgage Corporation plus two percentage points as published in the Wall Street Journal 
86.21 	and in effect 56 days prior to the application deadline. If the applicant's proposal uses this 
86.22 	interest rate, the commissioner of human services, in determining the facility's actual 
86.23 	property-related payment rate to be established upon completion of the project must use 
86.24 	the actual interest rate obtained by the facility for the project's permanent financing up to 
86.25 	the maximum permitted under subdivision 6 Minnesota Rules, part 9549.0060, subpart 6.
86.26 	The applicant may choose an alternate interest rate for estimating the project's cost. 
86.27 	If the applicant makes this election, the commissioner of human services, in determining 
86.28 	the facility's actual property-related payment rate to be established upon completion of the 
86.29 	project, must use the lesser of the actual interest rate obtained for the project's permanent 
86.30 	financing or the interest rate which was used to estimate the proposal's project cost. For 
86.31 	succeeding rate years, the applicant is at risk for financing costs in excess of the interest 
86.32 	rate selected.

86.33 	Sec. 3. Minnesota Statutes 2010, section 256B.431, subdivision 26, is amended to read:
87.1 		Subd. 26.Changes to nursing facility reimbursement beginning July 1, 1997.
 87.2 	The nursing facility reimbursement changes in paragraphs (a) to (e) shall apply in the 
87.3 	sequence specified in Minnesota Rules, parts 9549.0010 to 9549.0080, and this section, 
87.4 	beginning July 1, 1997.
87.5 	(a) For rate years beginning on or after July 1, 1997, the commissioner shall limit a 
87.6 	nursing facility's allowable operating per diem for each case mix category for each rate 
87.7 	year. The commissioner shall group nursing facilities into two groups, freestanding and 
87.8 	nonfreestanding, within each geographic group, using their operating cost per diem for 
87.9 	the case mix A classification. A nonfreestanding nursing facility is a nursing facility 
87.10 	whose other operating cost per diem is subject to the hospital attached, short length of 
87.11 	stay, or the rule 80 limits. All other nursing facilities shall be considered freestanding 
87.12 	nursing facilities. The commissioner shall then array all nursing facilities in each grouping 
87.13 	by their allowable case mix A operating cost per diem. In calculating a nursing facility's 
87.14 	operating cost per diem for this purpose, the commissioner shall exclude the raw food 
87.15 	cost per diem related to providing special diets that are based on religious beliefs, as 
87.16 	determined in subdivision 2b, paragraph (h). For those nursing facilities in each grouping 
87.17 	whose case mix A operating cost per diem:
87.18 	(1) is at or below the median of the array, the commissioner shall limit the nursing 
87.19 	facility's allowable operating cost per diem for each case mix category to the lesser of 
87.20 	the prior reporting year's allowable operating cost per diem as specified in Laws 1996, 
87.21 	chapter 451, article 3, section 11, paragraph (h), plus the inflation factor as established 
87.22 	in paragraph (d), clause (2), increased by two percentage points, or the current reporting 
87.23 	year's corresponding allowable operating cost per diem; or
87.24 	(2) is above the median of the array, the commissioner shall limit the nursing 
87.25 	facility's allowable operating cost per diem for each case mix category to the lesser of 
87.26 	the prior reporting year's allowable operating cost per diem as specified in Laws 1996, 
87.27 	chapter 451, article 3, section 11, paragraph (h), plus the inflation factor as established 
87.28 	in paragraph (d), clause (2), increased by one percentage point, or the current reporting 
87.29 	year's corresponding allowable operating cost per diem.
87.30 	For purposes of paragraph (a), if a nursing facility reports on its cost report a 
87.31 	reduction in cost due to a refund or credit for a rate year beginning on or after July 1, 1998, 
87.32 	the commissioner shall increase that facility's spend-up limit for the rate year following 
87.33 	the current rate year by the amount of the cost reduction divided by its resident days for 
87.34 	the reporting year preceding the rate year in which the adjustment is to be made.
87.35 	(b) For rate years beginning on or after July 1, 1997, the commissioner shall limit the 
87.36 	allowable operating cost per diem for high cost nursing facilities. After application of the 
88.1 	limits in paragraph (a) to each nursing facility's operating cost per diem, the commissioner 
88.2 	shall group nursing facilities into two groups, freestanding or nonfreestanding, within each 
88.3 	geographic group. A nonfreestanding nursing facility is a nursing facility whose other 
88.4 	operating cost per diem are subject to hospital attached, short length of stay, or rule 80 
88.5 	limits. All other nursing facilities shall be considered freestanding nursing facilities. The 
88.6 	commissioner shall then array all nursing facilities within each grouping by their allowable 
88.7 	case mix A operating cost per diem. In calculating a nursing facility's operating cost per 
88.8 	diem for this purpose, the commissioner shall exclude the raw food cost per diem related to 
88.9 	providing special diets that are based on religious beliefs, as determined in subdivision 2b, 
88.10 	paragraph (h). For those nursing facilities in each grouping whose case mix A operating 
88.11 	cost per diem exceeds 1.0 standard deviation above the median, the commissioner shall 
88.12 	reduce their allowable operating cost per diem by three percent. For those nursing 
88.13 	facilities in each grouping whose case mix A operating cost per diem exceeds 0.5 standard 
88.14 	deviation above the median but is less than or equal to 1.0 standard deviation above the 
88.15 	median, the commissioner shall reduce their allowable operating cost per diem by two 
88.16 	percent. However, in no case shall a nursing facility's operating cost per diem be reduced 
88.17 	below its grouping's limit established at 0.5 standard deviations above the median.
88.18 	(c) For rate years beginning on or after July 1, 1997, the commissioner shall 
88.19 	determine a nursing facility's efficiency incentive by first computing the allowable 
88.20 	difference, which is the lesser of $4.50 or the amount by which the facility's other 
88.21 	operating cost limit exceeds its nonadjusted other operating cost per diem for that rate 
88.22 	year. The commissioner shall compute the efficiency incentive by:
88.23 	(1) subtracting the allowable difference from $4.50 and dividing the result by $4.50;
88.24 	(2) multiplying 0.20 by the ratio resulting from clause (1), and then;
88.25 	(3) adding 0.50 to the result from clause (2); and
88.26 	(4) multiplying the result from clause (3) times the allowable difference.
88.27 	The nursing facility's efficiency incentive payment shall be the lesser of $2.25 or the 
88.28 	product obtained in clause (4).
88.29 	(d) For rate years beginning on or after July 1, 1997, the forecasted price index for 
88.30 	a nursing facility's allowable operating cost per diem shall be determined under clauses 
88.31 	(1) and (2) using the change in the Consumer Price Index-All Items (United States city 
88.32 	average) (CPI-U) as forecasted by Data Resources, Inc. The commissioner shall use the 
88.33 	indices as forecasted in the fourth quarter of the calendar year preceding the rate year, 
88.34 	subject to subdivision 2l, paragraph (c).
89.1 	(1) The CPI-U forecasted index for allowable operating cost per diem shall be based 
89.2 	on the 21-month period from the midpoint of the nursing facility's reporting year to the 
89.3 	midpoint of the rate year following the reporting year.
89.4 	(2) For rate years beginning on or after July 1, 1997, the forecasted index for 
89.5 	operating cost limits referred to in subdivision 21, paragraph (b), shall be based on 
89.6 	the CPI-U for the 12-month period between the midpoints of the two reporting years 
89.7 	preceding the rate year.
89.8 	(e) After applying these provisions for the respective rate years, the commissioner 
89.9 	shall index these allowable operating cost per diem by the inflation factor provided for in 
89.10 	paragraph (d), clause (1), and add the nursing facility's efficiency incentive as computed in 
89.11 	paragraph (c).
89.12 	(f) For the rate years beginning on July 1, 1997, July 1, 1998, and July 1, 1999, a 
89.13 	nursing facility licensed for 40 beds effective May 1, 1992, with a subsequent increase of 
89.14 	20 Medicare/Medicaid certified beds, effective January 26, 1993, in accordance with an 
89.15 	increase in licensure is exempt from paragraphs (a) and (b).
89.16 	(g) For a nursing facility whose construction project was authorized according to 
89.17 	section 144A.073, subdivision 5, paragraph (g), the operating cost payment rates for 
89.18 	the new location shall be determined based on Minnesota Rules, part 9549.0057. The 
89.19 	relocation allowed under section 144A.073, subdivision 5, paragraph (g), and the rate 
89.20 	determination allowed under this paragraph must meet the cost neutrality requirements 
89.21 	of section 144A.073, subdivision 3c. Paragraphs (a) and (b) shall not apply until the 
89.22 	second rate year after the settle-up cost report is filed. Notwithstanding subdivision 2b, 
89.23 	paragraph (g), real estate taxes and special assessments payable by the new location, a 
89.24 	501(c)(3) nonprofit corporation, shall be included in the payment rates determined under 
89.25 	this subdivision for all subsequent rate years.
89.26 	(h)(g) For the rate year beginning July 1, 1997, the commissioner shall compute 
89.27 	the payment rate for a nursing facility licensed for 94 beds on September 30, 1996, 
89.28 	that applied in October 1993 for approval of a total replacement under the moratorium 
89.29 	exception process in section 144A.073, and completed the approved replacement in June 
89.30 	1995, with other operating cost spend-up limit under paragraph (a), increased by $3.98, 
89.31 	and after computing the facility's payment rate according to this section, the commissioner 
89.32 	shall make a one-year positive rate adjustment of $3.19 for operating costs related to the 
89.33 	newly constructed total replacement, without application of paragraphs (a) and (b). The 
89.34 	facility's per diem, before the $3.19 adjustment, shall be used as the prior reporting year's 
89.35 	allowable operating cost per diem for payment rate calculation for the rate year beginning 
90.1 	July 1, 1998. A facility described in this paragraph is exempt from paragraph (b) for the 
90.2 	rate years beginning July 1, 1997, and July 1, 1998.
90.3 	(i) (h) For the purpose of applying the limit stated in paragraph (a), a nursing facility 
90.4 	in Kandiyohi County licensed for 86 beds that was granted hospital-attached status on 
90.5 	December 1, 1994, shall have the prior year's allowable care-related per diem increased 
90.6 	by $3.207 and the prior year's other operating cost per diem increased by $4.777 before 
90.7 	adding the inflation in paragraph (d), clause (2), for the rate year beginning on July 1, 1997.
90.8 	(j) (i) For the purpose of applying the limit stated in paragraph (a), a 117 bed nursing 
90.9 	facility located in Pine County shall have the prior year's allowable other operating cost 
90.10 	per diem increased by $1.50 before adding the inflation in paragraph (d), clause (2), for 
90.11 	the rate year beginning on July 1, 1997.
90.12 	(k) (j) For the purpose of applying the limit under paragraph (a), a nursing facility in 
90.13 	Hibbing licensed for 192 beds shall have the prior year's allowable other operating cost 
90.14 	per diem increased by $2.67 before adding the inflation in paragraph (d), clause (2), 
90.15 	for the rate year beginning July 1, 1997.