HF 1405

1st Engrossment - 85th Legislature (2007 - 2008) Posted on 12/15/2009 12:00am

A bill for an act
relating to human services; allowing coverage of incidental nursing services
under the elderly waiver; providing rate exceptions; withholding long-term care
consultation payments for certain facilities in arrears; requiring a study and
report; amending Minnesota Statutes 2006, sections 256B.0911, subdivision 6;
256B.0915, subdivision 3e, by adding a subdivision.

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

Section 1.

Minnesota Statutes 2006, section 256B.0911, subdivision 6, is amended to
read:

Subd. 6.

Payment for long-term care consultation services.

(a) The total payment
for each county must be paid monthly by certified nursing facilities in the county. The
monthly amount to be paid by each nursing facility for each fiscal year must be determined
by dividing the county's annual allocation for long-term care consultation services by 12
to determine the monthly payment and allocating the monthly payment to each nursing
facility based on the number of licensed beds in the nursing facility. Payments to counties
in which there is no certified nursing facility must be made by increasing the payment
rate of the two facilities located nearest to the county seat.

(b) The commissioner shall include the total annual payment determined under
paragraph (a) for each nursing facility reimbursed under section 256B.431 or 256B.434
according to section 256B.431, subdivision 2b, paragraph (g), or 256B.435. new text begin Facilities
whose payments to one or more counties are more than three months in arrears shall have
their long-term care consultation payments from the commissioner withheld, and the
commissioner is authorized to send withheld amounts directly to affected counties.
new text end

(c) In the event of the layaway, delicensure and decertification, or removal from
layaway of 25 percent or more of the beds in a facility, the commissioner may adjust
the per diem payment amount in paragraph (b) and may adjust the monthly payment
amount in paragraph (a). The effective date of an adjustment made under this paragraph
shall be on or after the first day of the month following the effective date of the layaway,
delicensure and decertification, or removal from layaway.

(d) Payments for long-term care consultation services are available to the county
or counties to cover staff salaries and expenses to provide the services described in
subdivision 1a. The county shall employ, or contract with other agencies to employ, within
the limits of available funding, sufficient personnel to provide long-term care consultation
services while meeting the state's long-term care outcomes and objectives as defined in
section 256B.0917, subdivision 1. The county shall be accountable for meeting local
objectives as approved by the commissioner in the biennial home and community-based
services quality assurance plan on a form provided by the commissioner.

(e) Notwithstanding section 256B.0641, overpayments attributable to payment of the
screening costs under the medical assistance program may not be recovered from a facility.

(f) The commissioner of human services shall amend the Minnesota medical
assistance plan to include reimbursement for the local consultation teams.

(g) The county may bill, as case management services, assessments, support
planning, and follow-along provided to persons determined to be eligible for case
management under Minnesota health care programs. No individual or family member
shall be charged for an initial assessment or initial support plan development provided
under subdivision 3a or 3b.

Sec. 2.

Minnesota Statutes 2006, section 256B.0915, subdivision 3e, is amended to
read:

Subd. 3e.

Assisted living service rate.

(a) Payment for assisted living service
shall be a monthly rate negotiated and authorized by the county agency based on an
individualized service plan for each resident and may not cover direct rent or food costs.

(b) The individualized monthly negotiated payment for assisted living services as
described in section 256B.0913, subdivisions 5d to 5f, and residential care services as
described in section 256B.0913, subdivision 5c, shall not exceed 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.437 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.437
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.

(c) The individualized monthly negotiated payment for assisted living services
described in section 144A.4605 and delivered by a provider licensed by the Department
of Health as a class A home care provider or an assisted living home care provider and
provided in a building that is registered as a housing with services establishment under
chapter 144D and that provides 24-hour supervision in combination with the payment for
other elderly waiver services, including case management, must not exceed the limit
specified in subdivision 3a.

new text begin (d) 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,
injections, diabetic foot care, catheter insertion, monitoring of blood tests for therapeutic
treatments, nursing assessments, 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

Sec. 3.

Minnesota Statutes 2006, section 256B.0915, is amended by adding a
subdivision to read:

new text begin Subd. 3h. new text end

new text begin Individual rate exceptions authorized. new text end

new text begin Based on the determination of
the case manager, in consultation with the provider serving the elderly waiver client, if
the client needs additional services for 30 days or less in order to avoid a hospitalization
or nursing facility placement, the case manager may authorize additional elderly waiver
services that exceed the client's monthly cost limit. For these clients, the total cost of all
elderly waiver services may not exceed the monthly conversion limit for elderly waiver
applicants who reside in a nursing facility, as defined in subdivision 3b.
new text end

Sec. 4. new text begin STUDY AND REPORT ON ELDERLY WAIVER.
new text end

new text begin The commissioner of human services, after consulting with counties, by January
15, 2008, shall present a report to the legislature addressing the following aspects of the
home and community-based waivered services program for the elderly under Minnesota
Statutes, section 256B.0915:
new text end

new text begin (1) the length of time it takes each county, or joint-county consultation team, as
applicable, to complete a long-term care consultation under Minnesota Statutes, section
256B.0911, for a person who is seeking to qualify for, or is a current recipient of, elderly
waiver services, including recommendations on how to improve the process, to the extent
counties or joint-county consultation teams are not achieving compliance with Minnesota
Statutes, section 256B.0911, subdivision 3a;
new text end

new text begin (2) the methods and tools that lead agencies use to establish the level of, and payment
rates for, customized living and 24-hour customized living services provided under the
elderly waiver program, including recommendations for how to achieve consistency
across these lead agencies in providing access to and funding for these services; and
new text end

new text begin (3) options to fully fund the county responsibilities for long-term care consultations
as required under section 256B.0911 in a manner that will sustain and support these
responsibilities as a core county function to assist persons with long-term or chronic care
needs in making long-term care decisions and selecting options that meet their needs and
reflect their preferences, and to ensure the availability of, and access to, information and
other types of assistance intended to prevent or delay certified nursing facility placements
and to provide transition assistance after admission.
new text end