as introduced - 86th Legislature (2009 - 2010) Posted on 03/01/2010 09:15am
A bill for an act
relating to human services; making changes to continuing care policy and
technical provisions; amending Minnesota Statutes 2008, section 626.557,
subdivision 9a; Minnesota Statutes 2009 Supplement, sections 144.0724,
subdivision 11; 256B.0625, subdivision 19c; 256B.0651, by adding a
subdivision; 256B.0652, subdivision 6; 256B.0659, subdivisions 10, 11, 21,
30, by adding a subdivision.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Minnesota Statutes 2009 Supplement, section 144.0724, subdivision 11,
is amended to read:
(a) For purposes of medical assistance
payment of long-term care services, a recipient must be determined, using assessments
defined in subdivision 4, to meet one of the following nursing facility level of care criteria:
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(1) the person requires formal clinical monitoring at least once per day;
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deleted text begin (1)deleted text end new text begin (2)new text end the person needs the assistance of another person or constant supervision to
begin and complete at least four of the following activities of living: bathing, bed mobility,
dressing, eating, grooming, toileting, transferring, and walking;
deleted text begin (2)deleted text end new text begin (3)new text end the person needs the assistance of another person or constant supervision
to begin and complete toileting, transferring, or positioning and the assistance cannot
be scheduled;
deleted text begin (3)deleted text end new text begin (4)new text end the person has significant difficulty with memory, using information, daily
decision making, or behavioral needs that require intervention;
deleted text begin (4)deleted text end new text begin (5)new text end the person has had a qualifying nursing facility stay of at least 90 daysnew text begin ,
or meets the nursing facility level of care criteria as determined on the first quarterly
assessment after admission, whichever is laternew text end ; or
deleted text begin (5)deleted text end new text begin (6)new text end the person is determined to be at risk for nursing facility admission or
readmission through a face-to-face long-term care consultation assessment as specified
in section 256B.0911, subdivision 3a, 3b, or 4d, by a county, tribe, or managed care
organization under contract with the Department of Human Services. The person is
considered at risk under this clause if the person currently lives alone or will live alone
upon discharge and also meets one of the following criteria:
(i) the person has experienced a fall resulting in a fracture;
(ii) the person has been determined to be at risk of maltreatment or neglect,
including self-neglect; or
(iii) the person has a sensory impairment that substantially impacts functional ability
and maintenance of a community residence.
(b) The assessment used to establish medical assistance payment for nursing facility
services must be the most recent assessment performed under subdivision 4, paragraph
(b), that occurred no more than 90 calendar days before the effective date of medical
assistance eligibility for payment of long-term care services. In no case shall medical
assistance payment for long-term care services occur prior to the date of the determination
of nursing facility level of care.
(c) The assessment used to establish medical assistance payment for long-term care
services provided under sections 256B.0915 and 256B.49 and alternative care payment
for services provided under section 256B.0913 must be the most recent face-to-face
assessment performed under section 256B.0911, subdivision 3a, 3b, or 4d, that occurred
no more than 60 calendar days before the effective date of medical assistance eligibility
for payment of long-term care services.
Minnesota Statutes 2009 Supplement, section 256B.0625, subdivision 19c,
is amended to read:
Medical assistance covers personal care assistance
services provided by an individual who is qualified to provide the services according to
subdivision 19a and sections 256B.0651 to 256B.0656, provided in accordance with a
plan, and supervised by a qualified professional.
"Qualified professional" means a mental health professional as defined in section 245.462,
subdivision 18, or 245.4871, subdivision 27; or a registered nurse as defined in sections
148.171 to 148.285, a licensed social worker as defined in deleted text begin section 148B.21deleted text end new text begin sections
148D.010 and 148D.055new text end , or a qualified developmental disabilities specialist under section
245B.07, subdivision 4. The qualified professional shall perform the duties required in
section 256B.0659.
Minnesota Statutes 2009 Supplement, section 256B.0651, is amended by
adding a subdivision to read:
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(a) Providers of home care services must provide
each recipient with a copy of the home care bill of rights under section 144A.44 at start of
service and 30 days prior to terminating services to a recipient. If a home care provider
determines it is unable to continue providing services to a recipient, the provider must
notify the recipient, the recipient's responsible party, and the commissioner 30 days prior
to terminating services to the recipient, and must assist the recipient in transitioning to
another home care provider of the recipient's choice.
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(b) In the event of a payment withhold, a suspension of participation, or a termination
of participation of a home care provider under section 256B.064, the commissioner
may inform the lead agencies for all recipients with active service agreements with the
provider. At the commissioner's request, the lead agencies must contact recipients to
ensure that the recipients are continuing to receive needed care, and that the recipients
have been given free choice of provider if they transfer to another home care provider.
In addition, the commissioner may directly notify recipients who receive care from
the provider that payments have been withheld, or that the provider's participation in
medical assistance has been suspended or terminated if the commissioner determines that
notification is necessary to protect the welfare of the recipients.
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Minnesota Statutes 2009 Supplement, section 256B.0652, subdivision 6,
is amended to read:
(a) All personal care assistance services, supervision by a qualified professional, and
additional services beyond the limits established in subdivision 11, must be authorized
by the commissioner or the commissioner's designee before services begin except for the
assessments established in subdivision 11 and section 256B.0911. The authorization for
personal care assistance and qualified professional services under section 256B.0659 must
be completed within 30 days after receiving a complete request.
(b) The amount of personal care assistance services authorized must be based
on the recipient's home care rating. The home care rating shall be determined by the
commissioner or the commissioner's designee based on information submitted to the
commissioner identifying the following:
(1) total number of dependencies of activities of daily living as defined in section
256B.0659;
(2) deleted text begin numberdeleted text end new text begin presencenew text end of complex health-related needs as defined in section
256B.0659; and
(3) deleted text begin numberdeleted text end new text begin presencenew text end of behavior deleted text begin descriptionsdeleted text end as defined in section 256B.0659.
(c) The methodology to determine total time for personal care assistance services for
each home care rating is based on the median paid units per day for each home care rating
from fiscal year 2007 data for the personal care assistance program. Each home care rating
has a base level of hours assigned. Additional time is added through the assessment and
identification of the following:
(1) 30 additional minutes per day for a dependency in each critical activity of daily
living as defined in section 256B.0659;
(2) 30 additional minutes per day for each complex health-related function as
defined in section 256B.0659; and
(3) 30 additional minutes per day for each behavior issue as defined in section
256B.0659.
(d) A limit of 96 units of qualified professional supervision may be authorized for
each recipient receiving personal care assistance services. A request to the commissioner
to exceed this total in a calendar year must be requested by the personal care provider
agency on a form approved by the commissioner.
Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 10,
is amended to read:
(a) A responsible party shall
enter into a written agreement with a personal care assistance provider agency, on a form
determined by the commissioner, to perform the following duties:
(1) be available while care is provided in a method agreed upon by the individual
or the individual's legal representative and documented in the recipient's personal care
assistance care plan;
(2) monitor personal care assistance services to ensure the recipient's personal care
assistance care plan is being followed; and
(3) review and sign personal care assistance time sheets after services are provided
to provide verification of the personal care assistance services.
Failure to provide the support required by the recipient must result in a referral to the
county common entry point.
(b) Responsible parties who are parents of minors or guardians of minors or
incapacitated persons may delegate the responsibility to another adult who is not the
personal care assistant during a temporary absence of at least 24 hours but not more than
six months. The person delegated as a responsible party must be able to meet the definition
of the responsible party. The responsible party must ensure that the delegate performs the
functions of the responsible party, is identified at the time of the assessment, and is listed
on the personal care assistance care plan. The responsible party must communicate to the
personal care assistance provider agency about the need for a delegate responsible party,
including the name of the delegated responsible partydeleted text begin , dates the delegated responsible
party will be living with the recipient,deleted text end and contact numbers.
Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 11,
is amended to read:
(a) A personal care assistant
must meet the following requirements:
(1) be at least 18 years of age with the exception of persons who are 16 or 17 years
of age with these additional requirements:
(i) supervision by a qualified professional every 60 days; and
(ii) employment by only one personal care assistance provider agency responsible
for compliance with current labor laws;
(2) be employed by a personal care assistance provider agency;
(3) enroll with the department as a personal care assistant after clearing a background
study. new text begin Except as provided in subdivision 11a, new text end before a personal care assistant provides
services, the personal care assistance provider agency must initiate a background study on
the personal care assistant under chapter 245C, and the personal care assistance provider
agency must have received a notice from the commissioner that the personal care assistant
is:
(i) not disqualified under section 245C.14; or
(ii) is disqualified, but the personal care assistant has received a set aside of the
disqualification under section 245C.22;
(4) be able to effectively communicate with the recipient and personal care
assistance provider agency;
(5) be able to provide covered personal care assistance services according to the
recipient's personal care assistance care plan, respond appropriately to recipient needs,
and report changes in the recipient's condition to the supervising qualified professional
or physician;
(6) not be a consumer of personal care assistance services;
(7) maintain daily written records including, but not limited to, time sheets under
subdivision 12;
(8) effective January 1, 2010, complete standardized training as determined by the
commissioner before completing enrollment. Personal care assistant training must include
successful completion of the following training components: basic first aid, vulnerable
adult, child maltreatment, OSHA universal precautions, basic roles and responsibilities of
personal care assistants including information about assistance with lifting and transfers
for recipients, emergency preparedness, orientation to positive behavioral practices, fraud
issues, and completion of time sheets. Upon completion of the training components,
the personal care assistant must demonstrate the competency to provide assistance to
recipients;
(9) complete training and orientation on the needs of the recipient within the first
seven days after the services begin; and
(10) be limited to providing and being paid for up to 310 hours per month of personal
care assistance services regardless of the number of recipients being served or the number
of personal care assistance provider agencies enrolled with.
(b) A legal guardian may be a personal care assistant if the guardian is not being paid
for the guardian services and meets the criteria for personal care assistants in paragraph (a).
(c) Effective January 1, 2010, persons who do not qualify as a personal care assistant
include parents and stepparents of minors, spouses, paid legal guardians, family foster
care providers, except as otherwise allowed in section 256B.0625, subdivision 19a, or
staff of a residential setting.
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This section is effective retroactively from July 1, 2009.
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Minnesota Statutes 2009 Supplement, section 256B.0659, is amended by
adding a subdivision to read:
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The personal care
assistant for a recipient may be allowed to enroll with a different personal care assistant
provider agency upon initiation of a new background study according to chapter 245C, if
all of the following are met:
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(1) the commissioner determines that a change in enrollment or affiliation of the
personal care assistant is needed in order to assure continuity of services and protect the
health and safety of the recipient;
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(2) the chosen agency has been continuously enrolled as a personal care assistance
provider agency for at least two years;
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(3) the recipient chooses to transfer to the personal care assistance provider agency;
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(4) the personal care assistant has been continuously enrolled with the former
personal care assistance provider agency since the last background study was completed;
and
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(5) the personal care assistant continues to meet requirements of subdivision 11,
excluding paragraph (a), clause (3).
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This section is effective retroactively from July 1, 2009.
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Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 21,
is amended to read:
(a) All personal care assistance provider agencies must provide, at the
time of enrollment as a personal care assistance provider agency in a format determined
by the commissioner, information and documentation that includes, but is not limited to,
the following:
(1) the personal care assistance provider agency's current contact information
including address, telephone number, and e-mail address;
(2) proof of surety bond coverage in the amount of $50,000 or ten percent of the
provider's payments from Medicaid in the previous year, whichever is less;
(3) proof of fidelity bond coverage in the amount of $20,000;
(4) proof of workers' compensation insurance coverage;
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(5) proof of liability insurance;
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deleted text begin (5)deleted text end new text begin (6)new text end a description of the personal care assistance provider agency's organization
identifying the names of all owners, managing employees, staff, board of directors, and
the affiliations of the directors, owners, or staff to other service providers;
deleted text begin (6)deleted text end new text begin (7)new text end a copy of the personal care assistance provider agency's written policies
and procedures including: hiring of employees; training requirements; service delivery;
and employee and consumer safety including process for notification and resolution
of consumer grievances, identification and prevention of communicable diseases, and
employee misconduct;
deleted text begin (7)deleted text end new text begin (8)new text end copies of all other forms the personal care assistance provider agency uses in
the course of daily business including, but not limited to:
(i) a copy of the personal care assistance provider agency's time sheet if the time
sheet varies from the standard time sheet for personal care assistance services approved
by the commissioner, and a letter requesting approval of the personal care assistance
provider agency's nonstandard time sheet;
(ii) the personal care assistance provider agency's template for the personal care
assistance care plan; and
(iii) the personal care assistance provider agency's template for the written
agreement in subdivision 20 for recipients using the personal care assistance choice
option, if applicable;
deleted text begin (8)deleted text end new text begin (9)new text end a list of all deleted text begin trainingsdeleted text end new text begin trainingnew text end and classes that the personal care assistance
provider agency requires of its staff providing personal care assistance services;
deleted text begin (9)deleted text end new text begin (10)new text end documentation that the personal care assistance provider agency and staff
have successfully completed all the training required by this section;
deleted text begin (10)deleted text end new text begin (11)new text end documentation of the agency's marketing practices;
deleted text begin (11)deleted text end new text begin (12)new text end disclosure of ownership, leasing, or management of all residential
properties that is used or could be used for providing home care services; and
deleted text begin (12)deleted text end new text begin (13)new text end documentation that the agency will use the following percentages of
revenue generated from the medical assistance rate paid for personal care assistance
services for employee personal care assistant wages and benefits: 72.5 percent of revenue
in the personal care assistance choice option and 72.5 percent of revenue from other
personal care assistance providers.
(b) Personal care assistance provider agencies shall provide the information specified
in paragraph (a) to the commissioner at the time the personal care assistance provider
agency enrolls as a vendor or upon request from the commissioner. The commissioner
shall collect the information specified in paragraph (a) from all personal care assistance
providers beginning July 1, 2009.
(c) All personal care assistance provider agencies shall complete mandatory training
as determined by the commissioner before enrollment as a provider. Personal care
assistance provider agencies are required to send all owners, qualified professionals
employed by the agency, and all other managing employees to the initial and subsequent
deleted text begin trainingsdeleted text end new text begin trainingnew text end . Personal care assistance provider agency billing staff shall complete
training about personal care assistance program financial management. This training is
effective July 1, 2009. Any personal care assistance provider agency enrolled before that
date shall, if it has not already, complete the provider training within 18 months of July 1,
2009. Any new owners, new qualified professionals, and new managing employees are
required to complete mandatory training as a requisite of hiring.
Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 30,
is amended to read:
The commissioner must provide:
(1) by October 31, 2009, information to recipients likely to be affected that (i)
describes the changes to the personal care assistance program that may result in the
loss of access to personal care assistance services, and (ii) includes resources to obtain
further information; and
(2) notice of changes in medical assistance deleted text begin home caredeleted text end new text begin personal care assistantnew text end
services to each affected recipient at least 30 days before the effective date of the changenew text begin
for changes that occur prior to January 1, 2012. On or after January 1, 2012, a notice of at
least ten days before the effective date of the change is requirednew text end .
The notice shall include how to get further information on the changes, how to get help to
obtain other services, a list of community resources, and appeal rights. Notwithstanding
section 256.045, a recipient may request continued services pending appeal within the
time period allowed to request an appeal.
Minnesota Statutes 2008, section 626.557, subdivision 9a, is amended to read:
The common entry point must screen the reports of alleged or suspected maltreatment for
immediate risk and make all necessary referrals as follows:
(1) if the common entry point determines that there is an immediate need for
adult protective services, the common entry point agency shall immediately notify the
appropriate county agency;
(2) if the report contains suspected criminal activity against a vulnerable adult, the
common entry point shall immediately notify the appropriate law enforcement agency;
(3) deleted text begin if the report references alleged or suspected maltreatment and there is no
immediate need for adult protective services,deleted text end the common entry point shall deleted text begin notifydeleted text end new text begin refer
all reports tonew text end the appropriate lead agency as soon as possible, but in any event no longer
than two working days;new text begin and
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(4) if the report does not reference alleged or suspected maltreatment, the common
entry point may determine whether the information will be referred; and
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deleted text begin (5)deleted text end new text begin (4)new text end if the report contains information about a suspicious death, the common entry
point shall immediately notify the appropriate law enforcement agencies, the local medical
examiner, and the ombudsman established under section 245.92. Law enforcement
agencies shall coordinate with the local medical examiner and the ombudsman as provided
by law.
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Notwithstanding Minnesota Statutes, section 256B.0915, subdivision 3b, a person
age 65 or older with an MT home care rating on January 1, 2010, is eligible for the
elderly waiver program and shall be considered a conversion for purposes of accessing
monthly budget caps equal to no more than their monthly spending under the personal
care assistance program on January 1, 2010.
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