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HF 1114

1st Engrossment - 86th Legislature (2009 - 2010) Posted on 02/09/2010 01:44am

KEY: stricken = removed, old language.
underscored = added, new language.
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A bill for an act
relating to human services; changing capacity requirements for certain residential
programs; requiring the commissioner to request federal waivers; amending
Minnesota Statutes 2008, sections 245A.11, subdivision 2a; 256B.092,
subdivision 5a; 256B.49, subdivision 17.

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

Section 1.

Minnesota Statutes 2008, section 245A.11, subdivision 2a, is amended to
read:


Subd. 2a.

Adult foster care license capacity.

new text begin The commissioner shall issue adult
foster care licenses with a maximum licensed capacity of four beds, including nonstaff
roomers and boarders, but may issue a license with a capacity of five beds, including
roomers and boarders, only according to paragraphs (a) to (e).
new text end

(a) An adult foster care license holder may have a maximum license capacity of five
if all persons in care are age 55 or over and do not have a serious and persistent mental
illness or a developmental disability.

(b) The commissioner may grant variances to paragraph (a) to allow a foster care
provider with a licensed capacity of five persons to admit an individual under the age of 55
if the variance complies with section 245A.04, subdivision 9, and approval of the variance
is recommended by the county in which the licensed foster care provider is located.

(c) The commissioner may grant variances to paragraph (a) to allow the use of a fifth
bed for emergency crisis services for a person with serious and persistent mental illness
or a developmental disability, regardless of age, if the variance complies with section
245A.04, subdivision 9, and approval of the variance is recommended by the county in
which the licensed foster care provider is located.

(d) deleted text begin Notwithstanding paragraph (a),deleted text end The commissioner may issue an adult foster
care license with a capacity of five adultsnew text begin if the fifth bed does not increase the overall
statewide capacity of licensed adult foster care beds in homes which are not the primary
residence of the license holder, over the licensed capacity in such homes on July 1, 2009,
as identified in a plan submitted to the commissioner by the county,
new text end when the capacity is
recommended by the county licensing agency of the county in which the facility is located
and if the recommendation verifies that:

(1) the facility meets the physical environment requirements in the adult foster
care licensing rule;

(2) the five-bed living arrangement is specified for each resident in the resident's:

(i) individualized plan of care;

(ii) individual service plan under section 256B.092, subdivision 1b, if required; or

(iii) individual resident placement agreement under Minnesota Rules, part
9555.5105, subpart 19, if required;

(3) the license holder obtains written and signed informed consent from each
resident or resident's legal representative documenting the resident's informed choice to
living in the home and that the resident's refusal to consent would not have resulted in
service termination; and

(4) the facility was licensed for adult foster care before March 1, deleted text begin 2003deleted text end new text begin 2009new text end .

(e) The commissioner shall not issue a new adult foster care license under paragraph
(d) after June 30, deleted text begin 2005deleted text end new text begin 2011new text end . The commissioner shall allow a facility with an adult foster
care license issued under paragraph (d) before June 30, deleted text begin 2005deleted text end new text begin 2011new text end , to continue with a
capacity of five adults if the license holder continues to comply with the requirements in
paragraph (d).

Sec. 2.

Minnesota Statutes 2008, section 256B.092, subdivision 5a, is amended to read:


Subd. 5a.

Increasing adult foster care capacity to serve five persons.

deleted text begin (a)deleted text end When
deleted text begin andeleted text end new text begin a licensednew text end adult foster care provider increases the capacity of an existing new text begin four-bed new text end home
deleted text begin licensed to serve four personsdeleted text end new text begin and obtains a licensenew text end to serve a fifth person under this
section, the county agency shall deleted text begin reduce the contracteddeleted text end new text begin negotiate new text end per diem cost for room
and board and the deleted text begin developmental disabilitydeleted text end waiver services deleted text begin of the existing foster care
home by an average of 14 percent for all individuals living in that home. A county agency
may average the required per diem rate reductions across several adult foster care homes
that expand capacity under this section to achieve the necessary overall per diem reduction
deleted text end new text begin
with the provider to manage a legislated rate reduction. The revised per diem costs must
demonstrate an overall reduction in the payment to the provider for the persons receiving
services affected by the occupancy change
new text end .

deleted text begin (b) Following the contract changes in paragraph (a), the commissioner shall adjust:
deleted text end

deleted text begin (1) individual county allocations for developmental disability waivered services by
the amount of savings that results from the changes made for developmental disability
waiver recipients for whom the county is financially responsible; and
deleted text end

deleted text begin (2) group residential housing rate payments to the adult foster care home by the
amount of savings that results from the changes made.
deleted text end

deleted text begin (c) Effective July 1, 2003, when a new five-person adult foster care home is licensed
under this section, county agencies shall not establish group residential housing room
and board rates and developmental disability waiver service rates for the new home that
exceed 86 percent of the average per diem room and board and developmental disability
waiver services costs of four-person homes serving persons with comparable needs and in
the same geographic area. A county agency developing more than one new five-person
adult foster care home may average the required per diem rates across the homes to
achieve the necessary overall per diem reductions.
deleted text end

deleted text begin (d) The commissioner shall reduce the individual county allocations for
developmental disability waivered services by the savings resulting from the per diem
limits on adult foster care recipients for whom the county is financially responsible, and
shall limit the group residential housing rate for a new five-person adult foster care home.
deleted text end

Sec. 3.

Minnesota Statutes 2008, section 256B.49, subdivision 17, is amended to read:


Subd. 17.

Cost of services and supports.

(a) The commissioner shall ensure
that the average per capita expenditures estimated in any fiscal year for home and
community-based waiver recipients does not exceed the average per capita expenditures
that would have been made to provide institutional services for recipients in the absence
of the waiver.

(b) The commissioner shall implement on January 1, 2002, one or more aggregate,
need-based methods for allocating to local agencies the home and community-based
waivered service resources available to support recipients with disabilities in need of
the level of care provided in a nursing facility or a hospital. The commissioner shall
allocate resources to single counties and county partnerships in a manner that reflects
consideration of:

(1) an incentive-based payment process for achieving outcomes;

(2) the need for a state-level risk pool;

(3) the need for retention of management responsibility at the state agency level; and

(4) a phase-in strategy as appropriate.

(c) Until the allocation methods described in paragraph (b) are implemented, the
annual allowable reimbursement level of home and community-based waiver services
shall be the greater of:

(1) the statewide average payment amount which the recipient is assigned under the
waiver reimbursement system in place on June 30, 2001, modified by the percentage of
any provider rate increase appropriated for home and community-based services; or

(2) an amount approved by the commissioner based on the recipient's extraordinary
needs that cannot be met within the current allowable reimbursement level. The
increased reimbursement level must be necessary to allow the recipient to be discharged
from an institution or to prevent imminent placement in an institution. The additional
reimbursement may be used to secure environmental modifications; assistive technology
and equipment; and increased costs for supervision, training, and support services
necessary to address the recipient's extraordinary needs. The commissioner may approve
an increased reimbursement level for up to one year of the recipient's relocation from an
institution or up to six months of a determination that a current waiver recipient is at
imminent risk of being placed in an institution.

(d) Beginning July 1, 2001, medically necessary private duty nursing services will be
authorized under this section as complex and regular care according to sections 256B.0651
and 256B.0653 to 256B.0656. The rate established by the commissioner for registered
nurse or licensed practical nurse services under any home and community-based waiver as
of January 1, 2001, shall not be reduced.

new text begin (e) When a licensed adult foster care provider seeks to increase the capacity of an
existing four-bed home to be licensed to serve a fifth person under section 245A.11,
subdivision 2a, the county agency shall negotiate the per diem cost for room and board and
the waiver services with the provider to manage a legislatively required rate reduction.
The revised per diem costs must demonstrate an overall reduction in the payment to the
provider for the persons receiving services affected by the occupancy change.
new text end

Sec. 4. new text begin RESIDENTIAL HOME AND COMMUNITY-BASED WAIVERED
SERVICES.
new text end

new text begin Minnesota Statutes, section 252.28, subdivision 3, paragraph (d), shall not be in
effect from July 1, 2009, to June 30, 2011, to allow the commissioner to issue licenses
for residential programs with a capacity of five adults under the conditions specified in
Minnesota Statutes, section 245A.11, subdivision 2a.
new text end

Sec. 5. new text begin WAIVER.
new text end

new text begin By December 1, 2009, the commissioner shall request all federal approvals and
waiver amendments to the disability home and community-based waivers to allow properly
licensed adult foster care homes to provide residential services for up to five individuals.
new text end

Sec. 6. new text begin EFFECTIVE DATE.
new text end

new text begin Sections 1 to 5 are effective July 1, 2009.
new text end