HF 826

as introduced - 86th Legislature (2009 - 2010) Posted on 02/09/2010 01:42am

A bill for an act
relating to human services; permitting non-Medicare home care agencies to
provide alternative care services; eliminating the customized living rate cap;
amending Minnesota Statutes 2008, sections 256B.0913, subdivision 5a;
256B.0915, subdivision 3e.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2008, section 256B.0913, subdivision 5a, is amended to
read:

Subd. 5a.

Services; service definitions; service standards.

(a) new text begin Except as provided
in paragraph (b) and new text end unless new text begin otherwise new text end specified in statute, the services, service definitions,
and standards for alternative care services shall be the same as the services, service
definitions, and standards specified in the federally approved elderly waiver plan, except
alternative care does not cover transitional support services, assisted living services, adult
foster care services, and residential care and benefits defined under section 256B.0625 that
meet primary and acute health care needs.

(b) new text begin Alternative care services may be provided by a class A, class F, or class B home
care provider licensed by the commissioner. Medicare certification is not required.
new text end

new text begin (c) new text end The lead agency must ensure that the funds are not used to supplant or
supplement services available through other public assistance or services programs,
including supplementation of client co-pays, deductibles, premiums, or other cost-sharing
arrangements for health-related benefits and services or entitlement programs and services
that are available to the person, but in which they have elected not to enroll. For a provider
of supplies and equipment when the monthly cost of the supplies and equipment is less
than $250, persons or agencies must be employed by or under a contract with the lead
agency or the public health nursing agency of the local board of health in order to receive
funding under the alternative care program. Supplies and equipment may be purchased
from a vendor not certified to participate in the Medicaid program if the cost for the
item is less than that of a Medicaid vendor.

deleted text begin (c) deleted text end new text begin (d) new text end Personal care services must meet the service standards defined in the
federally approved elderly waiver plan, except that a lead agency may contract with a
client's relative who meets the relative hardship waiver requirements or a relative who
meets the criteria and is also the responsible party under an individual service plan that
ensures the client's health and safety and supervision of the personal care services by a
qualified professional as defined in section 256B.0625, subdivision 19c. Relative hardship
is established by the lead agency when the client's care causes a relative caregiver to do
any of the following: resign from a paying job, reduce work hours resulting in lost wages,
obtain a leave of absence resulting in lost wages, incur substantial client-related expenses,
provide services to address authorized, unstaffed direct care time, or meet special needs of
the client unmet in the formal service plan.

Sec. 2.

Minnesota Statutes 2008, section 256B.0915, subdivision 3e, is amended to
read:

Subd. 3e.

Customized living service rate.

(a) Payment for customized living
services shall be a monthly rate negotiated and authorized by the lead agency within the
parameters established by the commissioner. The payment agreement must delineate the
services that have been customized for each recipient and specify the amount of each
service to be provided. The lead agency shall ensure that there is a documented need for
all services authorized. Customized living services must not include rent or raw food
costs. The negotiated payment rate must be based on services to be provided. Negotiated
rates must not exceed payment rates for comparable elderly waiver or medical assistance
services and must reflect economies of scale.

(b) The individualized monthly negotiated payment for customized living services
shall not exceed deleted text begin the nonfederal share, in effect on July 1 of the state fiscal year for
which the rate limit is being calculated, of the greater of either the statewide or any
of the geographic groups' weighted average monthly nursing facility rate of the case
mix resident class to which the elderly waiver eligible client would be assigned under
Minnesota Rules, parts 9549.0050 to 9549.0059, less the maintenance needs allowance
as described in subdivision 1d, paragraph (a), until the July 1 of the state fiscal year in
which the resident assessment system as described in section 256B.438 for nursing
home rate determination is implemented. Effective on July 1 of the state fiscal year in
which the resident assessment system as described in section 256B.438 for nursing
home rate determination is implemented and July 1 of each subsequent state fiscal year,
the individualized monthly negotiated payment for the services described in this clause
shall not exceed the limit described in this clause which was in effect on June 30 of the
previous state fiscal year and which has been adjusted by the greater of any legislatively
adopted home and community-based services cost-of-living percentage increase or any
legislatively adopted statewide percent rate increase for nursing facilities. deleted text end new text begin the elderly
waiver cost limits described in subdivision 3a. The individualized monthly negotiated
payment for customized services must be determined by the lead agency based on the
needs of the client as determined by the long-term care consultation assessment and the
resulting authorized services. The individually negotiated customized living payments,
in combination with the payment for other elderly waiver services, including case
management, must not exceed the elderly waiver cost limits described in subdivision 3a. new text end

(c) new text begin Subject to the requirements of this section, customized living services and
24-hour customized living services include incidental nursing services that are provided
directly by a licensed nurse under a class A or class F home care license issued under
Minnesota Rules, chapter 4668, and that are not eligible to be covered by Medicare. For
purposes of this paragraph, "incidental nursing services" means medication set-ups, the
drawing up of insulin, injections, diabetic foot care, catheter insertion, monitoring of blood
tests for therapeutic treatments, and any other service identified by the commissioner
of human services. If the commissioner determines that incidental nursing services, as
defined, are not permitted under the terms of the federally approved elderly home and
community-based services waiver, the commissioner shall apply to amend the waiver to
permit coverage of the services within customized living and 24-hour customized living.
new text end

new text begin (d) new text end Customized living services are delivered by a provider licensed by the
Department of Health as a class A or class F home care provider and provided in a
building that is registered as a housing with services establishment under chapter 144D.