relating to human services; making changes to continuing care provisions;
modifying provisions related to advisory task forces, nursing homes, resident
relocation, medical assistance, long-term care consultation services, assessments,
and reporting of maltreatment; requiring a report;amending Minnesota Statutes
2012, sections 15.014, subdivision 2; 144.0724, subdivision 12; 144A.071,
subdivision 4d; 144A.161; 256B.056, subdivision 3; 256B.057, subdivision 9;
256B.0652, subdivision 5; 256B.0659, subdivision 7, by adding a subdivision;
256B.0911, subdivision 3a; 256B.092, subdivision 7; 256B.441, subdivisions 1,
43, 63; 256B.49, subdivision 14; 256B.492; 626.557, subdivision 10; repealing
Minnesota Statutes 2012, section 256B.437, subdivision 8; Laws 2012, chapter
216, article 11, section 31.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Section 1. Minnesota Statutes 2012, section 15.014, subdivision 2, is amended to read:
Subd. 2. Creation; limitations.
A commissioner of a state department, a state board
or other agency having the powers of a board as defined in section
, may create
advisory task forces to advise the commissioner or agency on specific programs or topics
within the jurisdiction of the department or agency. A task force so created shall have
no more than 15 members. The task force shall expire and the terms and removal of
members shall be as provided in section
15.059, subdivision 6
. The members of no more
than four task forces created pursuant to this section in a department or agency may be
paid expenses in the same manner and amount as authorized by the commissioner's plan
adopted according to section
43A.18, subdivision 2
. Task forces mandated by court order
1.24must not be counted for purposes of the limit on the number of task forces whose members
1.25may be paid expenses.
No member of a task force shall be compensated for services in a
manner not provided for in statute. A commissioner, board, council, committee, or other
state agency may not create any other multimember agency unless specifically authorized
by statute or unless the creation of the agency is authorized by federal law as a condition
precedent to the receipt of federal money.
Sec. 2. Minnesota Statutes 2012, section 144.0724, subdivision 12, is amended to read:
Subd. 12. Appeal of nursing facility level of care determination.
A resident or
prospective resident whose level of care determination results in a denial of long-term
care services can appeal the determination as outlined in section
, paragraph (h), clause
Sec. 3. Minnesota Statutes 2012, section 144A.071, subdivision 4d, is amended to read:
Subd. 4d. Consolidation of nursing facilities.
(a) The commissioner of health,
in consultation with the commissioner of human services, may approve a request for
consolidation of nursing facilities which includes the closure of one or more facilities
and the upgrading of the physical plant of the remaining nursing facility or facilities,
the costs of which exceed the threshold project limit under subdivision 2, clause (a).
The commissioners shall consider the criteria in this section, section
, in approving or rejecting a consolidation proposal. In the event the
commissioners approve the request, the commissioner of human services shall calculate a
property rate adjustment according to clauses (1) to (3):
(1) the closure of beds shall not be eligible for a planned closure rate adjustment
256B.437, subdivision 6
(2) the construction project permitted in this clause shall not be eligible for a
threshold project rate adjustment under section
256B.434, subdivision 4f
, or a moratorium
exception adjustment under section
(3) the property payment rate for a remaining facility or facilities shall be increased
by an amount equal to 65 percent of the projected net cost savings to the state calculated in
paragraph (b), divided by the state's medical assistance percentage of medical assistance
dollars, and then divided by estimated medical assistance resident days, as determined
in paragraph (c), of the remaining nursing facility or facilities in the request in this
paragraph. The rate adjustment is effective on the later of the first day of the month
2.29following completion of the construction upgrades in the consolidation plan or the first
2.30day of the month following the complete closure of a facility designated for closure in the
2.31consolidation plan. If more than one facility is receiving upgrades in the consolidation
2.32plan, each facility's date of construction completion must be evaluated separately.
(b) For purposes of calculating the net cost savings to the state, the commissioner
shall consider clauses (1) to (7):
(1) the annual savings from estimated medical assistance payments from the net
number of beds closed taking into consideration only beds that are in active service on the
date of the request and that have been in active service for at least three years;
(2) the estimated annual cost of increased case load of individuals receiving services
under the elderly waiver;
(3) the estimated annual cost of elderly waiver recipients receiving support under
group residential housing;
(4) the estimated annual cost of increased case load of individuals receiving services
under the alternative care program;
(5) the annual loss of license surcharge payments on closed beds;
(6) the savings from not paying planned closure rate adjustments that the facilities
would otherwise be eligible for under section
(7) the savings from not paying property payment rate adjustments from submission
of renovation costs that would otherwise be eligible as threshold projects under section
3.15256B.434, subdivision 4f
(c) For purposes of the calculation in paragraph (a), clause (3), the estimated medical
assistance resident days of the remaining facility or facilities shall be computed assuming
95 percent occupancy multiplied by the historical percentage of medical assistance
resident days of the remaining facility or facilities, as reported on the facility's or facilities'
most recent nursing facility statistical and cost report filed before the plan of closure
is submitted, multiplied by 365.
(d) For purposes of net cost of savings to the state in paragraph (b), the average
occupancy percentages will be those reported on the facility's or facilities' most recent
nursing facility statistical and cost report filed before the plan of closure is submitted, and
the average payment rates shall be calculated based on the approved payment rates in
effect at the time the consolidation request is submitted.
(e) To qualify for the property payment rate adjustment under this provision, the
closing facilities shall:
(1) submit an application for closure according to section
(2) follow the resident relocation provisions of section
(f) The county or counties in which a facility or facilities are closed under this
subdivision shall not be eligible for designation as a hardship area under section
subdivision 3, for five years from the date of the approval of the proposed consolidation.
The applicant shall notify the county of this limitation and the county shall acknowledge
this in a letter of support.
Sec. 4. Minnesota Statutes 2012, section 144A.161, is amended to read:
4.2144A.161 NURSING HOME AND BOARDING CARE HOME RESIDENT
Subdivision 1. Definitions.
The definitions in this subdivision apply to subdivisions
2 to 10.
(a) "Change in operations" means any alteration in operations which would require
4.7or encourage the relocation of residents.
"Closure" or "closing"
means the cessation of operations of a facility
4.9 delicensure and decertification of all beds within the facility
(b) "Curtailment," "reduction," or "Change" refers to any change in operations which
4.11 would result in or encourage the relocation of residents.
"Facility" means a nursing home licensed pursuant to this chapter, or a certified
4.13 boarding care home licensed pursuant to sections 144.50 to 144.56. "Contact information"
4.14means name, address, and telephone number and, when available, e-mail address and
4.16 (d) "Licensee" means the owner of the facility or the owner's designee or the
4.17 commissioner of health for a facility in receivership.
4.18 (e) (d)
"County social services agency" means the county or multicounty social
service agency authorized under sections 393.01 and 393.07, as the agency responsible for
providing social services for the county in which the
nursing home facility
4.21(e) "Facility" means a nursing home licensed pursuant to this chapter, or a boarding
4.22care home licensed pursuant to sections 144.50 to 144.56.
4.23(f) "Licensee" means the owner of the facility or the owner's designee or the
4.24commissioner of health for a facility in receivership.
"Plan" or "relocation plan"
means a description of the
under subdivision 3, paragraph (b), for the relocation of residents in cases of a facility
reduction, or change in operations
in a facility and the subsequent
4.28 relocation of residents
4.29(h) "Reduction" means a decrease in the number of beds that would require or
4.30encourage the relocation of residents.
"Relocation" means the
discharge of a resident and
movement of the resident
to another facility or living arrangement as a result of the closing,
or change in operations of a
nursing home or boarding care home facility
4.34(j) "Responsible party" means an individual acting as a legal representative for the
Subd. 1a. Scope.
Where a facility is undertaking a
or change in operations, or where a housing with services unit registered under chapter
144D is closed because the space that it occupies is being replaced by a nursing facility
bed that is being reactivated from layaway status, the facility and the county social
services agency must comply with the requirements of this section.
Subd. 2. Initial notice from licensee.
(a) A licensee shall notify the following
parties in writing when there is an intent to close
, reduce, or change operations
result in require
or encourage the relocation of residents:
(1) the commissioner of health;
(2) the commissioner of human services;
(3) the county social services agency;
(4) the Office of Ombudsman for Long-Term Care;
(5) the Office of Ombudsman for Mental Health and Developmental Disabilities
5.14(6) the managed care organizations contracting with Minnesota health care programs
5.15within the county where the nursing facility is located.
(b) The written notice shall include the
names, telephone numbers, facsimile
5.17 numbers, and e-mail addresses contact information
of the persons in the facility
responsible for coordinating the licensee's efforts in the planning process, and the number
of residents potentially affected by the closure
, reduction, or change in
operations. Only the copy of the notice provided to the county social services agency shall
5.21include a complete resident census, including resident name, date of birth, Social Security
5.22number, and medical assistance identification number if it is available.
(c) For a facility that is reducing or changing operations,
after providing written
this section subdivision 5a
, and prior to admission, the facility must fully
inform prospective residents and their
families responsible parties
of the intent to
or change operations, and of the relocation plan.
5.27(d) A closing facility is prohibited from admitting any new residents on or after the
5.28date of the written notice provided under subdivision 5a.
Subd. 3. Planning process.
(a) The county social services agency shall, within
five working days of receiving initial notice of the licensee's intent to close
reduce, or change operations, provide the licensee and all parties identified in subdivision
2, paragraph (a), with the
names, telephone numbers, facsimile numbers, and e-mail
5.33 addresses contact information
of those persons responsible for coordinating county social
services agency efforts in the planning process.
(b) Within ten working days of receipt of the notice under subdivision 2,
(a), the county social services agency and licensee shall meet to develop the relocation
plan. The county social services agency shall inform the
Health and the Department of
Human Services, the Office of Ombudsman for Long-Term
Care, and the Office of Ombudsman for Mental Health and Developmental Disabilities of
the date, time, and location of the meeting so that their representatives may attend. The
relocation plan must be completed
within no later than
receipt of the initial
notice in subdivision 2, paragraph (a)
However, the plan may be finalized on an earlier
6.7 schedule agreed to by all parties. To the extent practicable, consistent with requirements
6.8 to protect the safety and health of residents, the commissioner may authorize the planning
6.9 process under this subdivision to occur concurrent with the 60-day notice required under
6.10 subdivision 5a.
The plan shall:
(1) identify the expected date of closure,
reduction, or change in
(2) outline the process for public notification of the closure,
or change in operations;
(3) identify efforts that will be made to include other stakeholders in the relocation
(4) outline the process to ensure 60-day advance written notice to residents, family
members, and designated representatives;
(5) present an aggregate description of the resident population remaining to be
relocated and the population's needs;
(6) outline the individual resident assessment process to be utilized;
(7) identify an inventory of available relocation options and resources
home and community-based services;
(8) identify a timeline for submission of the list identified in subdivision 5c,
6.25 paragraph (b);
6.26 (9) (8)
identify a schedule for the timely completion of each element of the plan;
6.27 (10) (9)
identify the steps the licensee and the county social services agency will
take to address the relocation needs of individual residents who may be difficult to place
due to specialized care needs such as behavioral health problems
6.30(10) identify the steps needed to share information and coordinate relocation efforts
6.31with managed care organizations.
(c) All parties to the plan shall refrain from any public notification of the intent to
, reduce, or change operations until a relocation plan has been established
6.34 and the notice in subdivision 5a is given
If the planning process occurs concurrently with
6.35 the 60-day notice period, this requirement does not apply once 60-day notice is given.
Subd. 4. Responsibilities of licensee for resident relocations.
The licensee shall
provide for the safe, orderly, and appropriate relocation of residents. The licensee and
facility staff shall cooperate with representatives from the county social services agency,
the Department of Health, the Department of Human Services, the Office of Ombudsman
for Long-Term Care, and the Office of Ombudsman for Mental Health and Developmental
Disabilities in planning for and implementing the relocation of residents.
Subd. 5. Licensee responsibilities
prior related to relocation sending the notice
7.8in subdivision 5a.
(a) The licensee shall establish an interdisciplinary team responsible
for coordinating and implementing the plan. The interdisciplinary team shall include
representatives from the county social services agency, the Office of Ombudsman for
Long-Term Care, the Office of the Ombudsman for Mental Health and Developmental
facility staff that provide direct care services to the residents, and facility
(b) Concurrent with the notice provided in subdivision 5a,
the licensee shall
a an updated resident census
summary document to the county social services
agency, the Ombudsman for Long-Term Care, and the Ombudsman for Mental Health
7.17and Developmental Disabilities
that includes the following information on each resident
to be relocated:
(2) date of birth;
(3) Social Security number;
(4) payment source and medical assistance identification number, if applicable;
(5) county of financial responsibility if the resident is enrolled in a Minnesota health
(6) date of admission to the facility;
(7) all current
(8) the name of and contact information for the resident's physician;
(9) the name and contact information for the resident's
family or other designated
7.29 representative responsible party
of and contact information for any case
7.31managed care coordinator, or other care coordinator
, if known;
(11) information on the resident's status related to commitment and probation
7.33(12) the name of the managed care organization in which the resident is enrolled,
7.35 (c) The licensee shall consult with the county social services agency on the
7.36 availability and development of available resources and on the resident relocation process.
Subd. 5a. Administrator and licensee
responsibilities responsibility to provide
At least 60 days before the proposed date of closing,
change in operations as agreed to in the plan, the
shall send a
written notice of closure
, reduction, or change in operations to each resident
being relocated, the resident's
family member or designated representative responsible
and the resident's managed care organization if it is known, the county social
8.7services agency, the commissioner of health, the commissioner of human services, the
8.8Office of Ombudsman for Long-Term Care and the Office of Ombudsman for Mental
8.9Health and Developmental Disabilities,
the resident's attending physician, and, in the case
8.10of a complete facility closure, the Centers for Medicare and Medicaid Services regional
8.11office designated representative
. The notice must include the following:
(1) the date of the proposed closure,
reduction, or change in operations;
name, address, telephone number, facsimile number, and e-mail address
8.14 contact information
of the individual or individuals in the facility responsible for providing
assistance and information;
(3) notification of upcoming meetings for residents,
families and designated
8.17 representatives responsible parties
, and resident and family councils to discuss the plan
relocation of residents;
name, address, and telephone number contact information
of the county
social services agency contact person; and
name, address, and telephone number contact information
of the Office of
Ombudsman for Long-Term Care and the Office of Ombudsman for Mental Health and
The notice must comply with all applicable state and federal requirements for notice
8.25 of transfer or discharge of nursing home residents.
8.26 Subd. 5b. Licensee responsibility regarding medical information. The licensee
8.27 shall request the attending physician provide or arrange for the release of medical
8.28 information needed to update resident medical records and prepare all required forms
8.29 and discharge summaries.
Subd. 5c. Licensee responsibility regarding placement information.
licensee shall provide sufficient preparation to
residents each resident
to ensure safe
, and appropriate
discharge and relocation. The licensee shall assist
8.33 each resident
in finding placements that
respond to personal preferences, such as desired
8.34 geographic location take into consideration quality, services, location, the resident's needs
8.35and choices, and the best interests of each resident
(b) The licensee shall prepare a resource list with several relocation options for each
9.2 resident. The list must contain the following information for each relocation option,
9.3 when applicable:
9.4 (1) the name, address, and telephone and facsimile numbers of each facility with
9.5 appropriate, available beds or services;
9.6 (2) the certification level of the available beds;
9.7 (3) the types of services available; and
9.8 (4) the name, address, and telephone and facsimile numbers of appropriate available
9.9 home and community-based placements, services, and settings or other options for
9.10 individuals with special needs.
9.11 The list shall be made available to residents and their families or designated
9.12 representatives, and upon request to the Office of Ombudsman for Long-Term Care, the
9.13 Office of Ombudsman for Mental Health and Developmental Disabilities, and the county
9.14 social services agency.
9.15 (c) The Senior LinkAge line may make available via a Web site the name, address,
9.16 and telephone and facsimile numbers of each facility with available beds, the certification
9.17 level of the available beds, the types of services available, and the number of beds that are
9.18 available as updated daily by the listed facilities. The licensee must provide residents,
9.19 their families or designated representatives, the Office of Ombudsman for Long-Term
9.20 Care, the Office of Ombudsman for Mental Health and Developmental Disabilities, and
9.21 the county social services agency with the toll-free number and Web site address for
9.22 the Senior LinkAge line.
Subd. 5d. Licensee responsibility to meet with residents and
Following the establishment of the plan, the licensee shall conduct meetings with
residents, families and
designated representatives responsible parties
, and resident and
family councils to notify them of the process for resident relocation. Representatives from
the local county social services agency, the Office of Ombudsman for Long-Term Care,
the Office of Ombudsman for Mental Health and Developmental Disabilities, managed
9.29care organizations with residents in the facility,
the commissioner of health, and the
commissioner of human services shall receive advance notice of the meetings.
Subd. 5e. Licensee responsibility for site visits.
The licensee shall assist
residents desiring to make site visits to facilities with available beds or other appropriate
living options to which the resident may relocate, unless it is medically inadvisable, as
documented by the attending physician in the resident's care record. The licensee shall
provide or arrange make available to the resident at no charge
transportation for up to
site visits to facilities or other living options within
a 50-mile radius to which the
10.1 resident may relocate, or within a larger radius if no suitable options are available within
10.2 50 miles. The licensee shall provide available written materials to residents on a potential
10.3 new facility or living option the county or contiguous counties
Subd. 5f. Licensee
responsible responsibility for resident property, funds, and
10.5 telephone service communication devices.
(a) The licensee shall complete an inventory
of resident personal possessions and provide a copy of the final inventory to the resident
and the resident's
designated representative responsible party
prior to relocation. The
licensee shall be responsible for the transfer of the resident's possessions
for all relocations
10.9 within a 50-mile radius of the facility, or within a larger radius if no suitable options are
10.10 available within 50 miles to a selected new location within the county or contiguous
. The licensee shall complete the transfer of resident possessions in a timely
, but no later than the date of the actual physical relocation of the resident
(b) The licensee shall complete a final accounting of personal funds held in trust
by the facility and provide a copy of this accounting to the resident and the resident's
family or the resident's designated representative responsible party
. The licensee shall be
responsible for the transfer of all personal funds held in trust by the facility. The licensee
shall complete the transfer of all personal funds in a timely manner.
(c) The licensee shall assist residents with the transfer and reconnection of service
for telephones or
, for residents who are deaf or blind,
other personal communication
devices or services. The licensee shall pay the costs associated with reestablishing
service for telephones or other personal communication devices or services, such as
connection fees or other onetime charges. The transfer
reconnection of personal
communication devices or services shall be completed in a timely manner.
Subd. 5g. Licensee responsibilities for final written discharge notice and records
(a) The licensee shall provide the resident, the resident's
family or designated
10.26 representative responsible parties, the resident's managed care organization, if known
and the resident's attending physician with a
final written discharge
notice prior to the
relocation of the resident. The notice must:
(1) be provided
prior to the actual relocation
, unless the resident agrees
10.30 to waive the right to advance notice
(2) identify the effective
date of the anticipated relocation and the destination to
which the resident is being relocated.
(b) The licensee shall provide the receiving facility or other health, housing, or care
entity with complete and accurate resident records including contact
designated representatives responsible parties
or other contact information and managed care coordinators
records must also include all information necessary to provide appropriate medical care
and social services. This includes, but is not limited to, information on preadmission
screening, Level I and Level II screening, minimum data set (MDS),
resident diagnoses, social, behavioral, and medication information,
11.5required forms, and discharge summaries
(c) For residents with special care needs, the licensee shall consult with the receiving
facility or other placement entity and provide staff training or other preparation as needed
to assist in providing for the special needs.
Subd. 6. Responsibilities of licensee during relocation.
(a) The licensee shall, at
11.10no charge to the resident,
make arrangements or provide for the transportation of residents
to the new facility or
placement within a 50-mile radius, or within a larger radius if no
11.12 suitable options are available within 50 miles location within the county or contiguous
. The licensee shall provide a staff person to accompany the resident during
transportation to the new location within the county or contiguous counties
, upon request
of the resident, the resident's family, or
designated representative responsible party
discharge and relocation of residents must
comply with all applicable state and federal
11.17 requirements and must
be conducted in a safe
, and appropriate
The licensee must ensure that there is no disruption in providing meals, medications, or
treatments of a resident during the relocation process.
(b) Beginning the week following
development of the initial relocation plan the
11.21announcement in subdivision 5a
, the licensee shall submit weekly status reports to the
of health and the commissioner of
human services or their
designees, the Ombudsman for Long-Term Care and Ombudsman for Mental Health
11.24and Developmental Disabilities,
and to the county social services agency. The status
11.25reports must be submitted in the format required by the commissioner of health and the
11.26commissioner of human services.
The initial status report must identify:
(1) the relocation plan developed;
(2) the interdisciplinary team members; and
(3) the number of residents to be relocated.
(c) Subsequent status reports must identify:
(1) any modifications to the plan;
(2) any change of interdisciplinary team members;
(3) the number of residents relocated;
(4) the destination to which residents have been relocated;
(5) the number of residents remaining to be relocated; and
(6) issues or problems encountered during the process and resolution of these issues.
Subd. 7. Responsibilities of licensee following relocation.
The licensee shall retain
or make arrangements for the retention of all remaining resident records for the period
required by law. The licensee shall provide the Department of Health access to these
records. The licensee shall notify the Department of Health of the location of any resident
records that have not been transferred to the new facility or other health care entity.
Subd. 8. Responsibilities of county social services agency.
(a) The county social
services agency shall participate in the meeting as outlined in subdivision 3, paragraph
(b), to develop a relocation plan.
(b) The county social services agency shall designate a representative to the
interdisciplinary team established by the licensee responsible for coordinating the
(c) The county social services agency shall serve as a resource in the relocation
(d) Concurrent with the notice sent to residents from the licensee as provided in
subdivision 5a, the county social services agency shall provide written notice to residents
12.16 family, or designated representatives and responsible parties
(1) the county's role in the relocation process and in the follow-up to relocations;
county social services agency contact
name, address, and telephone number
name, address, and telephone number of contact information for
of Ombudsman for Long-Term Care and the Office of Ombudsman for Mental Health
and Developmental Disabilities.
(e) The county social services agency designee shall meet with appropriate facility
staff to coordinate any assistance in the relocation process. This coordination shall include
participating in group meetings with residents, families, and
12.26 responsible parties
to explain the relocation process.
(f) Beginning from the initial notice given in subdivision 2,
the county social services
agency shall monitor compliance with all components of this section and
the plan developed
12.29under subdivision 3, paragraph (b)
. If the licensee is not in compliance, the county
social services agency shall notify the
12.31 Department of
of Health and the commissioner of the Department of
(g) Except as requested by the resident
, family member, or designated representative
12.33 or responsible party
and within the parameters of the Vulnerable Adults Act, the
county social services agency, in coordination with the commissioner of health and the
12.35commissioner of human services,
may halt a relocation that it deems inappropriate or
dangerous to the health or safety of a resident. In situations where a resident relocation
13.1is halted, the county social services agency must notify the resident, family, responsible
13.2parties, Office of the Ombudsman for Long-Term Care and Office of the Ombudsman for
13.3Mental Health and Developmental Disabilities, and resident's managed care organization,
13.4of this action.
The county social services agency shall pursue remedies to protect the
resident during the relocation process, including, but not limited to, assisting the resident
with filing an appeal of transfer or discharge, notification of all appropriate licensing
boards and agencies, and other remedies available to the county under section 626.557,
(h) A member of the county social services agency staff shall
visit follow up
100 miles of the county within
30 days after
the relocation. This requirement does not apply to changes in operation where the
facility moved to a new location and residents chose to move to that new location.
The requirement also does not apply to residents admitted after the notice
13.14 in subdivision 5a is given
and discharged prior to the actual
closure change in facility
13.15operations or reduction
. County social services agency staff shall interview the resident
designated representative, observe the resident on site, responsible party
review and discuss pertinent medical or social records with appropriate facility staff to:
(1) assess the adjustment of the resident to the new placement;
(2) recommend services or methods to meet any special needs of the resident; and
(3) identify residents at risk.
(i) The county social services agency
conduct subsequent follow-up visits
in cases where the adjustment of the resident to the new placement is in question.
(j) Within 60 days of the completion of the follow-up
visits under paragraphs (h) and
, the county social services agency shall submit a written summary of the follow-up
work to the
of Health and the Department of
Human Services in
a manner approved by the commissioners.
(k) The county social services agency shall submit to the
of Health and the Department of
Human Services a report of any issues that may require
further review or monitoring.
(l) The county social services agency shall be responsible for the safe and orderly
relocation of residents in cases where an emergent need arises or when the licensee has
abrogated its responsibilities under the plan.
Subd. 9. Penalties.
Upon the recommendation of the commissioner of health,
the commissioner of human services may eliminate a closure rate adjustment under
subdivision 10 for violations of this section.
Subd. 10. Facility closure rate adjustment.
Upon the request of a closing facility,
the commissioner of human services must allow the facility a closure rate adjustment equal
to a 50 percent payment rate increase to reimburse relocation costs or other costs related to
facility closure. This rate increase is effective on the date the facility's occupancy decreases
to 90 percent of capacity days after the written notice of closure is distributed under
subdivision 5 and shall remain in effect for a period of up to 60 days. The commissioner
shall delay the implementation of rate adjustments under section
14.83, paragraph (b)
, and 6, paragraph (a), to offset the cost of this rate adjustment.
Subd. 11. County costs. The commissioner of human services shall allocate up
14.10 to $450 in total state and federal funds per nursing facility bed that is closing, within
14.11 the limits of the appropriation specified for this purpose, to be used for relocation costs
14.12 incurred by counties for resident relocation under this section or planned closures under
256B.437 . To be eligible for this allocation, a county in which a nursing facility
14.14 closes must provide to the commissioner a detailed statement in a form provided by the
14.15 commissioner of additional costs, not to exceed $450 in total state and federal funds per
14.16 bed closed, that are directly incurred related to the county's role in the relocation process.
Sec. 5. Minnesota Statutes 2012, section 256B.056, subdivision 3, is amended to read:
Subd. 3. Asset limitations for individuals and families.
(a) To be eligible for
medical assistance, a person must not individually own more than $3,000 in assets, or if a
member of a household with two family members, husband and wife, or parent and child,
the household must not own more than $6,000 in assets, plus $200 for each additional
legal dependent. In addition to these maximum amounts, an eligible individual or family
may accrue interest on these amounts, but they must be reduced to the maximum at the
time of an eligibility redetermination. The accumulation of the clothing and personal
needs allowance according to section
must also be reduced to the maximum at
the time of the eligibility redetermination. The value of assets that are not considered in
determining eligibility for medical assistance is the value of those assets excluded under
the supplemental security income program for aged, blind, and disabled persons, with
the following exceptions:
(1) household goods and personal effects are not considered;
(2) capital and operating assets of a trade or business that the local agency determines
are necessary to the person's ability to earn an income are not considered;
(3) motor vehicles are excluded to the same extent excluded by the supplemental
security income program;
(4) assets designated as burial expenses are excluded to the same extent excluded by
the supplemental security income program. Burial expenses funded by annuity contracts
or life insurance policies must irrevocably designate the individual's estate as contingent
beneficiary to the extent proceeds are not used for payment of selected burial expenses;
(5) for a person who no longer qualifies as an employed person with a disability due
to loss of earnings, assets allowed while eligible for medical assistance under section
15.7256B.057, subdivision 9
, are not considered for 12 months, beginning with the first month
of ineligibility as an employed person with a disability, to the extent that the person's total
assets remain within the allowed limits of section
256B.057, subdivision 9
, paragraph (d);
(6) when a person enrolled in medical assistance under section
, is age 65 or older and has been enrolled during each of the 24 consecutive months
before the person's 65th birthday, the assets owned by the person and the person's spouse
must be disregarded, up to the limits of section
256B.057, subdivision 9
, paragraph (d),
when determining eligibility for medical assistance under section
. The income of a spouse of a person enrolled in medical assistance under section
15.16256B.057, subdivision 9
, during each of the 24 consecutive months before the person's
65th birthday must be disregarded when determining eligibility for medical assistance
256B.055, subdivision 7
. Persons eligible under this clause are not subject to
the provisions in section
. A person whose 65th birthday occurs in 2012 or 2013
15.20 is required to have qualified for medical assistance under section
256B.057, subdivision 9 ,
15.21 prior to age 65 for at least 20 months in the 24 months prior to reaching age 65
(7) effective July 1, 2009, certain assets owned by American Indians are excluded as
required by section 5006 of the American Recovery and Reinvestment Act of 2009, Public
Law 111-5. For purposes of this clause, an American Indian is any person who meets the
definition of Indian according to Code of Federal Regulations, title 42, section
(b) No asset limit shall apply to persons eligible under section
15.28EFFECTIVE DATE.This section is effective January 1, 2014.
Sec. 6. Minnesota Statutes 2012, section 256B.057, subdivision 9, is amended to read:
Subd. 9. Employed persons with disabilities.
(a) Medical assistance may be paid
for a person who is employed and who:
(1) but for excess earnings or assets, meets the definition of disabled under the
Supplemental Security Income program;
(2) meets the asset limits in paragraph (d); and
(3) pays a premium and other obligations under paragraph (e).
(b) For purposes of eligibility, there is a $65 earned income disregard. To be eligible
for medical assistance under this subdivision, a person must have more than $65 of earned
income. Earned income must have Medicare, Social Security, and applicable state and
federal taxes withheld. The person must document earned income tax withholding. Any
spousal income or assets shall be disregarded for purposes of eligibility and premium
(c) After the month of enrollment, a person enrolled in medical assistance under
this subdivision who:
(1) is temporarily unable to work and without receipt of earned income due to a
medical condition, as verified by a physician; or
(2) loses employment for reasons not attributable to the enrollee, and is without
receipt of earned income may retain eligibility for up to four consecutive months after the
month of job loss. To receive a four-month extension, enrollees must verify the medical
condition or provide notification of job loss. All other eligibility requirements must be met
and the enrollee must pay all calculated premium costs for continued eligibility.
(d) For purposes of determining eligibility under this subdivision, a person's assets
must not exceed $20,000, excluding:
(1) all assets excluded under section
(2) retirement accounts, including individual accounts, 401(k) plans, 403(b) plans,
Keogh plans, and pension plans;
(3) medical expense accounts set up through the person's employer; and
(4) spousal assets, including spouse's share of jointly held assets.
(e) All enrollees must pay a premium to be eligible for medical assistance under this
subdivision, except as provided under clause (5).
(1) An enrollee must pay the greater of a $65 premium or the premium calculated
based on the person's gross earned and unearned income and the applicable family size
using a sliding fee scale established by the commissioner, which begins at one percent of
income at 100 percent of the federal poverty guidelines and increases to 7.5 percent of
income for those with incomes at or above 300 percent of the federal poverty guidelines.
(2) Annual adjustments in the premium schedule based upon changes in the federal
poverty guidelines shall be effective for premiums due in July of each year.
(3) All enrollees who receive unearned income must pay five percent of unearned
income in addition to the premium amount, except as provided under clause (5).
(4) Increases in benefits under title II of the Social Security Act shall not be counted
as income for purposes of this subdivision until July 1 of each year.
(5) Effective July 1, 2009, American Indians are exempt from paying premiums as
required by section 5006 of the American Recovery and Reinvestment Act of 2009, Public
Law 111-5. For purposes of this clause, an American Indian is any person who meets the
definition of Indian according to Code of Federal Regulations, title 42, section
(f) A person's eligibility and premium shall be determined by the local county
agency. Premiums must be paid to the commissioner. All premiums are dedicated to
(g) Any required premium shall be determined at application and redetermined at
the enrollee's six-month income review or when a change in income or household size is
reported. Enrollees must report any change in income or household size within ten days
of when the change occurs. A decreased premium resulting from a reported change in
income or household size shall be effective the first day of the next available billing month
after the change is reported. Except for changes occurring from annual cost-of-living
increases, a change resulting in an increased premium shall not affect the premium amount
until the next six-month review.
(h) Premium payment is due upon notification from the commissioner of the
premium amount required. Premiums may be paid in installments at the discretion of
(i) Nonpayment of the premium shall result in denial or termination of medical
assistance unless the person demonstrates good cause for nonpayment. Good cause exists
if the requirements specified in Minnesota Rules, part 9506.0040, subpart 7, items B to
D, are met. Except when an installment agreement is accepted by the commissioner, all
persons disenrolled for nonpayment of a premium must pay any past due premiums as well
as current premiums due prior to being reenrolled. Nonpayment shall include payment with
a returned, refused, or dishonored instrument. The commissioner may require a guaranteed
form of payment as the only means to replace a returned, refused, or dishonored instrument.
(j) The commissioner shall notify enrollees annually beginning at least 24 months
17.28 before the person's 65th birthday of the medical assistance eligibility rules affecting
17.29 income, assets, and treatment of a spouse's income and assets that will be applied upon
17.30 reaching age 65.
17.31 (k) (j)
For enrollees whose income does not exceed 200 percent of the federal
poverty guidelines and who are also enrolled in Medicare, the commissioner shall
reimburse the enrollee for Medicare part B premiums under section
, paragraph (a).
Sec. 7. Minnesota Statutes 2012, section 256B.0652, subdivision 5, is amended to read:
Subd. 5. Authorization; private duty nursing services.
(a) All private duty
nursing services shall be authorized by the commissioner or the commissioner's designee.
Authorization for private duty nursing services shall be based on medical necessity and
cost-effectiveness when compared with alternative care options. The commissioner may
authorize medically necessary private duty nursing services in quarter-hour units when:
(1) the recipient requires more individual and continuous care than can be provided
during a skilled nurse visit; or
(2) the cares are outside of the scope of services that can be provided by a home
health aide or personal care assistant.
(b) The commissioner may authorize:
(1) up to two times the average amount of direct care hours provided in nursing
facilities statewide for case mix classification "K" as established by the annual cost report
submitted to the department by nursing facilities in May 1992;
(2) private duty nursing in combination with other home care services up to the total
cost allowed under this subdivision and
subdivision 6 subdivision 7
(3) up to 16 hours per day if the recipient requires more nursing than the maximum
number of direct care hours as established in clause (1) and
the recipient meets the hospital
18.18 admission criteria established under Minnesota Rules, parts 9505.0501 to 9505.0540, but
18.19for the provision of the nursing services, the recipient would require a hospital level of
18.20care as defined in Code of Federal Regulations, title 42, section 440.10
(c) The commissioner may authorize up to 16 hours per day of medically necessary
private duty nursing services or up to 24 hours per day of medically necessary private duty
nursing services until such time as the commissioner is able to make a determination of
eligibility for recipients who are cooperatively applying for home care services under
the community alternative care program developed under section
, or until it is
determined by the appropriate regulatory agency that a health benefit plan is or is not
required to pay for appropriate medically necessary health care services. Recipients or their
representatives must cooperatively assist the commissioner in obtaining this determination.
Recipients who are eligible for the community alternative care program may not receive
more hours of nursing under this section and sections
than would otherwise be authorized under section
Sec. 8. Minnesota Statutes 2012, section 256B.0659, subdivision 7, is amended to read:
Subd. 7. Personal care assistance care plan.
(a) Each recipient must have a
current personal care assistance care plan based on the service plan in subdivision 6 that is
developed by the qualified professional with the recipient and responsible party. A copy of
the most current personal care assistance care plan is required to be in the recipient's home
and in the recipient's file at the provider agency.
(b) The personal care assistance care plan must have the following components:
(1) start and end date of the care plan;
(2) recipient demographic information, including name and telephone number;
(3) emergency numbers, procedures, and a description of measures to address
identified safety and vulnerability issues, including a backup staffing plan;
(4) name of responsible party and instructions for contact;
(5) description of the recipient's individualized needs for assistance with activities of
daily living, instrumental activities of daily living, health-related tasks, and behaviors; and
(6) dated signatures of recipient or responsible party and qualified professional.
(c) The personal care assistance care plan must have instructions and comments
about the recipient's needs for assistance and any special instructions or procedures
required, including whether or not the recipient has requested a personal care assistant
19.15of the same gender
. The month-to-month plan for the use of personal care assistance
services is part of the personal care assistance care plan. The personal care assistance
care plan must be completed within the first week after start of services with a personal
care provider agency and must be updated as needed when there is a change in need for
personal care assistance services. A new personal care assistance care plan is required
annually at the time of the reassessment.
Sec. 9. Minnesota Statutes 2012, section 256B.0659, is amended by adding a
subdivision to read:
19.23 Subd. 7a. Special instructions; gender. If a recipient requests a personal care
19.24assistant of the same gender as the recipient, the personal care assistance agency must
19.25make a reasonable effort to fulfill the request.
Sec. 10. Minnesota Statutes 2012, section 256B.0911, subdivision 3a, is amended to
Subd. 3a. Assessment and support planning.
(a) Persons requesting assessment,
services planning, or other assistance intended to support community-based living,
including persons who need assessment in order to determine waiver or alternative care
program eligibility, must be visited by a long-term care consultation team within 20
calendar days after the date on which an assessment was requested or recommended.
Upon statewide implementation of subdivisions 2b, 2c, and 5, this requirement also
applies to an assessment of a person requesting personal care assistance services and
private duty nursing. The commissioner shall provide at least a 90-day notice to lead
agencies prior to the effective date of this requirement. Face-to-face assessments must be
conducted according to paragraphs (b) to (i).
(b) The lead agency may utilize a team of either the social worker or public health
nurse, or both. Upon implementation of subdivisions 2b, 2c, and 5, lead agencies shall
use certified assessors to conduct the assessment. The consultation team members must
confer regarding the most appropriate care for each individual screened or assessed. For
a person with complex health care needs, a public health or registered nurse from the
team must be consulted.
(c) The assessment must be comprehensive and include a person-centered assessment
of the health, psychological, functional, environmental, and social needs of referred
individuals and provide information necessary to develop a community support plan that
meets the consumers needs, using an assessment form provided by the commissioner.
(d) The assessment must be conducted in a face-to-face interview with the person
being assessed and the person's legal representative, and other individuals as requested by
the person, who can provide information on the needs, strengths, and preferences of the
person necessary to develop a community support plan that ensures the person's health and
safety, but who is not a provider of service or has any financial interest in the provision
of services. For persons who are to be assessed for elderly waiver customized living
services under section
, with the permission of the person being assessed or
the person's designated or legal representative, the client's current or proposed provider
of services may submit a copy of the provider's nursing assessment or written report
outlining its recommendations regarding the client's care needs. The person conducting
the assessment will notify the provider of the date by which this information is to be
submitted. This information shall be provided to the person conducting the assessment
prior to the assessment. For a person who is to be assessed for waiver services under
20.27section 256B.092 or 256B.49, with the permission of the person being assessed or the
20.28person's designated legal representative, the person's current provider of services may
20.29submit a written report outlining recommendations regarding the person's care needs
20.30prepared by a direct service employee with a least 20 hours of service to that client. The
20.31person conducting the assessment or reassessment must notify the provider of the date
20.32by which this information is to be submitted. This information shall be provided to the
20.33person conducting the assessment and the person or the person's legal representative, and
20.34must be considered prior to the finalization of the assessment or reassessment.
(e) If the person chooses to use community-based services, the person or the person's
legal representative must be provided with a written community support plan within 40
calendar days of the assessment visit, regardless of whether the individual is eligible for
Minnesota health care programs. The written community support plan must include:
(1) a summary of assessed needs as defined in paragraphs (c) and (d);
(2) the individual's options and choices to meet identified needs, including all
available options for case management services and providers;
(3) identification of health and safety risks and how those risks will be addressed,
including personal risk management strategies;
(4) referral information; and
(5) informal caregiver supports, if applicable.
For a person determined eligible for state plan home care under subdivision 1a,
paragraph (b), clause (1), the person or person's representative must also receive a copy of
the home care service plan developed by the certified assessor.
(f) A person may request assistance in identifying community supports without
participating in a complete assessment. Upon a request for assistance identifying
community support, the person must be transferred or referred to long-term care options
counseling services available under sections
256.975, subdivision 7
subdivision 24, for telephone assistance and follow up.
(g) The person has the right to make the final decision between institutional
placement and community placement after the recommendations have been provided,
except as provided in subdivision 4a, paragraph (c).
(h) The lead agency must give the person receiving assessment or support planning,
or the person's legal representative, materials, and forms supplied by the commissioner
containing the following information:
(1) written recommendations for community-based services and consumer-directed
(2) documentation that the most cost-effective alternatives available were offered to
the individual. For purposes of this clause, "cost-effective" means community services and
living arrangements that cost the same as or less than institutional care. For an individual
found to meet eligibility criteria for home and community-based service programs under
, "cost-effectiveness" has the meaning found in the federally
approved waiver plan for each program;
(3) the need for and purpose of preadmission screening if the person selects nursing
(4) the role of long-term care consultation assessment and support planning in
eligibility determination for waiver and alternative care programs, and state plan home
care, case management, and other services as defined in subdivision 1a, paragraphs (a),
clause (7), and (b);
(5) information about Minnesota health care programs;
(6) the person's freedom to accept or reject the recommendations of the team;
(7) the person's right to confidentiality under the Minnesota Government Data
Practices Act, chapter 13;
(8) the certified assessor's decision regarding the person's need for institutional level
of care as determined under criteria established in section
256B.0911, subdivision 4a
paragraph (d), and the certified assessor's decision regarding eligibility for all services and
programs as defined in subdivision 1a, paragraphs (a), clause (7), and (b); and
(9) the person's right to appeal the certified assessor's decision regarding eligibility
for all services and programs as defined in subdivision 1a, paragraphs (a),
(7), (8), and (9)
, and (b), and incorporating the decision regarding the need for institutional
level of care or the lead agency's final decisions regarding public programs eligibility
according to section
256.045, subdivision 3
(i) Face-to-face assessment completed as part of eligibility determination for
the alternative care, elderly waiver, community alternatives for disabled individuals,
community alternative care, and brain injury waiver programs under sections
is valid to establish service eligibility for no more than 60
calendar days after the date of assessment.
(j) The effective eligibility start date for programs in paragraph (i) can never be
prior to the date of assessment. If an assessment was completed more than 60 days
before the effective waiver or alternative care program eligibility start date, assessment
and support plan information must be updated
in a face-to-face visit
and documented in
the department's Medicaid Management Information System (MMIS). Notwithstanding
retroactive medical assistance coverage of state plan services, the effective date of
eligibility for programs included in paragraph (i) cannot be prior to the date the most
recent updated assessment is completed.
Sec. 11. Minnesota Statutes 2012, section 256B.092, subdivision 7, is amended to read:
Screening teams Assessments.
(a) Assessments and reassessments shall
22.31be conducted by certified assessors according to section 256B.0911, and must incorporate
22.32appropriate referrals to determine eligibility for case management under subdivision 1a.
For persons with developmental disabilities,
screening teams a certified assessor
be established which shall
evaluate the need for
the an institutional
level of care
provided by residential-based habilitation services, residential services, training and
23.1 habilitation services, and nursing facility services
address whether home and community-based services are appropriate for persons who
are at risk of placement in an intermediate care facility for persons with developmental
disabilities, or for whom there is reasonable indication that they might require this level of
screening team certified assessor
shall make an evaluation of need within
working days of
a request for service by a person with a developmental disability,
23.7 and within five working days of
an emergency admission of a person to an intermediate
care facility for persons with developmental disabilities.
(b) The screening team shall consist of the case manager for persons with
23.10 developmental disabilities, the person, the person's legal guardian or conservator, or the
23.11 parent if the person is a minor, and a qualified developmental disability professional, as
23.12 defined in Code of Federal Regulations, title 42, section 483.430, as amended through
23.13 June 3, 1988. The case manager may also act as the qualified developmental disability
23.14 professional if the case manager meets the federal definition.
23.15 (c) County social service agencies may contract with a public or private agency
23.16 or individual who is not a service provider for the person for the public guardianship
23.17 representation required by the screening or individual service planning process. The
23.18 contract shall be limited to public guardianship representation for the screening and
23.19 individual service planning activities. The contract shall require compliance with the
23.20 commissioner's instructions and may be for paid or voluntary services.
23.21 (d) For persons determined to have overriding health care needs and are
23.22 seeking admission to a nursing facility or an ICF/MR, or seeking access to home and
23.23 community-based waivered services, a registered nurse must be designated as either the
23.24 case manager or the qualified developmental disability professional.
23.25 (e) For persons under the jurisdiction of a correctional agency, the case manager
23.26 must consult with the corrections administrator regarding additional health, safety, and
23.27 supervision needs.
23.28 (f) (c)
case manager certified assessor
, with the concurrence of the person, the
person's legal guardian or conservator, or the parent if the person is a minor, may invite other
individuals to attend
meetings of the screening team the assessment
. With the permission
of the person being
or the person's designated legal representative,
the person's current provider of services may submit a written report outlining their
recommendations regarding the person's care needs prepared by a direct service employee
with at least 20 hours of service to that client. The
screening team assessor
the provider of the date by which this information is to be submitted. This information
must be provided to the
screening team assessor
and the person or the person's legal
representative and must be considered prior to the finalization of the
(g) No member of the screening team shall have any direct or indirect service
24.4 provider interest in the case.
24.5 (h) Nothing in this section shall be construed as requiring the screening team
24.6 meeting to be separate from the service planning meeting.
Sec. 12. Minnesota Statutes 2012, section 256B.441, subdivision 1, is amended to read:
Subdivision 1. Rebasing of nursing facility operating payment rates.
commissioner shall rebase nursing facility operating payment rates to align payments to
facilities with the cost of providing care. The rebased operating payment rates shall be
calculated using the statistical and cost report filed by each nursing facility for the report
period ending one year prior to the rate year.
(b) The new operating payment rates based on this section shall take effect beginning
with the rate year beginning October 1, 2008, and shall be phased in over eight rate years
through October 1, 2015. For each year of the phase-in, the operating payment rates shall
be calculated using the statistical and cost report filed by each nursing facility for the
report period ending one year prior to the rate year.
(c) Operating payment rates shall be rebased on October 1, 2016, and every two
years after that date.
(d) Each cost reporting year shall begin on October 1 and end on the following
September 30. Beginning in
, a statistical and cost report shall be filed by each
nursing facility by
January 15 February 1
. Notice of rates shall be distributed by August
15 and the rates shall go into effect on October 1 for one year.
(e) Effective October 1, 2014, property rates shall be rebased in accordance with
and Minnesota Rules, chapter 9549. The commissioner shall determine
what the property payment rate for a nursing facility would be had the facility not had its
property rate determined under section
. The commissioner shall allow nursing
facilities to provide information affecting this rate determination that would have been
filed annually under Minnesota Rules, chapter 9549, and nursing facilities shall report
information necessary to determine allowable debt. The commissioner shall use this
information to determine the property payment rate.
Sec. 13. Minnesota Statutes 2012, section 256B.441, subdivision 43, is amended to read:
Subd. 43. Reporting of statistical and cost information.
(a) Beginning in 2006,
all nursing facilities shall provide information annually to the commissioner on a form
and in a manner determined by the commissioner. The commissioner may also require
nursing facilities to provide statistical and cost information for a subset of the items in
the annual report on a semiannual basis. Nursing facilities shall report only costs directly
related to the operation of the nursing facility. The facility shall not include costs which
are separately reimbursed by residents, medical assistance, or other payors. Allocations
of costs from central, affiliated, or corporate office and related organization transactions
shall be reported according to section
. Beginning with the September 30, 2013,
may shall no longer
grant to facilities
one extension of
25.9 up to 15 days for the filing of this report if the extension is requested by December 15 and
25.10 the commissioner determines that the extension will not prevent the commissioner from
25.11 establishing rates in a timely manner required by law extensions to the filing deadline
The commissioner may separately require facilities to submit in a manner specified by
the commissioner documentation of statistical and cost information included in the report
to ensure accuracy in establishing payment rates and to perform audit and appeal review
functions under this section. Facilities shall retain all records necessary to document
statistical and cost information on the report for a period of no less than seven years.
The commissioner may amend information in the report according to subdivision 47.
The commissioner may reject a report filed by a nursing facility under this section if the
commissioner determines that the report has been filed in a form that is incomplete or
inaccurate and the information is insufficient to establish accurate payment rates. In the
event that a complete report is not submitted in a timely manner, the commissioner shall
reduce the reimbursement payments to a nursing facility to 85 percent of amounts due
until the information is filed. The release of withheld payments shall be retroactive for
no more than 90 days. A nursing facility that does not submit a report or whose report is
filed in a timely manner but determined to be incomplete shall be given written notice that
a payment reduction is to be implemented and allowed ten days to complete the report
prior to any payment reduction. The commissioner may delay the payment withhold under
exceptional circumstances to be determined at the sole discretion of the commissioner.
(b) Nursing facilities may, within 12 months of the due date of a statistical and
cost report, file an amendment when errors or omissions in the annual statistical and
cost report are discovered and an amendment would result in a rate increase of at least
0.15 percent of the statewide weighted average operating payment rate and shall, at any
time, file an amendment which would result in a rate reduction of at least 0.15 percent of
the statewide weighted average operating payment rate. The commissioner shall make
retroactive adjustments to the total payment rate of a nursing facility if an amendment is
accepted. Where a retroactive adjustment is to be made as a result of an amended report,
audit findings, or other determination of an incorrect payment rate, the commissioner may
settle the payment error through a negotiated agreement with the facility and a gross
adjustment of the payments to the facility. Retroactive adjustments shall not be applied
to private pay residents. An error or omission for purposes of this item does not include
a nursing facility's determination that an election between permissible alternatives was
not advantageous and should be changed.
(c) If the commissioner determines that a nursing facility knowingly supplied
inaccurate or false information or failed to file an amendment to a statistical and cost report
that resulted in or would result in an overpayment, the commissioner shall immediately
adjust the nursing facility's payment rate and recover the entire overpayment. The
commissioner may also terminate the commissioner's agreement with the nursing facility
and prosecute under applicable state or federal law.
Sec. 14. Minnesota Statutes 2012, section 256B.441, subdivision 63, is amended to read:
Subd. 63. Critical access nursing facilities.
(a) The commissioner, in consultation
with the commissioner of health, may designate certain nursing facilities as critical access
nursing facilities. The designation shall be granted on a competitive basis, within the
limits of funds appropriated for this purpose.
(b) The commissioner shall request proposals from nursing facilities every two years.
Proposals must be submitted in the form and according to the timelines established by
the commissioner. In selecting applicants to designate, the commissioner, in consultation
with the commissioner of health, and with input from stakeholders, shall develop criteria
designed to preserve access to nursing facility services in isolated areas, rebalance
long-term care, and improve quality.
(c) The commissioner shall allow the benefits in clauses (1) to (5) for nursing
facilities designated as critical access nursing facilities:
(1) partial rebasing, with operating payment rates being the sum of 60 percent of the
operating payment rate determined in accordance with subdivision 54 and 40 percent of the
operating payment rate that would have been allowed had the facility not been designated;
(2) enhanced payments for leave days. Notwithstanding section
subdivision 2r, upon designation as a critical access nursing facility, the commissioner
shall limit payment for leave days to 60 percent of that nursing facility's total payment rate
for the involved resident, and shall allow this payment only when the occupancy of the
nursing facility, inclusive of bed hold days, is equal to or greater than 90 percent;
(3) two designated critical access nursing facilities, with up to 100 beds in active
service, may jointly apply to the commissioner of health for a waiver of Minnesota
Rules, part 4658.0500, subpart 2, in order to jointly employ a director of nursing. The
commissioner of health will consider each waiver request independently based on the
criteria under Minnesota Rules, part 4658.0040;
(4) the minimum threshold under section 256B.431,
subdivisions 3f, paragraph (a),
27.5 and 17e subdivision 15, paragraph (e)
, shall be 40 percent of the amount that would
otherwise apply; and
(5) notwithstanding subdivision 58, beginning October 1, 2014, the quality-based
rate limits under subdivision 50 shall apply to designated critical access nursing facilities.
(d) Designation of a critical access nursing facility shall be for a period of two
years, after which the benefits allowed under paragraph (c) shall be removed. Designated
facilities may apply for continued designation.
27.12EFFECTIVE DATE.This section is effective the day following final enactment.
Sec. 15. Minnesota Statutes 2012, section 256B.49, subdivision 14, is amended to read:
Subd. 14. Assessment and reassessment.
(a) Assessments and reassessments
shall be conducted by certified assessors according to section 256B.0911, subdivision 2b.
27.16The certified assessor, with the permission of the recipient or the recipient's designated
27.17legal representative, may invite other individuals to attend the assessment.
permission of the recipient or the recipient's designated legal representative, the recipient's
current provider of services may submit a written report outlining their recommendations
regarding the recipient's care needs prepared by a direct service employee with at least
20 hours of service to that client. The
person conducting the assessment or reassessment
27.22 certified assessor
must notify the provider of the date by which this information is to be
submitted. This information shall be provided to the
person conducting the assessment
27.24 certified assessor
and the person or the person's legal representative and must be
considered prior to the finalization of the assessment or reassessment.
(b) There must be a determination that the client requires a hospital level of care or a
nursing facility level of care as defined in section
, subdivision 4a, paragraph
(d), at initial and subsequent assessments to initiate and maintain participation in the
(c) Regardless of other assessments identified in section
144.0724, subdivision 4
appropriate to determine nursing facility level of care for purposes of medical assistance
payment for nursing facility services, only face-to-face assessments conducted according
256B.0911, subdivisions 3a
, 3b, and 4d, that result in a hospital level of care
determination or a nursing facility level of care determination must be accepted for
purposes of initial and ongoing access to waiver services payment.
(d) Recipients who are found eligible for home and community-based services under
this section before their 65th birthday may remain eligible for these services after their
65th birthday if they continue to meet all other eligibility factors.
(e) The commissioner shall develop criteria to identify recipients whose level of
functioning is reasonably expected to improve and reassess these recipients to establish
a baseline assessment. Recipients who meet these criteria must have a comprehensive
transitional service plan developed under subdivision 15, paragraphs (b) and (c), and be
reassessed every six months until there has been no significant change in the recipient's
functioning for at least 12 months. After there has been no significant change in the
recipient's functioning for at least 12 months, reassessments of the recipient's strengths,
informal support systems, and need for services shall be conducted at least every 12
months and at other times when there has been a significant change in the recipient's
functioning. Counties, case managers, and service providers are responsible for
conducting these reassessments and shall complete the reassessments out of existing funds.
Sec. 16. Minnesota Statutes 2012, section 256B.492, is amended to read:
28.16256B.492 HOME AND COMMUNITY-BASED SETTINGS FOR PEOPLE
(a) Individuals receiving services under a home and community-based waiver under
may receive services in the following settings:
(1) an individual's own home or family home;
(2) a licensed adult foster care or child foster care
setting of up to five people; and
(3) community living settings as defined in section
, subdivision 23, where
individuals with disabilities may reside in all of the units in a building of four or fewer
units, and no more than the greater of four or 25 percent of the units in a multifamily
building of more than four units.
(b) The settings in paragraph (a) must not:
(1) be located in a building that is a publicly or privately operated facility that
provides institutional treatment or custodial care;
(2) be located in a building on the grounds of or adjacent to a public or private
(3) be a housing complex designed expressly around an individual's diagnosis or
(4) be segregated based on a disability, either physically or because of setting
characteristics, from the larger community; and
(5) have the qualities of an institution which include, but are not limited to:
regimented meal and sleep times, limitations on visitors, and lack of privacy. Restrictions
agreed to and documented in the person's individual service plan shall not result in a
residence having the qualities of an institution as long as the restrictions for the person are
not imposed upon others in the same residence and are the least restrictive alternative,
imposed for the shortest possible time to meet the person's needs.
(c) The provisions of paragraphs (a) and (b) do not apply to any setting in which
individuals receive services under a home and community-based waiver as of July 1,
2012, and the setting does not meet the criteria of this section.
(d) Notwithstanding paragraph (c), a program in Hennepin County established as
part of a Hennepin County demonstration project is qualified for the exception allowed
under paragraph (c).
(e) The commissioner shall submit an amendment to the waiver plan no later than
December 31, 2012.
Sec. 17. Minnesota Statutes 2012, section 626.557, subdivision 10, is amended to read:
Subd. 10. Duties of county social service agency.
(a) Upon receipt of a report from
the common entry point staff, the county social service agency shall immediately assess
and offer emergency and continuing protective social services for purposes of preventing
further maltreatment and for safeguarding the welfare of the maltreated vulnerable adult.
29.20The county shall use a standardized tool made available by the commissioner. The
29.21information entered by the county into the standardized tool must be accessible to the
29.22Department of Human Services.
In cases of suspected sexual abuse, the county social
service agency shall immediately arrange for and make available to the vulnerable adult
appropriate medical examination and treatment. When necessary in order to protect the
vulnerable adult from further harm, the county social service agency shall seek authority
to remove the vulnerable adult from the situation in which the maltreatment occurred. The
county social service agency may also investigate to determine whether the conditions
which resulted in the reported maltreatment place other vulnerable adults in jeopardy of
being maltreated and offer protective social services that are called for by its determination.
(b) County social service agencies may enter facilities and inspect and copy records
as part of an investigation. The county social service agency has access to not public
data, as defined in section
, and medical records under sections
that are maintained by facilities to the extent necessary to conduct its investigation. The
inquiry is not limited to the written records of the facility, but may include every other
available source of information.
(c) When necessary in order to protect a vulnerable adult from serious harm, the
county social service agency shall immediately intervene on behalf of that adult to help
the family, vulnerable adult, or other interested person by seeking any of the following:
(1) a restraining order or a court order for removal of the perpetrator from the
residence of the vulnerable adult pursuant to section
(2) the appointment of a guardian or conservator pursuant to sections
, or guardianship or conservatorship pursuant to chapter 252A;
(3) replacement of a guardian or conservator suspected of maltreatment and
appointment of a suitable person as guardian or conservator, pursuant to sections
(4) a referral to the prosecuting attorney for possible criminal prosecution of the
perpetrator under chapter 609.
The expenses of legal intervention must be paid by the county in the case of indigent
persons, under section
and chapter 563.
In proceedings under sections
, if a suitable relative or
other person is not available to petition for guardianship or conservatorship, a county
employee shall present the petition with representation by the county attorney. The county
shall contract with or arrange for a suitable person or organization to provide ongoing
guardianship services. If the county presents evidence to the court exercising probate
jurisdiction that it has made a diligent effort and no other suitable person can be found,
a county employee may serve as guardian or conservator. The county shall not retaliate
against the employee for any action taken on behalf of the ward or protected person even
if the action is adverse to the county's interest. Any person retaliated against in violation
of this subdivision shall have a cause of action against the county and shall be entitled to
reasonable attorney fees and costs of the action if the action is upheld by the court.
Sec. 18. THIRD-PARTY REIMBURSEMENT FOR LONG-TERM CARE
30.28 The commissioner of human services shall submit a request within 60 days of
30.29final enactment to the federal government to amend the Medicaid cost allocation plan
30.30to allow county or tribal agencies to contract with nongovernmental organizations to
30.31conduct assessments under Minnesota Statutes, section 256B.0911, and be reimbursed for
30.32assessments conducted under contract. Upon federal approval, this shall be incorporated
30.33into the alternative payment methodology under Minnesota Statutes, section 256B.0911,
30.34subdivision 6, paragraph (h).
Sec. 19. RECOMMENDATIONS FOR FURTHER CASE MANAGEMENT
31.3 (a) By February 1, 2014, the commissioner of human services shall develop a
31.4legislative report with specific recommendations and language for proposed legislation to:
31.5 (1) increase opportunities for choice of case management service provider;
31.6 (2) define the service of case management to include the identification of roles and
31.7activities of a case manager to avoid duplication of services;
31.8 (3) provide guidance on caseload size to reduce variation across the state;
31.9 (4) develop a statewide system to standardize case management provider standards,
31.10which may include establishing a licensure or certification process;
31.11 (5) develop reporting measures to determine outcomes for case management services
31.12to increase continuous quality improvement;
31.13 (6) establish rates for the service of case management that are transparent and
31.14consistent for all medical assistance-paid case management;
31.15 (7) develop information for case management recipients to make an informed choice
31.16of case management service provider; and
31.17 (8) provide waiver case management recipients with an itemized list of case
31.18management services provided on a monthly basis.
31.19 (b) The commissioner shall consult with existing stakeholder groups which include
31.20representatives of counties, tribes, disability and senior advocacy groups including mental
31.21health stakeholders, managed care organizations, and service providers in preparing the
31.22recommendations and language for proposed legislation. The commissioner shall present
31.23findings, recommendations, and proposed legislation to the chairs and ranking minority
31.24members of the legislative committees with jurisdiction over health and human services
31.25policy and finance by February 1, 2014.
Sec. 20. REPEALER.
31.27(a) Minnesota Statutes 2012, section 256B.437, subdivision 8, is repealed.
31.28(b) Laws 2012, chapter 216, article 11, section 31, is repealed.