{\rtf1\ansi\deff0{\fonttbl{\f0 Times New Roman;}}\margl480\margr0\margt0\margb0\fs20\n\line \line\n\line \line\n\line \line\n\line {\pard\n\line \n\line \n\line 1.1 A bill for an act \n\line 1.2 relating to human services; making changes to \n\line 1.3 continuing care programs; amending Minnesota Statutes \n\line 1.4 2000, sections 245.462, subdivision 4; 245.4871, \n\line 1.5 subdivision 4; Minnesota Statutes 2001 Supplement, \n\line 1.6 sections 256B.0627, subdivision 10; 256B.0911, \n\line 1.7 subdivisions 4b, 4d; 256B.0913, subdivision 5; \n\line 1.8 256B.0915, subdivision 3; 256B.0924, subdivision 6; \n\line 1.9 256B.0951, subdivisions 7, 8; 256B.437, subdivision 6. \n\line 1.10 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: \n\line 1.11 Section 1. Minnesota Statutes 2000, section 245.462, \n\line 1.12 subdivision 4, is amended to read: \n\line 1.13 Subd. 4. [CASE MANAGEMENT SERVICE PROVIDER.] (a) "Case \n\line 1.14 management service provider" means a case manager or case \n\line 1.15 manager associate employed by the county or other entity \n\line 1.16 authorized by the county board to provide case management \n\line 1.17 services specified in section 245.4711. \n\line 1.18 (b) A case manager must: \n\line 1.19 (1) be skilled in the process of identifying and assessing \n\line 1.20 a wide range of client needs; \n\line 1.21 (2) be knowledgeable about local community resources and \n\line 1.22 how to use those resources for the benefit of the client; \n\line 1.23 (3) have a bachelor's degree in one of the behavioral \n\line 1.24 sciences or related fields including, but not limited to, social \n\line 1.25 work, psychology, or nursing from an accredited college or \n\line 1.26 university or meet the requirements of paragraph (c); and \n\line 1.27 (4) meet the supervision and continuing education \n\line 2.1 requirements described in paragraphs (d), (e), and (f), as \n\line 2.2 applicable. \n\line 2.3 (c) Case managers without a bachelor's degree must meet one \n\line 2.4 of the requirements in clauses (1) to (3): \n\line 2.5 (1) have three or four years of experience as a case \n\line 2.6 manager associate as defined in this section; \n\line 2.7 (2) be a registered nurse without a bachelor's degree and \n\line 2.8 have a combination of specialized training in psychiatry and \n\line 2.9 work experience consisting of community interaction and \n\line 2.10 involvement or community discharge planning in a mental health \n\line 2.11 setting totaling three years; or \n\line 2.12 (3) be a person who qualified as a case manager under the \n\line 2.13 1998 department of human service waiver provision and meet the \n\line 2.14 continuing education and mentoring requirements in this section. \n\line 2.15 (d) A case manager with at least 2,000 hours of supervised \n\line 2.16 experience in the delivery of services to adults with mental \n\line 2.17 illness must receive regular ongoing supervision and clinical \n\line 2.18 supervision totaling 38 hours per year of which at least one \n\line 2.19 hour per month must be clinical supervision regarding individual \n\line 2.20 service delivery with a case management supervisor. The \n\line 2.21 remaining 26 hours of supervision may be provided by a case \n\line 2.22 manager with two years of experience. Group supervision may not \n\line 2.23 constitute more than one-half of the required supervision \n\line 2.24 hours. Clinical supervision must be documented in the client \n\line 2.25 record. \n\line 2.26 (e) A case manager without 2,000 hours of supervised \n\line 2.27 experience in the delivery of services to adults with mental \n\line 2.28 illness must: \n\line 2.29 (1) receive clinical supervision regarding individual \n\line 2.30 service delivery from a mental health professional at least one \n\line 2.31 hour per week until the requirement of 2,000 hours of experience \n\line 2.32 is met; and \n\line 2.33 (2) complete 40 hours of training approved by the \n\line 2.34 commissioner in case management skills and the characteristics \n\line 2.35 and needs of adults with serious and persistent mental illness. \n\line 2.36 (f) A case manager who is not licensed, registered, or \n\line 3.1 certified by a health-related licensing board must receive 30 \n\line 3.2 hours of continuing education and training in mental illness and \n\line 3.3 mental health services {\strike annually} {\ul every two years}. \n\line 3.4 (g) A case manager associate (CMA) must: \n\line 3.5 (1) work under the direction of a case manager or case \n\line 3.6 management supervisor; \n\line 3.7 (2) be at least 21 years of age; \n\line 3.8 (3) have at least a high school diploma or its equivalent; \n\line 3.9 and \n\line 3.10 (4) meet one of the following criteria: \n\line 3.11 (i) have an associate of arts degree in one of the \n\line 3.12 behavioral sciences or human services; \n\line 3.13 (ii) be a registered nurse without a bachelor's degree; \n\line 3.14 (iii) within the previous ten years, have three years of \n\line 3.15 life experience with serious and persistent mental illness as \n\line 3.16 defined in section 245.462, subdivision 20; or as a child had \n\line 3.17 severe emotional disturbance as defined in section 245.4871, \n\line 3.18 subdivision 6; or have three years life experience as a primary \n\line 3.19 caregiver to an adult with serious and persistent mental illness \n\line 3.20 within the previous ten years; \n\line 3.21 (iv) have 6,000 hours work experience as a nondegreed state \n\line 3.22 hospital technician; or \n\line 3.23 (v) be a mental health practitioner as defined in section \n\line 3.24 245.462, subdivision 17, clause (2). \n\line 3.25 Individuals meeting one of the criteria in items (i) to \n\line 3.26 (iv), may qualify as a case manager after four years of \n\line 3.27 supervised work experience as a case manager associate. \n\line 3.28 Individuals meeting the criteria in item (v), may qualify as a \n\line 3.29 case manager after three years of supervised experience as a \n\line 3.30 case manager associate. \n\line 3.31 (h) A case management associate must meet the following \n\line 3.32 supervision, mentoring, and continuing education requirements: \n\line 3.33 (1) have 40 hours of preservice training described under \n\line 3.34 paragraph (e), clause (2); \n\line 3.35 (2) receive at least 40 hours of continuing education in \n\line 3.36 mental illness and mental health services annually; and \n\line 4.1 (3) receive at least five hours of mentoring per week from \n\line 4.2 a case management mentor. \n\line 4.3 A "case management mentor" means a qualified, practicing case \n\line 4.4 manager or case management supervisor who teaches or advises and \n\line 4.5 provides intensive training and clinical supervision to one or \n\line 4.6 more case manager associates. Mentoring may occur while \n\line 4.7 providing direct services to consumers in the office or in the \n\line 4.8 field and may be provided to individuals or groups of case \n\line 4.9 manager associates. At least two mentoring hours per week must \n\line 4.10 be individual and face-to-face. \n\line 4.11 (i) A case management supervisor must meet the criteria for \n\line 4.12 mental health professionals, as specified in section 245.462, \n\line 4.13 subdivision 18. \n\line 4.14 (j) An immigrant who does not have the qualifications \n\line 4.15 specified in this subdivision may provide case management \n\line 4.16 services to adult immigrants with serious and persistent mental \n\line 4.17 illness who are members of the same ethnic group as the case \n\line 4.18 manager if the person: \n\line 4.19 (1) is currently enrolled in and is actively pursuing \n\line 4.20 credits toward the completion of a bachelor's degree in one of \n\line 4.21 the behavioral sciences or a related field including, but not \n\line 4.22 limited to, social work, psychology, or nursing from an \n\line 4.23 accredited college or university; \n\line 4.24 (2) completes 40 hours of training as specified in this \n\line 4.25 subdivision; and \n\line 4.26 (3) receives clinical supervision at least once a week \n\line 4.27 until the requirements of this subdivision are met. \n\line 4.28 Sec. 2. Minnesota Statutes 2000, section 245.4871, \n\line 4.29 subdivision 4, is amended to read: \n\line 4.30 Subd. 4. [CASE MANAGEMENT SERVICE PROVIDER.] (a) "Case \n\line 4.31 management service provider" means a case manager or case \n\line 4.32 manager associate employed by the county or other entity \n\line 4.33 authorized by the county board to provide case management \n\line 4.34 services specified in subdivision 3 for the child with severe \n\line 4.35 emotional disturbance and the child's family. \n\line 4.36 (b) A case manager must: \n\line 5.1 (1) have experience and training in working with children; \n\line 5.2 (2) have at least a bachelor's degree in one of the \n\line 5.3 behavioral sciences or a related field including, but not \n\line 5.4 limited to, social work, psychology, or nursing from an \n\line 5.5 accredited college or university or meet the requirements of \n\line 5.6 paragraph (d); \n\line 5.7 (3) have experience and training in identifying and \n\line 5.8 assessing a wide range of children's needs; \n\line 5.9 (4) be knowledgeable about local community resources and \n\line 5.10 how to use those resources for the benefit of children and their \n\line 5.11 families; and \n\line 5.12 (5) meet the supervision and continuing education \n\line 5.13 requirements of paragraphs (e), (f), and (g), as applicable. \n\line 5.14 (c) A case manager may be a member of any professional \n\line 5.15 discipline that is part of the local system of care for children \n\line 5.16 established by the county board. \n\line 5.17 (d) A case manager without a bachelor's degree must meet \n\line 5.18 one of the requirements in clauses (1) to (3): \n\line 5.19 (1) have three or four years of experience as a case \n\line 5.20 manager associate; \n\line 5.21 (2) be a registered nurse without a bachelor's degree who \n\line 5.22 has a combination of specialized training in psychiatry and work \n\line 5.23 experience consisting of community interaction and involvement \n\line 5.24 or community discharge planning in a mental health setting \n\line 5.25 totaling three years; or \n\line 5.26 (3) be a person who qualified as a case manager under the \n\line 5.27 1998 department of human services waiver provision and meets the \n\line 5.28 continuing education, supervision, and mentoring requirements in \n\line 5.29 this section. \n\line 5.30 (e) A case manager with at least 2,000 hours of supervised \n\line 5.31 experience in the delivery of mental health services to children \n\line 5.32 must receive regular ongoing supervision and clinical \n\line 5.33 supervision totaling 38 hours per year, of which at least one \n\line 5.34 hour per month must be clinical supervision regarding individual \n\line 5.35 service delivery with a case management supervisor. The other \n\line 5.36 26 hours of supervision may be provided by a case manager with \n\line 6.1 two years of experience. Group supervision may not constitute \n\line 6.2 more than one-half of the required supervision hours. \n\line 6.3 (f) A case manager without 2,000 hours of supervised \n\line 6.4 experience in the delivery of mental health services to children \n\line 6.5 with emotional disturbance must: \n\line 6.6 (1) begin 40 hours of training approved by the commissioner \n\line 6.7 of human services in case management skills and in the \n\line 6.8 characteristics and needs of children with severe emotional \n\line 6.9 disturbance before beginning to provide case management \n\line 6.10 services; and \n\line 6.11 (2) receive clinical supervision regarding individual \n\line 6.12 service delivery from a mental health professional at least one \n\line 6.13 hour each week until the requirement of 2,000 hours of \n\line 6.14 experience is met. \n\line 6.15 (g) A case manager who is not licensed, registered, or \n\line 6.16 certified by a health-related licensing board must receive 30 \n\line 6.17 hours of continuing education and training in severe emotional \n\line 6.18 disturbance and mental health services {\strike annually} {\ul every two years}. \n\line 6.19 (h) Clinical supervision must be documented in the child's \n\line 6.20 record. When the case manager is not a mental health \n\line 6.21 professional, the county board must provide or contract for \n\line 6.22 needed clinical supervision. \n\line 6.23 (i) The county board must ensure that the case manager has \n\line 6.24 the freedom to access and coordinate the services within the \n\line 6.25 local system of care that are needed by the child. \n\line 6.26 (j) A case manager associate (CMA) must: \n\line 6.27 (1) work under the direction of a case manager or case \n\line 6.28 management supervisor; \n\line 6.29 (2) be at least 21 years of age; \n\line 6.30 (3) have at least a high school diploma or its equivalent; \n\line 6.31 and \n\line 6.32 (4) meet one of the following criteria: \n\line 6.33 (i) have an associate of arts degree in one of the \n\line 6.34 behavioral sciences or human services; \n\line 6.35 (ii) be a registered nurse without a bachelor's degree; \n\line 6.36 (iii) have three years of life experience as a primary \n\line 7.1 caregiver to a child with serious emotional disturbance as \n\line 7.2 defined in section 245.4871, subdivision 6, within the previous \n\line 7.3 ten years; \n\line 7.4 (iv) have 6,000 hours work experience as a nondegreed state \n\line 7.5 hospital technician; or \n\line 7.6 (v) be a mental health practitioner as defined in \n\line 7.7 subdivision 26, clause (2). \n\line 7.8 Individuals meeting one of the criteria in items (i) to \n\line 7.9 (iv) may qualify as a case manager after four years of \n\line 7.10 supervised work experience as a case manager associate. \n\line 7.11 Individuals meeting the criteria in item (v) may qualify as a \n\line 7.12 case manager after three years of supervised experience as a \n\line 7.13 case manager associate. \n\line 7.14 (k) Case manager associates must meet the following \n\line 7.15 supervision, mentoring, and continuing education requirements; \n\line 7.16 (1) have 40 hours of preservice training described under \n\line 7.17 paragraph (f), clause (1); \n\line 7.18 (2) receive at least 40 hours of continuing education in \n\line 7.19 severe emotional disturbance and mental health service annually; \n\line 7.20 and \n\line 7.21 (3) receive at least five hours of mentoring per week from \n\line 7.22 a case management mentor. A "case management mentor" means a \n\line 7.23 qualified, practicing case manager or case management supervisor \n\line 7.24 who teaches or advises and provides intensive training and \n\line 7.25 clinical supervision to one or more case manager associates. \n\line 7.26 Mentoring may occur while providing direct services to consumers \n\line 7.27 in the office or in the field and may be provided to individuals \n\line 7.28 or groups of case manager associates. At least two mentoring \n\line 7.29 hours per week must be individual and face-to-face. \n\line 7.30 (l) A case management supervisor must meet the criteria for \n\line 7.31 a mental health professional as specified in section 245.4871, \n\line 7.32 subdivision 27. \n\line 7.33 (m) An immigrant who does not have the qualifications \n\line 7.34 specified in this subdivision may provide case management \n\line 7.35 services to child immigrants with severe emotional disturbance \n\line 7.36 of the same ethnic group as the immigrant if the person: \n\line 8.1 (1) is currently enrolled in and is actively pursuing \n\line 8.2 credits toward the completion of a bachelor's degree in one of \n\line 8.3 the behavioral sciences or related fields at an accredited \n\line 8.4 college or university; \n\line 8.5 (2) completes 40 hours of training as specified in this \n\line 8.6 subdivision; and \n\line 8.7 (3) receives clinical supervision at least once a week \n\line 8.8 until the requirements of obtaining a bachelor's degree and \n\line 8.9 2,000 hours of supervised experience are met. \n\line 8.10 Sec. 3. Minnesota Statutes 2001 Supplement, section \n\line 8.11 256B.0627, subdivision 10, is amended to read: \n\line 8.12 Subd. 10. [FISCAL INTERMEDIARY OPTION AVAILABLE FOR \n\line 8.13 PERSONAL CARE ASSISTANT SERVICES.] (a) The commissioner may \n\line 8.14 allow a recipient of personal care assistant services to use a \n\line 8.15 fiscal intermediary to assist the recipient in paying and \n\line 8.16 accounting for medically necessary covered personal care \n\line 8.17 assistant services authorized in subdivision 4 and within the \n\line 8.18 payment parameters of subdivision 5. Unless otherwise provided \n\line 8.19 in this subdivision, all other statutory and regulatory \n\line 8.20 provisions relating to personal care assistant services apply to \n\line 8.21 a recipient using the fiscal intermediary option. \n\line 8.22 (b) The recipient or responsible party shall: \n\line 8.23 (1) recruit, hire, and terminate a qualified professional, \n\line 8.24 if a qualified professional is requested by the recipient or \n\line 8.25 responsible party; \n\line 8.26 (2) verify and document the credentials of the qualified \n\line 8.27 professional, if a qualified professional is requested by the \n\line 8.28 recipient or responsible party; \n\line 8.29 (3) develop a service plan based on physician orders and \n\line 8.30 public health nurse assessment with the assistance of a \n\line 8.31 qualified professional, if a qualified professional is requested \n\line 8.32 by the recipient or responsible party, that addresses the health \n\line 8.33 and safety of the recipient; \n\line 8.34 (4) recruit, hire, and terminate the personal care \n\line 8.35 assistant; \n\line 8.36 (5) orient and train the personal care assistant with \n\line 9.1 assistance as needed from the qualified professional; \n\line 9.2 (6) supervise and evaluate the personal care assistant with \n\line 9.3 assistance as needed from the recipient's physician or the \n\line 9.4 qualified professional; \n\line 9.5 (7) monitor and verify in writing and report to the fiscal \n\line 9.6 intermediary the number of hours worked by the personal care \n\line 9.7 assistant and the qualified professional; and \n\line 9.8 (8) enter into a written agreement, as specified in \n\line 9.9 paragraph (f). \n\line 9.10 (c) The duties of the fiscal intermediary shall be to: \n\line 9.11 (1) bill the medical assistance program for personal care \n\line 9.12 assistant and qualified professional services; \n\line 9.13 (2) request and secure background checks on personal care \n\line 9.14 assistants and qualified professionals according to section \n\line 9.15 245A.04; \n\line 9.16 (3) pay the personal care assistant and qualified \n\line 9.17 professional based on actual hours of services provided; \n\line 9.18 (4) withhold and pay all applicable federal and state \n\line 9.19 taxes; \n\line 9.20 (5) verify and keep records of hours worked by the personal \n\line 9.21 care assistant and qualified professional; \n\line 9.22 (6) make the arrangements and pay unemployment insurance, \n\line 9.23 taxes, workers' compensation, liability insurance, and other \n\line 9.24 benefits, if any; \n\line 9.25 (7) enroll in the medical assistance program as a fiscal \n\line 9.26 intermediary; and \n\line 9.27 (8) enter into a written agreement as specified in \n\line 9.28 paragraph (f) before services are provided. \n\line 9.29 (d) The fiscal intermediary: \n\line 9.30 (1) may not be related to the recipient, qualified \n\line 9.31 professional, or the personal care assistant; \n\line 9.32 (2) must ensure arm's length transactions with the \n\line 9.33 recipient and personal care assistant; and \n\line 9.34 (3) shall be considered a joint employer of the personal \n\line 9.35 care assistant and qualified professional to the extent \n\line 9.36 specified in this section. \n\line 10.1 The fiscal intermediary or owners of the entity that \n\line 10.2 provides fiscal intermediary services under this subdivision \n\line 10.3 must pass a criminal background check as required in section \n\line 10.4 256B.0627, subdivision 1, paragraph (e). \n\line 10.5 (e) If the recipient or responsible party requests a \n\line 10.6 qualified professional, the qualified professional providing \n\line 10.7 assistance to the recipient shall meet the qualifications \n\line 10.8 specified in section 256B.0625, subdivision 19c. The qualified \n\line 10.9 professional shall assist the recipient in developing and \n\line 10.10 revising a plan to meet the recipient's needs, as assessed by \n\line 10.11 the public health nurse. In performing this function, the \n\line 10.12 qualified professional must visit the recipient in the \n\line 10.13 recipient's home at least once annually. The qualified \n\line 10.14 professional must report any suspected abuse, neglect, or \n\line 10.15 financial exploitation of the recipient to the appropriate \n\line 10.16 authorities. \n\line 10.17 (f) The fiscal intermediary, recipient or responsible \n\line 10.18 party, personal care assistant, and qualified professional shall \n\line 10.19 enter into a written agreement before services are started. The \n\line 10.20 agreement shall include: \n\line 10.21 (1) the duties of the recipient, qualified professional, \n\line 10.22 personal care assistant, and fiscal agent based on paragraphs \n\line 10.23 (a) to (e); \n\line 10.24 (2) the salary and benefits for the personal care assistant \n\line 10.25 and the qualified professional; \n\line 10.26 (3) the administrative fee of the fiscal intermediary and \n\line 10.27 services paid for with that fee, including background check \n\line 10.28 fees; \n\line 10.29 (4) procedures to respond to billing or payment complaints; \n\line 10.30 and \n\line 10.31 (5) procedures for hiring and terminating the personal care \n\line 10.32 assistant and the qualified professional. \n\line 10.33 (g) The rates paid for personal care assistant \n\line 10.34 services, {\ul shared care services,} qualified professional services, \n\line 10.35 and fiscal intermediary services under this subdivision shall be \n\line 10.36 the same rates paid for personal care assistant services and \n\line 11.1 qualified professional services under subdivision 2 \n\line 11.2 respectively. Except for the administrative fee of the fiscal \n\line 11.3 intermediary specified in paragraph (f), the remainder of the \n\line 11.4 rates paid to the fiscal intermediary must be used to pay for \n\line 11.5 the salary and benefits for the personal care assistant or the \n\line 11.6 qualified professional. \n\line 11.7 (h) As part of the assessment defined in subdivision 1, the \n\line 11.8 following conditions must be met to use or continue use of a \n\line 11.9 fiscal intermediary: \n\line 11.10 (1) the recipient must be able to direct the recipient's \n\line 11.11 own care, or the responsible party for the recipient must be \n\line 11.12 readily available to direct the care of the personal care \n\line 11.13 assistant; \n\line 11.14 (2) the recipient or responsible party must be \n\line 11.15 knowledgeable of the health care needs of the recipient and be \n\line 11.16 able to effectively communicate those needs; \n\line 11.17 (3) a face-to-face assessment must be conducted by the \n\line 11.18 local county public health nurse at least annually, or when \n\line 11.19 there is a significant change in the recipient's condition or \n\line 11.20 change in the need for personal care assistant services; \n\line 11.21 (4) {\ul recipients who choose to use the shared care option as} \n\line 11.22 {\ul specified in subdivision 8 must utilize the same fiscal} \n\line 11.23 {\ul intermediary; and} \n\line 11.24 {\strike the recipient cannot select the shared services option as} \n\line 11.25 {\strike specified in subdivision 8; and} \n\line 11.26 (5) parties must be in compliance with the written \n\line 11.27 agreement specified in paragraph (f). \n\line 11.28 (i) The commissioner shall deny, revoke, or suspend the \n\line 11.29 authorization to use the fiscal intermediary option if: \n\line 11.30 (1) it has been determined by the qualified professional or \n\line 11.31 local county public health nurse that the use of this option \n\line 11.32 jeopardizes the recipient's health and safety; \n\line 11.33 (2) the parties have failed to comply with the written \n\line 11.34 agreement specified in paragraph (f); or \n\line 11.35 (3) the use of the option has led to abusive or fraudulent \n\line 11.36 billing for personal care assistant services. \n\line 12.1 The recipient or responsible party may appeal the \n\line 12.2 commissioner's action according to section 256.045. The denial, \n\line 12.3 revocation, or suspension to use the fiscal intermediary option \n\line 12.4 shall not affect the recipient's authorized level of personal \n\line 12.5 care assistant services as determined in subdivision 5. \n\line 12.6 Sec. 4. Minnesota Statutes 2001 Supplement, section \n\line 12.7 256B.0911, subdivision 4b, is amended to read: \n\line 12.8 Subd. 4b. [EXEMPTIONS AND EMERGENCY ADMISSIONS.] (a) \n\line 12.9 Exemptions from the federal screening requirements outlined in \n\line 12.10 subdivision 4a, paragraphs (b) and (c), are limited to: \n\line 12.11 (1) a person who, having entered an acute care facility \n\line 12.12 from a certified nursing facility, is returning to a certified \n\line 12.13 nursing facility; {\strike and} \n\line 12.14 (2) a person transferring from one certified nursing \n\line 12.15 facility in Minnesota to another certified nursing facility in \n\line 12.16 Minnesota{\ul ; and} \n\line 12.17 {\ul (3) a person, 21 years of age or older, who is admitted to} \n\line 12.18 {\ul a nursing facility from a hospital after receiving acute} \n\line 12.19 {\ul inpatient care at the hospital and whose admission to the} \n\line 12.20 {\ul nursing facility meets the criteria outlined in the Code of} \n\line 12.21 {\ul Federal Regulations, part 483.106, (b)(2)}. \n\line 12.22 (b) Persons who are exempt from preadmission screening for \n\line 12.23 purposes of level of care determination include: \n\line 12.24 (1) persons described in paragraph (a); \n\line 12.25 (2) an individual who has a contractual right to have \n\line 12.26 nursing facility care paid for indefinitely by the veterans' \n\line 12.27 administration; \n\line 12.28 (3) an individual enrolled in a demonstration project under \n\line 12.29 section 256B.69, subdivision 8, at the time of application to a \n\line 12.30 nursing facility; \n\line 12.31 (4) an individual currently being served under the \n\line 12.32 alternative care program or under a home and community-based \n\line 12.33 services waiver authorized under section 1915(c) of the federal \n\line 12.34 Social Security Act; and \n\line 12.35 (5) individuals admitted to a certified nursing facility \n\line 12.36 for a short-term stay, which is expected to be 14 days or less \n\line 13.1 in duration based upon a physician's certification, and who have \n\line 13.2 been assessed and approved for nursing facility admission within \n\line 13.3 the previous six months. This exemption applies only if the \n\line 13.4 consultation team member determines at the time of the initial \n\line 13.5 assessment of the six-month period that it is appropriate to use \n\line 13.6 the nursing facility for short-term stays and that there is an \n\line 13.7 adequate plan of care for return to the home or community-based \n\line 13.8 setting. If a stay exceeds 14 days, the individual must be \n\line 13.9 referred no later than the first county working day following \n\line 13.10 the 14th resident day for a screening, which must be completed \n\line 13.11 within five working days of the referral. The payment \n\line 13.12 limitations in subdivision 7 apply to an individual found at \n\line 13.13 screening to not meet the level of care criteria for admission \n\line 13.14 to a certified nursing facility. \n\line 13.15 (c) Persons admitted to a Medicaid-certified nursing \n\line 13.16 facility from the community on an emergency basis as described \n\line 13.17 in paragraph (d) or from an acute care facility on a nonworking \n\line 13.18 day must be screened the first working day after admission. \n\line 13.19 (d) Emergency admission to a nursing facility prior to \n\line 13.20 screening is permitted when all of the following conditions are \n\line 13.21 met: \n\line 13.22 (1) a person is admitted from the community to a certified \n\line 13.23 nursing or certified boarding care facility during county \n\line 13.24 nonworking hours; \n\line 13.25 (2) a physician has determined that delaying admission \n\line 13.26 until preadmission screening is completed would adversely affect \n\line 13.27 the person's health and safety; \n\line 13.28 (3) there is a recent precipitating event that precludes \n\line 13.29 the client from living safely in the community, such as \n\line 13.30 sustaining an injury, sudden onset of acute illness, or a \n\line 13.31 caregiver's inability to continue to provide care; \n\line 13.32 (4) the attending physician has authorized the emergency \n\line 13.33 placement and has documented the reason that the emergency \n\line 13.34 placement is recommended; and \n\line 13.35 (5) the county is contacted on the first working day \n\line 13.36 following the emergency admission. \n\line 14.1 Transfer of a patient from an acute care hospital to a nursing \n\line 14.2 facility is not considered an emergency except for a person who \n\line 14.3 has received hospital services in the following situations: \n\line 14.4 hospital admission for observation, care in an emergency room \n\line 14.5 without hospital admission, or following hospital 24-hour bed \n\line 14.6 care. \n\line 14.7 [EFFECTIVE DATE.] {\ul This section is effective the day} \n\line 14.8 {\ul following final enactment.} \n\line 14.9 Sec. 5. Minnesota Statutes 2001 Supplement, section \n\line 14.10 256B.0911, subdivision 4d, is amended to read: \n\line 14.11 Subd. 4d. [PREADMISSION SCREENING OF INDIVIDUALS UNDER 65 \n\line 14.12 YEARS OF AGE.] (a) It is the policy of the state of Minnesota to \n\line 14.13 ensure that individuals with disabilities or chronic illness are \n\line 14.14 served in the most integrated setting appropriate to their needs \n\line 14.15 and have the necessary information to make informed choices \n\line 14.16 about home and community-based service options. \n\line 14.17 (b) Individuals under 65 years of age who are admitted to a \n\line 14.18 nursing facility from a hospital must be screened prior to \n\line 14.19 admission as outlined in subdivisions 4a through 4c. \n\line 14.20 (c) Individuals under 65 years of age who are admitted to \n\line 14.21 nursing facilities with only a telephone screening must receive \n\line 14.22 a face-to-face assessment from the long-term care consultation \n\line 14.23 team member of the county in which the facility is located or \n\line 14.24 from the recipient's county case manager within 20 working days \n\line 14.25 of admission. \n\line 14.26 (d) {\ul Individuals under 65 years of age who are admitted to a} \n\line 14.27 {\ul nursing facility without preadmission screening according to the} \n\line 14.28 {\ul exemption described in subdivision 4b, paragraph (a), clause} \n\line 14.29 {\ul (3), and who remain in the facility longer than 30 days must} \n\line 14.30 {\ul receive a face-to-face assessment within 40 days of admission.} \n\line 14.31 {\ul (e)} At the face-to-face assessment, the long-term care \n\line 14.32 consultation team member or county case manager must perform the \n\line 14.33 activities required under subdivision 3b. \n\line 14.34 {\strike (e)} {\ul (f)} For individuals under 21 years of age, a screening \n\line 14.35 interview which recommends nursing facility admission must be \n\line 14.36 face-to-face and approved by the commissioner before the \n\line 15.1 individual is admitted to the nursing facility. \n\line 15.2 {\strike (f)} {\ul (g)} In the event that an individual under 65 years of \n\line 15.3 age is admitted to a nursing facility on an emergency basis, the \n\line 15.4 county must be notified of the admission on the next working \n\line 15.5 day, and a face-to-face assessment as described in paragraph (c) \n\line 15.6 must be conducted within 20 working days of admission. \n\line 15.7 {\strike (g)} {\ul (h)} At the face-to-face assessment, the long-term care \n\line 15.8 consultation team member or the case manager must present \n\line 15.9 information about home and community-based options so the \n\line 15.10 individual can make informed choices. If the individual chooses \n\line 15.11 home and community-based services, the long-term care \n\line 15.12 consultation team member or case manager must complete a written \n\line 15.13 relocation plan within 20 working days of the visit. The plan \n\line 15.14 shall describe the services needed to move out of the facility \n\line 15.15 and a time line for the move which is designed to ensure a \n\line 15.16 smooth transition to the individual's home and community. \n\line 15.17 {\strike (h)} {\ul (i)} An individual under 65 years of age residing in a \n\line 15.18 nursing facility shall receive a face-to-face assessment at \n\line 15.19 least every 12 months to review the person's service choices and \n\line 15.20 available alternatives unless the individual indicates, in \n\line 15.21 writing, that annual visits are not desired. In this case, the \n\line 15.22 individual must receive a face-to-face assessment at least once \n\line 15.23 every 36 months for the same purposes. \n\line 15.24 {\strike (i)} {\ul (j)} Notwithstanding the provisions of subdivision 6, \n\line 15.25 the commissioner may pay county agencies directly for \n\line 15.26 face-to-face assessments for individuals under 65 years of age \n\line 15.27 who are being considered for placement or residing in a nursing \n\line 15.28 facility. \n\line 15.29 [EFFECTIVE DATE.] {\ul This section is effective the day} \n\line 15.30 {\ul following final enactment.} \n\line 15.31 Sec. 6. Minnesota Statutes 2001 Supplement, section \n\line 15.32 256B.0913, subdivision 5, is amended to read: \n\line 15.33 Subd. 5. [SERVICES COVERED UNDER ALTERNATIVE CARE.] (a) \n\line 15.34 Alternative care funding may be used for payment of costs of: \n\line 15.35 (1) adult foster care; \n\line 15.36 (2) adult day care; \n\line 16.1 (3) home health aide; \n\line 16.2 (4) homemaker services; \n\line 16.3 (5) personal care; \n\line 16.4 (6) case management; \n\line 16.5 (7) respite care; \n\line 16.6 (8) assisted living; \n\line 16.7 (9) residential care services; \n\line 16.8 (10) care-related supplies and equipment; \n\line 16.9 (11) meals delivered to the home; \n\line 16.10 (12) transportation; \n\line 16.11 (13) skilled nursing; \n\line 16.12 (14) chore services; \n\line 16.13 (15) companion services; \n\line 16.14 (16) nutrition services; \n\line 16.15 (17) training for direct informal caregivers; \n\line 16.16 (18) telemedicine devices to monitor recipients in their \n\line 16.17 own homes as an alternative to hospital care, nursing home care, \n\line 16.18 or home visits; \n\line 16.19 (19) other services which includes discretionary funds and \n\line 16.20 direct cash payments to clients, following approval by the \n\line 16.21 commissioner, subject to the provisions of paragraph (j). Total \n\line 16.22 annual payments for "other services" for all clients within a \n\line 16.23 county may not exceed {\strike either ten} {\ul 25} percent of that county's \n\line 16.24 annual alternative care program base allocation {\strike or $5,000,} \n\line 16.25 {\strike whichever is greater. In no case shall this amount exceed the} \n\line 16.26 {\strike county's total annual alternative care program base allocation}; \n\line 16.27 and \n\line 16.28 (20) environmental modifications. \n\line 16.29 (b) The county agency must ensure that the funds are not \n\line 16.30 used to supplant services available through other public \n\line 16.31 assistance or services programs. \n\line 16.32 (c) Unless specified in statute, the service definitions \n\line 16.33 and standards for alternative care services shall be the same as \n\line 16.34 the service definitions and standards specified in the federally \n\line 16.35 approved elderly waiver plan. Except for the county agencies' \n\line 16.36 approval of direct cash payments to clients as described in \n\line 17.1 paragraph (j) or for a provider of supplies and equipment when \n\line 17.2 the monthly cost of the supplies and equipment is less than \n\line 17.3 $250, persons or agencies must be employed by or under a \n\line 17.4 contract with the county agency or the public health nursing \n\line 17.5 agency of the local board of health in order to receive funding \n\line 17.6 under the alternative care program. Supplies and equipment may \n\line 17.7 be purchased from a vendor not certified to participate in the \n\line 17.8 Medicaid program if the cost for the item is less than that of a \n\line 17.9 Medicaid vendor. \n\line 17.10 (d) The adult foster care rate shall be considered a \n\line 17.11 difficulty of care payment and shall not include room and \n\line 17.12 board. The adult foster care rate shall be negotiated between \n\line 17.13 the county agency and the foster care provider. The alternative \n\line 17.14 care payment for the foster care service in combination with the \n\line 17.15 payment for other alternative care services, including case \n\line 17.16 management, must not exceed the limit specified in subdivision \n\line 17.17 4, paragraph (a), clause (6). \n\line 17.18 (e) Personal care services must meet the service standards \n\line 17.19 defined in the federally approved elderly waiver plan, except \n\line 17.20 that a county agency may contract with a client's relative who \n\line 17.21 meets the relative hardship waiver requirement as defined in \n\line 17.22 section 256B.0627, subdivision 4, paragraph (b), clause (10), to \n\line 17.23 provide personal care services if the county agency ensures \n\line 17.24 supervision of this service by a registered nurse or mental \n\line 17.25 health practitioner. \n\line 17.26 (f) For purposes of this section, residential care services \n\line 17.27 are services which are provided to individuals living in \n\line 17.28 residential care homes. Residential care homes are currently \n\line 17.29 licensed as board and lodging establishments and are registered \n\line 17.30 with the department of health as providing special services \n\line 17.31 under section 157.17 and are not subject to registration under \n\line 17.32 chapter 144D. Residential care services are defined as \n\line 17.33 "supportive services" and "health-related services." \n\line 17.34 "Supportive services" means the provision of up to 24-hour \n\line 17.35 supervision and oversight. Supportive services includes: (1) \n\line 17.36 transportation, when provided by the residential care home only; \n\line 18.1 (2) socialization, when socialization is part of the plan of \n\line 18.2 care, has specific goals and outcomes established, and is not \n\line 18.3 diversional or recreational in nature; (3) assisting clients in \n\line 18.4 setting up meetings and appointments; (4) assisting clients in \n\line 18.5 setting up medical and social services; (5) providing assistance \n\line 18.6 with personal laundry, such as carrying the client's laundry to \n\line 18.7 the laundry room. Assistance with personal laundry does not \n\line 18.8 include any laundry, such as bed linen, that is included in the \n\line 18.9 room and board rate. "Health-related services" are limited to \n\line 18.10 minimal assistance with dressing, grooming, and bathing and \n\line 18.11 providing reminders to residents to take medications that are \n\line 18.12 self-administered or providing storage for medications, if \n\line 18.13 requested. Individuals receiving residential care services \n\line 18.14 cannot receive homemaking services funded under this section. \n\line 18.15 (g) For the purposes of this section, "assisted living" \n\line 18.16 refers to supportive services provided by a single vendor to \n\line 18.17 clients who reside in the same apartment building of three or \n\line 18.18 more units which are not subject to registration under chapter \n\line 18.19 144D and are licensed by the department of health as a class A \n\line 18.20 home care provider or a class E home care provider. Assisted \n\line 18.21 living services are defined as up to 24-hour supervision, and \n\line 18.22 oversight, supportive services as defined in clause (1), \n\line 18.23 individualized home care aide tasks as defined in clause (2), \n\line 18.24 and individualized home management tasks as defined in clause \n\line 18.25 (3) provided to residents of a residential center living in \n\line 18.26 their units or apartments with a full kitchen and bathroom. A \n\line 18.27 full kitchen includes a stove, oven, refrigerator, food \n\line 18.28 preparation counter space, and a kitchen utensil storage \n\line 18.29 compartment. Assisted living services must be provided by the \n\line 18.30 management of the residential center or by providers under \n\line 18.31 contract with the management or with the county. \n\line 18.32 (1) Supportive services include: \n\line 18.33 (i) socialization, when socialization is part of the plan \n\line 18.34 of care, has specific goals and outcomes established, and is not \n\line 18.35 diversional or recreational in nature; \n\line 18.36 (ii) assisting clients in setting up meetings and \n\line 19.1 appointments; and \n\line 19.2 (iii) providing transportation, when provided by the \n\line 19.3 residential center only. \n\line 19.4 (2) Home care aide tasks means: \n\line 19.5 (i) preparing modified diets, such as diabetic or low \n\line 19.6 sodium diets; \n\line 19.7 (ii) reminding residents to take regularly scheduled \n\line 19.8 medications or to perform exercises; \n\line 19.9 (iii) household chores in the presence of technically \n\line 19.10 sophisticated medical equipment or episodes of acute illness or \n\line 19.11 infectious disease; \n\line 19.12 (iv) household chores when the resident's care requires the \n\line 19.13 prevention of exposure to infectious disease or containment of \n\line 19.14 infectious disease; and \n\line 19.15 (v) assisting with dressing, oral hygiene, hair care, \n\line 19.16 grooming, and bathing, if the resident is ambulatory, and if the \n\line 19.17 resident has no serious acute illness or infectious disease. \n\line 19.18 Oral hygiene means care of teeth, gums, and oral prosthetic \n\line 19.19 devices. \n\line 19.20 (3) Home management tasks means: \n\line 19.21 (i) housekeeping; \n\line 19.22 (ii) laundry; \n\line 19.23 (iii) preparation of regular snacks and meals; and \n\line 19.24 (iv) shopping. \n\line 19.25 Individuals receiving assisted living services shall not \n\line 19.26 receive both assisted living services and homemaking services. \n\line 19.27 Individualized means services are chosen and designed \n\line 19.28 specifically for each resident's needs, rather than provided or \n\line 19.29 offered to all residents regardless of their illnesses, \n\line 19.30 disabilities, or physical conditions. Assisted living services \n\line 19.31 as defined in this section shall not be authorized in boarding \n\line 19.32 and lodging establishments licensed according to sections \n\line 19.33 157.011 and 157.15 to 157.22. \n\line 19.34 (h) For establishments registered under chapter 144D, \n\line 19.35 assisted living services under this section means either the \n\line 19.36 services described in paragraph (g) and delivered by a class E \n\line 20.1 home care provider licensed by the department of health or the \n\line 20.2 services described under section 144A.4605 and delivered by an \n\line 20.3 assisted living home care provider or a class A home care \n\line 20.4 provider licensed by the commissioner of health. \n\line 20.5 (i) Payment for assisted living services and residential \n\line 20.6 care services shall be a monthly rate negotiated and authorized \n\line 20.7 by the county agency based on an individualized service plan for \n\line 20.8 each resident and may not cover direct rent or food costs. \n\line 20.9 (1) The individualized monthly negotiated payment for \n\line 20.10 assisted living services as described in paragraph (g) or (h), \n\line 20.11 and residential care services as described in paragraph (f), \n\line 20.12 shall not exceed the nonfederal share in effect on July 1 of the \n\line 20.13 state fiscal year for which the rate limit is being calculated \n\line 20.14 of the greater of either the statewide or any of the geographic \n\line 20.15 groups' weighted average monthly nursing facility payment rate \n\line 20.16 of the case mix resident class to which the alternative care \n\line 20.17 eligible client would be assigned under Minnesota Rules, parts \n\line 20.18 9549.0050 to 9549.0059, less the maintenance needs allowance as \n\line 20.19 described in section 256B.0915, subdivision 1d, paragraph (a), \n\line 20.20 until the first day of the state fiscal year in which a resident \n\line 20.21 assessment system, under section 256B.437, of nursing home rate \n\line 20.22 determination is implemented. Effective on the first day of the \n\line 20.23 state fiscal year in which a resident assessment system, under \n\line 20.24 section 256B.437, of nursing home rate determination is \n\line 20.25 implemented and the first day of each subsequent state fiscal \n\line 20.26 year, the individualized monthly negotiated payment for the \n\line 20.27 services described in this clause shall not exceed the limit \n\line 20.28 described in this clause which was in effect on the last day of \n\line 20.29 the previous state fiscal year and which has been adjusted by \n\line 20.30 the greater of any legislatively adopted home and \n\line 20.31 community-based services cost-of-living percentage increase or \n\line 20.32 any legislatively adopted statewide percent rate increase for \n\line 20.33 nursing facilities. \n\line 20.34 (2) The individualized monthly negotiated payment for \n\line 20.35 assisted living services described under section 144A.4605 and \n\line 20.36 delivered by a provider licensed by the department of health as \n\line 21.1 a class A home care provider or an assisted living home care \n\line 21.2 provider and provided in a building that is registered as a \n\line 21.3 housing with services establishment under chapter 144D and that \n\line 21.4 provides 24-hour supervision in combination with the payment for \n\line 21.5 other alternative care services, including case management, must \n\line 21.6 not exceed the limit specified in subdivision 4, paragraph (a), \n\line 21.7 clause (6). \n\line 21.8 (j) A county agency may make payment from their alternative \n\line 21.9 care program allocation for "other services" which include use \n\line 21.10 of "discretionary funds" for services that are not otherwise \n\line 21.11 defined in this section and direct cash payments to the client \n\line 21.12 for the purpose of purchasing the services. The following \n\line 21.13 provisions apply to payments under this paragraph: \n\line 21.14 (1) a cash payment to a client under this provision cannot \n\line 21.15 exceed {\strike 80 percent of} the monthly payment limit for that client \n\line 21.16 as specified in subdivision 4, paragraph (a), clause (6); \n\line 21.17 (2) a county may not approve any cash payment for a client \n\line 21.18 who meets either of the following: \n\line 21.19 (i) has been assessed as having a dependency in \n\line 21.20 orientation, unless the client has an authorized \n\line 21.21 representative. An "authorized representative" means an \n\line 21.22 individual who is at least 18 years of age and is designated by \n\line 21.23 the person or the person's legal representative to act on the \n\line 21.24 person's behalf. This individual may be a family member, \n\line 21.25 guardian, representative payee, or other individual designated \n\line 21.26 by the person or the person's legal representative, if any, to \n\line 21.27 assist in purchasing and arranging for supports; or \n\line 21.28 (ii) is concurrently receiving adult foster care, \n\line 21.29 residential care, or assisted living services; \n\line 21.30 (3) cash payments to a person or a person's family will be \n\line 21.31 provided through a monthly payment and be in the form of cash, \n\line 21.32 voucher, or direct county payment to a vendor. Fees or premiums \n\line 21.33 assessed to the person for eligibility for health and human \n\line 21.34 services are not reimbursable through this service option. \n\line 21.35 Services and goods purchased through cash payments must be \n\line 21.36 identified in the person's individualized care plan and must \n\line 22.1 meet all of the following criteria: \n\line 22.2 (i) they must be over and above the normal cost of caring \n\line 22.3 for the person if the person did not have functional \n\line 22.4 limitations; \n\line 22.5 (ii) they must be directly attributable to the person's \n\line 22.6 functional limitations; \n\line 22.7 (iii) they must have the potential to be effective at \n\line 22.8 meeting the goals of the program; \n\line 22.9 (iv) they must be consistent with the needs identified in \n\line 22.10 the individualized service plan. The service plan shall specify \n\line 22.11 the needs of the person and family, the form and amount of \n\line 22.12 payment, the items and services to be reimbursed, and the \n\line 22.13 arrangements for management of the individual grant; and \n\line 22.14 (v) the person, the person's family, or the legal \n\line 22.15 representative shall be provided sufficient information to \n\line 22.16 ensure an informed choice of alternatives. The local agency \n\line 22.17 shall document this information in the person's care plan, \n\line 22.18 including the type and level of expenditures to be reimbursed; \n\line 22.19 (4) the county, lead agency under contract, or tribal \n\line 22.20 government under contract to administer the alternative care \n\line 22.21 program shall not be liable for damages, injuries, or \n\line 22.22 liabilities sustained through the purchase of direct supports or \n\line 22.23 goods by the person, the person's family, or the authorized \n\line 22.24 representative with funds received through the cash payments \n\line 22.25 under this section. Liabilities include, but are not limited \n\line 22.26 to, workers' compensation, the Federal Insurance Contributions \n\line 22.27 Act (FICA), or the Federal Unemployment Tax Act (FUTA); \n\line 22.28 (5) persons receiving grants under this section shall have \n\line 22.29 the following responsibilities: \n\line 22.30 (i) spend the grant money in a manner consistent with their \n\line 22.31 individualized service plan with the local agency; \n\line 22.32 (ii) notify the local agency of any necessary changes in \n\line 22.33 the grant expenditures; \n\line 22.34 (iii) arrange and pay for supports; and \n\line 22.35 (iv) inform the local agency of areas where they have \n\line 22.36 experienced difficulty securing or maintaining supports; and \n\line 23.1 (6) the county shall report client outcomes, services, and \n\line 23.2 costs under this paragraph in a manner prescribed by the \n\line 23.3 commissioner. \n\line 23.4 (k) Upon implementation of direct cash payments to clients \n\line 23.5 under this section, any person determined eligible for the \n\line 23.6 alternative care program who chooses a cash payment approved by \n\line 23.7 the county agency shall receive the cash payment under this \n\line 23.8 section and not under section 256.476 unless the person was \n\line 23.9 receiving a consumer support grant under section 256.476 before \n\line 23.10 implementation of direct cash payments under this section. \n\line 23.11 Sec. 7. Minnesota Statutes 2001 Supplement, section \n\line 23.12 256B.0915, subdivision 3, is amended to read: \n\line 23.13 Subd. 3. [LIMITS OF CASES, RATES, PAYMENTS, AND \n\line 23.14 FORECASTING.] (a) The number of medical assistance waiver \n\line 23.15 recipients that a county may serve must be allocated according \n\line 23.16 to the number of medical assistance waiver cases open on July 1 \n\line 23.17 of each fiscal year. Additional recipients may be served with \n\line 23.18 the approval of the commissioner. \n\line 23.19 (b) The monthly limit for the cost of waivered services to \n\line 23.20 an individual elderly waiver client shall be the weighted \n\line 23.21 average monthly nursing facility rate of the case mix resident \n\line 23.22 class to which the elderly waiver client would be assigned under \n\line 23.23 Minnesota Rules, parts 9549.0050 to 9549.0059, less the \n\line 23.24 recipient's maintenance needs allowance as described in \n\line 23.25 subdivision 1d, paragraph (a), until the first day of the state \n\line 23.26 fiscal year in which the resident assessment system as described \n\line 23.27 in section 256B.437 for nursing home rate determination is \n\line 23.28 implemented. Effective on the first day of the state fiscal \n\line 23.29 year in which the resident assessment system as described in \n\line 23.30 section 256B.437 for nursing home rate determination is \n\line 23.31 implemented and the first day of each subsequent state fiscal \n\line 23.32 year, the monthly limit for the cost of waivered services to an \n\line 23.33 individual elderly waiver client shall be the rate of the case \n\line 23.34 mix resident class to which the waiver client would be assigned \n\line 23.35 under Minnesota Rules, parts 9549.0050 to 9549.0059, in effect \n\line 23.36 on the last day of the previous state fiscal year, adjusted by \n\line 24.1 the greater of any legislatively adopted home and \n\line 24.2 community-based services cost-of-living percentage increase or \n\line 24.3 any legislatively adopted statewide percent rate increase for \n\line 24.4 nursing facilities. \n\line 24.5 (c) If extended medical supplies and equipment or \n\line 24.6 environmental modifications are or will be purchased for an \n\line 24.7 elderly waiver client, the costs may be prorated for up to 12 \n\line 24.8 consecutive months beginning with the month of purchase. If the \n\line 24.9 monthly cost of a recipient's waivered services exceeds the \n\line 24.10 monthly limit established in paragraph (b), the annual cost of \n\line 24.11 all waivered services shall be determined. In this event, the \n\line 24.12 annual cost of all waivered services shall not exceed 12 times \n\line 24.13 the monthly limit of waivered services as described in paragraph \n\line 24.14 (b). \n\line 24.15 (d) For a person who is a nursing facility resident at the \n\line 24.16 time of requesting a determination of eligibility for elderly \n\line 24.17 waivered services, a monthly conversion limit for the cost of \n\line 24.18 elderly waivered services may be requested. The monthly \n\line 24.19 conversion limit for the cost of elderly waiver services shall \n\line 24.20 be the resident class assigned under Minnesota Rules, parts \n\line 24.21 9549.0050 to 9549.0059, for that resident in the nursing \n\line 24.22 facility where the resident currently resides until July 1 of \n\line 24.23 the state fiscal year in which the resident assessment system as \n\line 24.24 described in section 256B.437 for nursing home rate \n\line 24.25 determination is implemented. Effective on July 1 of the state \n\line 24.26 fiscal year in which the resident assessment system as described \n\line 24.27 in section 256B.437 for nursing home rate determination is \n\line 24.28 implemented, the monthly conversion limit for the cost of \n\line 24.29 elderly waiver services shall be the per diem nursing facility \n\line 24.30 rate as determined by the resident assessment system as \n\line 24.31 described in section 256B.437 for that resident in the nursing \n\line 24.32 facility where the resident currently resides multiplied by 365 \n\line 24.33 and divided by 12, less the recipient's maintenance needs \n\line 24.34 allowance as described in subdivision 1d. {\ul The initially} \n\line 24.35 {\ul approved conversion rate may be adjusted by the greater of any} \n\line 24.36 {\ul subsequent legislatively adopted home and community-based} \n\line 25.1 {\ul services cost-of-living percentage increase or any subsequent} \n\line 25.2 {\ul legislatively adopted statewide percentage rate increase for} \n\line 25.3 {\ul nursing facilities.} The limit under this clause only applies to \n\line 25.4 persons discharged from a nursing facility after a minimum \n\line 25.5 30-day stay and found eligible for waivered services on or after \n\line 25.6 July 1, 1997. The following costs must be included in \n\line 25.7 determining the total monthly costs for the waiver client: \n\line 25.8 (1) cost of all waivered services, including extended \n\line 25.9 medical supplies and equipment and environmental modifications; \n\line 25.10 and \n\line 25.11 (2) cost of skilled nursing, home health aide, and personal \n\line 25.12 care services reimbursable by medical assistance. \n\line 25.13 (e) Medical assistance funding for skilled nursing \n\line 25.14 services, private duty nursing, home health aide, and personal \n\line 25.15 care services for waiver recipients must be approved by the case \n\line 25.16 manager and included in the individual care plan. \n\line 25.17 (f) A county is not required to contract with a provider of \n\line 25.18 supplies and equipment if the monthly cost of the supplies and \n\line 25.19 equipment is less than $250. \n\line 25.20 (g) The adult foster care rate shall be considered a \n\line 25.21 difficulty of care payment and shall not include room and \n\line 25.22 board. The adult foster care service rate shall be negotiated \n\line 25.23 between the county agency and the foster care provider. The \n\line 25.24 elderly waiver payment for the foster care service in \n\line 25.25 combination with the payment for all other elderly waiver \n\line 25.26 services, including case management, must not exceed the limit \n\line 25.27 specified in paragraph (b). \n\line 25.28 (h) Payment for assisted living service shall be a monthly \n\line 25.29 rate negotiated and authorized by the county agency based on an \n\line 25.30 individualized service plan for each resident and may not cover \n\line 25.31 direct rent or food costs. \n\line 25.32 (1) The individualized monthly negotiated payment for \n\line 25.33 assisted living services as described in section 256B.0913, \n\line 25.34 subdivision 5, paragraph (g) or (h), and residential care \n\line 25.35 services as described in section 256B.0913, subdivision 5, \n\line 25.36 paragraph (f), shall not exceed the nonfederal share, in effect \n\line 26.1 on July 1 of the state fiscal year for which the rate limit is \n\line 26.2 being calculated, of the greater of either the statewide or any \n\line 26.3 of the geographic groups' weighted average monthly nursing \n\line 26.4 facility rate of the case mix resident class to which the \n\line 26.5 elderly waiver eligible client would be assigned under Minnesota \n\line 26.6 Rules, parts 9549.0050 to 9549.0059, less the maintenance needs \n\line 26.7 allowance as described in subdivision 1d, paragraph (a), until \n\line 26.8 the July 1 of the state fiscal year in which the resident \n\line 26.9 assessment system as described in section 256B.437 for nursing \n\line 26.10 home rate determination is implemented. Effective on July 1 of \n\line 26.11 the state fiscal year in which the resident assessment system as \n\line 26.12 described in section 256B.437 for nursing home rate \n\line 26.13 determination is implemented and July 1 of each subsequent state \n\line 26.14 fiscal year, the individualized monthly negotiated payment for \n\line 26.15 the services described in this clause shall not exceed the limit \n\line 26.16 described in this clause which was in effect on June 30 of the \n\line 26.17 previous state fiscal year and which has been adjusted by the \n\line 26.18 greater of any legislatively adopted home and community-based \n\line 26.19 services cost-of-living percentage increase or any legislatively \n\line 26.20 adopted statewide percent rate increase for nursing facilities. \n\line 26.21 (2) The individualized monthly negotiated payment for \n\line 26.22 assisted living services described in section 144A.4605 and \n\line 26.23 delivered by a provider licensed by the department of health as \n\line 26.24 a class A home care provider or an assisted living home care \n\line 26.25 provider and provided in a building that is registered as a \n\line 26.26 housing with services establishment under chapter 144D and that \n\line 26.27 provides 24-hour supervision in combination with the payment for \n\line 26.28 other elderly waiver services, including case management, must \n\line 26.29 not exceed the limit specified in paragraph (b). \n\line 26.30 (i) The county shall negotiate individual service rates \n\line 26.31 with vendors and may authorize payment for actual costs up to \n\line 26.32 the county's current approved rate. Persons or agencies must be \n\line 26.33 employed by or under a contract with the county agency or the \n\line 26.34 public health nursing agency of the local board of health in \n\line 26.35 order to receive funding under the elderly waiver program, \n\line 26.36 except as a provider of supplies and equipment when the monthly \n\line 27.1 cost of the supplies and equipment is less than $250. \n\line 27.2 (j) Reimbursement for the medical assistance recipients \n\line 27.3 under the approved waiver shall be made from the medical \n\line 27.4 assistance account through the invoice processing procedures of \n\line 27.5 the department's Medicaid Management Information System (MMIS), \n\line 27.6 only with the approval of the client's case manager. The budget \n\line 27.7 for the state share of the Medicaid expenditures shall be \n\line 27.8 forecasted with the medical assistance budget, and shall be \n\line 27.9 consistent with the approved waiver. \n\line 27.10 (k) To improve access to community services and eliminate \n\line 27.11 payment disparities between the alternative care program and the \n\line 27.12 elderly waiver, the commissioner shall establish statewide \n\line 27.13 maximum service rate limits and eliminate county-specific \n\line 27.14 service rate limits. \n\line 27.15 (1) Effective July 1, 2001, for service rate limits, except \n\line 27.16 those described or defined in paragraphs (g) and (h), the rate \n\line 27.17 limit for each service shall be the greater of the alternative \n\line 27.18 care statewide maximum rate or the elderly waiver statewide \n\line 27.19 maximum rate. \n\line 27.20 (2) Counties may negotiate individual service rates with \n\line 27.21 vendors for actual costs up to the statewide maximum service \n\line 27.22 rate limit. \n\line 27.23 (l) Beginning July 1, 1991, the state shall reimburse \n\line 27.24 counties according to the payment schedule in section 256.025 \n\line 27.25 for the county share of costs incurred under this subdivision on \n\line 27.26 or after January 1, 1991, for individuals who are receiving \n\line 27.27 medical assistance. \n\line 27.28 Sec. 8. Minnesota Statutes 2001 Supplement, section \n\line 27.29 256B.0924, subdivision 6, is amended to read: \n\line 27.30 Subd. 6. [PAYMENT FOR TARGETED CASE MANAGEMENT.] (a) \n\line 27.31 Medical assistance and MinnesotaCare payment for targeted case \n\line 27.32 management shall be made on a monthly basis. In order to \n\line 27.33 receive payment for an eligible adult, the provider must \n\line 27.34 document at least one contact per month and not more than two \n\line 27.35 consecutive months without a face-to-face contact with the adult \n\line 27.36 or the adult's legal representative{\ul , family, primary caregiver,} \n\line 28.1 {\ul or other relevant persons identified as necessary to the} \n\line 28.2 {\ul development or implementation of the goals of the personal} \n\line 28.3 {\ul service plan}. \n\line 28.4 (b) Payment for targeted case management provided by county \n\line 28.5 staff under this subdivision shall be based on the monthly rate \n\line 28.6 methodology under section 256B.094, subdivision 6, paragraph \n\line 28.7 (b), calculated as one combined average rate together with adult \n\line 28.8 mental health case management under section 256B.0625, \n\line 28.9 subdivision 20, except for calendar year 2002. In calendar year \n\line 28.10 2002, the rate for case management under this section shall be \n\line 28.11 the same as the rate for adult mental health case management in \n\line 28.12 effect as of December 31, 2001. Billing and payment must \n\line 28.13 identify the recipient's primary population group to allow \n\line 28.14 tracking of revenues. \n\line 28.15 (c) Payment for targeted case management provided by \n\line 28.16 county-contracted vendors shall be based on a monthly rate \n\line 28.17 negotiated by the host county. The negotiated rate must not \n\line 28.18 exceed the rate charged by the vendor for the same service to \n\line 28.19 other payers. If the service is provided by a team of \n\line 28.20 contracted vendors, the county may negotiate a team rate with a \n\line 28.21 vendor who is a member of the team. The team shall determine \n\line 28.22 how to distribute the rate among its members. No reimbursement \n\line 28.23 received by contracted vendors shall be returned to the county, \n\line 28.24 except to reimburse the county for advance funding provided by \n\line 28.25 the county to the vendor. \n\line 28.26 (d) If the service is provided by a team that includes \n\line 28.27 contracted vendors and county staff, the costs for county staff \n\line 28.28 participation on the team shall be included in the rate for \n\line 28.29 county-provided services. In this case, the contracted vendor \n\line 28.30 and the county may each receive separate payment for services \n\line 28.31 provided by each entity in the same month. In order to prevent \n\line 28.32 duplication of services, the county must document, in the \n\line 28.33 recipient's file, the need for team targeted case management and \n\line 28.34 a description of the different roles of the team members. \n\line 28.35 (e) Notwithstanding section 256B.19, subdivision 1, the \n\line 28.36 nonfederal share of costs for targeted case management shall be \n\line 29.1 provided by the recipient's county of responsibility, as defined \n\line 29.2 in sections 256G.01 to 256G.12, from sources other than federal \n\line 29.3 funds or funds used to match other federal funds. \n\line 29.4 (f) The commissioner may suspend, reduce, or terminate \n\line 29.5 reimbursement to a provider that does not meet the reporting or \n\line 29.6 other requirements of this section. The county of \n\line 29.7 responsibility, as defined in sections 256G.01 to 256G.12, is \n\line 29.8 responsible for any federal disallowances. The county may share \n\line 29.9 this responsibility with its contracted vendors. \n\line 29.10 (g) The commissioner shall set aside five percent of the \n\line 29.11 federal funds received under this section for use in reimbursing \n\line 29.12 the state for costs of developing and implementing this section. \n\line 29.13 (h) Notwithstanding section 256.025, subdivision 2, \n\line 29.14 payments to counties for targeted case management expenditures \n\line 29.15 under this section shall only be made from federal earnings from \n\line 29.16 services provided under this section. Payments to contracted \n\line 29.17 vendors shall include both the federal earnings and the county \n\line 29.18 share. \n\line 29.19 (i) Notwithstanding section 256B.041, county payments for \n\line 29.20 the cost of case management services provided by county staff \n\line 29.21 shall not be made to the state treasurer. For the purposes of \n\line 29.22 targeted case management services provided by county staff under \n\line 29.23 this section, the centralized disbursement of payments to \n\line 29.24 counties under section 256B.041 consists only of federal \n\line 29.25 earnings from services provided under this section. \n\line 29.26 (j) If the recipient is a resident of a nursing facility, \n\line 29.27 intermediate care facility, or hospital, and the recipient's \n\line 29.28 institutional care is paid by medical assistance, payment for \n\line 29.29 targeted case management services under this subdivision is \n\line 29.30 limited to the last 180 days of the recipient's residency in \n\line 29.31 that facility and may not exceed more than six months in a \n\line 29.32 calendar year. \n\line 29.33 (k) Payment for targeted case management services under \n\line 29.34 this subdivision shall not duplicate payments made under other \n\line 29.35 program authorities for the same purpose. \n\line 29.36 (l) Any growth in targeted case management services and \n\line 30.1 cost increases under this section shall be the responsibility of \n\line 30.2 the counties. \n\line 30.3 Sec. 9. Minnesota Statutes 2001 Supplement, section \n\line 30.4 256B.0951, subdivision 7, is amended to read: \n\line 30.5 Subd. 7. [WAIVER OF RULES.] {\ul If a federal waiver is} \n\line 30.6 {\ul approved under subdivision 8,} the commissioner of health may \n\line 30.7 exempt residents of intermediate care facilities for persons \n\line 30.8 with mental retardation (ICFs/MR) who participate in the \n\line 30.9 {\strike three-year} {\ul alternative} quality assurance {\strike pilot} project \n\line 30.10 established in section 256B.095 from the requirements of \n\line 30.11 Minnesota Rules, chapter 4665{\strike , upon approval by the federal} \n\line 30.12 {\strike government of a waiver of federal certification requirements for} \n\line 30.13 {\strike ICFs/MR}. \n\line 30.14 Sec. 10. Minnesota Statutes 2001 Supplement, section \n\line 30.15 256B.0951, subdivision 8, is amended to read: \n\line 30.16 Subd. 8. [FEDERAL WAIVER.] The commissioner of human \n\line 30.17 services shall seek {\strike federal authority to waive provisions of} \n\line 30.18 {\strike intermediate care facilities for persons with mental retardation} \n\line 30.19 {\strike (ICFs/MR) regulations to enable the demonstration and evaluation} \n\line 30.20 {\strike of the alternative quality assurance system for ICFs/MR under} \n\line 30.21 {\strike the project. The commissioner of human services shall apply for} \n\line 30.22 {\strike any necessary waivers as soon as practicable.} {\ul a federal waiver} \n\line 30.23 {\ul to allow intermediate care facilities for persons with mental} \n\line 30.24 {\ul retardation (ICFs/MR) in Region 10 of Minnesota to participate} \n\line 30.25 {\ul in the alternative licensing system. If it is necessary for} \n\line 30.26 {\ul purposes of participation in this alternative licensing system} \n\line 30.27 {\ul for a facility to be decertified as an ICF/MR facility according} \n\line 30.28 {\ul to the terms of the federal waiver, when the facility seeks} \n\line 30.29 {\ul recertification under the provisions of ICF/MR regulations at} \n\line 30.30 {\ul the end of the demonstration project, it will not be considered} \n\line 30.31 {\ul a new ICF/MR as defined under section 252.291 provided the} \n\line 30.32 {\ul licensed capacity of the facility did not increase during its} \n\line 30.33 {\ul participation in the alternative licensing system. The} \n\line 30.34 {\ul provisions of sections 252.82, 252.292, and 256B.5011 to} \n\line 30.35 {\ul 256B.5015 will remain applicable for counties in Region 10 of} \n\line 30.36 {\ul Minnesota and the ICFs/MR located within those counties} \n\line 31.1 {\ul notwithstanding a county's participation in the alternative} \n\line 31.2 {\ul licensing system.} \n\line 31.3 Sec. 11. Minnesota Statutes 2001 Supplement, section \n\line 31.4 256B.437, subdivision 6, is amended to read: \n\line 31.5 Subd. 6. [PLANNED CLOSURE RATE ADJUSTMENT.] (a) The \n\line 31.6 commissioner of human services shall calculate the amount of the \n\line 31.7 planned closure rate adjustment available under subdivision 3, \n\line 31.8 paragraph (b), for up to 5,140 beds according to clauses (1) to \n\line 31.9 (4): \n\line 31.10 (1) the amount available is the net reduction of nursing \n\line 31.11 facility beds multiplied by $2,080; \n\line 31.12 (2) the total number of beds in the nursing facility or \n\line 31.13 facilities receiving the planned closure rate adjustment must be \n\line 31.14 identified; \n\line 31.15 (3) capacity days are determined by multiplying the number \n\line 31.16 determined under clause (2) by 365; and \n\line 31.17 (4) the planned closure rate adjustment is the amount \n\line 31.18 available in clause (1), divided by capacity days determined \n\line 31.19 under clause (3). \n\line 31.20 (b) A planned closure rate adjustment under this section is \n\line 31.21 effective on the first day of the month following completion of \n\line 31.22 closure of the facility designated for closure in the \n\line 31.23 application and becomes part of the nursing facility's total \n\line 31.24 operating payment rate. \n\line 31.25 (c) Applicants may use the planned closure rate adjustment \n\line 31.26 to allow for a property payment for a new nursing facility or an \n\line 31.27 addition to an existing nursing facility or as an operating \n\line 31.28 payment rate adjustment. Applications approved under this \n\line 31.29 subdivision are exempt from other requirements for moratorium \n\line 31.30 exceptions under section 144A.073, subdivisions 2 and 3. \n\line 31.31 (d) Upon the request of a closing facility, the \n\line 31.32 commissioner must allow the facility a closure rate adjustment \n\line 31.33 as provided under section 144A.161, subdivision 10. \n\line 31.34 {\ul (e) A facility that has received a planned closure rate} \n\line 31.35 {\ul adjustment may reassign it to another facility that is under the} \n\line 31.36 {\ul same ownership at any time within three years of its effective} \n\line 32.1 {\ul date. The amount of the adjustment shall be computed according} \n\line 32.2 {\ul to paragraph (a).}\n\line \n\line \par}
}