HF 2925

as introduced - 92nd Legislature (2021 - 2022) Posted on 03/10/2022 05:08pm

A bill for an act
relating to human services; providing for home and community-based services,
expanded access to shared services, appeals of service terminations for persons
living in own-home settings, and support coordination training; appropriating
money; amending Minnesota Statutes 2020, sections 245D.10, subdivision 3a;
256.045, subdivision 3; 256B.4912, by adding a subdivision.

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

Section 1.

Minnesota Statutes 2020, section 245D.10, subdivision 3a, is amended to read:

Subd. 3a.

Service termination.

(a) The license holder must establish policies and
procedures for service termination that promote continuity of care and service coordination
with the person and the case manager and with other licensed caregivers, if any, who also
provide support to the person. The policy must include the requirements specified in
paragraphs (b) to (f).

(b) The license holder must permit each person to remain in the program new text begin or to continue
receiving services new text end and must not terminate services unless:

(1) the termination is necessary for the person's welfare and the deleted text begin facility deleted text end new text begin provider new text end cannot
meet the person's needs;

(2) the safety of the person or others deleted text begin in the program deleted text end is endangered and positive support
strategies were attempted and have not achieved and effectively maintained safety for the
person or others;

(3) the health of the person or others deleted text begin in the program deleted text end would otherwise be endangered;

(4) the deleted text begin program deleted text end new text begin provider new text end has not been paid for services;

(5) the deleted text begin program deleted text end new text begin provider new text end ceases to operate;

(6) the person has been terminated by the lead agency from waiver eligibility; or

(7) for state-operated community-based services, the person no longer demonstrates
complex behavioral needs that cannot be met by private community-based providers
identified in section 252.50, subdivision 5, paragraph (a), clause (1).

(c) Prior to giving notice of service termination, the license holder must document actions
taken to minimize or eliminate the need for termination. Action taken by the license holder
must include, at a minimum:

(1) consultation with the person's support team or expanded support team to identify
and resolve issues leading to issuance of the termination notice;

(2) a request to the case manager for intervention services identified in section 245D.03,
subdivision 1, paragraph (c), clause (1), or other professional consultation or intervention
services to support the person in the program. This requirement does not apply to notices
of service termination issued under paragraph (b), clauses (4) and (7); and

(3) for state-operated community-based services terminating services under paragraph
(b), clause (7), the state-operated community-based services must engage in consultation
with the person's support team or expanded support team to:

(i) identify that the person no longer demonstrates complex behavioral needs that cannot
be met by private community-based providers identified in section 252.50, subdivision 5,
paragraph (a), clause (1);

(ii) provide notice of intent to issue a termination of services to the lead agency when a
finding has been made that a person no longer demonstrates complex behavioral needs that
cannot be met by private community-based providers identified in section 252.50, subdivision
5, paragraph (a), clause (1);

(iii) assist the lead agency and case manager in developing a person-centered transition
plan to a private community-based provider to ensure continuity of care; and

(iv) coordinate with the lead agency to ensure the private community-based service
provider is able to meet the person's needs and criteria established in a person's
person-centered transition plan.

If, based on the best interests of the person, the circumstances at the time of the notice were
such that the license holder was unable to take the action specified in clauses (1) and (2),
the license holder must document the specific circumstances and the reason for being unable
to do so.

(d) The notice of service termination must meet the following requirements:

(1) the license holder must notify the person or the person's legal representative and the
case manager in writing of the intended service termination. If the service termination is
from residential supports and services as defined in section 245D.03, subdivision 1, paragraph
(c), clause (3), the license holder must also notify the commissioner in writing; and

(2) the notice must include:

(i) the reason for the action;

(ii) except for a service termination under paragraph (b), clause (5), a summary of actions
taken to minimize or eliminate the need for service termination or temporary service
suspension as required under paragraph (c), and why these measures failed to prevent the
termination or suspension;

(iii) the person's right to appeal the termination of services under section 256.045,
subdivision 3, paragraph (a); and

(iv) the person's right to seek a temporary order staying the termination of services
according to the procedures in section 256.045, subdivision 4a or 6, paragraph (c).

(e) Notice of the proposed termination of service, including those situations that began
with a temporary service suspension, must be given at least 90 days prior to termination of
services under paragraph (b), clause (7), 60 days prior to termination when a license holder
is providing intensive supports and services identified in section 245D.03, subdivision 1,
paragraph (c), and 30 days prior to termination for all other services licensed under this
chapter. This notice may be given in conjunction with a notice of temporary service
suspension under subdivision 3.

(f) During the service termination notice period, the license holder must:

(1) work with the support team or expanded support team to develop reasonable
alternatives to protect the person and others and to support continuity of care;

(2) provide information requested by the person or case manager; and

(3) maintain information about the service termination, including the written notice of
intended service termination, in the service recipient record.

(g) For notices issued under paragraph (b), clause (7), the lead agency shall provide
notice to the commissioner and state-operated services at least 30 days before the conclusion
of the 90-day termination period, if an appropriate alternative provider cannot be secured.
Upon receipt of this notice, the commissioner and state-operated services shall reassess
whether a private community-based service can meet the person's needs. If the commissioner
determines that a private provider can meet the person's needs, state-operated services shall,
if necessary, extend notice of service termination until placement can be made. If the
commissioner determines that a private provider cannot meet the person's needs,
state-operated services shall rescind the notice of service termination and re-engage with
the lead agency in service planning for the person.

(h) For state-operated community-based services, the license holder shall prioritize the
capacity created within the existing service site by the termination of services under paragraph
(b), clause (7), to serve persons described in section 252.50, subdivision 5, paragraph (a),
clause (1).

Sec. 2.

Minnesota Statutes 2020, section 256.045, subdivision 3, is amended to read:

Subd. 3.

State agency hearings.

(a) State agency hearings are available for the following:

(1) any person applying for, receiving or having received public assistance, medical
care, or a program of social services granted by the state agency or a county agency or the
federal Food and Nutrition Act whose application for assistance is denied, not acted upon
with reasonable promptness, or whose assistance is suspended, reduced, terminated, or
claimed to have been incorrectly paid;

(2) any patient or relative aggrieved by an order of the commissioner under section
252.27;

(3) a party aggrieved by a ruling of a prepaid health plan;

(4) except as provided under chapter 245C, any individual or facility determined by a
lead investigative agency to have maltreated a vulnerable adult under section 626.557 after
they have exercised their right to administrative reconsideration under section 626.557;

(5) any person whose claim for foster care payment according to a placement of the
child resulting from a child protection assessment under chapter 260E is denied or not acted
upon with reasonable promptness, regardless of funding source;

(6) any person to whom a right of appeal according to this section is given by other
provision of law;

(7) an applicant aggrieved by an adverse decision to an application for a hardship waiver
under section 256B.15;

(8) an applicant aggrieved by an adverse decision to an application or redetermination
for a Medicare Part D prescription drug subsidy under section 256B.04, subdivision 4a;

(9) except as provided under chapter 245A, an individual or facility determined to have
maltreated a minor under chapter 260E, after the individual or facility has exercised the
right to administrative reconsideration under chapter 260E;

(10) except as provided under chapter 245C, an individual disqualified under sections
245C.14 and 245C.15, following a reconsideration decision issued under section 245C.23,
on the basis of serious or recurring maltreatment; a preponderance of the evidence that the
individual has committed an act or acts that meet the definition of any of the crimes listed
in section 245C.15, subdivisions 1 to 4; or for failing to make reports required under section
260E.06, subdivision 1, or 626.557, subdivision 3. Hearings regarding a maltreatment
determination under clause (4) or (9) and a disqualification under this clause in which the
basis for a disqualification is serious or recurring maltreatment, shall be consolidated into
a single fair hearing. In such cases, the scope of review by the human services judge shall
include both the maltreatment determination and the disqualification. The failure to exercise
the right to an administrative reconsideration shall not be a bar to a hearing under this section
if federal law provides an individual the right to a hearing to dispute a finding of
maltreatment;

(11) any person with an outstanding debt resulting from receipt of public assistance,
medical care, or the federal Food and Nutrition Act who is contesting a setoff claim by the
Department of Human Services or a county agency. The scope of the appeal is the validity
of the claimant agency's intention to request a setoff of a refund under chapter 270A against
the debt;

(12) a person issued a notice of service termination under section 245D.10, subdivision
3a, deleted text begin from deleted text end new text begin by a licensed provider of any new text end residential supports deleted text begin and deleted text end new text begin or new text end services deleted text begin as defined deleted text end new text begin listed new text end
in section 245D.03, subdivision 1, deleted text begin paragraph deleted text end new text begin paragraphs (b) and new text end (c), deleted text begin clause (3), deleted text end that is not
otherwise subject to appeal under subdivision 4a;

(13) an individual disability waiver recipient based on a denial of a request for a rate
exception under section 256B.4914; or

(14) a person issued a notice of service termination under section 245A.11, subdivision
11, that is not otherwise subject to appeal under subdivision 4a.

(b) The hearing for an individual or facility under paragraph (a), clause (4), (9), or (10),
is the only administrative appeal to the final agency determination specifically, including
a challenge to the accuracy and completeness of data under section 13.04. Hearings requested
under paragraph (a), clause (4), apply only to incidents of maltreatment that occur on or
after October 1, 1995. Hearings requested by nursing assistants in nursing homes alleged
to have maltreated a resident prior to October 1, 1995, shall be held as a contested case
proceeding under the provisions of chapter 14. Hearings requested under paragraph (a),
clause (9), apply only to incidents of maltreatment that occur on or after July 1, 1997. A
hearing for an individual or facility under paragraph (a), clauses (4), (9), and (10), is only
available when there is no district court action pending. If such action is filed in district
court while an administrative review is pending that arises out of some or all of the events
or circumstances on which the appeal is based, the administrative review must be suspended
until the judicial actions are completed. If the district court proceedings are completed,
dismissed, or overturned, the matter may be considered in an administrative hearing.

(c) For purposes of this section, bargaining unit grievance procedures are not an
administrative appeal.

(d) The scope of hearings involving claims to foster care payments under paragraph (a),
clause (5), shall be limited to the issue of whether the county is legally responsible for a
child's placement under court order or voluntary placement agreement and, if so, the correct
amount of foster care payment to be made on the child's behalf and shall not include review
of the propriety of the county's child protection determination or child placement decision.

(e) The scope of hearings under paragraph (a), clauses (12) and (14), shall be limited to
whether the proposed termination of services is authorized under section 245D.10,
subdivision 3a, paragraph (b), or 245A.11, subdivision 11, and whether the requirements
of section 245D.10, subdivision 3a, paragraphs (c) to (e), or 245A.11, subdivision 2a,
paragraphs (d) to (f), were met. If the appeal includes a request for a temporary stay of
termination of services, the scope of the hearing shall also include whether the case
management provider has finalized arrangements for a residential facility, a program, or
services that will meet the assessed needs of the recipient by the effective date of the service
termination.

(f) A vendor of medical care as defined in section 256B.02, subdivision 7, or a vendor
under contract with a county agency to provide social services is not a party and may not
request a hearing under this section, except if assisting a recipient as provided in subdivision
4.

(g) An applicant or recipient is not entitled to receive social services beyond the services
prescribed under chapter 256M or other social services the person is eligible for under state
law.

(h) The commissioner may summarily affirm the county or state agency's proposed
action without a hearing when the sole issue is an automatic change due to a change in state
or federal law.

(i) Unless federal or Minnesota law specifies a different time frame in which to file an
appeal, an individual or organization specified in this section may contest the specified
action, decision, or final disposition before the state agency by submitting a written request
for a hearing to the state agency within 30 days after receiving written notice of the action,
decision, or final disposition, or within 90 days of such written notice if the applicant,
recipient, patient, or relative shows good cause, as defined in section 256.0451, subdivision
13, why the request was not submitted within the 30-day time limit. The individual filing
the appeal has the burden of proving good cause by a preponderance of the evidence.

Sec. 3.

Minnesota Statutes 2020, section 256B.4912, is amended by adding a subdivision
to read:

new text begin Subd. 16. new text end

new text begin Shared services. new text end

new text begin (a) Medical assistance payments for shared services under
the home and community-based services waivers authorized under sections 256B.0913,
256B.092, and 256B.49 and chapter 256S are limited to this subdivision.
new text end

new text begin (b) For purposes of this subdivision, "shared services" means services provided at the
same time by the same direct care worker for individuals who have entered into an agreement
to share home and community-based services.
new text end

new text begin (c) Shared services may include the following services as outlined in the coordinated
service and support plan and shared services agreement:
new text end

new text begin (1) chore services;
new text end

new text begin (2) extended home care services;
new text end

new text begin (3) homemaker services;
new text end

new text begin (4) individualized home supports;
new text end

new text begin (5) integrated community supports;
new text end

new text begin (6) night supervision services; and
new text end

new text begin (7) other supports as deemed appropriate based on the individuals' coordinated service
and support plans and shared services agreement.
new text end

new text begin (d) Shared services may not include:
new text end

new text begin (1) services for more than three individuals provided by one worker at one time;
new text end

new text begin (2) use of more than one worker for the shared services; and
new text end

new text begin (3) a child care program licensed under chapter 245A or operated by a local school
district or private school.
new text end

new text begin (e) The individuals or, as needed, the individuals' representatives must develop the plan
for shared services when developing or amending the coordinated service and support plan
and must follow the coordinated service and support plan process for approval of the plan
by the lead agency. The plan for shared services in a coordinated service and support plan
must include the intention to utilize shared services based on individuals' needs and
preferences.
new text end

new text begin (f) Individuals whose coordinated service and support plans include an intent to utilize
shared services must jointly develop, with the support of the individuals' representatives as
needed, a shared services agreement. This agreement must include:
new text end

new text begin (1) the names of the individuals receiving shared services;
new text end

new text begin (2) the individuals' representatives, if identified in their coordinated service and support
plans, and their duties;
new text end

new text begin (3) the names of the case managers;
new text end

new text begin (4) the services provider;
new text end

new text begin (5) the shared services that must be provided;
new text end

new text begin (6) the schedule for shared services;
new text end

new text begin (7) the location where shared services must be provided;
new text end

new text begin (8) the training specific to each individual served;
new text end

new text begin (9) the training specific to providing shared services to the individuals identified in the
agreement;
new text end

new text begin (10) instructions to follow all required documentation for time and services provided;
new text end

new text begin (11) a contingency plan for each individual served that determines how services will be
provided and billed for when a person who shares services with the individual is absent due
to illness or other circumstances;
new text end

new text begin (12) signatures of all parties involved in the shared services; and
new text end

new text begin (13) an agreement by each individual who is sharing services on the number of shared
hours for services provided.
new text end

new text begin (g) An individual or an individual's representative may withdraw from participating in
a shared services agreement at any time.
new text end

new text begin (h) The lead agency for each individual must authorize the use of the shared services
option based on the criteria that the shared service is appropriate to meet the needs, health,
and safety of each individual for whom the lead agency provides case management or care
coordination.
new text end

new text begin (i) This subdivision must not be construed to reduce the total authorized budget for an
individual.
new text end

new text begin (j) No later than September 30, 2022, the commissioner of human services must:
new text end

new text begin (1) submit an amendment to the Centers for Medicare and Medicaid Services for the
home and community-based services waivers authorized under sections 256B.0913,
256B.092, and 256B.49 and chapter 256S to allow for shared services under the home and
community-based services waivers; and
new text end

new text begin (2) with stakeholder input, develop guidance for shared services. Guidance must include:
new text end

new text begin (i) recommendations for negotiating payment for one-to-two and one-to-three services;
and
new text end

new text begin (ii) a template of the shared services agreement.
new text end

Sec. 4. new text begin APPROPRIATION; SUPPORT COORDINATION TRAINING.
new text end

new text begin (a) $736,000 in fiscal year 2023 is appropriated from the general fund to the commissioner
of human services to develop and implement a curriculum and training plan to ensure all
lead agency assessors and case managers have the knowledge and skills necessary to fulfill
support planning and coordination responsibilities for people who use home and
community-based disability services waivers authorized under Minnesota Statutes, sections
256B.0913, 256B.092, and 256B.49 and chapter 256S, and live in own-home settings.
Training and competency evaluations must be completed annually by all staff responsible
for case management as described in Minnesota Statutes, sections 256B.092, subdivision
1a, paragraph (f), and 256B.49, subdivision 13, paragraph (e).
new text end

new text begin (b) The base for this appropriation is $377,000 in fiscal year 2024 and $377,000 in fiscal
year 2025 only.
new text end