1.1 	A bill for an act
1.2 	relating to human services; modifying policy provisions governing disability 
1.3 	services;amending Minnesota Statutes 2018, sections 245A.03, subdivision 7; 
1.4 	245D.03, subdivision 1; 245D.071, subdivisions 1, 3; 245D.091, subdivisions 2, 
1.5 	3, 4; 256B.0652, subdivision 10; 256B.0659, subdivision 3a; 256B.0911, 
1.6 	subdivisions 1a, 3a, 3f; 256B.0915, subdivision 6; 256B.092, subdivision 1b; 
1.7 	256B.49, subdivisions 13, 14; 256B.4914, subdivisions 3, 14; 256B.85, subdivisions 
1.8 	2, 4, 5, 6, 8, 9, 10, 11, 11b, 12, 12b, 13a, 18a, by adding a subdivision.
1.9 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.10 	Section 1. Minnesota Statutes 2018, section 245A.03, subdivision 7, is amended to read:
1.11 		Subd. 7.Licensing moratorium. (a) The commissioner shall not issue an initial license 
1.12 	for child foster care licensed under Minnesota Rules, parts 2960.3000 to 2960.3340, or adult 
1.13 	foster care licensed under Minnesota Rules, parts 9555.5105 to 9555.6265, under this chapter 
1.14 	for a physical location that will not be the primary residence of the license holder for the 
1.15 	entire period of licensure. If a license is issued during this moratorium, and the license 
1.16 	holder changes the license holder's primary residence away from the physical location of 
1.17 	the foster care license, the commissioner shall revoke the license according to section 
1.18 	245A.07. The commissioner shall not issue an initial license for a community residential 
1.19 	setting licensed under chapter 245D. When approving an exception under this paragraph, 
1.20 	the commissioner shall consider the resource need determination process in paragraph (h), 
1.21 	the availability of foster care licensed beds in the geographic area in which the licensee 
1.22 	seeks to operate, the results of a person's choices during their annual assessment and service 
1.23 	plan review, and the recommendation of the local county board. The determination by the 
1.24 	commissioner is final and not subject to appeal. Exceptions to the moratorium include:
1.25 	(1) foster care settings that are required to be registered under chapter 144D;
2.1 	(2) foster care licenses replacing foster care licenses in existence on May 15, 2009, or 
2.2 	community residential setting licenses replacing adult foster care licenses in existence on 
2.3 	December 31, 2013, and determined to be needed by the commissioner under paragraph 
2.4 	(b);
2.5 	(3) new foster care licenses or community residential setting licenses determined to be 
2.6 	needed by the commissioner under paragraph (b) for the closure of a nursing facility, ICF/DD, 
2.7 	or regional treatment center; restructuring of state-operated services that limits the capacity 
2.8 	of state-operated facilities; or allowing movement to the community for people who no 
2.9 	longer require the level of care provided in state-operated facilities as provided under section 
2.10 	256B.092, subdivision 13, or 256B.49, subdivision 24;
2.11 	(4) new foster care licenses or community residential setting licenses determined to be 
2.12 	needed by the commissioner under paragraph (b) for persons requiring hospital level care;
2.13 	(5) new foster care licenses or community residential setting licenses determined to be 
2.14 	needed by the commissioner for the transition of people from personal care assistance to 
2.15 	the home and community-based services;
2.16 	(6) (5) new foster care licenses or community residential setting licenses determined to 
2.17 	be needed by the commissioner for the transition of people from the residential care waiver 
2.18 	services to foster care services. This exception applies only when:
2.19 	(i) the person's case manager provided the person with information about the choice of 
2.20 	service, service provider, and location of service to help the person make an informed choice; 
2.21 	and
2.22 	(ii) the person's foster care services are less than or equal to the cost of the person's 
2.23 	services delivered in the residential care waiver service setting as determined by the lead 
2.24 	agency; or
2.25 	(7) (6) new foster care licenses or community residential setting licenses for people 
2.26 	receiving services under chapter 245D and residing in an unlicensed setting before May 1, 
2.27 	2017, and for which a license is required. This exception does not apply to people living in 
2.28 	their own home. For purposes of this clause, there is a presumption that a foster care or 
2.29 	community residential setting license is required for services provided to three or more 
2.30 	people in a dwelling unit when the setting is controlled by the provider. A license holder 
2.31 	subject to this exception may rebut the presumption that a license is required by seeking a 
2.32 	reconsideration of the commissioner's determination. The commissioner's disposition of a 
2.33 	request for reconsideration is final and not subject to appeal under chapter 14. The exception 
2.34 	is available until June 30, 2018. This exception is available when:
3.1 	(i) the person's case manager provided the person with information about the choice of 
3.2 	service, service provider, and location of service, including in the person's home, to help 
3.3 	the person make an informed choice; and
3.4 	(ii) the person's services provided in the licensed foster care or community residential 
3.5 	setting are less than or equal to the cost of the person's services delivered in the unlicensed 
3.6 	setting as determined by the lead agency.
3.7 	(b) The commissioner shall determine the need for newly licensed foster care homes or 
3.8 	community residential settings as defined under this subdivision. As part of the determination, 
3.9 	the commissioner shall consider the availability of foster care capacity in the area in which 
3.10 	the licensee seeks to operate, and the recommendation of the local county board. The 
3.11 	determination by the commissioner must be final. A determination of need is not required 
3.12 	for a change in ownership at the same address.
3.13 	(c) When an adult resident served by the program moves out of a foster home that is not 
3.14 	the primary residence of the license holder according to section 256B.49, subdivision 15, 
3.15 	paragraph (f), or the adult community residential setting, the county shall immediately 
3.16 	inform the Department of Human Services Licensing Division. The department may decrease 
3.17 	the statewide licensed capacity for adult foster care settings.
3.18 	(d) Residential settings that would otherwise be subject to the decreased license capacity 
3.19 	established in paragraph (c) shall be exempt if the license holder's beds are occupied by 
3.20 	residents whose primary diagnosis is mental illness and the license holder is certified under 
3.21 	the requirements in subdivision 6a or section 245D.33.
3.22 	(e) A resource need determination process, managed at the state level, using the available 
3.23 	reports required by section 144A.351, and other data and information shall be used to 
3.24 	determine where the reduced capacity determined under section 256B.493 will be 
3.25 	implemented. The commissioner shall consult with the stakeholders described in section 
3.26 	144A.351, and employ a variety of methods to improve the state's capacity to meet the 
3.27 	informed decisions of those people who want to move out of corporate foster care or 
3.28 	community residential settings, long-term service needs within budgetary limits, including 
3.29 	seeking proposals from service providers or lead agencies to change service type, capacity, 
3.30 	or location to improve services, increase the independence of residents, and better meet 
3.31 	needs identified by the long-term services and supports reports and statewide data and 
3.32 	information.
3.33 	(f) At the time of application and reapplication for licensure, the applicant and the license 
3.34 	holder that are subject to the moratorium or an exclusion established in paragraph (a) are 
4.1 	required to inform the commissioner whether the physical location where the foster care 
4.2 	will be provided is or will be the primary residence of the license holder for the entire period 
4.3 	of licensure. If the primary residence of the applicant or license holder changes, the applicant 
4.4 	or license holder must notify the commissioner immediately. The commissioner shall print 
4.5 	on the foster care license certificate whether or not the physical location is the primary 
4.6 	residence of the license holder.
4.7 	(g) License holders of foster care homes identified under paragraph (f) that are not the 
4.8 	primary residence of the license holder and that also provide services in the foster care home 
4.9 	that are covered by a federally approved home and community-based services waiver, as 
4.10 	authorized under section 256B.0915, 256B.092, or 256B.49, must inform the human services 
4.11 	licensing division that the license holder provides or intends to provide these waiver-funded 
4.12 	services.
4.13 	(h) The commissioner may adjust capacity to address needs identified in section 
4.14 	144A.351. Under this authority, the commissioner may approve new licensed settings or 
4.15 	delicense existing settings. Delicensing of settings will be accomplished through a process 
4.16 	identified in section 256B.493. Annually, by August 1, the commissioner shall provide 
4.17 	information and data on capacity of licensed long-term services and supports, actions taken 
4.18 	under the subdivision to manage statewide long-term services and supports resources, and 
4.19 	any recommendations for change to the legislative committees with jurisdiction over the 
4.20 	health and human services budget.
4.21 	(i) The commissioner must notify a license holder when its corporate foster care or 
4.22 	community residential setting licensed beds are reduced under this section. The notice of 
4.23 	reduction of licensed beds must be in writing and delivered to the license holder by certified 
4.24 	mail or personal service. The notice must state why the licensed beds are reduced and must 
4.25 	inform the license holder of its right to request reconsideration by the commissioner. The 
4.26 	license holder's request for reconsideration must be in writing. If mailed, the request for 
4.27 	reconsideration must be postmarked and sent to the commissioner within 20 calendar days 
4.28 	after the license holder's receipt of the notice of reduction of licensed beds. If a request for 
4.29 	reconsideration is made by personal service, it must be received by the commissioner within 
4.30 	20 calendar days after the license holder's receipt of the notice of reduction of licensed beds.
4.31 	(j) The commissioner shall not issue an initial license for children's residential treatment 
4.32 	services licensed under Minnesota Rules, parts 2960.0580 to 2960.0700, under this chapter 
4.33 	for a program that Centers for Medicare and Medicaid Services would consider an institution 
4.34 	for mental diseases. Facilities that serve only private pay clients are exempt from the 
4.35 	moratorium described in this paragraph. The commissioner has the authority to manage 
5.1 	existing statewide capacity for children's residential treatment services subject to the 
5.2 	moratorium under this paragraph and may issue an initial license for such facilities if the 
5.3 	initial license would not increase the statewide capacity for children's residential treatment 
5.4 	services subject to the moratorium under this paragraph.

5.5 	EFFECTIVE DATE. This section is effective the day following final enactment.

5.6 	Sec. 2. Minnesota Statutes 2018, section 245D.03, subdivision 1, is amended to read:
5.7 		Subdivision 1.Applicability.  (a) The commissioner shall regulate the provision of home 
5.8 	and community-based services to persons with disabilities and persons age 65 and older 
5.9 	pursuant to this chapter. The licensing standards in this chapter govern the provision of 
5.10 	basic support services and intensive support services.
5.11 	(b) Basic support services provide the level of assistance, supervision, and care that is 
5.12 	necessary to ensure the health and welfare of the person and do not include services that 
5.13 	are specifically directed toward the training, treatment, habilitation, or rehabilitation of the 
5.14 	person. Basic support services include:
5.15 	(1) in-home and out-of-home respite care services as defined in section 245A.02, 
5.16 	subdivision 15, and under the brain injury, community alternative care, community access 
5.17 	for disability inclusion, developmental disability, and elderly waiver plans, excluding 
5.18 	out-of-home respite care provided to children in a family child foster care home licensed 
5.19 	under Minnesota Rules, parts 2960.3000 to 2960.3100, when the child foster care license 
5.20 	holder complies with the requirements under section 245D.06, subdivisions 5, 6, 7, and 8, 
5.21 	or successor provisions; and section 245D.061 or successor provisions, which must be 
5.22 	stipulated in the statement of intended use required under Minnesota Rules, part 2960.3000, 
5.23 	subpart 4;
5.24 	(2) adult companion services as defined under the brain injury, community access for 
5.25 	disability inclusion, community alternative care, and elderly waiver plans, excluding adult 
5.26 	companion services provided under the Corporation for National and Community Services 
5.27 	Senior Companion Program established under the Domestic Volunteer Service Act of 1973, 
5.28 	Public Law 98-288;
5.29 	(3) personal support as defined under the developmental disability waiver plan;
5.30 	(4) 24-hour emergency assistance, personal emergency response as defined under the 
5.31 	community access for disability inclusion and developmental disability waiver plans;
6.1 	(5) night supervision services as defined under the brain injury, community access for 
6.2 	disability inclusion, community alternative care, and developmental disability waiver plan
6.3 	plans;
6.4 	(6) homemaker services as defined under the community access for disability inclusion, 
6.5 	brain injury, community alternative care, developmental disability, and elderly waiver plans, 
6.6 	excluding providers licensed by the Department of Health under chapter 144A and those 
6.7 	providers providing cleaning services only; and
6.8 	(7) individual community living support under section 256B.0915, subdivision 3j.
6.9 	(c) Intensive support services provide assistance, supervision, and care that is necessary 
6.10 	to ensure the health and welfare of the person and services specifically directed toward the 
6.11 	training, habilitation, or rehabilitation of the person. Intensive support services include:
6.12 	(1) intervention services, including:
6.13 	(i) behavioral positive support services as defined under the brain injury and, community 
6.14 	access for disability inclusion, community alternative care, and developmental disability
6.15 	waiver plans;
6.16 	(ii) in-home or out-of-home crisis respite services as defined under the brain injury, 
6.17 	community access for disability inclusion, community alternative care, and developmental 
6.18 	disability waiver plan plans; and
6.19 	(iii) specialist services as defined under the current brain injury, community access for 
6.20 	disability inclusion, community alternative care, and developmental disability waiver plan
6.21 	plans;
6.22 	(2) in-home support services, including:
6.23 	(i) in-home family support and supported living services as defined under the 
6.24 	developmental disability waiver plan;
6.25 	(ii) independent living services training as defined under the brain injury and community 
6.26 	access for disability inclusion waiver plans;
6.27 	(iii) semi-independent living services; and
6.28 	(iv) individualized home supports services as defined under the brain injury, community 
6.29 	alternative care, and community access for disability inclusion waiver plans;
6.30 	(3) residential supports and services, including:
7.1 	(i) supported living services as defined under the developmental disability waiver plan 
7.2 	provided in a family or corporate child foster care residence, a family adult foster care 
7.3 	residence, a community residential setting, or a supervised living facility;
7.4 	(ii) foster care services as defined in the brain injury, community alternative care, and 
7.5 	community access for disability inclusion waiver plans provided in a family or corporate 
7.6 	child foster care residence, a family adult foster care residence, or a community residential 
7.7 	setting; and
7.8 	(iii) residential services provided to more than four persons with developmental 
7.9 	disabilities in a supervised living facility, including ICFs/DD;
7.10 	(4) day services, including:
7.11 	(i) structured day services as defined under the brain injury waiver plan;
7.12 	(ii) day training and habilitation services under sections 252.41 to 252.46, and as defined 
7.13 	under the developmental disability waiver plan; and
7.14 	(iii) prevocational services as defined under the brain injury and community access for 
7.15 	disability inclusion waiver plans; and
7.16 	(5) employment exploration services as defined under the brain injury, community 
7.17 	alternative care, community access for disability inclusion, and developmental disability 
7.18 	waiver plans;
7.19 	(6) employment development services as defined under the brain injury, community 
7.20 	alternative care, community access for disability inclusion, and developmental disability 
7.21 	waiver plans; and
7.22 	(7) employment support services as defined under the brain injury, community alternative 
7.23 	care, community access for disability inclusion, and developmental disability waiver plans.

7.24 	Sec. 3. Minnesota Statutes 2018, section 245D.071, subdivision 1, is amended to read:
7.25 		Subdivision 1.Requirements for intensive support services.  Except for services 
7.26 	identified in section 245D.03, subdivision 1, paragraph (c), clauses (1) and (2), item (ii), a 
7.27 	license holder providing intensive support services identified in section 245D.03, subdivision 
7.28 	1, paragraph (c), must comply with the requirements in this section and section 245D.07, 
7.29 	subdivisions 1, 1a,and 3. Services identified in section 245D.03, subdivision 1, paragraph 
7.30 	(c), clauses (1) and (2), item (ii), must comply with the requirements in section 245D.07, 
7.31 	subdivision 2.

7.32 	EFFECTIVE DATE. This section is effective the day following final enactment.

8.1 	Sec. 4. Minnesota Statutes 2018, section 245D.071, subdivision 3, is amended to read:
8.2 		Subd. 3.Assessment and initial service planning. (a) Within 15 days of service initiation 
8.3 	the license holder must complete a preliminary coordinated service and support plan 
8.4 	addendum based on the coordinated service and support plan.
8.5 	(b) Within the scope of services, the license holder must, at a minimum, complete 
8.6 	assessments in the following areas before the 45-day planning meeting:
8.7 	(1) the person's ability to self-manage health and medical needs to maintain or improve 
8.8 	physical, mental, and emotional well-being, including, when applicable, allergies, seizures, 
8.9 	choking, special dietary needs, chronic medical conditions, self-administration of medication 
8.10 	or treatment orders, preventative screening, and medical and dental appointments;
8.11 	(2) the person's ability to self-manage personal safety to avoid injury or accident in the 
8.12 	service setting, including, when applicable, risk of falling, mobility, regulating water 
8.13 	temperature, community survival skills, water safety skills, and sensory disabilities; and
8.14 	(3) the person's ability to self-manage symptoms or behavior that may otherwise result 
8.15 	in an incident as defined in section 245D.02, subdivision 11, clauses (4) to (7), suspension 
8.16 	or termination of services by the license holder, or other symptoms or behaviors that may 
8.17 	jeopardize the health and welfare of the person or others.
8.18 	Assessments must produce information about the person that describes the person's overall 
8.19 	strengths, functional skills and abilities, and behaviors or symptoms. Assessments must be 
8.20 	based on the person's status within the last 12 months at the time of service initiation. 
8.21 	Assessments based on older information must be documented and justified. Assessments 
8.22 	must be conducted annually at a minimum or within 30 days of a written request from the 
8.23 	person or the person's legal representative or case manager. The results must be reviewed 
8.24 	by the support team or expanded support team as part of a service plan review.
8.25 	(c) Within 45 days of service initiation, the license holder must meet with the person, 
8.26 	the person's legal representative, the case manager, and other members of the support team 
8.27 	or expanded support team to determine the following based on information obtained from 
8.28 	the assessments identified in paragraph (b), the person's identified needs in the coordinated 
8.29 	service and support plan, and the requirements in subdivision 4 and section 245D.07, 
8.30 	subdivision 1a:
8.31 	(1) the scope of the services to be provided to support the person's daily needs and 
8.32 	activities;
9.1 	(2) the person's desired outcomes and the supports necessary to accomplish the person's 
9.2 	desired outcomes;
9.3 	(3) the person's preferences for how services and supports are provided, including how 
9.4 	the provider will support the person to have control of the person's schedule;
9.5 	(4) whether the current service setting is the most integrated setting available and 
9.6 	appropriate for the person; and
9.7 	(5) how services must be coordinated across other providers licensed under this chapter 
9.8 	serving the person and members of the support team or expanded support team to ensure 
9.9 	continuity of care and coordination of services for the person.
9.10 	(d) A discussion of how technology might be used to meet the person's desired outcomes 
9.11 	must be included in the 45-day planning meeting and at least annually thereafter. The 
9.12 	coordinated service and support plan or support plan addendum must include a summary 
9.13 	of this discussion. The summary must include a statement regarding any decision that is 
9.14 	made regarding the use of technology and a description of any further research that needs 
9.15 	to be completed before a decision regarding the use of technology can be made. Nothing 
9.16 	in this paragraph requires that the coordinated service and support plan include the use of 
9.17 	technology for the provision of services.

9.18 	Sec. 5. Minnesota Statutes 2018, section 245D.091, subdivision 2, is amended to read:
9.19 		Subd. 2.Behavior Positive support professional qualifications. A behavior positive 
9.20 	support professional providing behavioral positive support services as identified in section 
9.21 	245D.03, subdivision 1, paragraph (c), clause (1), item (i), must have competencies in the 
9.22 	following areas as required under the brain injury and, community access for disability 
9.23 	inclusion, community alternative care, and development disability waiver plans or successor 
9.24 	plans:
9.25 	(1) ethical considerations;
9.26 	(2) functional assessment;
9.27 	(3) functional analysis;
9.28 	(4) measurement of behavior and interpretation of data;
9.29 	(5) selecting intervention outcomes and strategies;
9.30 	(6) behavior reduction and elimination strategies that promote least restrictive approved 
9.31 	alternatives;
10.1 	(7) data collection;
10.2 	(8) staff and caregiver training;
10.3 	(9) support plan monitoring;
10.4 	(10) co-occurring mental disorders or neurocognitive disorder;
10.5 	(11) demonstrated expertise with populations being served; and
10.6 	(12) must be a:
10.7 	(i) psychologist licensed under sections 148.88 to 148.98, who has stated to the Board 
10.8 	of Psychology competencies in the above identified areas;
10.9 	(ii) clinical social worker licensed as an independent clinical social worker under chapter 
10.10 	148D, or a person with a master's degree in social work from an accredited college or 
10.11 	university, with at least 4,000 hours of post-master's supervised experience in the delivery 
10.12 	of clinical services in the areas identified in clauses (1) to (11);
10.13 	(iii) physician licensed under chapter 147 and certified by the American Board of 
10.14 	Psychiatry and Neurology or eligible for board certification in psychiatry with competencies 
10.15 	in the areas identified in clauses (1) to (11);
10.16 	(iv) licensed professional clinical counselor licensed under sections 148B.29 to 148B.39
10.17 	with at least 4,000 hours of post-master's supervised experience in the delivery of clinical 
10.18 	services who has demonstrated competencies in the areas identified in clauses (1) to (11);
10.19 	(v) person with a master's degree from an accredited college or university in one of the 
10.20 	behavioral sciences or related fields, with at least 4,000 hours of post-master's supervised 
10.21 	experience in the delivery of clinical services with demonstrated competencies in the areas 
10.22 	identified in clauses (1) to (11); or
10.23 	(vi) person with a master's degree or PhD in one of the behavioral sciences or related 
10.24 	field with demonstrated expertise in positive support services, as determined by the person's 
10.25 	case manager based on the person's needs as outlined in the person's community support 
10.26 	plan; or
10.27 	(vi) (vii) registered nurse who is licensed under sections 148.171 to 148.285, and who 
10.28 	is certified as a clinical specialist or as a nurse practitioner in adult or family psychiatric 
10.29 	and mental health nursing by a national nurse certification organization, or who has a master's 
10.30 	degree in nursing or one of the behavioral sciences or related fields from an accredited 
10.31 	college or university or its equivalent, with at least 4,000 hours of post-master's supervised 
10.32 	experience in the delivery of clinical services.

11.1 	Sec. 6. Minnesota Statutes 2018, section 245D.091, subdivision 3, is amended to read:
11.2 		Subd. 3.Behavior Positive support analyst qualifications. (a) A behavior positive 
11.3 	support analyst providing behavioral positive support services as identified in section 
11.4 	245D.03, subdivision 1, paragraph (c), clause (1), item (i), must have competencies in the 
11.5 	following areas as required under the brain injury and, community access for disability 
11.6 	inclusion, community alternative care, and developmental disability waiver plans or successor 
11.7 	plans:
11.8 	(1) have obtained a baccalaureate degree, master's degree, or PhD in a social services 
11.9 	discipline; or
11.10 	(2) meet the qualifications of a mental health practitioner as defined in section 245.462, 
11.11 	subdivision 17.; or
11.12 	(3) certification as a board-certified behavior analyst or board-certified assistant behavior 
11.13 	analyst by the Behavior Analyst Certification Board.
11.14 	(b) In addition, a behavior positive support analyst must:
11.15 	(1) have four years of supervised experience working with individuals who exhibit 
11.16 	challenging behaviors as well as co-occurring mental disorders or neurocognitive disorder;
11.17 	conducting functional behavior assessments and designing, implementing, and evaluating 
11.18 	the effectiveness of positive practices behavior support strategies for people who exhibit 
11.19 	challenging behaviors as well as co-occurring mental disorders and neurocognitive disorder;
11.20 	(2) have received ten hours of instruction in functional assessment and functional analysis;
11.21 	(3) have received 20 hours of instruction in the understanding of the function of behavior;
11.22 	(4) have received ten hours of instruction on design of positive practices behavior support 
11.23 	strategies;
11.24 	(5) have received 20 hours of instruction on the use of behavior reduction approved 
11.25 	strategies used only in combination with behavior positive practices strategies;
11.26 	(2) have training prior to hire or within 90 calendar days of hire that includes:
11.27 	(i) ten hours of instruction in functional assessment and functional analysis;
11.28 	(ii) 20 hours of instruction in the understanding of the function of behavior;
11.29 	(iii) ten hours of instruction on design of positive practices behavior support strategies;
11.30 	(iv) 20 hours of instruction preparing written intervention strategies, designing data 
11.31 	collection protocols, training other staff to implement positive practice behavior support 
12.1 	strategies, summarizing and reporting program evaluation data, analyzing program evaluation 
12.2 	data to identify design flaws in behavioral interventions or failures in implementation fidelity, 
12.3 	and recommending enhancements based on evaluation data; and
12.4 	(v) eight hours of instruction on principles of person-centered thinking;
12.5 	(6) (3) be determined by a behavior positive support professional to have the training 
12.6 	and prerequisite skills required to provide positive practice strategies as well as behavior 
12.7 	reduction approved and permitted intervention to the person who receives behavioral positive
12.8 	support; and
12.9 	(7) (4) be under the direct supervision of a behavior positive support professional.
12.10 	(c) Meeting the qualifications for a positive support professional under subdivision 2 
12.11 	shall substitute for meeting the qualifications listed in paragraph (b).

12.12 	Sec. 7. Minnesota Statutes 2018, section 245D.091, subdivision 4, is amended to read:
12.13 		Subd. 4.Behavior Positive support specialist qualifications. (a) A behavior positive 
12.14 	support specialist providing behavioral positive support services as identified in section 
12.15 	245D.03, subdivision 1, paragraph (c), clause (1), item (i), must have competencies in the 
12.16 	following areas as required under the brain injury and, community access for disability 
12.17 	inclusion, community alternative care, and developmental disability waiver plans or successor 
12.18 	plans:
12.19 	(1) have an associate's degree in a social services discipline; or
12.20 	(2) have two years of supervised experience working with individuals who exhibit 
12.21 	challenging behaviors as well as co-occurring mental disorders or neurocognitive disorder.
12.22 	(b) In addition, a behavior specialist must:
12.23 	(1) have received a minimum of four hours of training in functional assessment;
12.24 	(2) have received 20 hours of instruction in the understanding of the function of behavior;
12.25 	(3) have received ten hours of instruction on design of positive practices behavioral 
12.26 	support strategies;
12.27 	(1) have received training prior to hire or within 90 calendar days of hire that includes:
12.28 	(i) a minimum of four hours of training in functional assessment;
12.29 	(ii) 20 hours of instruction in the understanding of the function of behavior;
13.1 	(iii) ten hours of instruction on design of positive practices behavior support strategies; 
13.2 	and
13.3 	(iv) eight hours of instruction on person-centered thinking principles;
13.4 	(4) (2) be determined by a behavior positive support professional to have the training 
13.5 	and prerequisite skills required to provide positive practices behavior support strategies as 
13.6 	well as behavior reduction approved intervention to the person who receives behavioral
13.7 	positive support; and
13.8 	(5) (3) be under the direct supervision of a behavior positive support professional.
13.9 	(c) Meeting the qualifications for a positive support professional under subdivision 2 
13.10 	shall substitute for meeting the qualifications listed in paragraphs (a) and (b).

13.11 	Sec. 8. Minnesota Statutes 2018, section 256B.0652, subdivision 10, is amended to read:
13.12 		Subd. 10. Authorization for foster care setting. (a) Home care services provided in 
13.13 	an adult or child foster care setting must receive authorization by the commissioner according 
13.14 	to the limits established in subdivision 11.
13.15 	(b) The commissioner may not authorize:
13.16 	(1) home care services that are the responsibility of the foster care provider under the 
13.17 	terms of the foster care placement agreement, difficulty of care rate as of January 1, 2010, 
13.18 	and administrative rules;
13.19 	(2) personal care assistance services when the foster care license holder is also the 
13.20 	personal care provider or personal care assistant, unless the foster home is the licensed 
13.21 	provider's primary residence as defined in section 256B.0625, subdivision 19a; or
13.22 	(3) personal care assistant and home care nursing services when the licensed capacity 
13.23 	is greater than four, unless all conditions for a variance under Minnesota Rules, part 
13.24 	2960.3030, subpart 3, are satisfied for a sibling, as defined in section 260C.007, subdivision 
13.25 	32.

13.26 	EFFECTIVE DATE. This section is effective the day following final enactment.

13.27 	Sec. 9. Minnesota Statutes 2018, section 256B.0659, subdivision 3a, is amended to read:
13.28 		Subd. 3a.Assessment; defined. (a) "Assessment" means a review and evaluation of a 
13.29 	recipient's need for personal care assistance services conducted in person. Assessments for 
13.30 	personal care assistance services shall be conducted by the county public health nurse or a 
13.31 	certified public health nurse under contract with the county except when a long-term care 
14.1 	consultation assessment is being conducted for the purposes of determining a person's 
14.2 	eligibility for home and community-based waiver services including personal care assistance 
14.3 	services according to section 256B.0911. During the transition to MnCHOICES, a certified 
14.4 	assessor may complete the assessment required in this subdivision. An in-person assessment 
14.5 	must include: documentation of health status, determination of need, evaluation of service 
14.6 	effectiveness, identification of appropriate services, service plan development or modification, 
14.7 	coordination of services, referrals and follow-up to appropriate payers and community 
14.8 	resources, completion of required reports, recommendation of service authorization, and 
14.9 	consumer education. Once the need for personal care assistance services is determined under 
14.10 	this section, the county public health nurse or certified public health nurse under contract 
14.11 	with the county is responsible for communicating this recommendation to the commissioner 
14.12 	and the recipient. An in-person assessment must occur at least annually or when there is a 
14.13 	significant change in the recipient's condition or when there is a change in the need for 
14.14 	personal care assistance services. A service update may substitute for the annual face-to-face 
14.15 	assessment when there is not a significant change in recipient condition or a change in the 
14.16 	need for personal care assistance service. A service update may be completed by telephone, 
14.17 	used when there is no need for an increase in personal care assistance services, and used 
14.18 	for two consecutive assessments if followed by a face-to-face assessment. A service update 
14.19 	must be completed on a form approved by the commissioner. A service update or review 
14.20 	for temporary increase includes a review of initial baseline data, evaluation of service 
14.21 	effectiveness, redetermination of service need, modification of service plan and appropriate 
14.22 	referrals, update of initial forms, obtaining service authorization, and on going consumer 
14.23 	education. Assessments or reassessments must be completed on forms provided by the 
14.24 	commissioner within 30 days of a request for home care services by a recipient or responsible 
14.25 	party.
14.26 	(b) This subdivision expires when notification is given by the commissioner as described 
14.27 	in section 256B.0911, subdivision 3a.

14.28 	Sec. 10. Minnesota Statutes 2018, section 256B.0911, subdivision 1a, is amended to read:
14.29 		Subd. 1a.Definitions. For purposes of this section, the following definitions apply:
14.30 	(a) Until additional requirements apply under paragraph (b), "long-term care consultation 
14.31 	services" means:
14.32 	(1) intake for and access to assistance in identifying services needed to maintain an 
14.33 	individual in the most inclusive environment;
15.1 	(2) providing recommendations for and referrals to cost-effective community services 
15.2 	that are available to the individual;
15.3 	(3) development of an individual's person-centered community support plan;
15.4 	(4) providing information regarding eligibility for Minnesota health care programs;
15.5 	(5) face-to-face long-term care consultation assessments, which may be completed in a 
15.6 	hospital, nursing facility, intermediate care facility for persons with developmental disabilities 
15.7 	(ICF/DDs), regional treatment centers, or the person's current or planned residence;
15.8 	(6) determination of home and community-based waiver and other service eligibility as 
15.9 	required under sections 256B.0913, 256B.0915, 256B.092, and 256B.49, including level 
15.10 	of care determination for individuals who need an institutional level of care as determined 
15.11 	under subdivision 4e, based on assessment and community support plan development, 
15.12 	appropriate referrals to obtain necessary diagnostic information, and including an eligibility 
15.13 	determination for consumer-directed community supports;
15.14 	(7) providing recommendations for institutional placement when there are no 
15.15 	cost-effective community services available;
15.16 	(8) providing access to assistance to transition people back to community settings after 
15.17 	institutional admission; and
15.18 	(9) providing information about competitive employment, with or without supports, for 
15.19 	school-age youth and working-age adults and referrals to the Disability Linkage Line Hub
15.20 	and Disability Benefits 101 to ensure that an informed choice about competitive employment 
15.21 	can be made. For the purposes of this subdivision, "competitive employment" means work 
15.22 	in the competitive labor market that is performed on a full-time or part-time basis in an 
15.23 	integrated setting, and for which an individual is compensated at or above the minimum 
15.24 	wage, but not less than the customary wage and level of benefits paid by the employer for 
15.25 	the same or similar work performed by individuals without disabilities.
15.26 	(b) Upon statewide implementation of lead agency requirements in subdivisions 2b, 2c, 
15.27 	and 3a, "long-term care consultation services" also means:
15.28 	(1) service eligibility determination for state plan home care services identified in:
15.29 	(i) section 256B.0625, subdivisions 7, 19a, and 19c;
15.30 	(ii) consumer support grants under section 256.476; or
15.31 	(iii) section 256B.85;
16.1 	(2) notwithstanding provisions in Minnesota Rules, parts 9525.0004 to 9525.0024, 
16.2 	determination of eligibility for gaining access to case management services available under 
16.3 	sections 256B.0621, subdivision 2, paragraph (4), and 256B.0924 and Minnesota Rules, 
16.4 	part 9525.0016; and
16.5 	(3) determination of institutional level of care, home and community-based service 
16.6 	waiver, and other service eligibility as required under section 256B.092, determination of 
16.7 	eligibility for family support grants under section 252.32, semi-independent living services 
16.8 	under section 252.275, and day training and habilitation services under section 256B.092; 
16.9 	and
16.10 	(4) (3) obtaining necessary diagnostic information to determine eligibility under clauses
16.11 	clause (2) and (3).
16.12 	(c) "Long-term care options counseling" means the services provided by the linkage 
16.13 	lines as mandated by sections 256.01, subdivision 24, and 256.975, subdivision 7, and also 
16.14 	includes telephone assistance and follow up once a long-term care consultation assessment 
16.15 	has been completed.
16.16 	(d) "Minnesota health care programs" means the medical assistance program under this 
16.17 	chapter and the alternative care program under section 256B.0913.
16.18 	(e) "Lead agencies" means counties administering or tribes and health plans under 
16.19 	contract with the commissioner to administer long-term care consultation assessment and 
16.20 	support planning services.
16.21 	(f) "Person-centered planning" is a process that includes the active participation of a 
16.22 	person in the planning of the person's services, including in making meaningful and informed 
16.23 	choices about the person's own goals, talents, and objectives, as well as making meaningful 
16.24 	and informed choices about the services the person receives. For the purposes of this section, 
16.25 	"informed choice" means a voluntary choice of services by a person from all available 
16.26 	service options based on accurate and complete information concerning all available service 
16.27 	options and concerning the person's own preferences, abilities, goals, and objectives. In 
16.28 	order for a person to make an informed choice, all available options must be developed and 
16.29 	presented to the person to empower the person to make decisions.

16.30 	EFFECTIVE DATE. This section is effective August 1, 2019.

16.31 	Sec. 11. Minnesota Statutes 2018, section 256B.0911, subdivision 3a, is amended to read:
16.32 		Subd. 3a.Assessment and support planning. (a) Persons requesting assessment, services 
16.33 	planning, or other assistance intended to support community-based living, including persons 
17.1 	who need assessment in order to determine waiver or alternative care program eligibility, 
17.2 	must be visited by a long-term care consultation team within 20 calendar days after the date 
17.3 	on which the person accepts an assessment was requested or recommended. Upon statewide 
17.4 	implementation of subdivisions 2b, 2c, and 5, this requirement also applies to an assessment 
17.5 	of a person requesting personal care assistance services and home care nursing. The 
17.6 	commissioner shall provide at least a 90-day notice to lead agencies prior to the effective 
17.7 	date of this requirement. Face-to-face assessments must be conducted according to paragraphs 
17.8 	(b) to (i).
17.9 	(b) Upon implementation of subdivisions 2b, 2c, and 5, lead agencies shall use certified 
17.10 	assessors to conduct the assessment. For a person with complex health care needs, a public 
17.11 	health or registered nurse from the team must be consulted.
17.12 	(c) The MnCHOICES assessment provided by the commissioner to lead agencies must 
17.13 	be used to complete a comprehensive, person-centered assessment. The assessment must 
17.14 	include the health, psychological, functional, environmental, and social needs of the 
17.15 	individual person necessary to develop a community support plan that meets the individual's
17.16 	person's needs and preferences.
17.17 	(d) The assessment must be conducted assessor must conduct the assessment in a 
17.18 	face-to-face interview with the person being assessed and the person's legal representative.
17.19 	The person's legal representative must provide input during the assessment interview and 
17.20 	may do so remotely. At the request of the person, other individuals may participate in the 
17.21 	assessment to provide information on the needs, strengths, and preferences of the person 
17.22 	necessary to develop a community support plan that ensures the person's health and safety. 
17.23 	Except for legal representatives or family members invited by the person, persons 
17.24 	participating in the assessment may not be a provider of service or have any financial interest 
17.25 	in the provision of services. For persons who are to be assessed for elderly waiver customized 
17.26 	living or adult day services under section 256B.0915, with the permission of the person 
17.27 	being assessed or the person's designated or legal representative, the client's current or 
17.28 	proposed provider of services may submit a copy of the provider's nursing assessment or 
17.29 	written report outlining its recommendations regarding the client's care needs. The person 
17.30 	conducting the assessment must notify the provider of the date by which this information 
17.31 	is to be submitted. This information shall be provided to the person conducting the assessment 
17.32 	prior to the assessment. For a person who is to be assessed for waiver services under section 
17.33 	256B.092 or 256B.49, with the permission of the person being assessed or the person's 
17.34 	designated legal representative, the person's current provider of services may submit a 
17.35 	written report outlining recommendations regarding the person's care needs prepared by a 
18.1 	direct service employee with at least 20 hours of service to that client who is familiar with 
18.2 	the person. The person conducting the assessment or reassessment must notify the provider 
18.3 	of the date by which this information is to be submitted. This information shall be provided 
18.4 	to the person conducting the assessment and the person or the person's legal representative, 
18.5 	and must be considered prior to the finalization of the assessment or reassessment.
18.6 	(e) The certified assessor and the individual responsible for developing the coordinated 
18.7 	service and support plan must ensure the person has timely access to needed resources and 
18.8 	must complete the community support plan and the coordinated service and support plan 
18.9 	no more than 60 calendar days from the assessment visit. The person or the person's legal 
18.10 	representative must be provided with a written community support plan within 40 calendar 
18.11 	days of the assessment visit the timelines established by the commissioner, regardless of 
18.12 	whether the individual person is eligible for Minnesota health care programs. The 
18.13 	commissioner shall monitor and evaluate lead agency performance in meeting timeline 
18.14 	requirements to ensure timely access for people seeking long-term services and supports.
18.15 	(f) For a person being assessed for elderly waiver services under section 256B.0915, a 
18.16 	provider who submitted information under paragraph (d) shall receive the final written 
18.17 	community support plan when available and the Residential Services Workbook.
18.18 	(g) The written community support plan must include:
18.19 	(1) a summary of assessed needs as defined in paragraphs (c) and (d);
18.20 	(2) the individual's person's options and choices to meet identified needs, including all 
18.21 	available options for case management services and providers, including service provided 
18.22 	in a non-disability-specific setting;
18.23 	(3) identification of health and safety risks and how those risks will be addressed, 
18.24 	including personal risk management strategies;
18.25 	(4) referral information; and
18.26 	(5) informal caregiver supports, if applicable.
18.27 	For a person determined eligible for state plan home care under subdivision 1a, paragraph 
18.28 	(b), clause (1), the person or person's representative must also receive a copy of the home 
18.29 	care service plan developed by the certified assessor.
18.30 	(h) A person may request assistance in identifying community supports without 
18.31 	participating in a complete assessment. Upon a request for assistance identifying community 
18.32 	support, the person must be transferred or referred to long-term care options counseling 
19.1 	services available under sections 256.975, subdivision 7, and 256.01, subdivision 24, for 
19.2 	telephone assistance and follow up.
19.3 	(i) The person has the right to make the final decision between institutional placement 
19.4 	and community placement after the recommendations have been provided, except as provided 
19.5 	in section 256.975, subdivision 7a, paragraph (d).
19.6 	(j) The lead agency must give the person receiving assessment or support planning, or 
19.7 	the person's legal representative, materials, and forms supplied by the commissioner 
19.8 	containing the following information:
19.9 	(1) written recommendations for community-based services and consumer-directed 
19.10 	options;
19.11 	(2) documentation that the most cost-effective alternatives available were offered to the 
19.12 	individual person. For purposes of this clause, "cost-effective" means community services 
19.13 	and living arrangements that cost the same as or less than institutional care. For an individual
19.14 	a person found to meet eligibility criteria for home and community-based service programs 
19.15 	under section 256B.0915 or 256B.49, "cost-effectiveness" has the meaning found in the 
19.16 	federally approved waiver plan for each program;
19.17 	(3) the need for and purpose of preadmission screening conducted by long-term care 
19.18 	options counselors according to section 256.975, subdivisions 7a to 7c, if the person selects 
19.19 	nursing facility placement. If the individual person selects nursing facility placement, the 
19.20 	lead agency shall forward information needed to complete the level of care determinations 
19.21 	and screening for developmental disability and mental illness collected during the assessment 
19.22 	to the long-term care options counselor using forms provided by the commissioner;
19.23 	(4) the role of long-term care consultation assessment and support planning in eligibility 
19.24 	determination for waiver and alternative care programs, and state plan home care, case 
19.25 	management, and other services as defined in subdivision 1a, paragraphs (a), clause (6), 
19.26 	and (b);
19.27 	(5) information about Minnesota health care programs;
19.28 	(6) the person's freedom to accept or reject the recommendations of the team;
19.29 	(7) the person's right to confidentiality under the Minnesota Government Data Practices 
19.30 	Act, chapter 13;
19.31 	(8) the certified assessor's decision regarding the person's need for institutional level of 
19.32 	care as determined under criteria established in subdivision 4e and the certified assessor's 
20.1 	decision regarding eligibility for all services and programs as defined in subdivision 1a, 
20.2 	paragraphs (a), clause (6), and (b); and
20.3 	(9) the person's right to appeal the certified assessor's decision regarding eligibility for 
20.4 	all services and programs as defined in subdivision 1a, paragraphs (a), clauses (6), (7), and 
20.5 	(8), and (b), and incorporating the decision regarding the need for institutional level of care 
20.6 	or the lead agency's final decisions regarding public programs eligibility according to section 
20.7 	256.045, subdivision 3.
20.8 	(k) Face-to-face assessment completed as part of eligibility determination for the 
20.9 	alternative care, elderly waiver, community access for disability inclusion, community 
20.10 	alternative care, and brain injury, and developmental disabilities waiver programs under 
20.11 	sections 256B.0913, 256B.0915, 256B.092, and 256B.49 is valid to establish service 
20.12 	eligibility for no more than 60 calendar days after the date of assessment.
20.13 	(l) The effective eligibility start date for programs in paragraph (k) can never be prior 
20.14 	to the date of assessment. If an assessment was completed more than 60 days before the 
20.15 	effective waiver or alternative care program eligibility start date, assessment and support 
20.16 	plan information must be updated and documented in the department's Medicaid Management 
20.17 	Information System (MMIS). Notwithstanding retroactive medical assistance coverage of 
20.18 	state plan services, the effective date of eligibility for programs included in paragraph (k) 
20.19 	cannot be prior to the date the most recent updated assessment is completed.
20.20 	(m) If an eligibility update is completed within 90 days of the previous face-to-face 
20.21 	assessment and documented in the department's Medicaid Management Information System 
20.22 	(MMIS), the effective date of eligibility for programs included in paragraph (k) is the date 
20.23 	of the previous face-to-face assessment when all other eligibility requirements are met.
20.24 	(n) At the time of reassessment, the certified assessor shall assess each person receiving 
20.25 	waiver services currently residing in a community residential setting, or licensed adult foster 
20.26 	care home that is not the primary residence of the license holder, or in which the license 
20.27 	holder is not the primary caregiver, to determine if that person would prefer to be served in 
20.28 	a community-living setting as defined in section 256B.49, subdivision 23. The certified 
20.29 	assessor shall offer the person, through a person-centered planning process, the option to 
20.30 	receive alternative housing and service options.

20.31 	Sec. 12. Minnesota Statutes 2018, section 256B.0911, subdivision 3f, is amended to read:
20.32 		Subd. 3f.Long-term care reassessments and community support plan 
20.33 	updates. Reassessments must be tailored using the professional judgment of the assessor 
21.1 	to the person's known needs, strengths, preferences, and circumstances. Reassessments 
21.2 	provide information to support the person's informed choice and opportunities to express 
21.3 	choice regarding activities that contribute to quality of life, as well as information and 
21.4 	opportunity to identify goals related to desired employment, community activities, and 
21.5 	preferred living environment. Reassessments allow for a review of the current support plan's 
21.6 	effectiveness, monitoring of services, and the development of an updated person-centered 
21.7 	community support plan. Reassessments verify continued eligibility or offer alternatives as 
21.8 	warranted and provide an opportunity for quality assurance of service delivery. Face-to-face 
21.9 	assessments must be conducted annually or as required by federal and state laws and rules.
21.10 	The certified assessor and the individual responsible for developing the coordinated service 
21.11 	and support plan must ensure the continuity of care for the person receiving services and 
21.12 	must complete the updated community support plan and the updated coordinated service 
21.13 	and support plan no more than 60 calendar days from the reassessment visit. The 
21.14 	commissioner shall monitor and evaluate lead agency performance in meeting timeline 
21.15 	requirements to ensure timely access for people seeking long-term services and supports.

21.16 	Sec. 13. Minnesota Statutes 2018, section 256B.0915, subdivision 6, is amended to read:
21.17 		Subd. 6.Implementation of coordinated service and support plan. (a) Each elderly 
21.18 	waiver client shall be provided a copy of a written coordinated service and support plan 
21.19 	which:
21.20 	(1) is developed with and signed by the recipient within ten working days after the case 
21.21 	manager receives the assessment information and written community support plan as 
21.22 	described in section 256B.0911, subdivision 3a, from the certified assessor the timelines 
21.23 	established by the commissioner and section 256B.0911, subdivision 3a, paragraph (e);
21.24 	(2) includes the person's need for service and identification of service needs that will be 
21.25 	or that are met by the person's relatives, friends, and others, as well as community services 
21.26 	used by the general public;
21.27 	(3) reasonably ensures the health and welfare of the recipient;
21.28 	(4) identifies the person's preferences for services as stated by the person or the person's 
21.29 	legal guardian or conservator;
21.30 	(5) reflects the person's informed choice between institutional and community-based 
21.31 	services, as well as choice of services, supports, and providers, including available case 
21.32 	manager providers;
21.33 	(6) identifies long-range and short-range goals for the person;
22.1 	(7) identifies specific services and the amount, frequency, duration, and cost of the 
22.2 	services to be provided to the person based on assessed needs, preferences, and available 
22.3 	resources;
22.4 	(8) includes information about the right to appeal decisions under section 256.045; and
22.5 	(9) includes the authorized annual and estimated monthly amounts for the services.
22.6 	(b) In developing the coordinated service and support plan, the case manager should 
22.7 	also include the use of volunteers, religious organizations, social clubs, and civic and service 
22.8 	organizations to support the individual in the community. The lead agency must be held 
22.9 	harmless for damages or injuries sustained through the use of volunteers and agencies under 
22.10 	this paragraph, including workers' compensation liability.

22.11 	Sec. 14. Minnesota Statutes 2018, section 256B.092, subdivision 1b, is amended to read:
22.12 		Subd. 1b.Coordinated service and support plan. (a) Each recipient of home and 
22.13 	community-based waivered services shall be provided a copy of the written coordinated 
22.14 	service and support plan which:
22.15 	(1) is developed with and signed by the recipient within ten working days after the case 
22.16 	manager receives the assessment information and written community support plan as 
22.17 	described in section 256B.0911, subdivision 3a, from the certified assessor the timelines 
22.18 	established by the commissioner and section 256B.0911, subdivision 3a, paragraph (e);
22.19 	(2) includes the person's need for service, including identification of service needs that 
22.20 	will be or that are met by the person's relatives, friends, and others, as well as community 
22.21 	services used by the general public;
22.22 	(3) reasonably ensures the health and welfare of the recipient;
22.23 	(4) identifies the person's preferences for services as stated by the person, the person's 
22.24 	legal guardian or conservator, or the parent if the person is a minor, including the person's 
22.25 	choices made on self-directed options and on services and supports to achieve employment 
22.26 	goals;
22.27 	(5) provides for an informed choice, as defined in section 256B.77, subdivision 2, 
22.28 	paragraph (o), of service and support providers, and identifies all available options for case 
22.29 	management services and providers;
22.30 	(6) identifies long-range and short-range goals for the person;
22.31 	(7) identifies specific services and the amount and frequency of the services to be provided 
22.32 	to the person based on assessed needs, preferences, and available resources. The coordinated 
23.1 	service and support plan shall also specify other services the person needs that are not 
23.2 	available;
23.3 	(8) identifies the need for an individual program plan to be developed by the provider 
23.4 	according to the respective state and federal licensing and certification standards, and 
23.5 	additional assessments to be completed or arranged by the provider after service initiation;
23.6 	(9) identifies provider responsibilities to implement and make recommendations for 
23.7 	modification to the coordinated service and support plan;
23.8 	(10) includes notice of the right to request a conciliation conference or a hearing under 
23.9 	section 256.045;
23.10 	(11) is agreed upon and signed by the person, the person's legal guardian or conservator, 
23.11 	or the parent if the person is a minor, and the authorized county representative;
23.12 	(12) is reviewed by a health professional if the person has overriding medical needs that 
23.13 	impact the delivery of services; and
23.14 	(13) includes the authorized annual and monthly amounts for the services.
23.15 	(b) In developing the coordinated service and support plan, the case manager is 
23.16 	encouraged to include the use of volunteers, religious organizations, social clubs, and civic 
23.17 	and service organizations to support the individual in the community. The lead agency must 
23.18 	be held harmless for damages or injuries sustained through the use of volunteers and agencies 
23.19 	under this paragraph, including workers' compensation liability.
23.20 	(c) Approved, written, and signed changes to a consumer's services that meet the criteria 
23.21 	in this subdivision shall be an addendum to that consumer's individual service plan.

23.22 	Sec. 15. Minnesota Statutes 2018, section 256B.49, subdivision 13, is amended to read:
23.23 		Subd. 13.Case management. (a) Each recipient of a home and community-based waiver 
23.24 	shall be provided case management services by qualified vendors as described in the federally 
23.25 	approved waiver application. The case management service activities provided must include:
23.26 	(1) finalizing the written coordinated service and support plan within ten working days 
23.27 	after the case manager receives the plan from the certified assessor the timelines established 
23.28 	by the commissioner and section 256B.0911, subdivision 3a, paragraph (e);
23.29 	(2) informing the recipient or the recipient's legal guardian or conservator of service 
23.30 	options;
24.1 	(3) assisting the recipient in the identification of potential service providers and available 
24.2 	options for case management service and providers, including services provided in a 
24.3 	non-disability-specific setting;
24.4 	(4) assisting the recipient to access services and assisting with appeals under section 
24.5 	256.045; and
24.6 	(5) coordinating, evaluating, and monitoring of the services identified in the service 
24.7 	plan.
24.8 	(b) The case manager may delegate certain aspects of the case management service 
24.9 	activities to another individual provided there is oversight by the case manager. The case 
24.10 	manager may not delegate those aspects which require professional judgment including:
24.11 	(1) finalizing the coordinated service and support plan;
24.12 	(2) ongoing assessment and monitoring of the person's needs and adequacy of the 
24.13 	approved coordinated service and support plan; and
24.14 	(3) adjustments to the coordinated service and support plan.
24.15 	(c) Case management services must be provided by a public or private agency that is 
24.16 	enrolled as a medical assistance provider determined by the commissioner to meet all of 
24.17 	the requirements in the approved federal waiver plans. Case management services must not 
24.18 	be provided to a recipient by a private agency that has any financial interest in the provision 
24.19 	of any other services included in the recipient's coordinated service and support plan. For 
24.20 	purposes of this section, "private agency" means any agency that is not identified as a lead 
24.21 	agency under section 256B.0911, subdivision 1a, paragraph (e).
24.22 	(d) For persons who need a positive support transition plan as required in chapter 245D, 
24.23 	the case manager shall participate in the development and ongoing evaluation of the plan 
24.24 	with the expanded support team. At least quarterly, the case manager, in consultation with 
24.25 	the expanded support team, shall evaluate the effectiveness of the plan based on progress 
24.26 	evaluation data submitted by the licensed provider to the case manager. The evaluation must 
24.27 	identify whether the plan has been developed and implemented in a manner to achieve the 
24.28 	following within the required timelines:
24.29 	(1) phasing out the use of prohibited procedures;
24.30 	(2) acquisition of skills needed to eliminate the prohibited procedures within the plan's 
24.31 	timeline; and
24.32 	(3) accomplishment of identified outcomes.
25.1 	If adequate progress is not being made, the case manager shall consult with the person's 
25.2 	expanded support team to identify needed modifications and whether additional professional 
25.3 	support is required to provide consultation.

25.4 	Sec. 16. Minnesota Statutes 2018, section 256B.49, subdivision 14, is amended to read:
25.5 		Subd. 14.Assessment and reassessment. (a) Assessments and reassessments shall be 
25.6 	conducted by certified assessors according to section 256B.0911, subdivision 2b. The 
25.7 	certified assessor, with the permission of the recipient or the recipient's designated legal 
25.8 	representative, may invite other individuals to attend the assessment. With the permission 
25.9 	of the recipient or the recipient's designated legal representative, the recipient's current 
25.10 	provider of services may submit a written report outlining their recommendations regarding 
25.11 	the recipient's care needs prepared by a direct service employee with at least 20 hours of 
25.12 	service to that client who is familiar with the person. The certified assessor must notify the 
25.13 	provider of the date by which this information is to be submitted. This information shall be 
25.14 	provided to the certified assessor and the person or the person's legal representative and 
25.15 	must be considered prior to the finalization of the assessment or reassessment.
25.16 	(b) There must be a determination that the client requires a hospital level of care or a 
25.17 	nursing facility level of care as defined in section 256B.0911, subdivision 4e, at initial and 
25.18 	subsequent assessments to initiate and maintain participation in the waiver program.
25.19 	(c) Regardless of other assessments identified in section 144.0724, subdivision 4, as 
25.20 	appropriate to determine nursing facility level of care for purposes of medical assistance 
25.21 	payment for nursing facility services, only face-to-face assessments conducted according 
25.22 	to section 256B.0911, subdivisions 3a, 3b, and 4d, that result in a hospital level of care 
25.23 	determination or a nursing facility level of care determination must be accepted for purposes 
25.24 	of initial and ongoing access to waiver services payment.
25.25 	(d) Recipients who are found eligible for home and community-based services under 
25.26 	this section before their 65th birthday may remain eligible for these services after their 65th 
25.27 	birthday if they continue to meet all other eligibility factors.

25.28 	Sec. 17. Minnesota Statutes 2018, section 256B.4914, subdivision 3, is amended to read:
25.29 		Subd. 3.Applicable services. Applicable services are those authorized under the state's 
25.30 	home and community-based services waivers under sections 256B.092 and 256B.49, 
25.31 	including the following, as defined in the federally approved home and community-based 
25.32 	services plan:
26.1 	(1) 24-hour customized living;
26.2 	(2) adult day care;
26.3 	(3) adult day care bath;
26.4 	(4) behavioral programming positive support services;
26.5 	(5) companion services;
26.6 	(6) customized living;
26.7 	(7) day training and habilitation;
26.8 	(8) employment development services;
26.9 	(9) employment exploration services;
26.10 	(10) employment support services;
26.11 	(8) (11) housing access coordination;
26.12 	(9) (12) independent living skills;
26.13 	(13) independent living skills specialist services;
26.14 	(14) individualized home supports;
26.15 	(10) (15) in-home family support;
26.16 	(11) (16) night supervision;
26.17 	(12) (17) personal support;
26.18 	(13) (18) prevocational services;
26.19 	(14) (19) residential care services;
26.20 	(15) (20) residential support services;
26.21 	(16) (21) respite services;
26.22 	(17) (22) structured day services;
26.23 	(18) (23) supported employment services;
26.24 	(19) (24) supported living services;
26.25 	(20) (25) transportation services; and
26.26 	(21) individualized home supports;
26.27 	(22) independent living skills specialist services;
27.1 	(23) employment exploration services;
27.2 	(24) employment development services;
27.3 	(25) employment support services; and
27.4 	(26) other services as approved by the federal government in the state home and 
27.5 	community-based services plan.

27.6 	Sec. 18. Minnesota Statutes 2018, section 256B.4914, subdivision 14, is amended to read:
27.7 		Subd. 14.Exceptions. (a) In a format prescribed by the commissioner, lead agencies 
27.8 	must identify individuals with exceptional needs that cannot be met under the disability 
27.9 	waiver rate system. The commissioner shall use that information to evaluate and, if necessary, 
27.10 	approve an alternative payment rate for those individuals. Whether granted, denied, or 
27.11 	modified, the commissioner shall respond to all exception requests in writing. The 
27.12 	commissioner shall include in the written response the basis for the action and provide 
27.13 	notification of the right to appeal under paragraph (h).
27.14 	(b) Lead agencies must act on an exception request within 30 days and from the date 
27.15 	that the lead agency receives all application materials described in paragraph (d). Lead 
27.16 	agencies must notify the initiator of the request of their recommendation in writing. A lead 
27.17 	agency shall submit all exception requests along with its recommendation to the 
27.18 	commissioner.
27.19 	(c) An application for a rate exception may be submitted for the following criteria:
27.20 	(1) an individual has service needs that cannot be met through additional units of service;
27.21 	(2) an individual's rate determined under subdivisions 6, 7, 8, and 9 is so insufficient 
27.22 	that it has resulted in an individual receiving a notice of discharge from the individual's 
27.23 	provider; or
27.24 	(3) an individual's service needs, including behavioral changes, require a level of service 
27.25 	which necessitates a change in provider or which requires the current provider to propose 
27.26 	service changes beyond those currently authorized.
27.27 	(d) Exception requests must include the following information:
27.28 	(1) the service needs required by each individual that are not accounted for in subdivisions 
27.29 	6, 7, 8, and 9;
27.30 	(2) the service rate requested and the difference from the rate determined in subdivisions 
27.31 	6, 7, 8, and 9;
28.1 	(3) a basis for the underlying costs used for the rate exception and any accompanying
28.2 	based on real costs related to the individual's extraordinary needs borne by the provider, 
28.3 	including documentation of these costs; and
28.4 	(4) any contingencies for approval.
28.5 	(e) Approved rate exceptions shall be managed within lead agency allocations under 
28.6 	sections 256B.092 and 256B.49.
28.7 	(f) Individual disability waiver recipients, an interested party, or the license holder that 
28.8 	would receive the rate exception increase may request that a lead agency submit an exception 
28.9 	request. A lead agency that denies such a request shall notify the individual waiver recipient, 
28.10 	interested party, or license holder of its decision and the reasons for denying the request in 
28.11 	writing no later than 30 days after the request has been made and shall submit its denial to 
28.12 	the commissioner in accordance with paragraph (b). The reasons for the denial must be 
28.13 	based on the failure to meet the criteria in paragraph (c).
28.14 	(g) The commissioner shall determine whether to approve or deny an exception request 
28.15 	no more than 30 days after receiving the request. If the commissioner denies the request, 
28.16 	the commissioner shall notify the lead agency and the individual disability waiver recipient, 
28.17 	the interested party, and the license holder in writing of the reasons for the denial.
28.18 	(h) The individual disability waiver recipient may appeal any denial of an exception 
28.19 	request by either the lead agency or the commissioner, pursuant to sections 256.045 and 
28.20 	256.0451. When the denial of an exception request results in the proposed demission of a 
28.21 	waiver recipient from a residential or day habilitation program, the commissioner shall issue 
28.22 	a temporary stay of demission, when requested by the disability waiver recipient, consistent 
28.23 	with the provisions of section 256.045, subdivisions 4a and 6, paragraph (c). The temporary 
28.24 	stay shall remain in effect until the lead agency can provide an informed choice of 
28.25 	appropriate, alternative services to the disability waiver.
28.26 	(i) Providers may petition lead agencies to update values that were entered incorrectly 
28.27 	or erroneously into the rate management system, based on past service level discussions 
28.28 	and determination in subdivision 4, without applying for a rate exception.
28.29 	(j) The starting date for the rate exception will be the later of the date of the recipient's 
28.30 	change in support or the date of the request to the lead agency for an exception.
28.31 	(k) The commissioner shall track all exception requests received and their dispositions. 
28.32 	The commissioner shall issue quarterly public exceptions statistical reports, including the 
29.1 	number of exception requests received and the numbers granted, denied, withdrawn, and 
29.2 	pending. The report shall include the average amount of time required to process exceptions.
29.3 	(l) No later than January 15, 2016, the commissioner shall provide research findings on 
29.4 	the estimated fiscal impact, the primary cost drivers, and common population characteristics 
29.5 	of recipients with needs that cannot be met by the framework rates.
29.6 	(m) No later than July 1, 2016, the commissioner shall develop and implement, in 
29.7 	consultation with stakeholders, a process to determine eligibility for rate exceptions for 
29.8 	individuals with rates determined under the methodology in section 256B.4913, subdivision 
29.9 	4a. Determination of eligibility for an exception will occur as annual service renewals are 
29.10 	completed.
29.11 	(n) Approved rate exceptions will be implemented at such time that the individual's rate 
29.12 	is no longer banded and remain in effect in all cases until an individual's needs change as 
29.13 	defined in paragraph (c).

29.14 	EFFECTIVE DATE. This section is effective August 1, 2019.

29.15 	Sec. 19. Minnesota Statutes 2018, section 256B.85, subdivision 2, is amended to read:
29.16 		Subd. 2.Definitions. (a) For the purposes of this section, the terms defined in this 
29.17 	subdivision have the meanings given.
29.18 	(b) "Activities of daily living" or "ADLs" means eating, toileting, grooming, dressing, 
29.19 	bathing, mobility, positioning, and transferring.:
29.20 	(1) dressing, including assistance with choosing, application, and changing of clothing 
29.21 	and application of special appliances, wraps, or clothing;
29.22 	(2) grooming, including assistance with basic hair care, oral care, shaving, applying 
29.23 	cosmetics and deodorant, and care of eyeglasses and hearing aids. Nail care is included, 
29.24 	except for recipients who are diabetic or have poor circulation;
29.25 	(3) bathing, including assistance with basic personal hygiene and skin care;
29.26 	(4) eating, including assistance with hand washing and application of orthotics required 
29.27 	for eating, transfers, or feeding;
29.28 	(5) transfers, including assistance with transferring the recipient from one seating or 
29.29 	reclining area to another;
29.30 	(6) mobility, including assistance with ambulation and use of a wheelchair. Mobility 
29.31 	does not include providing transportation for a recipient;
30.1 	(7) positioning, including assistance with positioning or turning a recipient for necessary 
30.2 	care and comfort; and
30.3 	(8) toileting, including assistance with bowel or bladder elimination and care, transfers, 
30.4 	mobility, positioning, feminine hygiene, use of toileting equipment or supplies, cleansing 
30.5 	the perineal area, inspection of the skin, and adjusting clothing.
30.6 	(c) "Agency-provider model" means a method of CFSS under which a qualified agency 
30.7 	provides services and supports through the agency's own employees and policies. The agency 
30.8 	must allow the participant to have a significant role in the selection and dismissal of support 
30.9 	workers of their choice for the delivery of their specific services and supports.
30.10 	(d) "Behavior" means a description of a need for services and supports used to determine 
30.11 	the home care rating and additional service units. The presence of Level I behavior is used 
30.12 	to determine the home care rating.
30.13 	(e) "Budget model" means a service delivery method of CFSS that allows the use of a 
30.14 	service budget and assistance from a financial management services (FMS) provider for a 
30.15 	participant to directly employ support workers and purchase supports and goods.
30.16 	(f) "Complex health-related needs" means an intervention listed in clauses (1) to (8) that 
30.17 	has been ordered by a physician, and is specified in a community services and support plan, 
30.18 	including:
30.19 	(1) tube feedings requiring:
30.20 	(i) a gastrojejunostomy tube; or
30.21 	(ii) continuous tube feeding lasting longer than 12 hours per day;
30.22 	(2) wounds described as:
30.23 	(i) stage III or stage IV;
30.24 	(ii) multiple wounds;
30.25 	(iii) requiring sterile or clean dressing changes or a wound vac; or
30.26 	(iv) open lesions such as burns, fistulas, tube sites, or ostomy sites that require specialized 
30.27 	care;
30.28 	(3) parenteral therapy described as:
30.29 	(i) IV therapy more than two times per week lasting longer than four hours for each 
30.30 	treatment; or
30.31 	(ii) total parenteral nutrition (TPN) daily;
31.1 	(4) respiratory interventions, including:
31.2 	(i) oxygen required more than eight hours per day;
31.3 	(ii) respiratory vest more than one time per day;
31.4 	(iii) bronchial drainage treatments more than two times per day;
31.5 	(iv) sterile or clean suctioning more than six times per day;
31.6 	(v) dependence on another to apply respiratory ventilation augmentation devices such 
31.7 	as BiPAP and CPAP; and
31.8 	(vi) ventilator dependence under section 256B.0651;
31.9 	(5) insertion and maintenance of catheter, including:
31.10 	(i) sterile catheter changes more than one time per month;
31.11 	(ii) clean intermittent catheterization, and including self-catheterization more than six 
31.12 	times per day; or
31.13 	(iii) bladder irrigations;
31.14 	(6) bowel program more than two times per week requiring more than 30 minutes to 
31.15 	perform each time;
31.16 	(7) neurological intervention, including:
31.17 	(i) seizures more than two times per week and requiring significant physical assistance 
31.18 	to maintain safety; or
31.19 	(ii) swallowing disorders diagnosed by a physician and requiring specialized assistance 
31.20 	from another on a daily basis; and
31.21 	(8) other congenital or acquired diseases creating a need for significantly increased direct 
31.22 	hands-on assistance and interventions in six to eight activities of daily living.
31.23 	(g) "Community first services and supports" or "CFSS" means the assistance and supports 
31.24 	program under this section needed for accomplishing activities of daily living, instrumental 
31.25 	activities of daily living, and health-related tasks through hands-on assistance to accomplish 
31.26 	the task or constant supervision and cueing to accomplish the task, or the purchase of goods 
31.27 	as defined in subdivision 7, clause (3), that replace the need for human assistance.
31.28 	(h) "Community first services and supports service delivery plan" or "CFSS service 
31.29 	delivery plan" means a written document detailing the services and supports chosen by the 
31.30 	participant to meet assessed needs that are within the approved CFSS service authorization, 
32.1 	as determined in subdivision 8. Services and supports are based on the coordinated service 
32.2 	and support plan identified in section sections256B.0915, subdivision 6, and 256B.092, 
32.3 	subdivision 1b.
32.4 	(i) "Consultation services" means a Minnesota health care program enrolled provider 
32.5 	organization that provides assistance to the participant in making informed choices about 
32.6 	CFSS services in general and self-directed tasks in particular, and in developing a 
32.7 	person-centered CFSS service delivery plan to achieve quality service outcomes.
32.8 	(j) "Critical activities of daily living" means transferring, mobility, eating, and toileting.
32.9 	(k) "Dependency" in activities of daily living means a person requires hands-on assistance 
32.10 	or constant supervision and cueing to accomplish one or more of the activities of daily living 
32.11 	every day or on the days during the week that the activity is performed; however, a child 
32.12 	may not be found to be dependent in an activity of daily living if, because of the child's age, 
32.13 	an adult would either perform the activity for the child or assist the child with the activity 
32.14 	and the assistance needed is the assistance appropriate for a typical child of the same age.
32.15 	(l) "Extended CFSS" means CFSS services and supports provided under CFSS that are 
32.16 	included in the CFSS service delivery plan through one of the home and community-based 
32.17 	services waivers and as approved and authorized under sections 256B.0915; 256B.092, 
32.18 	subdivision 5; and 256B.49, which exceed the amount, duration, and frequency of the state 
32.19 	plan CFSS services for participants. Extended CFSS excludes the purchase of goods.
32.20 	(m) "Financial management services provider" or "FMS provider" means a qualified 
32.21 	organization required for participants using the budget model under subdivision 13 that is 
32.22 	an enrolled provider with the department to provide vendor fiscal/employer agent financial 
32.23 	management services (FMS).
32.24 	(n) "Health-related procedures and tasks" means procedures and tasks related to the 
32.25 	specific assessed health needs of a participant that can be taught or assigned by a 
32.26 	state-licensed health care or mental health professional and performed by a support worker.
32.27 	(o) "Instrumental activities of daily living" means activities related to living independently 
32.28 	in the community, including but not limited to: meal planning, preparation, and cooking; 
32.29 	shopping for food, clothing, or other essential items; laundry; housecleaning; assistance 
32.30 	with medications; managing finances; communicating needs and preferences during activities; 
32.31 	arranging supports; and assistance with traveling around and participating in the community.
32.32 	(p) "Lead agency" has the meaning given in section 256B.0911, subdivision 1a, paragraph 
32.33 	(e).
33.1 	(q) "Legal representative" means parent of a minor, a court-appointed guardian, or 
33.2 	another representative with legal authority to make decisions about services and supports 
33.3 	for the participant. Other representatives with legal authority to make decisions include but 
33.4 	are not limited to a health care agent or an attorney-in-fact authorized through a health care 
33.5 	directive or power of attorney.
33.6 	(r) "Level I behavior" means physical aggression towards self or others or destruction 
33.7 	of property that requires the immediate response of another person.
33.8 	(s) "Medication assistance" means providing verbal or visual reminders to take regularly 
33.9 	scheduled medication, and includes any of the following supports listed in clauses (1) to 
33.10 	(3) and other types of assistance, except that a support worker may not determine medication 
33.11 	dose or time for medication or inject medications into veins, muscles, or skin:
33.12 	(1) under the direction of the participant or the participant's representative, bringing 
33.13 	medications to the participant including medications given through a nebulizer, opening a 
33.14 	container of previously set-up medications, emptying the container into the participant's 
33.15 	hand, opening and giving the medication in the original container to the participant, or 
33.16 	bringing to the participant liquids or food to accompany the medication;
33.17 	(2) organizing medications as directed by the participant or the participant's representative; 
33.18 	and
33.19 	(3) providing verbal or visual reminders to perform regularly scheduled medications.
33.20 	(t) "Participant" means a person who is eligible for CFSS.
33.21 	(u) "Participant's representative" means a parent, family member, advocate, or other 
33.22 	adult authorized by the participant or participant's legal representative, if any, to serve as a 
33.23 	representative in connection with the provision of CFSS. This authorization must be in 
33.24 	writing or by another method that clearly indicates the participant's free choice and may be 
33.25 	withdrawn at any time. The participant's representative must have no financial interest in 
33.26 	the provision of any services included in the participant's CFSS service delivery plan and 
33.27 	must be capable of providing the support necessary to assist the participant in the use of 
33.28 	CFSS. If through the assessment process described in subdivision 5 a participant is 
33.29 	determined to be in need of a participant's representative, one must be selected. If the 
33.30 	participant is unable to assist in the selection of a participant's representative, the legal 
33.31 	representative shall appoint one. Two persons may be designated as a participant's 
33.32 	representative for reasons such as divided households and court-ordered custodies. Duties 
33.33 	of a participant's representatives may include:
34.1 	(1) being available while services are provided in a method agreed upon by the participant 
34.2 	or the participant's legal representative and documented in the participant's CFSS service 
34.3 	delivery plan;
34.4 	(2) monitoring CFSS services to ensure the participant's CFSS service delivery plan is 
34.5 	being followed; and
34.6 	(3) reviewing and signing CFSS time sheets after services are provided to provide 
34.7 	verification of the CFSS services.
34.8 	(v) "Person-centered planning process" means a process that is directed by the participant 
34.9 	to plan for CFSS services and supports.
34.10 	(w) "Service budget" means the authorized dollar amount used for the budget model or 
34.11 	for the purchase of goods.
34.12 	(x) "Shared services" means the provision of CFSS services by the same CFSS support 
34.13 	worker to two or three participants who voluntarily enter into an agreement to receive 
34.14 	services at the same time and in the same setting by the same employer.
34.15 	(y) "Support worker" means a qualified and trained employee of the agency-provider 
34.16 	as required by subdivision 11b or of the participant employer under the budget model as 
34.17 	required by subdivision 14 who has direct contact with the participant and provides services 
34.18 	as specified within the participant's CFSS service delivery plan.
34.19 	(z) "Unit" means the increment of service based on hours or minutes identified in the 
34.20 	service agreement.
34.21 	(aa) "Vendor fiscal employer agent" means an agency that provides financial management 
34.22 	services.
34.23 	(bb) "Wages and benefits" means the hourly wages and salaries, the employer's share 
34.24 	of FICA taxes, Medicare taxes, state and federal unemployment taxes, workers' compensation, 
34.25 	mileage reimbursement, health and dental insurance, life insurance, disability insurance, 
34.26 	long-term care insurance, uniform allowance, contributions to employee retirement accounts, 
34.27 	or other forms of employee compensation and benefits.
34.28 	(cc) "Worker training and development" means services provided according to subdivision 
34.29 	18a for developing workers' skills as required by the participant's individual CFSS service 
34.30 	delivery plan that are arranged for or provided by the agency-provider or purchased by the 
34.31 	participant employer. These services include training, education, direct observation and 
34.32 	supervision, and evaluation and coaching of job skills and tasks, including supervision of 
34.33 	health-related tasks or behavioral supports.

35.1 	Sec. 20. Minnesota Statutes 2018, section 256B.85, subdivision 4, is amended to read:
35.2 		Subd. 4.Eligibility for other services. Selection of CFSS by a participant must not 
35.3 	restrict access to other medically necessary care and services furnished under the state plan 
35.4 	benefit or other services available through the alternative care program.

35.5 	Sec. 21. Minnesota Statutes 2018, section 256B.85, subdivision 5, is amended to read:
35.6 		Subd. 5.Assessment requirements. (a) The assessment of functional need must:
35.7 	(1) be conducted by a certified assessor according to the criteria established in section 
35.8 	256B.0911, subdivision 3a;
35.9 	(2) be conducted face-to-face, initially and at least annually thereafter, or when there is 
35.10 	a significant change in the participant's condition or a change in the need for services and 
35.11 	supports, or at the request of the participant when the participant experiences a change in 
35.12 	condition or needs a change in the services or supports; and
35.13 	(3) be completed using the format established by the commissioner.
35.14 	(b) The results of the assessment and any recommendations and authorizations for CFSS 
35.15 	must be determined and communicated in writing by the lead agency's certified assessor as 
35.16 	defined in section 256B.0911 to the participant and the agency-provider or FMS provider 
35.17 	chosen by the participant or participant's representative and chosen CFSS providers within 
35.18 	40 calendar ten business days and must include the participant's right to appeal under section 
35.19 	256.045, subdivision 3 of the assessment.
35.20 	(c) The lead agency assessor may authorize a temporary authorization for CFSS services 
35.21 	to be provided under the agency-provider model. Authorization for a temporary level of 
35.22 	CFSS services under the agency-provider model is limited to the time specified by the 
35.23 	commissioner, but shall not exceed 45 days. The level of services authorized under this 
35.24 	paragraph shall have no bearing on a future authorization.
35.25 	For CFSS services beyond the temporary authorization, participants approved for a temporary 
35.26 	authorization shall access the consultation service to complete their orientation and selection 
35.27 	of a service model.

35.28 	Sec. 22. Minnesota Statutes 2018, section 256B.85, subdivision 6, is amended to read:
35.29 		Subd. 6.Community first services and supports service delivery plan. (a) The CFSS 
35.30 	service delivery plan must be developed and evaluated through a person-centered planning 
35.31 	process by the participant, or the participant's representative or legal representative who 
36.1 	may be assisted by a consultation services provider. The CFSS service delivery plan must 
36.2 	reflect the services and supports that are important to the participant and for the participant 
36.3 	to meet the needs assessed by the certified assessor and identified in the coordinated service 
36.4 	and support plan identified in section sections256B.0915, subdivision 6, and 256B.092, 
36.5 	subdivision 1b. The CFSS service delivery plan must be reviewed by the participant, the 
36.6 	consultation services provider, and the agency-provider or FMS provider prior to starting 
36.7 	services and at least annually upon reassessment, or when there is a significant change in 
36.8 	the participant's condition, or a change in the need for services and supports.
36.9 	(b) The commissioner shall establish the format and criteria for the CFSS service delivery 
36.10 	plan.
36.11 	(c) The CFSS service delivery plan must be person-centered and:
36.12 	(1) specify the consultation services provider, agency-provider, or FMS provider selected 
36.13 	by the participant;
36.14 	(2) reflect the setting in which the participant resides that is chosen by the participant;
36.15 	(3) reflect the participant's strengths and preferences;
36.16 	(4) include the methods and supports used to address the needs as identified through an 
36.17 	assessment of functional needs;
36.18 	(5) include the participant's identified goals and desired outcomes;
36.19 	(6) reflect the services and supports, paid and unpaid, that will assist the participant to 
36.20 	achieve identified goals, including the costs of the services and supports, and the providers 
36.21 	of those services and supports, including natural supports;
36.22 	(7) identify the amount and frequency of face-to-face supports and amount and frequency 
36.23 	of remote supports and technology that will be used;
36.24 	(8) identify risk factors and measures in place to minimize them, including individualized 
36.25 	backup plans;
36.26 	(9) be understandable to the participant and the individuals providing support;
36.27 	(10) identify the individual or entity responsible for monitoring the plan;
36.28 	(11) be finalized and agreed to in writing by the participant and signed by all individuals 
36.29 	and providers responsible for its implementation;
36.30 	(12) be distributed to the participant and other people involved in the plan;
36.31 	(13) prevent the provision of unnecessary or inappropriate care;
37.1 	(14) include a detailed budget for expenditures for budget model participants or 
37.2 	participants under the agency-provider model if purchasing goods; and
37.3 	(15) include a plan for worker training and development provided according to 
37.4 	subdivision 18a detailing what service components will be used, when the service components 
37.5 	will be used, how they will be provided, and how these service components relate to the 
37.6 	participant's individual needs and CFSS support worker services.
37.7 	(d) The CFSS service delivery plan must describe the units or dollar amount available 
37.8 	to the participant. The total units of agency-provider services or the service budget amount 
37.9 	for the budget model include both annual totals and a monthly average amount that cover 
37.10 	the number of months of the service agreement. The amount used each month may vary, 
37.11 	but additional funds must not be provided above the annual service authorization amount, 
37.12 	determined according to subdivision 8, unless a change in condition is assessed and 
37.13 	authorized by the certified assessor and documented in the coordinated service and support 
37.14 	plan and CFSS service delivery plan.
37.15 	(e) In assisting with the development or modification of the CFSS service delivery plan 
37.16 	during the authorization time period, the consultation services provider shall:
37.17 	(1) consult with the FMS provider on the spending budget when applicable; and
37.18 	(2) consult with the participant or participant's representative, agency-provider, and case 
37.19 	manager/care coordinator.
37.20 	(f) The CFSS service delivery plan must be approved by the consultation services provider 
37.21 	for participants without a case manager or care coordinator who is responsible for authorizing 
37.22 	services. A case manager or care coordinator must approve the plan for a waiver or alternative 
37.23 	care program participant.

37.24 	Sec. 23. Minnesota Statutes 2018, section 256B.85, subdivision 8, is amended to read:
37.25 		Subd. 8.Determination of CFSS service authorization amount. (a) All community 
37.26 	first services and supports must be authorized by the commissioner or the commissioner's 
37.27 	designee before services begin. The authorization for CFSS must be completed as soon as 
37.28 	possible following an assessment but no later than 40 calendar days from the date of the 
37.29 	assessment.
37.30 	(b) The amount of CFSS authorized must be based on the participant's home care rating 
37.31 	described in paragraphs (d) and (e) and any additional service units for which the participant 
37.32 	qualifies as described in paragraph (f).
38.1 	(c) The home care rating shall be determined by the commissioner or the commissioner's 
38.2 	designee based on information submitted to the commissioner identifying the following for 
38.3 	a participant:
38.4 	(1) the total number of dependencies of activities of daily living;
38.5 	(2) the presence of complex health-related needs; and
38.6 	(3) the presence of Level I behavior.
38.7 	(d) The methodology to determine the total service units for CFSS for each home care 
38.8 	rating is based on the median paid units per day for each home care rating from fiscal year 
38.9 	2007 data for the PCA program.
38.10 	(e) Each home care rating is designated by the letters P through Z and EN and has the 
38.11 	following base number of service units assigned:
38.12 	(1) P home care rating requires Level I behavior or one to three dependencies in ADLs 
38.13 	and qualifies the person for five service units;
38.14 	(2) Q home care rating requires Level I behavior and one to three dependencies in ADLs 
38.15 	and qualifies the person for six service units;
38.16 	(3) R home care rating requires a complex health-related need and one to three 
38.17 	dependencies in ADLs and qualifies the person for seven service units;
38.18 	(4) S home care rating requires four to six dependencies in ADLs and qualifies the person 
38.19 	for ten service units;
38.20 	(5) T home care rating requires four to six dependencies in ADLs and Level I behavior 
38.21 	and qualifies the person for 11 service units;
38.22 	(6) U home care rating requires four to six dependencies in ADLs and a complex 
38.23 	health-related need and qualifies the person for 14 service units;
38.24 	(7) V home care rating requires seven to eight dependencies in ADLs and qualifies the 
38.25 	person for 17 service units;
38.26 	(8) W home care rating requires seven to eight dependencies in ADLs and Level I 
38.27 	behavior and qualifies the person for 20 service units;
38.28 	(9) Z home care rating requires seven to eight dependencies in ADLs and a complex 
38.29 	health-related need and qualifies the person for 30 service units; and
38.30 	(10) EN home care rating includes ventilator dependency as defined in section 256B.0651, 
38.31 	subdivision 1, paragraph (g). A person who meets the definition of ventilator-dependent 
39.1 	and the EN home care rating and utilize a combination of CFSS and home care nursing 
39.2 	services is limited to a total of 96 service units per day for those services in combination. 
39.3 	Additional units may be authorized when a person's assessment indicates a need for two 
39.4 	staff to perform activities. Additional time is limited to 16 service units per day.
39.5 	(f) Additional service units are provided through the assessment and identification of 
39.6 	the following:
39.7 	(1) 30 additional minutes per day for a dependency in each critical activity of daily 
39.8 	living;
39.9 	(2) 30 additional minutes per day for each complex health-related need; and
39.10 	(3) 30 additional minutes per day when the behavior requires assistance at least four 
39.11 	times per week for one or more of the following behaviors 30 additional minutes per day 
39.12 	for each behavior under this clause that requires assistance at least four times per week:
39.13 	(i) level I behavior that requires the immediate response of another person;
39.14 	(ii) increased vulnerability due to cognitive deficits or socially inappropriate behavior; 
39.15 	or
39.16 	(iii) increased need for assistance for participants who are verbally aggressive or resistive 
39.17 	to care so that the time needed to perform activities of daily living is increased.
39.18 	(g) The service budget for budget model participants shall be based on:
39.19 	(1) assessed units as determined by the home care rating; and
39.20 	(2) an adjustment needed for administrative expenses.

39.21 	Sec. 24. Minnesota Statutes 2018, section 256B.85, subdivision 9, is amended to read:
39.22 		Subd. 9.Noncovered services. (a) Services or supports that are not eligible for payment 
39.23 	under this section include those that:
39.24 	(1) are not authorized by the certified assessor or included in the CFSS service delivery 
39.25 	plan;
39.26 	(2) are provided prior to the authorization of services and the approval of the CFSS 
39.27 	service delivery plan;
39.28 	(3) are duplicative of other paid services in the CFSS service delivery plan;
40.1 	(4) supplant natural unpaid supports that appropriately meet a need in the CFSS service 
40.2 	delivery plan, are provided voluntarily to the participant, and are selected by the participant 
40.3 	in lieu of other services and supports;
40.4 	(5) are not effective means to meet the participant's needs; and
40.5 	(6) are available through other funding sources, including, but not limited to, funding 
40.6 	through title IV-E of the Social Security Act.
40.7 	(b) Additional services, goods, or supports that are not covered include:
40.8 	(1) those that are not for the direct benefit of the participant, except that services for 
40.9 	caregivers such as training to improve the ability to provide CFSS are considered to directly 
40.10 	benefit the participant if chosen by the participant and approved in the support plan;
40.11 	(2) any fees incurred by the participant, such as Minnesota health care programs fees 
40.12 	and co-pays, legal fees, or costs related to advocate agencies;
40.13 	(3) insurance, except for insurance costs related to employee coverage;
40.14 	(4) room and board costs for the participant;
40.15 	(5) services, supports, or goods that are not related to the assessed needs;
40.16 	(6) special education and related services provided under the Individuals with Disabilities 
40.17 	Education Act and vocational rehabilitation services provided under the Rehabilitation Act 
40.18 	of 1973;
40.19 	(7) assistive technology devices and assistive technology services other than those for 
40.20 	back-up systems or mechanisms to ensure continuity of service and supports listed in 
40.21 	subdivision 7;
40.22 	(8) medical supplies and equipment covered under medical assistance;
40.23 	(9) environmental modifications, except as specified in subdivision 7;
40.24 	(10) expenses for travel, lodging, or meals related to training the participant or the 
40.25 	participant's representative or legal representative;
40.26 	(11) experimental treatments;
40.27 	(12) any service or good covered by other state plan services, including prescription and 
40.28 	over-the-counter medications, compounds, and solutions and related fees, including premiums 
40.29 	and co-payments;
40.30 	(13) membership dues or costs, except when the service is necessary and appropriate to 
40.31 	treat a health condition or to improve or maintain the adult participant's health condition. 
41.1 	The condition must be identified in the participant's CFSS service delivery plan and 
41.2 	monitored by a Minnesota health care program enrolled physician;
41.3 	(14) vacation expenses other than the cost of direct services;
41.4 	(15) vehicle maintenance or modifications not related to the disability, health condition, 
41.5 	or physical need;
41.6 	(16) tickets and related costs to attend sporting or other recreational or entertainment 
41.7 	events;
41.8 	(17) services provided and billed by a provider who is not an enrolled CFSS provider;
41.9 	(18) CFSS provided by a participant's representative or paid legal guardian;
41.10 	(19) services that are used solely as a child care or babysitting service;
41.11 	(20) services that are the responsibility or in the daily rate of a residential or program 
41.12 	license holder under the terms of a service agreement and administrative rules;
41.13 	(21) sterile procedures;
41.14 	(22) giving of injections into veins, muscles, or skin;
41.15 	(23) homemaker services that are not an integral part of the assessed CFSS service;
41.16 	(24) home maintenance or chore services;
41.17 	(25) home care services, including hospice services if elected by the participant, covered 
41.18 	by Medicare or any other insurance held by the participant;
41.19 	(26) services to other members of the participant's household;
41.20 	(27) services not specified as covered under medical assistance as CFSS;
41.21 	(28) application of restraints or implementation of deprivation procedures;
41.22 	(29) assessments by CFSS provider organizations or by independently enrolled registered 
41.23 	nurses;
41.24 	(30) services provided in lieu of legally required staffing in a residential or child care 
41.25 	setting; and
41.26 	(31) services provided by the residential or program license holder in a residence for 
41.27 	more than four participants. in licensed foster care, except when:
41.28 	(i) the foster care home is the foster care license holder's primary residence; or
42.1 	(ii) the licensed capacity is four or fewer, or all conditions for a variance under Minnesota 
42.2 	Rules, part 2960.3030, subpart 3, are met for a group of siblings, as defined in section 
42.3 	260C.007, subdivision 32;
42.4 	(32) services from a provider who owns or otherwise controls for the living arrangement, 
42.5 	except when the provider of services is related by blood, marriage, or adoption or when the 
42.6 	provider meets the requirements under clause (31); and
42.7 	(33) instrumental activities of daily living for children younger than 18 years of age, 
42.8 	except when immediate attention is needed for health or hygiene reasons integral to the 
42.9 	personal care services and the assessor lists the need in the service plan.

42.10 	Sec. 25. Minnesota Statutes 2018, section 256B.85, subdivision 10, is amended to read:
42.11 		Subd. 10.Agency-provider and FMS provider qualifications and duties. (a) 
42.12 	Agency-providers identified in subdivision 11 and FMS providers identified in subdivision 
42.13 	13a shall:
42.14 	(1) enroll as a medical assistance Minnesota health care programs provider and meet all 
42.15 	applicable provider standards and requirements including completion of required provider 
42.16 	training as determined by the commissioner;
42.17 	(2) demonstrate compliance with federal and state laws and policies for CFSS as 
42.18 	determined by the commissioner;
42.19 	(3) comply with background study requirements under chapter 245C and maintain 
42.20 	documentation of background study requests and results;
42.21 	(4) verify and maintain records of all services and expenditures by the participant, 
42.22 	including hours worked by support workers;
42.23 	(5) not engage in any agency-initiated direct contact or marketing in person, by telephone, 
42.24 	or other electronic means to potential participants, guardians, family members, or participants' 
42.25 	representatives;
42.26 	(6) directly provide services and not use a subcontractor or reporting agent;
42.27 	(7) meet the financial requirements established by the commissioner for financial 
42.28 	solvency;
42.29 	(8) have never had a lead agency contract or provider agreement discontinued due to 
42.30 	fraud, or have never had an owner, board member, or manager fail a state or FBI-based 
42.31 	criminal background check while enrolled or seeking enrollment as a Minnesota health care 
42.32 	programs provider; and
43.1 	(9) have an office located in Minnesota.
43.2 	(b) In conducting general duties, agency-providers and FMS providers shall:
43.3 	(1) pay support workers based upon actual hours of services provided;
43.4 	(2) pay for worker training and development services based upon actual hours of services 
43.5 	provided or the unit cost of the training session purchased;
43.6 	(3) withhold and pay all applicable federal and state payroll taxes;
43.7 	(4) make arrangements and pay unemployment insurance, taxes, workers' compensation, 
43.8 	liability insurance, and other benefits, if any;
43.9 	(5) enter into a written agreement with the participant, participant's representative, or 
43.10 	legal representative that assigns roles and responsibilities to be performed before services, 
43.11 	supports, or goods are provided;
43.12 	(6) report maltreatment as required under sections 626.556 and 626.557; and
43.13 	(7) comply with any data requests from the department consistent with the Minnesota 
43.14 	Government Data Practices Act under chapter 13.; and
43.15 	(8) request reassessments at least 60 days before the end of the current authorization for 
43.16 	CFSS on forms provided by the commissioner.

43.17 	Sec. 26. Minnesota Statutes 2018, section 256B.85, subdivision 11, is amended to read:
43.18 		Subd. 11.Agency-provider model. (a) The agency-provider model includes services 
43.19 	provided by support workers and staff providing worker training and development services 
43.20 	who are employed by an agency-provider that meets the criteria established by the 
43.21 	commissioner, including required training.
43.22 	(b) The agency-provider shall allow the participant to have a significant role in the 
43.23 	selection and dismissal of the support workers for the delivery of the services and supports 
43.24 	specified in the participant's CFSS service delivery plan. The agency must make a reasonable 
43.25 	effort to fulfill the participant's request for the participant's preferred worker.
43.26 	(c) A participant may use authorized units of CFSS services as needed within a service 
43.27 	agreement that is not greater than 12 months. Using authorized units in a flexible manner 
43.28 	in either the agency-provider model or the budget model does not increase the total amount 
43.29 	of services and supports authorized for a participant or included in the participant's CFSS 
43.30 	service delivery plan.
44.1 	(d) A participant may share CFSS services. Two or three CFSS participants may share 
44.2 	services at the same time provided by the same support worker.
44.3 	(e) The agency-provider must use a minimum of 72.5 percent of the revenue generated 
44.4 	by the medical assistance payment for CFSS for support worker wages and benefits. The 
44.5 	agency-provider must document how this requirement is being met. The revenue generated 
44.6 	by the worker training and development services and the reasonable costs associated with 
44.7 	the worker training and development services must not be used in making this calculation.
44.8 	(f) The agency-provider model must be used by individuals who are restricted by the 
44.9 	Minnesota restricted recipient program under Minnesota Rules, parts 9505.2160 to 
44.10 	9505.2245.
44.11 	(g) Participants purchasing goods under this model, along with support worker services, 
44.12 	must:
44.13 	(1) specify the goods in the CFSS service delivery plan and detailed budget for 
44.14 	expenditures that must be approved by the consultation services provider, case manager, or 
44.15 	care coordinator; and
44.16 	(2) use the FMS provider for the billing and payment of such goods.

44.17 	Sec. 27. Minnesota Statutes 2018, section 256B.85, subdivision 11b, is amended to read:
44.18 		Subd. 11b.Agency-provider model; support worker competency. (a) The 
44.19 	agency-provider must ensure that support workers are competent to meet the participant's 
44.20 	assessed needs, goals, and additional requirements as written in the CFSS service delivery 
44.21 	plan. Within 30 days of any support worker beginning to provide services for a participant, 
44.22 	the agency-provider must evaluate the competency of the worker through direct observation 
44.23 	of the support worker's performance of the job functions in a setting where the participant 
44.24 	is using CFSS.
44.25 	(b) The agency-provider must verify and maintain evidence of support worker 
44.26 	competency, including documentation of the support worker's:
44.27 	(1) education and experience relevant to the job responsibilities assigned to the support 
44.28 	worker and the needs of the participant;
44.29 	(2) relevant training received from sources other than the agency-provider;
44.30 	(3) orientation and instruction to implement services and supports to participant needs 
44.31 	and preferences as identified in the CFSS service delivery plan; and
45.1 	(4) orientation and instruction delivered by an individual competent to perform, teach, 
45.2 	or assign the health-related tasks for tracheostomy suctioning and services to participants 
45.3 	on ventilator support, including equipment operation and maintenance; and
45.4 	(5) periodic performance reviews completed by the agency-provider at least annually, 
45.5 	including any evaluations required under subdivision 11a, paragraph (a).
45.6 	If a support worker is a minor, all evaluations of worker competency must be completed in 
45.7 	person and in a setting where the participant is using CFSS.
45.8 	(c) The agency-provider must develop a worker training and development plan with the 
45.9 	participant to ensure support worker competency. The worker training and development 
45.10 	plan must be updated when:
45.11 	(1) the support worker begins providing services;
45.12 	(2) there is any change in condition or a modification to the CFSS service delivery plan; 
45.13 	or
45.14 	(3) a performance review indicates that additional training is needed.

45.15 	Sec. 28. Minnesota Statutes 2018, section 256B.85, subdivision 12, is amended to read:
45.16 		Subd. 12.Requirements for enrollment of CFSS agency-providers. (a) All CFSS 
45.17 	agency-providers must provide, at the time of enrollment, reenrollment, and revalidation 
45.18 	as a CFSS agency-provider in a format determined by the commissioner, information and 
45.19 	documentation that includes, but is not limited to, the following:
45.20 	(1) the CFSS agency-provider's current contact information including address, telephone 
45.21 	number, and e-mail address;
45.22 	(2) proof of surety bond coverage. Upon new enrollment, or if the agency-provider's 
45.23 	Medicaid revenue in the previous calendar year is less than or equal to $300,000, the 
45.24 	agency-provider must purchase a surety bond of $50,000. If the agency-provider's Medicaid 
45.25 	revenue in the previous calendar year is greater than $300,000, the agency-provider must 
45.26 	purchase a surety bond of $100,000. The surety bond must be in a form approved by the 
45.27 	commissioner, must be renewed annually, and must allow for recovery of costs and fees in 
45.28 	pursuing a claim on the bond;
45.29 	(3) proof of fidelity bond coverage in the amount of $20,000 per provider location;
45.30 	(4) proof of workers' compensation insurance coverage;
45.31 	(5) proof of liability insurance;
46.1 	(6) a description copy of the CFSS agency-provider's organization organizational chart
46.2 	identifying the names and roles of all owners, managing employees, staff, board of directors, 
46.3 	and the additional documentation reporting any affiliations of the directors and owners to 
46.4 	other service providers;
46.5 	(7) a copy of proof that the CFSS agency-provider's agency-provider has written policies 
46.6 	and procedures including: hiring of employees; training requirements; service delivery; and 
46.7 	employee and consumer safety, including the process for notification and resolution of 
46.8 	participant grievances, incident response, identification and prevention of communicable 
46.9 	diseases, and employee misconduct;
46.10 	(8) copies of all other forms proof that the CFSS agency-provider uses in the course of 
46.11 	daily business has all of the following forms and documents including, but not limited to:
46.12 	(i) a copy of the CFSS agency-provider's time sheet; and
46.13 	(ii) a copy of the participant's individual CFSS service delivery plan;
46.14 	(9) a list of all training and classes that the CFSS agency-provider requires of its staff 
46.15 	providing CFSS services;
46.16 	(10) documentation that the CFSS agency-provider and staff have successfully completed 
46.17 	all the training required by this section;
46.18 	(11) documentation of the agency-provider's marketing practices;
46.19 	(12) disclosure of ownership, leasing, or management of all residential properties that 
46.20 	are used or could be used for providing home care services;
46.21 	(13) documentation that the agency-provider will use at least the following percentages 
46.22 	of revenue generated from the medical assistance rate paid for CFSS services for CFSS 
46.23 	support worker wages and benefits: 72.5 percent of revenue from CFSS providers. The 
46.24 	revenue generated by the worker training and development services and the reasonable costs 
46.25 	associated with the worker training and development services shall not be used in making 
46.26 	this calculation; and
46.27 	(14) documentation that the agency-provider does not burden participants' free exercise 
46.28 	of their right to choose service providers by requiring CFSS support workers to sign an 
46.29 	agreement not to work with any particular CFSS participant or for another CFSS 
46.30 	agency-provider after leaving the agency and that the agency is not taking action on any 
46.31 	such agreements or requirements regardless of the date signed.
47.1 	(b) CFSS agency-providers shall provide to the commissioner the information specified 
47.2 	in paragraph (a).
47.3 	(c) All CFSS agency-providers shall require all employees in management and 
47.4 	supervisory positions and owners of the agency who are active in the day-to-day management 
47.5 	and operations of the agency to complete mandatory training as determined by the 
47.6 	commissioner. Employees in management and supervisory positions and owners who are 
47.7 	active in the day-to-day operations of an agency who have completed the required training 
47.8 	as an employee with a CFSS agency-provider do not need to repeat the required training if 
47.9 	they are hired by another agency, if they have completed the training within the past three 
47.10 	years. CFSS agency-provider billing staff shall complete training about CFSS program 
47.11 	financial management. Any new owners or employees in management and supervisory 
47.12 	positions involved in the day-to-day operations are required to complete mandatory training 
47.13 	as a requisite of working for the agency.
47.14 	(d) The commissioner shall send annual review notifications to agency-providers 30 
47.15 	days prior to renewal. The notification must:
47.16 	(1) list the materials and information the agency-provider is required to submit;
47.17 	(2) provide instructions on submitting information to the commissioner; and
47.18 	(3) provide a due date by which the commissioner must receive the requested information.
47.19 	Agency-providers shall submit all required documentation for annual review within 30 days 
47.20 	of notification from the commissioner. If an agency-provider fails to submit all the required 
47.21 	documentation, the commissioner may take action under subdivision 23a.

47.22 	Sec. 29. Minnesota Statutes 2018, section 256B.85, subdivision 12b, is amended to read:
47.23 		Subd. 12b.CFSS agency-provider requirements; notice regarding termination of 
47.24 	services. (a) An agency-provider must provide written notice when it intends to terminate 
47.25 	services with a participant at least ten 30 calendar days before the proposed service 
47.26 	termination is to become effective, except in cases where:
47.27 	(1) the participant engages in conduct that significantly alters the terms of the CFSS 
47.28 	service delivery plan with the agency-provider;
47.29 	(2) the participant or other persons at the setting where services are being provided 
47.30 	engage in conduct that creates an imminent risk of harm to the support worker or other 
47.31 	agency-provider staff; or
48.1 	(3) an emergency or a significant change in the participant's condition occurs within a 
48.2 	24-hour period that results in the participant's service needs exceeding the participant's 
48.3 	identified needs in the current CFSS service delivery plan so that the agency-provider cannot 
48.4 	safely meet the participant's needs.
48.5 	(b) When a participant initiates a request to terminate CFSS services with the 
48.6 	agency-provider, the agency-provider must give the participant a written acknowledgement
48.7 	acknowledgment of the participant's service termination request that includes the date the 
48.8 	request was received by the agency-provider and the requested date of termination.
48.9 	(c) The agency-provider must participate in a coordinated transfer of the participant to 
48.10 	a new agency-provider to ensure continuity of care.

48.11 	Sec. 30. Minnesota Statutes 2018, section 256B.85, subdivision 13a, is amended to read:
48.12 		Subd. 13a.Financial management services. (a) Services provided by an FMS provider 
48.13 	include but are not limited to: filing and payment of federal and state payroll taxes on behalf 
48.14 	of the participant; initiating and complying with background study requirements under 
48.15 	chapter 245C and maintaining documentation of background study requests and results; 
48.16 	billing for approved CFSS services with authorized funds; monitoring expenditures; 
48.17 	accounting for and disbursing CFSS funds; providing assistance in obtaining and filing for 
48.18 	liability, workers' compensation, and unemployment coverage; and providing participant 
48.19 	instruction and technical assistance to the participant in fulfilling employer-related 
48.20 	requirements in accordance with section 3504 of the Internal Revenue Code and related 
48.21 	regulations and interpretations, including Code of Federal Regulations, title 26, section 
48.22 	31.3504-1.
48.23 	(b) Agency-provider services shall not be provided by the FMS provider.
48.24 	(c) The FMS provider shall provide service functions as determined by the commissioner 
48.25 	for budget model participants that include but are not limited to:
48.26 	(1) assistance with the development of the detailed budget for expenditures portion of 
48.27 	the CFSS service delivery plan as requested by the consultation services provider or 
48.28 	participant;
48.29 	(2) data recording and reporting of participant spending;
48.30 	(3) other duties established by the department, including with respect to providing 
48.31 	assistance to the participant, participant's representative, or legal representative in performing 
48.32 	employer responsibilities regarding support workers. The support worker shall not be 
48.33 	considered the employee of the FMS provider; and
49.1 	(4) billing, payment, and accounting of approved expenditures for goods.
49.2 	(d) The FMS provider shall obtain an assurance statement from the participant employer 
49.3 	agreeing to follow state and federal regulations and CFSS policies regarding employment 
49.4 	of support workers.
49.5 	(e) The FMS provider shall:
49.6 	(1) not limit or restrict the participant's choice of service or support providers or service 
49.7 	delivery models consistent with any applicable state and federal requirements;
49.8 	(2) provide the participant, consultation services provider, and case manager or care 
49.9 	coordinator, if applicable, with a monthly written summary of the spending for services and 
49.10 	supports that were billed against the spending budget;
49.11 	(3) be knowledgeable of state and federal employment regulations, including those under 
49.12 	the Fair Labor Standards Act of 1938, and comply with the requirements under section 3504 
49.13 	of the Internal Revenue Code and related regulations and interpretations, including Code 
49.14 	of Federal Regulations, title 26, section 31.3504-1, regarding agency employer tax liability 
49.15 	for vendor fiscal/employer agent, and any requirements necessary to process employer and 
49.16 	employee deductions, provide appropriate and timely submission of employer tax liabilities, 
49.17 	and maintain documentation to support medical assistance claims;
49.18 	(4) have current and adequate liability insurance and bonding and sufficient cash flow 
49.19 	as determined by the commissioner and have on staff or under contract a certified public 
49.20 	accountant or an individual with a baccalaureate degree in accounting;
49.21 	(5) assume fiscal accountability for state funds designated for the program and be held 
49.22 	liable for any overpayments or violations of applicable statutes or rules, including but not 
49.23 	limited to the Minnesota False Claims Act, chapter 15C; and
49.24 	(6) maintain documentation of receipts, invoices, and bills to track all services and 
49.25 	supports expenditures for any goods purchased and maintain time records of support workers. 
49.26 	The documentation and time records must be maintained for a minimum of five years from 
49.27 	the claim date and be available for audit or review upon request by the commissioner. Claims 
49.28 	submitted by the FMS provider to the commissioner for payment must correspond with 
49.29 	services, amounts, and time periods as authorized in the participant's service budget and 
49.30 	service plan and must contain specific identifying information as determined by the 
49.31 	commissioner.; and
49.32 	(7) provide written notice to the participant or the participant's representative at least 30 
49.33 	calendar days before a proposed service termination becomes effective.
50.1 	(f) The commissioner of human services shall:
50.2 	(1) establish rates and payment methodology for the FMS provider;
50.3 	(2) identify a process to ensure quality and performance standards for the FMS provider 
50.4 	and ensure statewide access to FMS providers; and
50.5 	(3) establish a uniform protocol for delivering and administering CFSS services to be 
50.6 	used by eligible FMS providers.

50.7 	Sec. 31. Minnesota Statutes 2018, section 256B.85, is amended by adding a subdivision 
50.8 	to read:
50.9 		Subd. 14a.Participant's representative responsibilities. (a) If a participant is unable 
50.10 	to direct the participant's own care, the participant must use a participant's representative 
50.11 	to receive CFSS services. A participant's representative is required if:
50.12 	(1) the person is under 18 years of age;
50.13 	(2) the person has a court-appointed guardian; or
50.14 	(3) an assessment according to section 256B.0659, subdivision 3a, determines that the 
50.15 	participant is in need of a participant's representative.
50.16 	(b) A participant's representative must:
50.17 	(1) be at least 18 years of age and actively participate in planning and directing CFSS 
50.18 	services;
50.19 	(2) have sufficient knowledge of the participant's circumstances to use CFSS services 
50.20 	consistent with the participant's health and safety needs identified in the participant's care 
50.21 	plan;
50.22 	(3) not have a financial interest in the provision of any services included in the 
50.23 	participant's CFSS service delivery plan; and
50.24 	(4) be capable of providing the support necessary to assist the participant in the use of 
50.25 	CFSS services.
50.26 	(c) A participant's representative must not be the:
50.27 	(1) support worker;
50.28 	(2) worker training and development service provider;
50.29 	(3) agency-provider staff, unless related to the participant by blood, marriage, or adoption;
51.1 	(4) consultation service provider, unless related to the participant by blood, marriage, 
51.2 	or adoption;
51.3 	(5) FMS staff, unless related to the participant by blood, marriage, or adoption;
51.4 	(6) FMS owner or manager; or
51.5 	(7) lead agency staff acting as part of employment.
51.6 	(d) A licensed family foster parent who lives with the participant may be the participant's 
51.7 	representative if the family foster parent meets the other participant's representative 
51.8 	requirements.
51.9 	(e) There may be two persons designated as the participant's representative, including 
51.10 	instances of divided households and court-ordered custodies. Each person named as 
51.11 	participant's representative must meet the program criteria and responsibilities.
51.12 	(f) The participant or the participant's legal representative shall appoint a participant's 
51.13 	representative. The participant's file must include written documentation that indicates the 
51.14 	participant's free choice. The participant's representative must be identified at the time of 
51.15 	assessment and listed on the participant's service agreement and CFSS service delivery plan.
51.16 	(g) A participant's representative shall enter into a written agreement with an 
51.17 	agency-provider or FMS, on a form determined by the commissioner, to:
51.18 	(1) be available while care is provided in a method agreed upon by the participant or 
51.19 	the participant's legal representative and documented in the participant's service delivery 
51.20 	plan;
51.21 	(2) monitor CFSS services to ensure the participant's service delivery plan is followed;
51.22 	(3) review and sign support worker time sheets after services are provided to verify the 
51.23 	provision of services;
51.24 	(4) review and sign vendor paperwork to verify receipt of the good; and
51.25 	(5) review and sign documentation to verify worker training after receipt of the worker 
51.26 	training.
51.27 	(h) A participant's representative may delegate the responsibility to another adult who 
51.28 	is not the support worker during a temporary absence of at least 24 hours but not more than 
51.29 	six months. To delegate responsibility the participant's representative must:
51.30 	(1) ensure that the delegate as the participant's representative satisfies the requirement 
51.31 	of the participant's representative;
52.1 	(2) ensure that the delegate performs the functions of the participant's representative;
52.2 	(3) communicate to the CFSS agency-provider or FMS about the need for a delegate by 
52.3 	updating the written agreement to include the name of the delegate and the delegate's contact 
52.4 	information; and
52.5 	(4) ensure that the delegate protects the participant's privacy according to federal and 
52.6 	state data privacy laws.
52.7 	(i) The designation of a participant's representative remains in place until:
52.8 	(1) the participant revokes the designation;
52.9 	(2) the participant's representative withdraws the designation or becomes unable to fulfill 
52.10 	the duties;
52.11 	(3) the legal authority to act as a participant's representative changes; or
52.12 	(4) the participant's representative is disqualified.
52.13 	(j) A lead agency may disqualify a participant's representative who engages in conduct 
52.14 	that creates an imminent risk of harm to the participant, the support workers, or other staff. 
52.15 	A participant's representative that fails to provide support required by the participant must 
52.16 	be referred to the common entry point.

52.17 	Sec. 32. Minnesota Statutes 2018, section 256B.85, subdivision 18a, is amended to read:
52.18 		Subd. 18a.Worker training and development services. (a) The commissioner shall 
52.19 	develop the scope of tasks and functions, service standards, and service limits for worker 
52.20 	training and development services.
52.21 	(b) Worker training and development costs are in addition to the participant's assessed 
52.22 	service units or service budget. Services provided according to this subdivision must:
52.23 	(1) help support workers obtain and expand the skills and knowledge necessary to ensure 
52.24 	competency in providing quality services as needed and defined in the participant's CFSS 
52.25 	service delivery plan and as required under subdivisions 11b and 14;
52.26 	(2) be provided or arranged for by the agency-provider under subdivision 11, or purchased 
52.27 	by the participant employer under the budget model as identified in subdivision 13; and
52.28 	(3) be delivered by an individual competent to perform, teach, or assign the tasks 
52.29 	identified, including health-related tasks, in the plan through education, training, and work 
52.30 	experience relevant to the person's assessed needs; and
53.1 	(4) be described in the participant's CFSS service delivery plan and documented in the 
53.2 	participant's file.
53.3 	(c) Services covered under worker training and development shall include:
53.4 	(1) support worker training on the participant's individual assessed needs and condition, 
53.5 	provided individually or in a group setting by a skilled and knowledgeable trainer beyond 
53.6 	any training the participant or participant's representative provides;
53.7 	(2) tuition for professional classes and workshops for the participant's support workers 
53.8 	that relate to the participant's assessed needs and condition;
53.9 	(3) direct observation, monitoring, coaching, and documentation of support worker job 
53.10 	skills and tasks, beyond any training the participant or participant's representative provides, 
53.11 	including supervision of health-related tasks or behavioral supports that is conducted by an 
53.12 	appropriate professional based on the participant's assessed needs. These services must be 
53.13 	provided at the start of services or the start of a new support worker except as provided in 
53.14 	paragraph (d) and must be specified in the participant's CFSS service delivery plan; and
53.15 	(4) the activities to evaluate CFSS services and ensure support worker competency 
53.16 	described in subdivisions 11a and 11b.
53.17 	(d) The services in paragraph (c), clause (3), are not required to be provided for a new 
53.18 	support worker providing services for a participant due to staffing failures, unless the support 
53.19 	worker is expected to provide ongoing backup staffing coverage.
53.20 	(e) Worker training and development services shall not include:
53.21 	(1) general agency training, worker orientation, or training on CFSS self-directed models;
53.22 	(2) payment for preparation or development time for the trainer or presenter;
53.23 	(3) payment of the support worker's salary or compensation during the training;
53.24 	(4) training or supervision provided by the participant, the participant's support worker, 
53.25 	or the participant's informal supports, including the participant's representative; or
53.26 	(5) services in excess of 96 units per annual service agreement, unless approved by the 
53.27 	department.

53.28 	Sec. 33. REVISOR INSTRUCTION; CORRECTING TERMINOLOGY.
 53.29 	(a) The revisor of statutes shall change the term "developmental disability waiver" or 
53.30 	similar terms to "developmental disabilities waiver" or similar terms wherever they appear 
54.1 	in Minnesota Statutes. The revisor shall also make technical and other necessary changes 
54.2 	to sentence structure to preserve the meaning of the text.
54.3 	(b) In Minnesota Statutes, sections 256.01, subdivisions 2 and 24; 256.975, subdivision 
54.4 	7; 256B.0911, subdivisions 1a, 3b, and 4d; and 256B.439, subdivision 4, the revisor of 
54.5 	statutes shall substitute the term "Disability Linkage Line" or similar terms for "Disability 
54.6 	Hub" or similar terms. The revisor shall also make grammatical changes related to the 
54.7 	changes in terms.

54.8 	Sec. 34. REVISOR INSTRUCTION; PCA TRANSITION TO CFSS.
 54.9 	The revisor of statutes, in consultation with the House Research Department, Office of 
54.10 	Senate Counsel, Research and Fiscal Analysis, and Department of Human Services, shall 
54.11 	prepare legislation for the 2020 legislative session to repeal laws governing the consumer 
54.12 	support grant program and personal care assistance program in Minnesota Statutes, chapters 
54.13 	256 and 256B, correct cross-references, remove obsolete language, and, as necessary, provide 
54.14 	for the transition from the personal care assistance program to community first services and 
54.15 	supports.

54.16 	EFFECTIVE DATE. This section is effective the day following final enactment.