SF 884

as introduced - 87th Legislature (2011 - 2012) Posted on 04/30/2012 03:47pm

A bill for an act
relating to human services; modifying the self-directed supports option for
elderly and disabled individuals; requiring a report; amending Minnesota Statutes
2010, sections 256.045, subdivision 4a; 256B.0657; 256B.0911, subdivisions 1a,
3a; 256B.0916, subdivision 6a; 256B.092, subdivisions 1a, 1b, 1e, 1g, 3, 8, 8a;
256B.49, subdivisions 13, 14, 15; 256G.02, subdivision 6.

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

Section 1.

Minnesota Statutes 2010, section 256.045, subdivision 4a, is amended to
read:

Subd. 4a.

Case management deleted text begin appeals deleted text end new text begin temporary stay of demission new text end .

deleted text begin Any recipient
of case management services pursuant to section 256B.092, who contests the county
agency's action or failure to act in the provision of those services, other than a failure
to act with reasonable promptness or a suspension, reduction, denial, or termination of
services, must submit a written request for a conciliation conference to the county agency.
The county agency shall inform the commissioner of the receipt of a request when it is
submitted and shall schedule a conciliation conference. The county agency shall notify the
recipient, the commissioner, and all interested persons of the time, date, and location of the
conciliation conference. The commissioner may assist the county by providing mediation
services or by identifying other resources that may assist in the mediation between the
parties. Within 30 days, the county agency shall conduct the conciliation conference
and inform the recipient in writing of the action the county agency is going to take and
when that action will be taken and notify the recipient of the right to a hearing under this
subdivision. The conciliation conference shall be conducted in a manner consistent with
the commissioner's instructions. If the county fails to conduct the conciliation conference
and issue its report within 30 days, or, at any time up to 90 days after the conciliation
conference is held, a recipient may submit to the commissioner a written request for a
hearing before a state human services referee to determine whether case management
services have been provided in accordance with applicable laws and rules or whether the
county agency has assured that the services identified in the recipient's individual service
plan have been delivered in accordance with the laws and rules governing the provision
of those services. The state human services referee shall recommend an order to the
commissioner, who shall, in accordance with the procedure in subdivision 5, issue a final
order within 60 days of the receipt of the request for a hearing, unless the commissioner
refuses to accept the recommended order, in which event a final order shall issue within 90
days of the receipt of that request. The order may direct the county agency to take those
actions necessary to comply with applicable laws or rules. deleted text end The commissioner may issue a
temporary order prohibiting the demission of a recipient of case management services
new text begin under section 256B.092 new text end from a residential or day habilitation program licensed under
chapter 245A, while a county agency review process or an appeal brought by a recipient
under this subdivision is pending, or for the period of time necessary for the county agency
to implement the commissioner's order. The commissioner shall not issue a final order
staying the demission of a recipient of case management services from a residential or day
habilitation program licensed under chapter 245A.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2012.
new text end

Sec. 2.

Minnesota Statutes 2010, section 256B.0657, is amended to read:

256B.0657 SELF-DIRECTED SUPPORTS OPTION.

Subdivision 1.

Definition.

new text begin (a) "Lead agency" has the meaning given in section
256B.0911, subdivision 1a, paragraph (d).
new text end

new text begin (b) "Legal representative" means a legal guardian of a child or an adult, or parent of
a minor child.
new text end

new text begin (c) "Managing partner" means an individual who has been authorized, in a written
statement by the person or the person's legal representative, to speak on the person's
behalf and help the person understand and make informed choices in matters related
to identification of needs and choice of services and supports and assist the person to
implement an approved support plan.
new text end

new text begin (d) new text end "Self-directed supports option" means personal assistance, supports, items, and
related services purchased under an approved budget plan and budget by a recipient.

Subd. 2.

Eligibility.

(a) The self-directed supports option is available to a person
who:

(1) is a recipient of medical assistance as determined under sections 256B.055,
256B.056, and 256B.057, subdivision 9;

(2) is eligible for personal care assistance services under section 256B.0659 new text begin , or
for a home and community-based services waiver program under section 256B.0915,
256B.092, or 256B.49, or alternative care under section 256B.0913 new text end ;

(3) lives in the person's own apartment or home, which is not owned, operated, or
controlled by a provider of services not related by blood or marriage;

(4) has the ability to hire, fire, supervise, establish staff compensation for, and
manage the individuals providing services, and to choose and obtain items, related
services, and supports as described in the participant's plan. If the recipient is not able to
carry out these functions but has a legal guardian new text begin , managing partner, new text end or parent to carry
them out, the guardian new text begin , managing partner, new text end or parent may fulfill these functions on behalf
of the recipient; and

(5) has not been excluded or disenrolled by the commissioner.

(b) The commissioner may disenroll or exclude recipients, including guardians deleted text begin and deleted text end new text begin ,
new text end parents, new text begin and managing partners new text end under the following circumstances:

(1) recipients who have been restricted by the Primary Care Utilization Review
Committee may be excluded for a specified time period;

(2) recipients who exit the self-directed supports option during the recipient's
service plan year shall not access the self-directed supports option for the remainder of
that service plan year; and

(3) when the department determines that the recipient cannot manage recipient
responsibilities under the program.

Subd. 3.

Eligibility for other services.

Selection of the self-directed supports
option by a recipient shall not restrict access to other medically necessary care and
services furnished under the state plan medical assistance benefit deleted text begin , including home care
targeted case management deleted text end , except that a person deleted text begin receiving deleted text end new text begin choosing agency-provided
new text end home and community-based waiver services, new text begin agency-provided personal care assistance
services, new text end a family support grant, or a consumer support grant is not eligible for funding
under the self-directed supports option.

Subd. 4.

Assessment requirements.

(a) The self-directed supports option
assessment must meet the following requirements:

(1) it shall be conducted deleted text begin by the county public health nurse or a certified public health
nurse under contract with the county deleted text end new text begin consistent with the requirements of personal care
assistant services under section 256B.0659, subdivision 3a; home and community-based
waiver services programs under section 256B.0915, 256B.092, or 256B.49; and the
alternative care program under section 256B.0913, until section 256B.0911, subdivision
3a, has been implemented new text end ;

(2) it shall be conducted face-to-face in the recipient's home initially, and at least
annually thereafter; when there is a significant change in the recipient's condition; and
when there is a change in the new text begin person's new text end need for deleted text begin personal care assistance deleted text end services new text begin under the
programs listed in subdivision 2, paragraph (a), clause (2) new text end . A recipient who is residing in a
facility may be assessed for the self-directed support option for the purpose of returning
to the community using this option; and

(3) it shall be completed using the format established by the commissioner.

(b) The results of the new text begin personal care assistance new text end assessment and recommendations
shall be communicated to the commissioner and the recipient deleted text begin by the county public health
nurse or certified public health nurse under contract with the county deleted text end new text begin as required under
section 256B.0659, subdivision 3a. The person's annual and self-directed budget amount
shall be provided within 40 days after the personal care assessment or reassessment, or
within ten days after a request not related to an assessment new text end .

new text begin (c) The lead agency responsible for administration of home and community-based
waiver services under section 256B.0915, 256B.092, or 256B.49, and alternative care
under section 256B.0913 shall provide annual and monthly self-directed services budget
amounts for all eligible persons within 40 days after an initial assessment or annual review
and within ten days if requested at a time unrelated to the assessment or annual review.
new text end

Subd. 5.

Self-directed supports option plan requirements.

(a) The plan for the
self-directed supports option must meet the following requirements:

(1) the plan must be completed using a person-centered process that:

(i) builds upon the recipient's capacity to engage in activities that promote
community life;

(ii) respects the recipient's preferences, choices, and abilities;

(iii) involves families, friends, and professionals in the planning or delivery of
services or supports as desired or required by the recipient; and

(iv) addresses the need for personal care assistance services identified in the
recipient's self-directed supports option assessment;

(2) the plan shall be developed by the recipient new text begin , legal representative, new text end or deleted text begin by the
guardian of an adult recipient or by a parent or guardian of a minor child, deleted text end new text begin managing
partner, new text end and may be assisted by a provider who meets the requirements established for
using a person-centered planning process and shall be reviewed at least annually upon
reassessment or when there is a significant change in the recipient's condition; and

(3) the plan must include the total budget amount available divided into monthly
amounts that cover the number of months of personal care assistance services new text begin or home
and community-based waiver or alternative care new text end authorization included in the budget.
new text begin A recipient may reserve funds monthly for the purchase of items that meet the standards
in subdivision 6, paragraph (a), clause (2), and are reflected in the support plan. new text end The
amount used each month may vary, but additional funds shall not be provided above the
annual personal care assistance services authorized amount unless a change in condition
is documented.

(b) The commissioner new text begin or the commissioner's designee new text end shall:

(1) establish the format and criteria for the plan as well as the new text begin provider enrollment
new text end requirements for providers who new text begin will engage in outreach and training on self-directed
options, new text end assist with plan development new text begin , and offer person-centered plan support services new text end ;

(2) review the assessment and plan and, within 30 days after receiving the
assessment and plan, make a decision on approval of the plan;

(3) notify the recipient, deleted text begin parent, or guardian deleted text end new text begin legal representative, or managing partner
new text end of approval or denial of the plan and provide notice of the right to appeal under section
256.045; and

(4) provide a copy of the plan to the fiscal support entity selected by the recipient new text begin
from among at least three certified entities new text end .

Subd. 6.

Services covered.

(a) Services covered under the self-directed supports
option include:

(1) personal care assistance services under section 256B.0659 new text begin , and services under
the home and community-based waivers, except those provided in licensed or registered
settings new text end ; and

(2) items, related services, and supports, including assistive technology, that increase
independence or substitute for human assistance to the extent expenditures would
otherwise be used for human assistance.

(b) Items, supports, and related services purchased under this option shall not be
considered home care services for the purposes of section 144A.43.

Subd. 7.

Noncovered services.

Services or supports that are not eligible for
payment under the self-directed supports option include:

(1) services, goods, or supports that do not benefit the recipient;

(2) any fees incurred by the recipient, such as Minnesota health care program fees
and co-pays, legal fees, or costs related to advocate agencies;

(3) insurance, except for insurance costs related to employee coverage or fiscal
support entity payments;

(4) room and board and personal items that are not related to the disability, except
that medically prescribed specialized diet items may be covered if they reduce the need for
human assistance;

(5) home modifications that add square footage new text begin , except those modifications that
configure a bathroom to accommodate a wheelchair new text end ;

(6) home modifications for a residence other than the primary residence of the
recipient, or in the event of a minor with parents not living together, the primary residences
of the parents;

(7) expenses for travel, lodging, or meals related to training the recipient, the
deleted text begin parent or guardian of an adult recipient, or the parent or guardian of a minor child deleted text end new text begin legal
representative new text end , or paid or unpaid caregivers that exceed $500 in a 12-month period;

(8) experimental treatment;

(9) any service or item new text begin to the extent the service or item is new text end covered by other medical
assistance state plan services, including prescription and over-the-counter medications,
compounds, and solutions and related fees, including premiums and co-payments;

(10) membership dues or costs, except when the service is necessary and appropriate
to treat a physical condition or to improve or maintain the recipient's physical condition.
The condition must be identified in the recipient's plan of care and monitored by a
Minnesota health care program enrolled physician;

(11) vacation expenses other than the cost of direct services;

(12) vehicle maintenance or modifications not related to the disability;

(13) tickets and related costs to attend sporting or other recreational events new text begin that are
not related to a need or goal identified in the person-centered service plan new text end ; and

(14) costs related to Internet access, except when necessary for operation of assistive
technology, to increase independence, or to substitute for human assistance.

Subd. 8.

Self-directed budget requirements.

new text begin (a) new text end The budget for the provision of
the self-directed service option shall be established new text begin for persons eligible for personal care
assistant services under section 256B.0659 new text end based on:

(1) assessed personal care assistance units, not to exceed the maximum number of
personal care assistance units available, as determined by section 256B.0659; and

(2) the personal care assistance unit rate:

(i) with a reduction to the unit rate to pay for a program administrator as defined in
subdivision 10; and

(ii) an additional adjustment to the unit rate as needed to ensure cost neutrality for
the state.

new text begin (b) The budget for persons eligible for programs listed in subdivision 2, paragraph
(a), clause (2), is based on the approved budget methodologies for each program.
new text end

Subd. 9.

Quality assurance and risk management.

(a) The commissioner
shall establish quality assurance and risk management measures for use in developing
and implementing self-directed plans and budgets that (1) recognize the roles and
responsibilities involved in obtaining services in a self-directed manner, and (2) assure
the appropriateness of such plans and budgets based upon a recipient's resources and
capabilities. These measures must include (i) background studies, and (ii) backup and
emergency plans, including disaster planning.

(b) The commissioner shall provide ongoing technical assistance and resource
and educational materials for families and recipients selecting the self-directed option new text begin ,
including information on the quality assurance efforts and activities of region 10 under
sections 256B.095 to 256B.096 new text end .

(c) Performance assessments measures, such as of a recipient's new text begin functioning,
new text end satisfaction with the services and supports, and ongoing monitoring of health and
well-being shall be identified in consultation with the stakeholder group.

Subd. 10.

Fiscal support entity.

(a) Each recipient new text begin or legal representative new text end shall
choose a fiscal support entity provider certified by the commissioner to make payments
for services, items, supports, and administrative costs related to managing a self-directed
service plan authorized for payment in the approved plan and budget. deleted text begin Recipients deleted text end new text begin The
recipient or legal representative new text end shall also choose the payroll, agency with choice, or the
fiscal conduit model of financial and service management.

(b) The fiscal support entity:

(1) may not limit or restrict the recipient's choice of service or support providers,
including use of the payroll, agency with choice, or fiscal conduit model of financial
and service management;

(2) must have a written agreement with the recipient new text begin , managing partner, new text end or the
recipient's new text begin legal new text end representative that identifies the duties and responsibilities to be
performed and the specific related charges;

(3) must provide the recipient deleted text begin and the home care targeted case manager deleted text end new text begin , legal
representative, and managing partner new text end with a monthly written summary of the self-directed
supports option services that were billed, including charges from the fiscal support entity;

(4) must be knowledgeable of and comply with Internal Revenue Service
requirements necessary to process employer and employee deductions, provide appropriate
and timely submission of employer tax liabilities, and maintain documentation to support
medical assistance claims;

(5) must have current and adequate liability insurance and bonding and sufficient
cash flow and have on staff or under contract a certified public accountant or an individual
with a baccalaureate degree in accounting; and

(6) must maintain records to track all self-directed supports option services
expenditures, including time records of persons paid to provide supports and receipts for
any goods purchased. The records must be maintained for a minimum of five years from
the claim date and be available for audit or review upon request. Claims submitted by
the fiscal support entity must correspond with services, amounts, and time periods as
authorized in the recipient's self-directed supports option plan.

(c) The commissioner shall have authority to:

(1) set or negotiate rates with fiscal support entities;

(2) limit the number of fiscal support entities;

(3) identify a process to certify and recertify fiscal support entities and assure fiscal
support entities are available to recipients throughout the state; and

(4) establish a uniform format and protocol to be used by eligible fiscal support
entities.

Subd. 11.

Stakeholder consultation.

The commissioner shall consult with
a statewide deleted text begin consumer-directed deleted text end new text begin self-directed new text end services stakeholder group, including
representatives of all types of deleted text begin consumer-directed deleted text end new text begin self-directed new text end service users, advocacy
organizations, counties, and deleted text begin consumer-directed deleted text end new text begin self-directed new text end service providers. The
commissioner shall seek recommendations from this stakeholder group in developing new text begin ,
monitoring, evaluating, and modifying new text end :

(1) the self-directed plan format;

(2) requirements and guidelines for the person-centered plan assessment and
planning process;

(3) implementation of the option and the quality assurance and risk management
techniques; deleted text begin and
deleted text end

(4) standards and requirements, including rates for the personal support plan
development provider and the fiscal support entity; policies; training; and implementation new text begin ;
and
new text end

new text begin (5) the self-directed supports options available through the home and
community-based waivers under section 256B.0916 and the personal care assistance
program under section 256B.0659, including ways to increase participation, improve
flexibility, and include incentives for recipients to participate in a life transition and crisis
funding pool with others to save and contribute part of their authorized budgets, which
can be carried over year to year and used according to priority standards under section
256B.092, subdivision 12, clauses (1), (3), (4), (5), and (6) new text end .

The stakeholder group shall provide recommendations on the repeal of the personal
care assistance choice option, transition issues, and whether the consumer support grant
program under section 256.476 should be modified. The stakeholder group shall meet
at least three times each year to provide advice on policy, implementation, and other
aspects of deleted text begin consumer and deleted text end self-directed services.

Subd. 12.

Enrollment and evaluation.

Enrollment in the self-directed supports
option is available to current personal care assistance recipients upon annual personal
care assistance reassessment, with a maximum enrollment of deleted text begin 1,000 deleted text end new text begin 2,000 new text end people in the
first fiscal year of implementation and an additional deleted text begin 1,000 deleted text end new text begin 3,000 new text end people in the second
fiscal year. The commissioner shall evaluate the self-directed supports option during the
first two years of implementation and make any necessary changes deleted text begin prior to the option
becoming available statewide deleted text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2012.
new text end

Sec. 3.

Minnesota Statutes 2010, section 256B.0911, subdivision 1a, is amended to
read:

Subd. 1a.

Definitions.

For purposes of this section, the following definitions apply:

(a) "Long-term care consultation services" means:

(1) assistance in identifying services needed to maintain an individual in the most
inclusive environment;

(2) providing recommendations on cost-effective community services that are
available to the individual;

(3) development of an individual's person-centered community support plan;

(4) providing information regarding eligibility for Minnesota health care programs;

(5) face-to-face long-term care consultation assessments, which may be completed
in a hospital, nursing facility, intermediate care facility for persons with developmental
disabilities (ICF/DDs), regional treatment centers, or the person's current or planned
residence;

(6) federally mandated screening to determine the need for an institutional level of
care under subdivision 4a;

(7) determination of home and community-based waiver service eligibility
including level of care determination for individuals who need an institutional level of
care as defined under section 144.0724, subdivision 11, or 256B.092, service eligibility
including state plan home care services identified in sections 256B.0625, subdivisions
6, 7, and 19, paragraphs (a) and (c), and 256B.0657, based on assessment and support
plan development with appropriate referrals, including the option for deleted text begin consumer-directed
community deleted text end new text begin self-directed new text end supports;

(8) providing recommendations for nursing facility placement when there are no
cost-effective community services available; deleted text begin and
deleted text end

(9) assistance to transition people back to community settings after facility
admission new text begin ; and
new text end

new text begin (10) providing notice to the individual and legal representative of the annual and
monthly amount authorized for traditional agency services and self-directed services under
section 256B.0657 for which the recipient is found eligible new text end .

(b) "Long-term care options counseling" means the services provided by the linkage
lines as mandated by sections 256.01 and 256.975, subdivision 7, and also includes
telephone assistance and follow up once a long-term care consultation assessment has
been completed.

(c) "Minnesota health care programs" means the medical assistance program under
chapter 256B and the alternative care program under section 256B.0913.

(d) "Lead agencies" means counties or a collaboration of counties, tribes, and health
plans administering long-term care consultation assessment and support planning services.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2012.
new text end

Sec. 4.

Minnesota Statutes 2010, section 256B.0911, subdivision 3a, is amended to
read:

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 15
calendar days after the date on which an assessment was requested or recommended. After
January 1, 2011, these requirements also apply to personal care assistance services, private
duty nursing, and home health agency services, on timelines established in subdivision 5.
Face-to-face assessments must be conducted according to paragraphs (b) to (i).

(b) The county may utilize a team of either the social worker or public health nurse,
or both. After January 1, 2011, lead agencies shall use certified assessors to conduct the
assessment in a face-to-face interview. The consultation team members must confer
regarding the most appropriate care for each individual screened or assessed.

(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 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, as required by legally executed
documents, 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 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.

(e) The person, or the person's legal representative, must be provided with
written recommendations for community-based services, including deleted text begin consumer-directed deleted text end new text begin
self-directed new text end options, or institutional care that include documentation that the most
cost-effective alternatives available were offered to the individual. For purposes of
this requirement, "cost-effective alternatives" means community services and living
arrangements that cost the same as or less than institutional care. new text begin For persons determined
eligible for services defined under subdivision 1a, paragraph (a), clauses (7) to (9), the
community support plan must also include the estimated annual and monthly budget
amount for those services.
new text end

(f) 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, regardless
of whether the individual is eligible for Minnesota health care programs. 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 the services available under sections 256.975, subdivision 7,
and 256.01, 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 team 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) the need for and purpose of preadmission screening if the person selects nursing
facility placement;

(2) the role of the long-term care consultation assessment and support planning in
waiver and alternative care program eligibility determination;

(3) information about Minnesota health care programs;

(4) the person's freedom to accept or reject the recommendations of the team;

(5) the person's right to confidentiality under the Minnesota Government Data
Practices Act, chapter 13;

(6) the long-term care consultant's decision regarding the person's need for
institutional level of care as determined under criteria established in section 144.0724,
subdivision 11, or 256B.092; and

(7) the person's right to appeal the decision regarding the need for nursing facility
level of care or the county'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 traumatic brain injury waiver programs under sections
256B.0915, 256B.0917, and 256B.49 is valid to establish service eligibility for no more
than 60 calendar days after the date of assessment. The effective eligibility start date
for these programs 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). The effective date of program eligibility in this case cannot be prior to
the date the updated assessment is completed.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2012.
new text end

Sec. 5.

Minnesota Statutes 2010, section 256B.0916, subdivision 6a, is amended to
read:

Subd. 6a.

Statewide availability of deleted text begin consumer-directed community deleted text end new text begin self-directed
new text end support services.

(a) The commissioner shall submit to the federal Health Care Financing
Administration by August 1, 2001, an amendment to the home and community-based
waiver deleted text begin for persons with developmental disabilities deleted text end new text begin under section 256B.092 and by April 1,
2005, for waivers under sections 256B.0915 and 256B.49, new text end to make deleted text begin consumer-directed
community deleted text end new text begin self-directed new text end support services available in every county of the state deleted text begin by January
1, 2002 deleted text end .

(b) new text begin Until the waiver amendment under section 18 of this act is effective, new text end if a
county declines to meet the requirements for provision of deleted text begin consumer-directed community deleted text end
new text begin self-directed new text end supports, the commissioner shall contract with another county, a group of
counties, or a private agency to plan for and administer deleted text begin consumer-directed community deleted text end new text begin
self-directed new text end supports in that county.

(c) The state of Minnesota, county agencies, tribal governments, or administrative
entities under contract to participate in the implementation and administration of the home
and community-based waiver for persons with developmental disabilities, shall not be
liable for damages, injuries, or liabilities sustained through the purchase of support by the
individual, the individual's family, legal representative, or the authorized representative
with funds received through the deleted text begin consumer-directed community deleted text end new text begin self-directed new text end support
service under this section. Liabilities include but are not limited to: workers' compensation
liability, the Federal Insurance Contributions Act (FICA), or the Federal Unemployment
Tax Act (FUTA).

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2011.
new text end

Sec. 6.

Minnesota Statutes 2010, section 256B.092, subdivision 1a, is amended to read:

Subd. 1a.

Case management deleted text begin administration and deleted text end services.

(a) deleted text begin The administrative
functions of case management provided to or arranged for a person include:
deleted text end

deleted text begin (1) review of eligibility for services;
deleted text end

deleted text begin (2) screening;
deleted text end

deleted text begin (3) intake;
deleted text end

deleted text begin (4) diagnosis;
deleted text end

deleted text begin (5) the review and authorization of services based upon an individualized service
plan; and
deleted text end

deleted text begin (6) responding to requests for conciliation conferences and appeals according to
section 256.045 made by the person, the person's legal guardian or conservator, or the
parent if the person is a minor deleted text end new text begin Case management services shall be provided by public or
private agencies that are enrolled as a medical assistance provider determined by the
commissioner to meet all of the requirements in the approved federal waiver plans. Case
management services cannot be provided to a recipient by a private agency that has
any financial interest in the provisions of any other services included in the recipient's
coordinated service and support plan new text end .

(b) Case management deleted text begin service activities provided to or arranged for a person include deleted text end new text begin
services shall be provided to each recipient of home and community-based waiver
services and available to those eligible for case management under sections 256B.0621
and 256B.0924, subdivision 4, who choose this service. Case management services for an
eligible person include new text end :

(1) development of the deleted text begin individual deleted text end new text begin coordinated new text end service new text begin and support new text end plan;

(2) informing the individual or the individual's legal guardian or conservator, or
parent if the person is a minor, of service options;

(3) consulting with relevant medical experts or service providers;

(4) assisting the person in the identification of potential providers;

(5) assisting the person to access services;

(6) coordination of services, new text begin including coordinating with the person's health care
home or health coordinator, new text end if coordination new text begin of long-term care or community supports and
health care new text end is not provided by another service provider;

(7) evaluation and monitoring of the services identified in the plan new text begin including at least
one face-to-face visit with each person annually by the case manager new text end ; and

(8) deleted text begin annual reviews of service plans and services provided deleted text end new text begin review and provide the
lead agency with recommendations for service authorization based upon the individual's
needs identified in the support plan within ten working days after receiving the community
support plan from the certified assessor under section 256B.0911 new text end .

(c) Case management deleted text begin administration and deleted text end service activities that are provided to the
person with a developmental disability shall be provided directly by deleted text begin county agencies or
under contract deleted text end new text begin a public or private agency that is enrolled as a medical assistance provider
determined by the commissioner to meet all of the requirements in section 256B.0621,
subdivision 5, paragraphs (a) and (b), clauses (1) to (5), and have no financial interest in
the provision of any other services to the person choosing case management service new text end .

(d) deleted text begin Case managers are responsible for the administrative duties and service
provisions listed in paragraphs (a) and (b). deleted text end Case managers shall collaborate with
consumers, families, legal representatives, and relevant medical experts and service
providers in the development and annual review of the individualized service and
habilitation plans.

(e) The Department of Human Services shall offer ongoing education in case
management to case managers. Case managers shall receive no less than ten hours of case
management education and disability-related training each year.

new text begin (f) For persons eligible for home and community-based waiver services under this
section, case management service must be provided and paid for under the terms of the
approved federal waiver plans and cannot be billed as targeted case management.
new text end

new text begin (g) Persons may choose a case management service provider from among the public
or private vendors enrolled according to paragraph (d).
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2012.
new text end

Sec. 7.

Minnesota Statutes 2010, section 256B.092, subdivision 1b, is amended to read:

Subd. 1b.

deleted text begin Individual deleted text end new text begin Coordinated new text end service new text begin and support new text end plan.

deleted text begin The individual deleted text end
new text begin Each recipient of case management service and any legal representative shall be provided
a written copy of the coordinated new text end service new text begin and support new text end plan deleted text begin must deleted text end new text begin , which new text end :

(1) deleted text begin include deleted text end new text begin is developed within ten working days after the case management service
receives the community support plan from the certified assessor under section 256B.0911;
new text end

new text begin (2) includes new text end the results of the assessment information on the person's need for
service, including identification of service needs that will be or that are met by the person's
relatives, friends, and others, as well as community services used by the general public;

new text begin (3) reasonably assures the health, safety, and welfare of the recipient;
new text end

deleted text begin (2) identify deleted text end new text begin (4) identifies new text end the person's preferences for services as stated by the person,
the person's legal guardian or conservator, or the parent if the person is a minor;

new text begin (5) provides for an informed choice, as defined in section 256B.77, subdivision 2,
paragraph (o), of service and support providers;
new text end

deleted text begin (3) identify deleted text end new text begin (6) identifies new text end long- and short-range goals for the person;

deleted text begin (4) identify deleted text end new text begin (7) identifies new text end specific services and the amount and frequency of the
services to be provided to the person based on assessed needs, preferences, and available
resources. The deleted text begin individual deleted text end new text begin coordinated new text end service new text begin and support new text end plan shall also specify other
services the person needs that are not available;

deleted text begin (5) identify deleted text end new text begin (8) identifies new text end the need for an deleted text begin individual program deleted text end new text begin individual's provider
new text end plan to be developed by the provider according to the respective state and federal licensing
and certification standards, and additional assessments to be completed or arranged by the
provider after service initiation;

deleted text begin (6) identify deleted text end new text begin (9) identifies new text end provider responsibilities to implement and make
recommendations for modification to the deleted text begin individual deleted text end new text begin coordinated new text end service new text begin and support new text end plan;

deleted text begin (7) include deleted text end new text begin (10) includes new text end notice of the right to new text begin have assessments completed and
service plans developed within specified time periods, the right to appeal action or
inaction, and the right to new text end request deleted text begin a conciliation conference or a hearing deleted text end new text begin an appeal new text end under
section 256.045;

deleted text begin (8) be deleted text end new text begin (11) is new text end agreed upon and signed by the person, the person's legal guardian
or conservator, or the parent if the person is a minor, and the authorized county
representative; and

deleted text begin (9) be deleted text end new text begin (12) is new text end reviewed by a health professional if the person has overriding medical
needs that impact the delivery of services.

deleted text begin Service planning formats developed for interagency planning such as transition,
vocational, and individual family service plans may be substituted for service planning
formats developed by county agencies.
deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2012.
new text end

Sec. 8.

Minnesota Statutes 2010, section 256B.092, subdivision 1e, is amended to read:

Subd. 1e.

new text begin Case management service monitoring, new text end coordination, new text begin and new text end evaluation deleted text begin ,
and monitoring of services deleted text end new text begin duties new text end .

(a) If the deleted text begin individual deleted text end new text begin coordinated new text end service new text begin and support
new text end plan identifies the need for individual deleted text begin program deleted text end new text begin provider new text end plans for authorized services,
the case deleted text begin manager deleted text end new text begin management service provider new text end shall assure that deleted text begin individual program deleted text end new text begin the
individual provider new text end plans are developed by the providers according to clauses (2) to (5).
The providers shall assure that the individual deleted text begin program deleted text end new text begin provider new text end plans:

(1) are developed according to the respective state and federal licensing and
certification requirements;

(2) are designed to achieve the goals of the individual service plan;

(3) are consistent with other aspects of the deleted text begin individual deleted text end new text begin coordinated new text end service new text begin and
support new text end plan;

(4) assure the health and safety of the person; and

(5) are developed with consistent and coordinated approaches to services among the
various service providers.

(b) The case deleted text begin manager deleted text end new text begin management service provider new text end shall monitor the provision of
services:

(1) to assure that the individual service plan is being followed according to
paragraph (a);

(2) to identify any changes or modifications that might be needed in the individual
service plan, including changes resulting from recommendations of current service
providers;

(3) to determine if the person's legal rights are protected, and if not, notify the
person's legal guardian or conservator, or the parent if the person is a minor, protection
services, or licensing agencies as appropriate; and

(4) to determine if the person, the person's legal guardian or conservator, or the
parent if the person is a minor, is satisfied with the services provided.

(c) If the provider fails to develop or carry out the individual program plan according
to paragraph (a), the case manager shall notify the person's legal guardian or conservator,
or the parent if the person is a minor, the provider, the respective licensing and certification
agencies, and the county board where the services are being provided. In addition, the
case manager shall identify other steps needed to assure the person receives the services
identified in the deleted text begin individual deleted text end new text begin coordinated new text end service new text begin and support new text end plan.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2012.
new text end

Sec. 9.

Minnesota Statutes 2010, section 256B.092, subdivision 1g, is amended to read:

Subd. 1g.

Conditions not requiring development of deleted text begin individual deleted text end new text begin a coordinated
new text end service new text begin and support new text end plan.

Unless otherwise required by federal law, the county agency is
not required to complete deleted text begin an individual deleted text end new text begin a coordinated new text end service new text begin and support new text end plan as defined in
subdivision 1b for:

(1) persons whose families are requesting respite care for their family member who
resides with them, or whose families are requesting a family support grant and are not
requesting purchase or arrangement of habilitative services; and

(2) persons with developmental disabilities, living independently without authorized
services or receiving funding for services at a rehabilitation facility as defined in section
268A.01, subdivision 6, and not in need of or requesting additional services.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2012.
new text end

Sec. 10.

Minnesota Statutes 2010, section 256B.092, subdivision 3, is amended to read:

Subd. 3.

Authorization and termination of services.

deleted text begin County agency case
managers deleted text end new text begin Lead agencies new text end , under rules of the commissioner, shall authorize and terminate
services of community and regional treatment center providers according to deleted text begin individual deleted text end new text begin
coordinated new text end service new text begin and support new text end plans. Services provided to persons with developmental
disabilities may only be authorized and terminated deleted text begin by case managers deleted text end according to (1)
rules of the commissioner and (2) the deleted text begin individual deleted text end new text begin coordinated new text end service new text begin and support new text end plan as
defined in subdivision 1b. Medical assistance services not needed shall not be authorized
by county agencies or funded by the commissioner. When purchasing or arranging for
unlicensed respite care services for persons with overriding health needs, the county
agency shall seek the advice of a health care professional in assessing provider staff
training needs and skills necessary to meet the medical needs of the person.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2012.
new text end

Sec. 11.

Minnesota Statutes 2010, section 256B.092, subdivision 8, is amended to read:

Subd. 8.

deleted text begin Screening team deleted text end new text begin Additional certified assessor new text end duties.

The deleted text begin screening team deleted text end
new text begin certified assessor new text end shall:

(1) review diagnostic data;

(2) review health, social, and developmental assessment data using a deleted text begin uniform
screening deleted text end new text begin comprehensive assessment new text end tool specified by the commissioner;

(3) identify the level of services appropriate to maintain the person in the most
normal and least restrictive setting that is consistent with the person's treatment needs;

(4) identify other noninstitutional public assistance or social service that may prevent
or delay long-term residential placement;

(5) assess whether a person is in need of long-term residential care;

(6) make recommendations regarding deleted text begin placement deleted text end new text begin services new text end and payment for: (i) social
service or public assistance support, or both, to maintain a person in the person's own home
or other place of residence; (ii) training and habilitation service, vocational rehabilitation,
and employment training activities; (iii) community residential deleted text begin placement deleted text end new text begin services new text end ; deleted text begin (iv)
regional treatment center placement; deleted text end or deleted text begin (v) deleted text end new text begin (iv) new text end a home and community-based service
alternative to community residential placement or regional treatment center placement;

(7) evaluate the availability, location, and quality of the services listed in clause
(6), including the impact of deleted text begin placement alternatives deleted text end new text begin services and supports options new text end on the
person's ability to maintain or improve existing patterns of contact and involvement with
parents and other family members;

(8) identify the cost implications of recommendations in clause (6) new text begin and provide
written notice of the annual and monthly amount authorized to be spent for services for
the recipient new text end ;

(9) make recommendations to a court as may be needed to assist the court in making
decisions regarding commitment of persons with developmental disabilities; and

(10) inform the person and the person's legal guardian or conservator, or the parent if
the person is a minor, that appeal may be made to the commissioner pursuant to section
256.045.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2012.
new text end

Sec. 12.

Minnesota Statutes 2010, section 256B.092, subdivision 8a, is amended to
read:

Subd. 8a.

County deleted text begin concurrence deleted text end new text begin notification new text end .

(a) If the county of financial
responsibility wishes to place a person in another county for services, the county of
financial responsibility shall deleted text begin seek concurrence from deleted text end new text begin notify new text end the proposed county of service
and the placement shall be made cooperatively between the two counties. Arrangements
shall be made between the two counties for ongoing social service, including annual
reviews of the person's individual service plan. The county where services are provided
may not make changes in the person's service plan without approval by the county of
financial responsibility.

(b) deleted text begin When a person has been screened and authorized for services in an intermediate
care facility for persons with developmental disabilities or for home and community-based
services for persons with developmental disabilities, the case manager shall assist that
person in identifying a service provider who is able to meet the needs of the person
according to the person's individual service plan. If the identified service is to be provided
in a county other than the county of financial responsibility, the county of financial
responsibility shall request concurrence of the county where the person is requesting to
receive the identified services. deleted text end The county of service deleted text begin may refuse to concur deleted text end new text begin shall notify
the county of financial responsibility new text end if deleted text begin : deleted text end new text begin ,
new text end

deleted text begin (1) it can demonstrate that the provider is unable to provide the services identified in
the person's individual service plan as services that are needed and are to be provided; or
deleted text end

deleted text begin (2) deleted text end in the case of an intermediate care facility for persons with developmental
disabilities, there has been no authorization for admission by the admission review team
as required in section 256B.0926.

(c) The county of service shall notify the county of financial responsibility of
deleted text begin concurrence or refusal to concur deleted text end new text begin any concerns about the chosen provider's capacity to
meet the needs of the person seeking to move to residential services in another county new text end no
later than 20 working days following receipt of the written deleted text begin request deleted text end new text begin notification new text end . Unless
other mutually acceptable arrangements are made by the involved county agencies, the
county of financial responsibility is responsible for costs of social services and the costs
associated with the development and maintenance of the placement. The county of
service may request that the county of financial responsibility purchase case management
services from the county of service or from a contracted provider of case management
when the county of financial responsibility is not providing case management as defined
in this section and rules adopted under this section, unless other mutually acceptable
arrangements are made by the involved county agencies. Standards for payment limits
under this section may be established by the commissioner. Financial disputes between
counties shall be resolved as provided in section 256G.09.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2011.
new text end

Sec. 13.

Minnesota Statutes 2010, section 256B.49, subdivision 13, is amended to read:

Subd. 13.

Case management.

deleted text begin (a) deleted text end Each recipient of a home and community-based
waiver new text begin under this section new text end shall be provided case management services new text begin according to
section 256B.092, subdivisions 1a, 1b, and 1e, new text end by qualified vendors as described in the
federally approved waiver application. deleted text begin The case management service activities provided
will include:
deleted text end

deleted text begin (1) assessing the needs of the individual within 20 working days of a recipient's
request;
deleted text end

deleted text begin (2) developing the written individual service plan within ten working days after the
assessment is completed;
deleted text end

deleted text begin (3) informing the recipient or the recipient's legal guardian or conservator of service
options;
deleted text end

deleted text begin (4) assisting the recipient in the identification of potential service providers;
deleted text end

deleted text begin (5) assisting the recipient to access services;
deleted text end

deleted text begin (6) coordinating, evaluating, and monitoring of the services identified in the service
plan;
deleted text end

deleted text begin (7) completing the annual reviews of the service plan; and
deleted text end

deleted text begin (8) informing the recipient or legal representative of the right to have assessments
completed and service plans developed within specified time periods, and to appeal county
action or inaction under section 256.045, subdivision 3, including the determination of
nursing facility level of care.
deleted text end

deleted text begin (b) The case manager may delegate certain aspects of the case management service
activities to another individual provided there is oversight by the case manager. The case
manager may not delegate those aspects which require professional judgment including
assessments, reassessments, and care plan development.
deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2012.
new text end

Sec. 14.

Minnesota Statutes 2010, section 256B.49, subdivision 14, is amended to read:

Subd. 14.

Assessment and reassessment.

(a) Assessments of each recipient's
strengths, informal support systems, and need for services shall be completed within 20
working days of the recipient's request new text begin as provided in section 256B.0911 new text end . Reassessment
of each recipient's strengths, 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.

(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 144.0724, subdivision 11, at initial and
subsequent assessments to initiate and maintain participation in the waiver program.

(c) Regardless of other assessments identified in section 144.0724, subdivision 4, as
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
to section 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) Persons with developmental disabilities who apply for services under the nursing
facility level waiver programs shall be screened for the appropriate level of care according
to section 256B.092.

(e) 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.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2012.
new text end

Sec. 15.

Minnesota Statutes 2010, section 256B.49, subdivision 15, is amended to read:

Subd. 15.

deleted text begin Individualized deleted text end new text begin Coordinated new text end service new text begin and support new text end plan.

(a) Each
recipient of home and community-based waivered services shall be provided a copy of the
written new text begin coordinated new text end service new text begin and support new text end plan deleted text begin which: deleted text end new text begin that complies with the requirements
of section 256B.092, subdivision 1b.
new text end

deleted text begin (1) is developed and signed by the recipient within ten working days of the
completion of the assessment;
deleted text end

deleted text begin (2) meets the assessed needs of the recipient;
deleted text end

deleted text begin (3) reasonably ensures the health and safety of the recipient;
deleted text end

deleted text begin (4) promotes independence;
deleted text end

deleted text begin (5) allows for services to be provided in the most integrated settings; and
deleted text end

deleted text begin (6) provides for an informed choice, as defined in section 256B.77, subdivision 2,
paragraph (p), of service and support providers.
deleted text end

(b) When a county is evaluating denials, reductions, or terminations of home and
community-based services under section 256B.49 for an individual, the case manager
shall offer to meet with the individual or the individual's guardian in order to discuss the
prioritization of service needs within the individualized service plan. The reduction in
the authorized services for an individual due to changes in funding for waivered services
may not exceed the amount needed to ensure medically necessary services to meet the
individual's health, safety, and welfare.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2012.
new text end

Sec. 16.

Minnesota Statutes 2010, section 256G.02, subdivision 6, is amended to read:

Subd. 6.

Excluded time.

"Excluded time" means:

(a) any period an applicant spends in a hospital, sanitarium, nursing home, shelter
other than an emergency shelter, halfway house, foster home, semi-independent living
domicile or services program, residential facility offering care, board and lodging facility
or other institution for the hospitalization or care of human beings, as defined in section
144.50, 144A.01, or 245A.02, subdivision 14; maternity home, battered women's shelter,
or correctional facility; or any facility based on an emergency hold under sections
253B.05, subdivisions 1 and 2, and 253B.07, subdivision 6;

(b) any period an applicant spends on a placement basis in a training and habilitation
program, including a rehabilitation facility or work or employment program as defined
in section 268A.01; deleted text begin or receiving personal care assistance services pursuant to section
256B.0659; deleted text end semi-independent living services provided under section 252.275, and
Minnesota Rules, parts 9525.0500 to 9525.0660; day training and habilitation programs
and assisted living services; and

(c) any placement for a person with an indeterminate commitment, including
independent living.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2011.
new text end

Sec. 17. new text begin STATE PLAN AMENDMENT TO IMPLEMENT SELF-DIRECTED
PERSONAL SUPPORTS.
new text end

new text begin By July 15, 2011, the commissioner shall submit a state plan amendment to
implement Minnesota Statutes, section 256B.0657, as soon as possible upon federal
approval.
new text end

Sec. 18. new text begin AMENDMENT FOR SELF-DIRECTED COMMUNITY SUPPORTS.
new text end

new text begin By September 1, 2011, the commissioner shall submit an amendment to the home
and community-based waiver programs consistent with implementing the self-directed
option under Minnesota Statutes, section 256B.0657, through statewide enrolled providers
contracted to provide outreach information, training, and fiscal support entity services to
all eligible recipients choosing this option and with shared care in some types of services.
The waiver amendment shall be consistent with changes in case management service
under Minnesota Statutes, section 256B.092.
new text end

Sec. 19. new text begin ESTABLISHMENT OF RATES FOR SHARED HOME AND
COMMUNITY-BASED WAIVER ADMINISTRATIVE SERVICES.
new text end

new text begin By January 1, 2012, the commissioner shall establish rates to be paid for in-home
services and personal supports under all of the home and community-based waiver
services programs consistent with the standards in Minnesota Statutes, section 256B.4912,
subdivision 2.
new text end

Sec. 20. new text begin ESTABLISHMENT OF RATES FOR CASE MANAGEMENT
SERVICES.
new text end

new text begin By January 1, 2012, the commissioner shall establish the rate to be paid for
case management services under Minnesota Statutes, sections 256B.092 and 256B.49,
consistent with the standards in Minnesota Statutes, section 256B.4912, subdivision 2.
new text end

Sec. 21. new text begin RECOMMENDATIONS FOR FURTHER CASE MANAGEMENT
REDESIGN.
new text end

new text begin By February 1, 2012, the commissioner of human services shall develop a legislative
report with specific recommendations and language for proposed legislation to be effective
July 1, 2012, for the following:
new text end

new text begin (1) definitions of service and consolidation of standards and rates to the extent
appropriate for all types of medical assistance case management services, including
targeted case management under Minnesota Statutes, sections 256B.0621; 256B.0625,
subdivision 20; and 256B.0924; mental health case management services for children
and adults, all types of home and community-based waiver case management, and case
management under Minnesota Rules, parts 9525.0004 to 9525.0036. This work shall be
completed in collaboration with efforts under Minnesota Statutes, section 256B.4912;
new text end

new text begin (2) recommendations on county of financial responsibility requirements and quality
assurance measures for case management; and
new text end

new text begin (3) identification of county administrative functions that may remain entwined in
case management service delivery models.
new text end