SF 903

as introduced - 93rd Legislature (2023 - 2024) Posted on 01/28/2023 10:37am

A bill for an act
relating to human services; establishing care evaluation as a covered medical
assistance home care service; modifying medical assistance homemaker rates;
requiring a report; amending Minnesota Statutes 2022, sections 256B.0651,
subdivisions 1, 2; 256B.0652, subdivision 11; 256B.0653, subdivisions 1, 6, by
adding a subdivision; 256B.0654, by adding a subdivision; 256B.4912, by adding
a subdivision; 256B.85, subdivision 8; 256S.18, subdivision 1; 256S.2101,
subdivision 2, by adding subdivisions; 256S.212, by adding a subdivision.

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

Section 1.

Minnesota Statutes 2022, section 256B.0651, subdivision 1, is amended to read:

Subdivision 1.

Definitions.

(a) For the purposes of sections 256B.0651 to 256B.0654
and 256B.0659, the terms in deleted text begin paragraphs (b) to (g) deleted text end new text begin this subdivision new text end have the meanings given.

(b) "Activities of daily living" has the meaning given in section 256B.0659, subdivision
1, paragraph (b).

(c) "Assessment" means a review and evaluation of a recipient's need for home care
services conducted in person.

(d) new text begin "Care evaluation" means a face-to-face evaluation of a person to develop, update,
or review a recipient's plan of care for home care services, except personal care assistance.
new text end

new text begin (e) new text end "Home care services" means medical assistance covered services that are home health
agency services, including skilled nurse visits; home health aide visits; physical therapy,
occupational therapy, respiratory therapy, and language-speech pathology therapy; home
care nursing; and personal care assistance.

deleted text begin (e) deleted text end new text begin (f) new text end "Home residence deleted text begin , deleted text end " deleted text begin effective January 1, 2010, deleted text end means a residence owned or rented
by the recipient either alone, with roommates of the recipient's choosing, or with an unpaid
responsible party or legal representative; or a family foster home where the license holder
lives with the recipient and is not paid to provide home care services for the recipient except
as allowed under sections 256B.0652, subdivision 10, and 256B.0654, subdivision 4.

deleted text begin (f) deleted text end new text begin (g) new text end "Medically necessary" has the meaning given in Minnesota Rules, parts 9505.0170
to 9505.0475.

deleted text begin (g) deleted text end new text begin (h) new text end "Ventilator-dependent" means an individual who receives mechanical ventilation
for life support at least six hours per day and is expected to be or has been dependent on a
ventilator for at least 30 consecutive days.

Sec. 2.

Minnesota Statutes 2022, section 256B.0651, subdivision 2, is amended to read:

Subd. 2.

Services covered.

Home care services covered under this section and sections
256B.0652 to 256B.0654 and 256B.0659 include:

(1) nursing services under sections 256B.0625, subdivision 6a, and 256B.0653;

(2) home care nursing services under sections 256B.0625, subdivision 7, and 256B.0654;

(3) home health services under sections 256B.0625, subdivision 6a, and 256B.0653;

(4) personal care assistance services under sections 256B.0625, subdivision 19a, and
256B.0659;

(5) supervision of personal care assistance services provided by a qualified professional
under sections 256B.0625, subdivision 19a, and 256B.0659;

(6) face-to-face assessments by county public health nurses for new text begin personal care assistance new text end
services under sections 256B.0625, subdivision 19a, and 256B.0659; deleted text begin and
deleted text end

(7) service updates and deleted text begin review deleted text end new text begin reviews by county public health nurses new text end of temporary
increases for personal care assistance services deleted text begin by the county public health nurse for services deleted text end
under sections 256B.0625, subdivision 19a, and 256B.0659 new text begin ; and
new text end

new text begin (8) care evaluations under sections 256B.0625, subdivisions 6a and 7; 256B.0653; and
256B.0654 new text end .

Sec. 3.

Minnesota Statutes 2022, section 256B.0652, subdivision 11, is amended to read:

Subd. 11.

Limits on services without authorization.

new text begin During a calendar year new text end a recipient
may receive the following home care services deleted text begin during a calendar year deleted text end new text begin without authorization new text end :

(1) up to two face-to-face assessments to determine a recipient's need for personal care
assistance services;

(2) one service update done to determine a recipient's need for personal care assistance
services; and

(3) up to nine face-to-face new text begin visits that may include only new text end skilled nurse visits new text begin or care
evaluations new text end .

Sec. 4.

Minnesota Statutes 2022, section 256B.0653, subdivision 1, is amended to read:

Subdivision 1.

Scope.

This section applies to home health agency services including
home health aide, skilled nursing visits, physical therapy, occupational therapy, respiratory
therapy, deleted text begin and deleted text end speech-language pathology therapy new text begin , and care evaluations new text end .

Sec. 5.

Minnesota Statutes 2022, section 256B.0653, subdivision 6, is amended to read:

Subd. 6.

Noncovered home health agency services.

The following are not eligible for
payment under medical assistance as a home health agency service:

(1) telehomecare skilled nurses services that is communication between the home care
nurse and recipient that consists solely of a telephone conversation, facsimile, electronic
mail, or a consultation between two health care practitioners;

(2) the following skilled nurse visits:

(i) for the purpose of monitoring medication compliance with an established medication
program for a recipient;

(ii) administering or assisting with medication administration, including injections,
prefilling syringes for injections, or oral medication setup of an adult recipient, when, as
determined and documented by the registered nurse, the need can be met by an available
pharmacy or the recipient or a family member is physically and mentally able to
self-administer or prefill a medication;

(iii) services done for the sole purpose of supervision of the home health aide or personal
care assistant;

(iv) services done for the sole purpose to train other home health agency workers;

(v) services done for the sole purpose of blood samples or lab draw when the recipient
is able to access these services outside the home; and

(vi) Medicare evaluation or administrative nursing visits required by Medicare new text begin , except
as provided in subdivision 9, paragraph (a) new text end ;

(3) home health aide visits when the following activities are the sole purpose for the
visit: companionship, socialization, household tasks, transportation, and education;

(4) home care therapies provided in other settings such as a clinic or as an inpatient or
when the recipient can access therapy outside of the recipient's residence; and

(5) home health agency services without qualifying documentation of a face-to-face
encounter as specified in subdivision 7.

Sec. 6.

Minnesota Statutes 2022, section 256B.0653, is amended by adding a subdivision
to read:

new text begin Subd. 9. new text end

new text begin Care evaluations. new text end

new text begin (a) Notwithstanding the coverage limitation in subdivision
6, clause (2), item (vi), medical assistance covers care evaluations as a home health service
under section 256B.0625, subdivision 6a, provided that the recipient's home health services
are not covered under the Medicare program or any other insurance held by the recipient.
new text end

new text begin (b) The reimbursement rate for care evaluations under this section must equal ... percent
of the medical assistance reimbursement rate for a skilled nursing visit.
new text end

new text begin (c) Care evaluations under this section must occur during a start-of-care visit, a
resumption-of-care visit, or a recertification visit. Care evaluations under this section must
be provided by a registered nurse whenever the recipient's plan of care involves nursing
tasks or medically oriented tasks requiring skilled nursing visits or home health aide visits.
If the service recipient's plan of care involves only home care therapy, an appropriate therapist
may conduct a care evaluation under this section.
new text end

Sec. 7.

Minnesota Statutes 2022, section 256B.0654, is amended by adding a subdivision
to read:

new text begin Subd. 6. new text end

new text begin Care evaluations. new text end

new text begin (a) Medical assistance covers care evaluations as a home
care nursing service under section 256B.0625, subdivision 7, provided the recipient's home
care nursing services are not covered by the Medicare program or any other insurance held
by the recipient.
new text end

new text begin (b) The reimbursement rate for care evaluations under this section must equal ... percent
of the medical assistance reimbursement rate for a skilled nursing visit.
new text end

new text begin (c) Care evaluations under this section must occur during a start-of-care visit, a
resumption-of-care visit, or a recertification visit. Care evaluations under this section must
be provided by a registered nurse.
new text end

Sec. 8.

Minnesota Statutes 2022, section 256B.4912, is amended by adding a subdivision
to read:

new text begin Subd. 16. new text end

new text begin Rates established by the commissioner. new text end

new text begin For homemaker services eligible
for reimbursement under the developmental disabilities waiver, the brain injury waiver, the
community alternative care waiver, and the community access for disability inclusion waiver,
the commissioner must establish rates equal to the rates established under sections 256S.21
to 256S.215 for the corresponding homemaker services.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024.
new text end

Sec. 9.

Minnesota Statutes 2022, section 256B.85, subdivision 8, is amended to read:

Subd. 8.

Determination of CFSS service authorization amount.

(a) All community
first services and supports must be authorized by the commissioner or the commissioner's
designee before services begin. The authorization for CFSS must be completed as soon as
possible following an assessment but no later than 40 calendar days from the date of the
assessment.

(b) The amount of CFSS authorized must be based on the participant's home care rating
described in paragraphs (d) and (e) and any additional service units for which the participant
qualifies as described in paragraph (f).

(c) The home care rating shall be determined by the commissioner or the commissioner's
designee based on information submitted to the commissioner identifying the following for
a participant:

(1) the total number of dependencies of activities of daily living;

(2) the presence of complex health-related needs; and

(3) the presence of Level I behavior.

(d) The methodology to determine the total service units for CFSS for each home care
rating is based on the median paid units per day for each home care rating from fiscal year
2007 data for the PCA program.

(e) Each home care rating is designated by the letters P through Z and EN and has the
following base number of service units assigned:

(1) P home care rating requires Level I behavior or one to three dependencies in ADLs
and qualifies the person for five service units;

(2) Q home care rating requires Level I behavior and one to three dependencies in ADLs
and qualifies the person for six service units;

(3) R home care rating requires a complex health-related need and one to three
dependencies in ADLs and qualifies the person for seven service units;

(4) S home care rating requires four to six dependencies in ADLs and qualifies the person
for ten service units;

(5) T home care rating requires four to six dependencies in ADLs and Level I behavior
and qualifies the person for 11 service units;

(6) U home care rating requires four to six dependencies in ADLs and a complex
health-related need and qualifies the person for 14 service units;

(7) V home care rating requires seven to eight dependencies in ADLs and qualifies the
person for 17 service units;

(8) W home care rating requires seven to eight dependencies in ADLs and Level I
behavior and qualifies the person for 20 service units;

(9) Z home care rating requires seven to eight dependencies in ADLs and a complex
health-related need and qualifies the person for 30 service units; and

(10) EN home care rating includes ventilator dependency as defined in section 256B.0651,
subdivision 1 deleted text begin , paragraph (g) deleted text end . A person who meets the definition of ventilator-dependent
and the EN home care rating and utilize a combination of CFSS and home care nursing
services is limited to a total of 96 service units per day for those services in combination.
Additional units may be authorized when a person's assessment indicates a need for two
staff to perform activities. Additional time is limited to 16 service units per day.

(f) Additional service units are provided through the assessment and identification of
the following:

(1) 30 additional minutes per day for a dependency in each critical activity of daily
living;

(2) 30 additional minutes per day for each complex health-related need; and

(3) 30 additional minutes per day for each behavior under this clause that requires
assistance at least four times per week:

(i) level I behavior that requires the immediate response of another person;

(ii) increased vulnerability due to cognitive deficits or socially inappropriate behavior;
or

(iii) increased need for assistance for participants who are verbally aggressive or resistive
to care so that the time needed to perform activities of daily living is increased.

(g) The service budget for budget model participants shall be based on:

(1) assessed units as determined by the home care rating; and

(2) an adjustment needed for administrative expenses.

Sec. 10.

Minnesota Statutes 2022, section 256S.18, subdivision 1, is amended to read:

Subdivision 1.

Case mix classifications.

(a) The elderly waiver case mix classifications
A to K shall be the resident classes A to K established under Minnesota Rules, parts
9549.0058 and 9549.0059.

(b) A participant assigned to elderly waiver case mix classification A must be reassigned
to elderly waiver case mix classification L if an assessment or reassessment performed
under section 256B.0911 determines that the participant has:

(1) no dependencies in activities of daily living; or

(2) up to two dependencies in bathing, dressing, grooming, walking, or eating when the
dependency score in eating is three or greater.

(c) A participant must be assigned to elderly waiver case mix classification V if the
participant meets the definition of ventilator-dependent in section 256B.0651, subdivision
1 deleted text begin , paragraph (g) deleted text end .

Sec. 11.

Minnesota Statutes 2022, section 256S.2101, subdivision 2, is amended to read:

Subd. 2.

Phase-in for elderly waiver rates.

Except for deleted text begin home-delivered meals as
described in section 256S.215, subdivision 15 deleted text end new text begin the services in subdivisions 3 and 4 new text end , all rates
and rate components for elderly waiver, elderly waiver customized living, and elderly waiver
foster care under this chapter; alternative care under section 256B.0913; and essential
community supports under section 256B.0922 shall be the sum of 18.8 percent of the rates
calculated under sections 256S.211 to 256S.215, and 81.2 percent of the rates calculated
using the rate methodology in effect as of June 30, 2017. deleted text begin The rate for home-delivered meals
shall be the sum of the service rate in effect as of January 1, 2019, and the increases described
in section 256S.215, subdivision 15.
deleted text end

Sec. 12.

Minnesota Statutes 2022, section 256S.2101, is amended by adding a subdivision
to read:

new text begin Subd. 3. new text end

new text begin Phase-in for home-delivered meals rate. new text end

new text begin The home-delivered meals rate for
elderly waiver under this chapter, alternative care under section 256B.0913, and essential
community supports under section 256B.0922 must be the sum of the service rate in effect
as of January 1, 2019, and the increases described in section 256S.215, subdivision 15.
new text end

Sec. 13.

Minnesota Statutes 2022, section 256S.2101, is amended by adding a subdivision
to read:

new text begin Subd. 4. new text end

new text begin Service rates exempt from phase-in. new text end

new text begin Subdivision 2 does not apply to rates
for homemaker services described in section 256S.215, subdivisions 9 to 11.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024.
new text end

Sec. 14.

Minnesota Statutes 2022, section 256S.212, is amended by adding a subdivision
to read:

new text begin Subd. 1a. new text end

new text begin Updating base wages. new text end

new text begin (a) On January 1, 2024, and every two years thereafter,
the commissioner shall update the base wages for the services listed in paragraph (b) based
on the most recently available Bureau of Labor Statistics Minneapolis-St. Paul-Bloomington,
MN-WI MetroSA data.
new text end

new text begin (b) This subdivision applies to:
new text end

new text begin (1) the homemaker services and assistance with personal care base wage under subdivision
8;
new text end

new text begin (2) the homemaker services and cleaning base wage under subdivision 9;
new text end

new text begin (3) the homemaker services and home management base wage under subdivision 10;
and
new text end

new text begin (4) for the purposes of calculating the registered nurse management and supervision
factor used to calculate the homemaker services rates under section 256S.215, subdivisions
9 to 11, the registered nurse base wage under subdivision 14.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024.
new text end

Sec. 15. new text begin DIRECTION TO COMMISSIONER; CARE COORDINATION
EXPANSION.
new text end

new text begin Subdivision 1. new text end

new text begin Identifying billable care coordination activities. new text end

new text begin The commissioner of
human services must collaborate with interested stakeholders to identify new or existing
billable medical assistance services for care coordination activities for medical assistance
home care services. Care coordination activities may include:
new text end

new text begin (1) managing documentation requirements;
new text end

new text begin (2) supporting transitions in care;
new text end

new text begin (3) managing medication;
new text end

new text begin (4) facilitating and sequencing referrals for behavioral and medical health needs;
new text end

new text begin (5) making community referrals for patient and family education and support; and
new text end

new text begin (6) other administrative activities required to effectively meet a person's individualized
support needs.
new text end

new text begin Subd. 2. new text end

new text begin Providing guidance regarding existing billable care coordination
activities. new text end

new text begin No later than January 1, 2024, the commissioner must issue guidance to home
care providers regarding existing billable medical assistance services for care coordination
activities for medical assistance home care services.
new text end

new text begin Subd. 3. new text end

new text begin Reporting on potential billable care coordination activities. new text end

new text begin No later than
February 1, 2024, the commissioner must provide to the chairs and ranking minority members
of the legislative committees and divisions with jurisdiction over medical assistance home
care services a report summarizing any potentially billable medical assistance services for
care coordination activities for medical assistance home care services identified by the
commissioner and interested stakeholders under subdivision 1.
new text end