HF 2627

1st Engrossment - 87th Legislature (2011 - 2012) Posted on 03/22/2012 04:47pm

A bill for an act
relating to human services; changing a requirement for electronic claims and
electronic transactions; making changes to health care and disability services
provisions; providing for a supplemental agreement to a contract for community
social services; making changes to family stabilization services provisions;
requiring procedures to establish a reciprocal child support agreement with
Bermuda; amending Minnesota Statutes 2010, sections 62J.497, subdivision 2;
62J.536, subdivision 1; 256.0112, by adding a subdivision; 256.962, by adding
a subdivision; 256J.575, subdivisions 1, 2, 5, 6, 8; Minnesota Statutes 2011
Supplement, sections 256B.0911, subdivision 3a; 256B.0915, subdivisions 3e,
3h.

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

ARTICLE 1

HEALTH CARE

Section 1.

Minnesota Statutes 2010, section 62J.497, subdivision 2, is amended to read:

Subd. 2.

Requirements for electronic prescribing.

(a) Effective January 1, 2011,
all providers, group purchasers, prescribers, and dispensers must establish, maintain,
and use an electronic prescription drug program. This program must comply with the
applicable standards in this section for transmitting, directly or through an intermediary,
prescriptions and prescription-related information using electronic media.

(b) If transactions described in this section are conducted, they must be done
electronically using the standards described in this section. Nothing in this section
requires providers, group purchasers, prescribers, or dispensers to electronically conduct
transactions that are expressly prohibited by other sections or federal law.

(c) Providers, group purchasers, prescribers, and dispensers must use either HL7
messages or the NCPDP SCRIPT Standard to transmit prescriptions or prescription-related
information internally when the sender and the recipient are part of the same legal entity. If
an entity sends prescriptions outside the entity, it must use the NCPDP SCRIPT Standard
or other applicable standards required by this section. Any pharmacy within an entity
must be able to receive electronic prescription transmittals from outside the entity using
the adopted NCPDP SCRIPT Standard. This exemption does not supersede any Health
Insurance Portability and Accountability Act (HIPAA) requirement that may require the
use of a HIPAA transaction standard within an organization.

new text begin (d) Notwithstanding paragraph (a), any clinic with two or fewer practicing
physicians is exempt from this subdivision if the clinic is making a good-faith effort to
meet the electronic health records system requirement under section 62J.495 that includes
an electronic prescribing component. This paragraph expires January 1, 2015.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective retroactively from January 1, 2011.
new text end

Sec. 2.

Minnesota Statutes 2010, section 62J.536, subdivision 1, is amended to read:

Subdivision 1.

Electronic claims and eligibility transactions required.

(a)
Beginning January 15, 2009, all group purchasers must accept from health care providers
the eligibility for a health plan transaction described under Code of Federal Regulations,
title 45, part 162, subpart L. Beginning July 15, 2009, all group purchasers must accept
from health care providers the health care claims or equivalent encounter information
transaction described under Code of Federal Regulations, title 45, part 162, subpart K.

(b) Beginning January 15, 2009, all group purchasers must transmit to providers the
eligibility for a health plan transaction described under Code of Federal Regulations, title
45, part 162, subpart L. Beginning December 15, 2009, all group purchasers must transmit
to providers the health care payment and remittance advice transaction described under
Code of Federal Regulations, title 45, part 162, subpart P.

(c) Beginning January 15, 2009, all health care providers must submit to group
purchasers the eligibility for a health plan transaction described under Code of Federal
Regulations, title 45, part 162, subpart L. Beginning July 15, 2009, all health care
providers must submit to group purchasers the health care claims or equivalent encounter
information transaction described under Code of Federal Regulations, title 45, part 162,
subpart K.

(d) Beginning January 15, 2009, all health care providers must accept from group
purchasers the eligibility for a health plan transaction described under Code of Federal
Regulations, title 45, part 162, subpart L. Beginning December 15, 2009, all health care
providers must accept from group purchasers the health care payment and remittance
advice transaction described under Code of Federal Regulations, title 45, part 162, subpart
P.

(e) Beginning January 1, 2012, all health care providers, health care clearinghouses,
and group purchasers must provide an appropriate, standard, electronic acknowledgment
when receiving the health care claims or equivalent encounter information transaction
or the health care payment and remittance advice transaction. new text begin An appropriate, standard,
electronic National Council for Prescription Drug Programs response must be used for
prescription drug claims or equivalent encounter information. new text end The acknowledgment
provided new text begin for claims or equivalent encounter information, other than for prescription drugs,
new text end must be based on one or more of the following American National Standards Institute,
Accredited Standards Committee X12 standard transactions:

(1) TA1;

(2) deleted text begin 997;
deleted text end

deleted text begin (3) deleted text end 999; or

deleted text begin (4) deleted text end new text begin (3) new text end 277CA.

Health care providers, health care clearinghouses, and group purchasers may send and
receive more than one type of standard acknowledgment as mutually agreed upon. The
mutually agreed upon acknowledgments must be exchanged electronically. Electronic
exchanges of acknowledgments do not include e-mail or facsimile.

(f) Each of the transactions described in paragraphs (a) to (e) shall require the use
of a single, uniform companion guide to the implementation guides described under
Code of Federal Regulations, title 45, part 162. The companion guides will be developed
pursuant to subdivision 2.

(g) Notwithstanding any other provisions in sections 62J.50 to 62J.61, all group
purchasers and health care providers must exchange claims and eligibility information
electronically using the transactions, companion guides, implementation guides, and
timelines required under this subdivision. Group purchasers may not impose any fee on
providers or providers' clearinghouses for the use of the transactions prescribed in this
subdivision. Health care providers may not impose a fee on group purchasers or group
purchasers' clearinghouses for the use of the transactions prescribed in this subdivision.
A clearinghouse may not charge a fee solely to receive a standard transaction from a
health care provider, a health care provider's clearinghouse, a group purchaser, or a group
purchaser's clearinghouse when it is not an agent of the sending entity. A clearinghouse
may not charge a fee solely to send a standard transaction to a health care provider, a health
care provider's clearinghouse, a group purchaser, or a group purchaser's clearinghouse
when it is not an agent of the receiving entity.

(h) Nothing in this subdivision shall prohibit group purchasers and health care
providers from using a direct data entry, Web-based methodology for complying with
the requirements of this subdivision. Any direct data entry method for conducting
the transactions specified in this subdivision must be consistent with the data content
component of the single, uniform companion guides required in paragraph (f) and the
implementation guides described under Code of Federal Regulations, title 45, part 162.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2012.
new text end

Sec. 3.

Minnesota Statutes 2010, section 256.962, is amended by adding a subdivision
to read:

new text begin Subd. 8. new text end

new text begin Coverage dates. new text end

new text begin The commissioner, upon the request of a managed care
or county-based purchasing plan, shall include the end of coverage dates on the monthly
rosters of medical assistance and MinnesotaCare enrollees provided to the plans. The
commissioner may assess plans a fee for the cost of producing the monthly roster of
enrollees with end of coverage dates.
new text end

ARTICLE 2

HUMAN SERVICES

Section 1.

Minnesota Statutes 2010, section 256.0112, is amended by adding a
subdivision to read:

new text begin Subd. 9. new text end

new text begin Contracting for performance. new text end

new text begin In addition to the agreements in
subdivision 8, a local agency may negotiate a supplemental agreement to a contract
executed between a lead agency and an approved vendor under subdivision 6 for the
purposes of contracting for specific performance. The supplemental agreement may
augment the lead contract requirements and rates for services authorized by that local
agency only. The additional provisions must be negotiated with the vendor and designed
to encourage successful, timely, and cost-effective outcomes for clients, and may establish
incentive payments, penalties, performance-related reporting requirements, and similar
conditions. The per diem rate allowed under this subdivision must not be less than the rate
established in the lead county contract. Nothing in the supplemental agreement between
a local agency and an approved vendor binds the lead agency or other local agencies to
the terms and conditions of the supplemental agreement.
new text end

Sec. 2.

Minnesota Statutes 2010, section 256J.575, subdivision 1, is amended to read:

Subdivision 1.

Purpose.

deleted text begin (a) The deleted text end Family stabilization services serve families who
are not making significant progress within the new text begin regular employment and training services
track of the new text end Minnesota family investment program (MFIP) due to a variety of barriers to
employment.

deleted text begin (b) The goal of the services is to stabilize and improve the lives of families at risk
of long-term welfare dependency or family instability due to employment barriers such
as physical disability, mental disability, age, or providing care for a disabled household
member. These services promote and support families to achieve the greatest possible
degree of self-sufficiency.
deleted text end

Sec. 3.

Minnesota Statutes 2010, section 256J.575, subdivision 2, is amended to read:

Subd. 2.

Definitions.

The terms used in this section have the meanings given them
in paragraphs (a) deleted text begin to (d) deleted text end new text begin and (b) new text end .

(a) deleted text begin "Case manager" means the county-designated staff person or employment
services counselor.
deleted text end

deleted text begin (b) "Case management" deleted text end new text begin "Family stabilization services" new text end means deleted text begin the deleted text end new text begin programs,
activities, and new text end services provided by or through the county agency or through the
employment services agency to participating families deleted text begin , including deleted text end new text begin . Services include, but
are not limited to, new text end assessment new text begin as defined in section 256J.521, subdivision 1 new text end , deleted text begin information, deleted text end
referrals, and assistance in the preparation and implementation of a family stabilization
plan under subdivision 5.

deleted text begin (c) deleted text end new text begin (b) new text end "Family stabilization plan" means a plan developed deleted text begin by a case manager
and deleted text end new text begin with new text end the participant, which identifies the participant's most appropriate path to
unsubsidized employment, family stability, and barrier reduction, taking into account the
family's circumstances.

deleted text begin (d) "Family stabilization services" means programs, activities, and services in this
section that provide participants and their family members with assistance regarding,
but not limited to:
deleted text end

deleted text begin (1) obtaining and retaining unsubsidized employment;
deleted text end

deleted text begin (2) family stability;
deleted text end

deleted text begin (3) economic stability; and
deleted text end

deleted text begin (4) barrier reduction.
deleted text end

deleted text begin The goal of the services is to achieve the greatest degree of economic self-sufficiency
and family well-being possible for the family under the circumstances.
deleted text end

Sec. 4.

Minnesota Statutes 2010, section 256J.575, subdivision 5, is amended to read:

Subd. 5.

deleted text begin Case management; deleted text end Family stabilization plans; deleted text begin coordinated deleted text end services.

(a) The county agency or employment services provider shall provide deleted text begin family stabilization
services to families through a case management model. A case manager shall be assigned
to each participating family within 30 days after the family is determined to be eligible
for family stabilization services. The case manager, with the full involvement of the
participant, shall recommend, and the county agency shall establish and modify as
necessary, deleted text end a family stabilization plan for each participating family. new text begin Once a participant
has been determined eligible for family stabilization services, the county agency or
employment services provider must attempt to meet with the participant to develop a
plan within 30 days.
new text end

new text begin (b) new text end If a participant is already assigned to a county case manager or a
county-designated case manager in social services, disability services, or housing services
that case manager already assigned may be the case manager for purposes of these services.

deleted text begin (b) The family stabilization plan must include:
deleted text end

deleted text begin (1) each participant's plan for long-term self-sufficiency, including an employment
goal where applicable;
deleted text end

deleted text begin (2) an assessment of each participant's strengths and barriers, and any special
circumstances of the participant's family that impact, or are likely to impact, the
participant's progress towards the goals in the plan; and
deleted text end

deleted text begin (3) an identification of the services, supports, education, training, and
accommodations needed to reduce or overcome any barriers to enable the family to
achieve self-sufficiency and to fulfill each caregiver's personal and family responsibilities.
deleted text end

deleted text begin (c) The case manager and the participant shall meet within 30 days of the family's
referral to the case manager. The initial family stabilization plan must be completed within
30 days of the first meeting with the case manager. The case manager shall establish a
schedule for periodic review of the family stabilization plan that includes personal contact
with the participant at least once per month. In addition, the case manager shall review
and, if necessary, modify the plan under the following circumstances:
deleted text end

deleted text begin (1) there is a lack of satisfactory progress in achieving the goals of the plan;
deleted text end

deleted text begin (2) the participant has lost unsubsidized or subsidized employment;
deleted text end

deleted text begin (3) a family member has failed or is unable to comply with a family stabilization
plan requirement;
deleted text end

deleted text begin (4) services, supports, or other activities required by the plan are unavailable;
deleted text end

deleted text begin (5) changes to the plan are needed to promote the well-being of the children; or
deleted text end

deleted text begin (6) the participant and case manager determine that the plan is no longer appropriate
for any other reason.
deleted text end

new text begin (c) Participants determined eligible for family stabilization services must have
access to employment and training services under sections 256J.515 to 256J.575, to the
extent these services are available to other MFIP participants.
new text end

Sec. 5.

Minnesota Statutes 2010, section 256J.575, subdivision 6, is amended to read:

Subd. 6.

Cooperation with services requirements.

deleted text begin (a) deleted text end A participant who is eligible
for family stabilization services deleted text begin under this section shall comply with paragraphs (b) to (d).
deleted text end

deleted text begin (b) Participants deleted text end shall engage in family stabilization deleted text begin plan deleted text end services for the appropriate
number of hours per week deleted text begin that the activities are scheduled and available, deleted text end new text begin based on the
needs of the participant and the participant's family, new text end unless good cause exists for not
doing so, as defined in section 256J.57, subdivision 1. deleted text begin The appropriate number of hours
must be based on the participant's plan.
deleted text end

deleted text begin (c) The case manager shall review the participant's progress toward the goals in the
family stabilization plan every six months to determine whether conditions have changed,
including whether revisions to the plan are needed.
deleted text end

deleted text begin (d) A participant's requirement to comply with any or all family stabilization plan
requirements under this subdivision is excused when the case management services,
training and educational services, or family support services identified in the participant's
family stabilization plan are unavailable for reasons beyond the control of the participant,
including when money appropriated is not sufficient to provide the services.
deleted text end

Sec. 6.

Minnesota Statutes 2010, section 256J.575, subdivision 8, is amended to read:

Subd. 8.

Funding.

(a) The commissioner of human services shall treat MFIP
expenditures made to or on behalf of any minor child under this section, who is part of a
household that meets criteria in subdivision 3, as expenditures under a separately funded
state program. These expenditures shall not count toward the state's maintenance of effort
requirements under the federal TANF program.

(b) A family is no longer part of a separately funded program under this section if
the caregiver no longer meets the criteria for family stabilization services in subdivision
3 deleted text begin , or if it is determined at recertification that a caregiver with a child under the age of six
is working at least 87 hours per month in paid or unpaid employment, or a caregiver
without a child under the age of six is working at least 130 hours per month in paid or
unpaid employment, whichever occurs sooner deleted text end .

Sec. 7. new text begin RECIPROCAL AGREEMENT; CHILD SUPPORT ENFORCEMENT.
new text end

new text begin The commissioner of human services shall initiate procedures no later than October
1, 2012, to enter into a reciprocal agreement with Bermuda for the establishment and
enforcement of child support obligations under United States Code, title 42, section
659a(d).
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon Bermuda's written acceptance
and agreement to enforce Minnesota child support orders. If Bermuda does not accept and
declines to enforce Minnesota orders, this section expires December 31, 2013.
new text end

ARTICLE 3

DISABILITY SERVICES

Section 1.

Minnesota Statutes 2011 Supplement, section 256B.0911, subdivision 3a,
is amended to read:

Subd. 3a.

Assessment and support planning.

(a) Persons requesting assessment,
services planning, or other assistance intended to support community-based living,
including persons who need assessment in order to determine waiver or alternative care
program eligibility, must be visited by a long-term care consultation team within 15
calendar days after the date on which an assessment was requested or recommended. After
January 1, 2011, these requirements also apply to personal care assistance services, private
duty nursing, and home health agency services, on timelines established in subdivision 5.
Face-to-face assessments must be conducted according to paragraphs (b) to (i).

(b) The county may utilize a team of either the social worker or public health nurse,
or both. After January 1, 2011, lead agencies shall use certified assessors to conduct the
assessment in a face-to-face interview. The consultation team members must confer
regarding the most appropriate care for each individual screened or assessed.

(c) The assessment must be comprehensive and include a person-centered
assessment of the health, psychological, functional, environmental, and social needs of
referred individuals and provide information necessary to develop a support plan that
meets the consumers needs, using an assessment form provided by the commissioner.

(d) The assessment must be conducted in a face-to-face interview with the person
being assessed and the person's legal representative, as required by legally executed
documents, and other individuals as requested by the person, who can provide information
on the needs, strengths, and preferences of the person necessary to develop a support plan
that ensures the person's health and safety, but who is not a provider of service or has any
financial interest in the provision of services. new text begin For persons who are to be assessed for
elderly waiver customized living services under section 256B.0915, with the permission
of the person being assessed or the person's designated or legal representative, the client's
current or proposed provider of services may submit a copy of the provider's nursing
assessment or written report outlining its recommendations regarding the client's care
needs. The person conducting the assessment will notify the provider of the date by which
this information is to be submitted. This information shall be provided to the person
conducting the assessment prior to the assessment.
new text end

(e) The person, or the person's legal representative, must be provided with written
recommendations for community-based services, including consumer-directed options,
or institutional care that include documentation that the most cost-effective alternatives
available were offered to the individual, and alternatives to residential settings, including,
but not limited to, foster care settings that are not the primary residence of the license
holder. For purposes of this requirement, "cost-effective alternatives" means community
services and living arrangements that cost the same as or less than institutional care.

(f) If the person chooses to use community-based services, the person or the person's
legal representative must be provided with a written community support plan, regardless
of whether the individual is eligible for Minnesota health care programs. A person may
request assistance in identifying community supports without participating in a complete
assessment. Upon a request for assistance identifying community support, the person must
be transferred or referred to the services available under sections 256.975, subdivision 7,
and 256.01, subdivision 24, for telephone assistance and follow up.

(g) The person has the right to make the final decision between institutional
placement and community placement after the recommendations have been provided,
except as provided in subdivision 4a, paragraph (c).

(h) The team must give the person receiving assessment or support planning, or
the person's legal representative, materials, and forms supplied by the commissioner
containing the following information:

(1) the need for and purpose of preadmission screening if the person selects nursing
facility placement;

(2) the role of the long-term care consultation assessment and support planning in
waiver and alternative care program eligibility determination;

(3) information about Minnesota health care programs;

(4) the person's freedom to accept or reject the recommendations of the team;

(5) the person's right to confidentiality under the Minnesota Government Data
Practices Act, chapter 13;

(6) the long-term care consultant's decision regarding the person's need for
institutional level of care as determined under criteria established in section 144.0724,
subdivision 11, or 256B.092; and

(7) the person's right to appeal the decision regarding the need for nursing facility
level of care or the county's final decisions regarding public programs eligibility according
to section 256.045, subdivision 3.

(i) Face-to-face assessment completed as part of eligibility determination for
the alternative care, elderly waiver, community alternatives for disabled individuals,
community alternative care, and traumatic brain injury waiver programs under sections
256B.0915, 256B.0917, and 256B.49 is valid to establish service eligibility for no more
than 60 calendar days after the date of assessment. The effective eligibility start date
for these programs can never be prior to the date of assessment. If an assessment was
completed more than 60 days before the effective waiver or alternative care program
eligibility start date, assessment and support plan information must be updated in a
face-to-face visit and documented in the department's Medicaid Management Information
System (MMIS). The effective date of program eligibility in this case cannot be prior to
the date the updated assessment is completed.

Sec. 2.

Minnesota Statutes 2011 Supplement, 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 authorized by the lead agency within the parameters
established by the commissioner. The payment agreement must delineate the amount of
each component service included in the recipient's customized living service plan. The
lead agency new text begin , with input from the provider of customized living services, new text end shall ensure that
there is a documented need within the parameters established by the commissioner for all
component customized living services authorized.

(b) The payment rate must be based on the amount of component services to be
provided utilizing component rates established by the commissioner. Counties and tribes
shall use tools issued by the commissioner to develop and document customized living
service plans and rates.

(c) Component service rates must not exceed payment rates for comparable elderly
waiver or medical assistance services and must reflect economies of scale. Customized
living services must not include rent or raw food costs.

(d) With the exception of individuals described in subdivision 3a, paragraph (b), the
individualized monthly authorized payment for the customized living service plan shall
not exceed 50 percent 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 authorized payment for the services described in this clause shall
not exceed the limit which was in effect on June 30 of the previous state fiscal year
updated annually based on legislatively adopted changes to all service rate maximums for
home and community-based service providers.

(e) Effective July 1, 2011, the individualized monthly payment for the customized
living service plan for individuals described in subdivision 3a, paragraph (b), must be the
monthly authorized payment limit for customized living for individuals classified as case
mix A, reduced by 25 percent. This rate limit must be applied to all new participants
enrolled in the program on or after July 1, 2011, who meet the criteria described in
subdivision 3a, paragraph (b). This monthly limit also applies to all other participants who
meet the criteria described in subdivision 3a, paragraph (b), at reassessment.

(f) 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.
Licensed home care providers are subject to section 256B.0651, subdivision 14.

(g) A provider may not bill or otherwise charge an elderly waiver participant or their
family for additional units of any allowable component service beyond those available
under the service rate limits described in paragraph (d), nor for additional units of any
allowable component service beyond those approved in the service plan by the lead agency.

Sec. 3.

Minnesota Statutes 2011 Supplement, section 256B.0915, subdivision 3h,
is amended to read:

Subd. 3h.

Service rate limits; 24-hour customized living services.

(a) The
payment rate for 24-hour customized living services is a monthly rate authorized by the
lead agency within the parameters established by the commissioner of human services.
The payment agreement must delineate the amount of each component service included
in each recipient's customized living service plan. The lead agency new text begin , with input from
the provider of customized living services, new text end shall ensure that there is a documented need
within the parameters established by the commissioner for all component customized
living services authorized. The lead agency shall not authorize 24-hour customized living
services unless there is a documented need for 24-hour supervision.

(b) For purposes of this section, "24-hour supervision" means that the recipient
requires assistance due to needs related to one or more of the following:

(1) intermittent assistance with toileting, positioning, or transferring;

(2) cognitive or behavioral issues;

(3) a medical condition that requires clinical monitoring; or

(4) for all new participants enrolled in the program on or after July 1, 2011, and
all other participants at their first reassessment after July 1, 2011, dependency in at
least three of the following activities of daily living as determined by assessment under
section 256B.0911: bathing; dressing; grooming; walking; or eating when the dependency
score in eating is three or greater; and needs medication management and at least 50
hours of service per month. The lead agency shall ensure that the frequency and mode
of supervision of the recipient and the qualifications of staff providing supervision are
described and meet the needs of the recipient.

(c) The payment rate for 24-hour customized living services must be based on the
amount of component services to be provided utilizing component rates established by the
commissioner. Counties and tribes will use tools issued by the commissioner to develop
and document customized living plans and authorize rates.

(d) Component service rates must not exceed payment rates for comparable elderly
waiver or medical assistance services and must reflect economies of scale.

(e) The individually authorized 24-hour customized living payments, in combination
with the payment for other elderly waiver services, including case management, must not
exceed the recipient's community budget cap specified in subdivision 3a. Customized
living services must not include rent or raw food costs.

(f) The individually authorized 24-hour customized living payment rates shall not
exceed the 95 percentile of statewide monthly authorizations for 24-hour customized
living services in effect and in the Medicaid management information systems on March
31, 2009, for each case mix resident class under Minnesota Rules, parts 9549.0050
to 9549.0059, to which elderly waiver service clients are assigned. When there are
fewer than 50 authorizations in effect in the case mix resident class, the commissioner
shall multiply the calculated service payment rate maximum for the A classification by
the standard weight for that classification under Minnesota Rules, parts 9549.0050 to
9549.0059, to determine the applicable payment rate maximum. Service payment rate
maximums shall be updated annually based on legislatively adopted changes to all service
rates for home and community-based service providers.

(g) Notwithstanding the requirements of paragraphs (d) and (f), the commissioner
may establish alternative payment rate systems for 24-hour customized living services in
housing with services establishments which are freestanding buildings with a capacity of
16 or fewer, by applying a single hourly rate for covered component services provided
in either:

(1) licensed corporate adult foster homes; or

(2) specialized dementia care units which meet the requirements of section 144D.065
and in which:

(i) each resident is offered the option of having their own apartment; or

(ii) the units are licensed as board and lodge establishments with maximum capacity
of eight residents, and which meet the requirements of Minnesota Rules, part 9555.6205,
subparts 1, 2, 3, and 4, item A.

(h) A provider may not bill or otherwise charge an elderly waiver participant or their
family for additional units of any allowable component service beyond those available
under the service rate limits described in paragraph (e), nor for additional units of any
allowable component service beyond those approved in the service plan by the lead agency.