Skip to main content Skip to office menu Skip to footer
Minnesota Legislature

Office of the Revisor of Statutes

HF 481

1st Engrossment - 90th Legislature (2017 - 2018) Posted on 04/09/2018 04:28pm

KEY: stricken = removed, old language.
underscored = added, new language.

Current Version - 1st Engrossment

Line numbers 1.1 1.2 1.3 1.4 1.5
1.6 1.7 1.8 1.9 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 1.19 1.20 1.21 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9 2.10 2.11 2.12 2.13 2.14 2.15 2.16 2.17 2.18 2.19 2.20 2.21 2.22 2.23 2.24 2.25 2.26 2.27 2.28 2.29 2.30 2.31 2.32 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 3.10 3.11 3.12 3.13 3.14 3.15
3.16 3.17 3.18 3.19 3.20 3.21 3.22 3.23 3.24 3.25 3.26 3.27 3.28 3.29 3.30 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 4.9 4.10 4.11 4.12 4.13 4.14 4.15 4.16 4.17 4.18 4.19 4.20 4.21 4.22 4.23 4.24 4.25 4.26 4.27 4.28 4.29 4.30 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 5.9 5.10 5.11 5.12 5.13 5.14 5.15
5.16 5.17 5.18 5.19 5.20 5.21 5.22 5.23 5.24 5.25 5.26 5.27 5.28 5.29 5.30 5.31 6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8 6.9 6.10 6.11 6.12 6.13 6.14 6.15 6.16 6.17 6.18 6.19 6.20 6.21 6.22 6.23 6.24 6.25 6.26 6.27 6.28 6.29 6.30 6.31 6.32 6.33 7.1 7.2 7.3 7.4 7.5 7.6
7.7 7.8 7.9 7.10 7.11
7.12 7.13 7.14 7.15 7.16 7.17 7.18 7.19 7.20 7.21 7.22 7.23 7.24 7.25 7.26 7.27 7.28 7.29 7.30 7.31 8.1 8.2 8.3 8.4 8.5 8.6 8.7 8.8 8.9 8.10 8.11 8.12 8.13 8.14 8.15 8.16 8.17 8.18 8.19 8.20 8.21 8.22 8.23 8.24 8.25 8.26 8.27 8.28 8.29 8.30 8.31 8.32 8.33 9.1 9.2 9.3 9.4 9.5 9.6 9.7 9.8 9.9 9.10 9.11 9.12 9.13 9.14 9.15 9.16 9.17 9.18 9.19 9.20 9.21 9.22 9.23 9.24 9.25 9.26 9.27 9.28 9.29 9.30

A bill for an act
relating to human services; modifying the personal care assistance program;
amending Minnesota Statutes 2016, section 256B.0659, subdivisions 1, 2, 11, 21,
by adding a subdivision.

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

Section 1.

Minnesota Statutes 2016, section 256B.0659, subdivision 1, is amended to read:


Subdivision 1.

Definitions.

(a) For the purposes of this section, the terms defined in
paragraphs (b) to deleted text begin(r)deleted text endnew text begin (s)new text end have the meanings given unless otherwise provided in text.

(b) "Activities of daily living" means grooming, dressing, bathing, transferring, mobility,
positioning, eating, and toileting.

(c) "Behavior," effective January 1, 2010, means a category to determine the home care
rating and is based on the criteria found in this section. "Level I behavior" means physical
aggression towards self, others, or destruction of property that requires the immediate
response of another person.

(d) "Complex health-related needs," effective January 1, 2010, means a category to
determine the home care rating and is based on the criteria found in this section.

new text begin (e) "Complex personal care assistance services" means personal care assistance services:
new text end

new text begin (1) for a person who qualifies for ten hours or more of personal care assistance services
per day; and
new text end

new text begin (2) provided by a personal care assistant who is qualified to provide complex personal
care assistance services under subdivision 11, paragraph (d).
new text end

deleted text begin (e)deleted text endnew text begin (f)new text end "Critical activities of daily living," effective January 1, 2010, means transferring,
mobility, eating, and toileting.

deleted text begin (f)deleted text endnew text begin (g)new text end "Dependency in activities of daily living" means a person requires assistance to
begin and complete one or more of the activities of daily living.

deleted text begin (g)deleted text endnew text begin (h)new text end "Extended personal care assistance service" means personal care assistance
services included in a service plan under one of the home and community-based services
waivers authorized under sections 256B.0915, 256B.092, subdivision 5, and 256B.49, which
exceed the amount, duration, and frequency of the state plan personal care assistance services
for participants who:

(1) need assistance provided periodically during a week, but less than daily will not be
able to remain in their homes without the assistance, and other replacement services are
more expensive or are not available when personal care assistance services are to be reduced;
or

(2) need additional personal care assistance services beyond the amount authorized by
the state plan personal care assistance assessment in order to ensure that their safety, health,
and welfare are provided for in their homes.

deleted text begin (h)deleted text endnew text begin (i)new text end "Health-related procedures and tasks" means procedures and tasks that can be
delegated or assigned by a licensed health care professional under state law to be performed
by a personal care assistant.

deleted text begin (i)deleted text endnew text begin (j)new text end "Instrumental activities of daily living" means activities to include meal planning
and preparation; basic assistance with paying bills; shopping for food, clothing, and other
essential items; performing household tasks integral to the personal care assistance services;
communication by telephone and other media; and traveling, including to medical
appointments and to participate in the community.

deleted text begin (j)deleted text endnew text begin (k)new text end "Managing employee" has the same definition as Code of Federal Regulations,
title 42, section 455.

deleted text begin (k)deleted text endnew text begin (l)new text end "Qualified professional" means a professional providing supervision of personal
care assistance services and staff as defined in section 256B.0625, subdivision 19c.

deleted text begin (l)deleted text endnew text begin (m)new text end "Personal care assistance provider agency" means a medical assistance enrolled
provider that provides or assists with providing personal care assistance services and includes
a personal care assistance provider organization, personal care assistance choice agency,
class A licensed nursing agency, and Medicare-certified home health agency.

deleted text begin (m)deleted text endnew text begin (n)new text end "Personal care assistant" or "PCA" means an individual employed by a personal
care assistance agency who provides personal care assistance services.

deleted text begin (n)deleted text endnew text begin (o)new text end "Personal care assistance care plan" means a written description of personal care
assistance services developed by the personal care assistance provider according to the
service plan.

deleted text begin (o)deleted text endnew text begin (p)new text end "Responsible party" means an individual who is capable of providing the support
necessary to assist the recipient to live in the community.

deleted text begin (p)deleted text endnew text begin (q)new text end "Self-administered medication" means medication taken orally, by injection,
nebulizer, or insertion, or applied topically without the need for assistance.

deleted text begin (q)deleted text endnew text begin (r)new text end "Service plan" means a written summary of the assessment and description of the
services needed by the recipient.

deleted text begin (r)deleted text endnew text begin (s)new text end "Wages and benefits" means wages and salaries, the employer's share of FICA
taxes, Medicare taxes, state and federal unemployment taxes, workers' compensation, mileage
reimbursement, health and dental insurance, life insurance, disability insurance, long-term
care insurance, uniform allowance, and contributions to employee retirement accounts.

Sec. 2.

Minnesota Statutes 2016, section 256B.0659, subdivision 2, is amended to read:


Subd. 2.

Personal care assistance services; covered services.

(a) The personal care
assistance services eligible for payment include services and supports furnished to an
individual, as needed, to assist in:

(1) activities of daily living;

(2) health-related procedures and tasks;

(3) observation and redirection of behaviors; and

(4) instrumental activities of daily living.

(b) Activities of daily living include the following covered services:

(1) dressing, including assistance with choosing, application, and changing of clothing
and application of special appliances, wraps, or clothing;

(2) grooming, including assistance with basic hair care, oral care, shaving, applying
cosmetics and deodorant, and care of eyeglasses and hearing aids. Nail care is included,
except for recipients who are diabetic or have poor circulation;

(3) bathing, including assistance with basic personal hygiene and skin care;

(4) eating, including assistance with hand washing and application of orthotics required
for eating, transfers, and feeding;

(5) transfers, including assistance with transferring the recipient from one seating or
reclining area to another;

(6) mobility, including assistance with ambulation, including use of a wheelchair.
Mobility does not include providing transportation for a recipient;

(7) positioning, including assistance with positioning or turning a recipient for necessary
care and comfort; and

(8) toileting, including assistance with helping recipient with bowel or bladder elimination
and care including transfers, mobility, positioning, feminine hygiene, use of toileting
equipment or supplies, cleansing the perineal area, inspection of the skin, and adjusting
clothing.

(c) Health-related procedures and tasks include the following covered services:

(1) range of motion and passive exercise to maintain a recipient's strength and muscle
functioning;

(2) assistance with self-administered medication as defined by this section, including
reminders to take medication, bringing medication to the recipient, and assistance with
opening medication under the direction of the recipient or responsible party, including
medications given through a nebulizer;

(3) interventions for seizure disorders, including monitoring and observation; and

(4) other activities considered within the scope of the personal care service and meeting
the definition of health-related procedures and tasks under this section.

(d) A personal care assistant may provide health-related procedures and tasks associated
with the complex health-related needs of a recipient if the procedures and tasks meet the
definition of health-related procedures and tasks under this section and the personal care
assistant is trained by a qualified professional and demonstrates competency to safely
complete the procedures and tasks. Delegation of health-related procedures and tasks and
all training must be documented in the personal care assistance care plan and the recipient's
and personal care assistant's files. A personal care assistant must not determine the medication
dose or time for medication.

(e) Effective January 1, 2010, for a personal care assistant to provide the health-related
procedures and tasks of tracheostomy suctioning and services to recipients on ventilator
support there must be:

(1) delegation and training by a registered nurse, certified or licensed respiratory therapist,
or a physician;

(2) utilization of clean rather than sterile procedure;

(3) specialized training about the health-related procedures and tasks and equipment,
including ventilator operation and maintenance;

(4) individualized training regarding the needs of the recipient; and

(5) supervision by a qualified professional who is a registered nurse.

(f) Effective January 1, 2010, a personal care assistant may observe and redirect the
recipient for episodes where there is a need for redirection due to behaviors. Training of
the personal care assistant must occur based on the needs of the recipient, the personal care
assistance care plan, and any other support services provided.

(g) Instrumental activities of daily living under subdivision 1, paragraph deleted text begin(i)deleted text endnew text begin (j)new text end.

Sec. 3.

Minnesota Statutes 2016, section 256B.0659, subdivision 11, is amended to read:


Subd. 11.

Personal care assistant; requirements.

(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. Except as provided in subdivision 11a, 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. The training must be available in languages
other than English and to those who need accommodations due to disabilities. 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; and

(10) be limited to providing and being paid for up to 275 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. The number of hours worked
per day shall not be disallowed by the department unless in violation of the law.

(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) Persons who do not qualify as a personal care assistant include parents, stepparents,
and legal guardians of minors; spouses; paid legal guardians of adults; family foster care
providers, except as otherwise allowed in section 256B.0625, subdivision 19a; and staff of
a residential setting.

new text begin (d) A personal care assistant is qualified to provide complex personal care assistance
services as defined in subdivision 1, paragraph (e), if the personal care assistant:
new text end

new text begin (1) provides services according to the care plan in subdivision 7 to an individual described
in subdivision 1, paragraph (e), clause (1); and
new text end

new text begin (2) beginning July 1, 2018, satisfies the current requirements of Medicare for training
and competency or competency evaluation of home health aides or nursing assistants, as
provided by Code of Federal Regulations, title 42, section 483.151 or 484.36, or alternative
comparable state approved training and competency requirements.
new text end

Sec. 4.

Minnesota Statutes 2016, section 256B.0659, is amended by adding a subdivision
to read:


new text begin Subd. 17a. new text end

new text begin Rate for complex personal care assistance services. new text end

new text begin The rate paid to a
provider for complex personal care assistance services shall be 120 percent of the rate paid
for personal care assistance services.
new text end

Sec. 5.

Minnesota Statutes 2016, section 256B.0659, subdivision 21, is amended to read:


Subd. 21.

Requirements for provider enrollment of personal care assistance provider
agencies.

(a) All personal care assistance provider agencies must provide, at the time of
enrollment, reenrollment, and revalidation 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. Upon new enrollment, or if the provider's Medicaid
revenue in the previous calendar year is up to and including $300,000, the provider agency
must purchase a surety bond of $50,000. If the Medicaid revenue in the previous year is
over $300,000, the provider agency must purchase a surety bond of $100,000. The surety
bond must be in a form approved by the commissioner, must be renewed annually, and must
allow for recovery of costs and fees in pursuing a claim on the bond;

(3) proof of fidelity bond coverage in the amount of $20,000;

(4) proof of workers' compensation insurance coverage;

(5) proof of liability insurance;

(6) 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;

(7) 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;

(8) 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;

(9) a list of all training and classes that the personal care assistance provider agency
requires of its staff providing personal care assistance services;

(10) documentation that the personal care assistance provider agency and staff have
successfully completed all the training required by this sectionnew text begin, including the requirements
under subdivision 11, paragraph (d), if complex personal care assistance services are provided
and submitted for payment
new text end;

(11) documentation of the agency's marketing practices;

(12) disclosure of ownership, leasing, or management of all residential properties that
is used or could be used for providing home care services;

(13) 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. The revenue generated by the qualified professional and the reasonable costs
associated with the qualified professional shall not be used in making this calculation; and

(14) effective May 15, 2010, documentation that the agency does not burden recipients'
free exercise of their right to choose service providers by requiring personal care assistants
to sign an agreement not to work with any particular personal care assistance recipient or
for another personal care assistance provider agency after leaving the agency and that the
agency is not taking action on any such agreements or requirements regardless of the date
signed.

(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 require all employees in
management and supervisory positions and owners of the agency who are active in the
day-to-day management and operations of the agency to complete mandatory training as
determined by the commissioner before enrollment of the agency as a provider. Employees
in management and supervisory positions and owners who are active in the day-to-day
operations of an agency who have completed the required training as an employee with a
personal care assistance provider agency do not need to repeat the required training if they
are hired by another agency, if they have completed the training within the past three years.
By September 1, 2010, the required training must be available with meaningful access
according to title VI of the Civil Rights Act and federal regulations adopted under that law
or any guidance from the United States Health and Human Services Department. The
required training must be available online or by electronic remote connection. The required
training must provide for competency testing. 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 or employees in management and
supervisory positions involved in the day-to-day operations are required to complete
mandatory training as a requisite of working for the agency. Personal care assistance provider
agencies certified for participation in Medicare as home health agencies are exempt from
the training required in this subdivision. When available, Medicare-certified home health
agency owners, supervisors, or managers must successfully complete the competency test.