SF 1054

1st Engrossment - 85th Legislature (2007 - 2008) Posted on 12/15/2009 12:00am

A bill for an act
relating to human services; authorizing a medical assistance self-directed
supports option; expanding eligibility for Minnesota supplemental aid shelter
needy payments; authorizing licensure of nonresidential programs for youth with
disabilities; appropriating money; amending Minnesota Statutes 2006, sections
256B.0625, by adding a subdivision; 256D.44, subdivision 5; proposing coding
for new law in Minnesota Statutes, chapter 256B.

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

Section 1.

Minnesota Statutes 2006, section 256B.0625, is amended by adding a
subdivision to read:

new text begin Subd. 49. new text end

new text begin Self-directed personal services. new text end

new text begin Upon federal approval, medical
assistance covers the self-directed supports option as defined under section 256B.0657 and
section 6087 of the Federal Deficit Reduction Act of 2005, Public Law 109-171.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon federal approval of the state
Medicaid plan amendment. The commissioner of human services shall inform the Office
of the Revisor of Statutes when approval is obtained.
new text end

Sec. 2.

new text begin [256B.0657] SELF-DIRECTED SUPPORTS OPTION.
new text end

new text begin Subdivision 1. new text end

new text begin Definition. new text end

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

new text begin Subd. 2. new text end

new text begin Eligibility. new text end

new text begin (a) The self-directed supports option is available to a person
who:
new text end

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

new text begin (2) is eligible for personal care assistant services under section 256B.0655;
new text end

new text begin (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;
new text end

new text begin (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 or parent to carry them out, the guardian
or parent may fulfill these functions on behalf of the recipient; and
new text end

new text begin (5) has not been excluded or disenrolled by the commissioner.
new text end

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

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

new text begin (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.
new text end

new text begin Subd. 3. new text end

new text begin Eligibility for other services. new text end

new text begin 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, including home care
targeted case management, except that a person receiving home and community-based
waiver services, a family support grant or a consumer support grant is not eligible for
funding under the self-directed supports option.
new text end

new text begin Subd. 4. new text end

new text begin Assessment requirements. new text end

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

new text begin (1) it shall be conducted by the county public health nurse or a certified public
health nurse under contract with the county;
new text end

new text begin (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 need for personal care assistant services. 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
new text end

new text begin (3) it shall be completed using the format established by the commissioner.
new text end

new text begin (b) The results of the assessment and recommendations shall be communicated to
the commissioner and the recipient by the county public health nurse or certified public
health nurse under contract with the county.
new text end

new text begin Subd. 5. new text end

new text begin Self-directed supports option plan requirements. new text end

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

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

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

new text begin (ii) respects the recipient's preferences, choices, and abilities;
new text end

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

new text begin (iv) addresses the need for personal care assistant services identified in the recipient's
self-directed supports option assessment;
new text end

new text begin (2) the plan shall be developed by the recipient or by the guardian of an adult
recipient or by a parent or guardian of a minor child, with the assistance of an enrolled
medical assistance home care targeted case manager 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
new text end

new text begin (3) the plan must include the total budget amount available divided into monthly
amounts that cover the number of months of personal care assistant services authorization
included in the budget. The amount used each month may vary, but additional funds shall
not be provided above the annual personal care assistant services authorized amount
unless a change in condition is documented.
new text end

new text begin (b) The commissioner shall:
new text end

new text begin (1) establish the format and criteria for the plan as well as the requirements for
providers who assist with plan development;
new text end

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

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

new text begin (4) provide a copy of the plan to the fiscal support entity selected by the recipient.
new text end

new text begin Subd. 6. new text end

new text begin Services covered. new text end

new text begin (a) Services covered under the self-directed supports
option include:
new text end

new text begin (1) personal care assistant services under section 256B.0655; and
new text end

new text begin (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.
new text end

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

new text begin Subd. 7. new text end

new text begin Noncovered services. new text end

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

new text begin (1) services, goods, or supports that do not benefit the recipient;
new text end

new text begin (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;
new text end

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

new text begin (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;
new text end

new text begin (5) home modifications that add square footage;
new text end

new text begin (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;
new text end

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

new text begin (8) experimental treatment;
new text end

new text begin (9) any service or item 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;
new text end

new text begin (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;
new text end

new text begin (11) vacation expenses other than the cost of direct services;
new text end

new text begin (12) vehicle maintenance or modifications not related to the disability;
new text end

new text begin (13) tickets and related costs to attend sporting or other recreational events; and
new text end

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

new text begin Subd. 8. new text end

new text begin Self-directed budget requirements. new text end

new text begin The budget for the provision of the
self-directed service option shall be equal to the greater of either:
new text end

new text begin (1) the annual amount of personal care assistant services under section 256B.0655
that the recipient has used in the most recent 12-month period; or
new text end

new text begin (2) the amount determined using the consumer support grant methodology under
section 256.476, subdivision 11, except that the budget amount shall include the federal
and nonfederal share of the average service costs.
new text end

new text begin Subd. 9. new text end

new text begin Quality assurance and risk management. new text end

new text begin (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.
new text end

new text begin (b) The commissioner shall provide ongoing technical assistance and resource and
educational materials for families and recipients selecting the self-directed option.
new text end

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

new text begin Subd. 10. new text end

new text begin Fiscal support entity. new text end

new text begin (a) Each recipient 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. Recipients shall also choose
the payroll, agency with choice, or the fiscal conduit model of financial and service
management.
new text end

new text begin (b) The fiscal support entity:
new text end

new text begin (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;
new text end

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

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

new text begin (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;
new text end

new text begin (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
new text end

new text begin (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.
new text end

new text begin (c) The commissioner shall have authority to:
new text end

new text begin (1) set or negotiate rates with fiscal support entities;
new text end

new text begin (2) limit the number of fiscal support entities;
new text end

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

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

new text begin Subd. 11. new text end

new text begin Stakeholder consultation. new text end

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

new text begin (1) the self-directed plan format;
new text end

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

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

new text begin (4) standards and requirements, including rates for the personal support plan
development provider and the fiscal support entity; policies; training; and implementation.
The stakeholder group shall provide recommendations on the repeal of the personal care
assistant 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
consumer and self-directed services.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin Subdivisions 1 to 10 are effective upon federal approval of
the state Medicaid plan amendment. The commissioner of human services shall inform
the Office of the Revisor of Statutes when federal approval is obtained. Subdivision 11
is effective July 1, 2007.
new text end

Sec. 3.

Minnesota Statutes 2006, section 256D.44, subdivision 5, is amended to read:

Subd. 5.

Special needs.

In addition to the state standards of assistance established in
subdivisions 1 to 4, payments are allowed for the following special needs of recipients of
Minnesota supplemental aid who are not residents of a nursing home, a regional treatment
center, or a group residential housing facility.

(a) The county agency shall pay a monthly allowance for medically prescribed
diets if the cost of those additional dietary needs cannot be met through some other
maintenance benefit. The need for special diets or dietary items must be prescribed by
a licensed physician. Costs for special diets shall be determined as percentages of the
allotment for a one-person household under the thrifty food plan as defined by the United
States Department of Agriculture. The types of diets and the percentages of the thrifty
food plan that are covered are as follows:

(1) high protein diet, at least 80 grams daily, 25 percent of thrifty food plan;

(2) controlled protein diet, 40 to 60 grams and requires special products, 100 percent
of thrifty food plan;

(3) controlled protein diet, less than 40 grams and requires special products, 125
percent of thrifty food plan;

(4) low cholesterol diet, 25 percent of thrifty food plan;

(5) high residue diet, 20 percent of thrifty food plan;

(6) pregnancy and lactation diet, 35 percent of thrifty food plan;

(7) gluten-free diet, 25 percent of thrifty food plan;

(8) lactose-free diet, 25 percent of thrifty food plan;

(9) antidumping diet, 15 percent of thrifty food plan;

(10) hypoglycemic diet, 15 percent of thrifty food plan; or

(11) ketogenic diet, 25 percent of thrifty food plan.

(b) Payment for nonrecurring special needs must be allowed for necessary home
repairs or necessary repairs or replacement of household furniture and appliances using
the payment standard of the AFDC program in effect on July 16, 1996, for these expenses,
as long as other funding sources are not available.

(c) A fee for guardian or conservator service is allowed at a reasonable rate
negotiated by the county or approved by the court. This rate shall not exceed five percent
of the assistance unit's gross monthly income up to a maximum of $100 per month. If the
guardian or conservator is a member of the county agency staff, no fee is allowed.

(d) The county agency shall continue to pay a monthly allowance of $68 for
restaurant meals for a person who was receiving a restaurant meal allowance on June 1,
1990, and who eats two or more meals in a restaurant daily. The allowance must continue
until the person has not received Minnesota supplemental aid for one full calendar month
or until the person's living arrangement changes and the person no longer meets the criteria
for the restaurant meal allowance, whichever occurs first.

(e) A fee of ten percent of the recipient's gross income or $25, whichever is less,
is allowed for representative payee services provided by an agency that meets the
requirements under SSI regulations to charge a fee for representative payee services. This
special need is available to all recipients of Minnesota supplemental aid regardless of
their living arrangement.

(f) Notwithstanding the language in this subdivision, an amount equal to the
maximum allotment authorized by the federal Food Stamp Program for a single individual
which is in effect on the first day of deleted text begin January deleted text end new text begin July new text end of deleted text begin the previous deleted text end new text begin each new text end year will be added
to the standards of assistance established in subdivisions 1 to 4 for deleted text begin individuals deleted text end new text begin adults new text end
under the age of 65 who new text begin qualify as shelter needy and new text end are new text begin :
new text end

new text begin (1) new text end relocating from an institution, or an adult mental health residential treatment
program under section 256B.0622 deleted text begin , and who are shelter needy deleted text end new text begin ;
new text end

new text begin (2) self-directed supports option participants defined under section 256B.0657; or
new text end

new text begin (3) home and community-based waiver recipients living in their own rented, leased,
or owned apartment or home not owned, operated, or controlled by a provider of service
not related by blood or marriage.
new text end

new text begin Notwithstanding subdivision 3, paragraph (c), an individual eligible for the shelter needy
benefit under this paragraph is considered a household of one new text end . An eligible individual who
receives this benefit prior to age 65 may continue to receive the benefit after the age of 65.

new text begin (g) (1) Persons eligible for shelter needy funding under paragraph (f), who are not
receiving medical assistance home and community-based waiver services, are eligible for
a state-funded transitional supports allowance under section 256B.49, subdivision 16,
paragraph (e), to establish their own residence not owned, operated, or controlled by a
provider of service not related by blood or marriage.
new text end

new text begin (2) new text end "Shelter needy" means that the assistance unit incurs monthly shelter costs that
exceed 40 percent of the assistance unit's gross income before the application of this
special needs standard. "Gross income" for the purposes of this section is the applicant's or
recipient's income as defined in section 256D.35, subdivision 10, or the standard specified
in subdivision 3, whichever is greater. A recipient of a federal or state housing subsidy,
that limits shelter costs to a percentage of gross income, shall not be considered shelter
needy for purposes of this paragraph.

Sec. 4. new text begin LICENSURE; SERVICES FOR YOUTH WITH DISABILITIES.
new text end

new text begin (a) Notwithstanding the requirements of Minnesota Statutes, chapter 245A, upon the
recommendation of a county agency, the commissioner of human services shall grant a
license with any necessary variances to a nonresidential program for youth that provides
services to youth with disabilities under age 21 during nonschool hours established
to ensure health and safety, prevent out-of-home placement, and increase community
inclusion of youth with disabilities. The nonresidential youth program is subject to the
conditions of any variances granted and with consumer rights under Minnesota Statutes,
section 245B.04, consumer protection standards under Minnesota Statutes, section
245B.05, service standards under Minnesota Statutes, section 245B.06, management
standards under Minnesota Statutes, section 245B.07, and fire marshal inspections under
Minnesota Statutes, section 245A.151, until the commissioner develops other licensure
requirements for this type of program.
new text end

new text begin (b) By February 1, 2008, the commissioner shall recommend amendments to
licensure requirements in Minnesota Statutes, chapter 245A, to allow licensure of
appropriate services for school-age youth with disabilities under age 21 who need
supervision and services to develop skills necessary to maintain personal safety and
increase their independence, productivity, and participation in their communities during
nonschool hours. As part of developing the recommendations, the commissioner shall
survey county agencies to determine how the needs of youth with disabilities under age 21
who require supervision and support services are being met and the funding sources used.
The recommendations must be provided to the house and senate chairs of the committees
with jurisdiction over licensing of programs for youth with disabilities.
new text end

Sec. 5. new text begin APPROPRIATIONS.
new text end

new text begin (a) $....... is appropriated from the general fund to the commissioner of human
services to provide the nonfederal Medicaid match for the assessment, self-directed
supports option plan development, and other administrative costs related to implementing
and managing the self-directed supports option, including quality assurance measures.
Federal Medicaid match obtained for administrative activities for this option must be
dedicated to the commissioner for this purpose.
new text end

new text begin (b) $....... is appropriated from the general fund to the commissioner of human
services for shelter needy payments under section 3.
new text end