SF 1102

as introduced - 90th Legislature (2017 - 2018) Posted on 02/17/2017 09:16am

A bill for an act
relating to human services; modifying the community first services and supports
program; amending Minnesota Statutes 2016, section 256B.85, subdivisions 1, 2,
7.

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

Section 1.

Minnesota Statutes 2016, section 256B.85, subdivision 1, is amended to read:

Subdivision 1.

Basis and scope.

(a) Upon federal approval, the commissioner shall
establish a state plan option for the provision of home and community-based personal
assistance service and supports called "community first services and supports (CFSS)."

(b) CFSS is a participant-controlled method of selecting and providing services and
supports that allows the participant maximum control of the services and supports.
Participants may choose the degree to which they direct and manage their supports by
choosing to have a significant and meaningful role in the management of services and
supports including by directly employing support workers with the necessary supports to
perform that function.

(c) CFSS is available statewide to eligible people to assist with accomplishing activities
of daily living (ADLs), instrumental activities of daily living (IADLs), and health-related
procedures and tasks through hands-on assistance to accomplish the task or deleted text begin constant deleted text end
supervision and cueing to accomplish the task; and to assist with acquiring, maintaining,
and enhancing the skills necessary to accomplish ADLs, IADLs, and health-related
procedures and tasks. CFSS allows payment for certain supports and goods such as
environmental modifications and technology that are intended to replace or decrease the
need for human assistance.

(d) Upon federal approval, CFSS will replace the personal care assistance program under
sections 256.476, 256B.0625, subdivisions 19a and 19c, and 256B.0659.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon federal approval. The service will
begin 90 days after federal approval. The commissioner of human services shall notify the
revisor of statutes when federal approval is obtained.
new text end

Sec. 2.

Minnesota Statutes 2016, section 256B.85, subdivision 2, is amended to read:

Subd. 2.

Definitions.

(a) For the purposes of this section, the terms defined in this
subdivision have the meanings given.

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

(c) "Agency-provider model" means a method of CFSS under which a qualified agency
provides services and supports through the agency's own employees and policies. The agency
must allow the participant to have a significant role in the selection and dismissal of support
workers of their choice for the delivery of their specific services and supports.

(d) "Behavior" means a description of a need for services and supports used to determine
the home care rating and additional service units. The presence of Level I behavior is used
to determine the home care rating.

(e) "Budget model" means a service delivery method of CFSS that allows the use of a
service budget and assistance from a financial management services (FMS) provider for a
participant to directly employ support workers and purchase supports and goods.

(f) "Complex health-related needs" means an intervention listed in clauses (1) to (8) that
has been ordered by a physician, and is specified in a community services and support plan,
including:

(1) tube feedings requiring:

(i) a gastrojejunostomy tube; or

(ii) continuous tube feeding lasting longer than 12 hours per day;

(2) wounds described as:

(i) stage III or stage IV;

(ii) multiple wounds;

(iii) requiring sterile or clean dressing changes or a wound vac; or

(iv) open lesions such as burns, fistulas, tube sites, or ostomy sites that require specialized
care;

(3) parenteral therapy described as:

(i) IV therapy more than two times per week lasting longer than four hours for each
treatment; or

(ii) total parenteral nutrition (TPN) daily;

(4) respiratory interventions, including:

(i) oxygen required more than eight hours per day;

(ii) respiratory vest more than one time per day;

(iii) bronchial drainage treatments more than two times per day;

(iv) sterile or clean suctioning more than six times per day;

(v) dependence on another to apply respiratory ventilation augmentation devices such
as BiPAP and CPAP; and

(vi) ventilator dependence under section 256B.0651;

(5) insertion and maintenance of catheter, including:

(i) sterile catheter changes more than one time per month;

(ii) clean intermittent catheterization, and including self-catheterization more than six
times per day; or

(iii) bladder irrigations;

(6) bowel program more than two times per week requiring more than 30 minutes to
perform each time;

(7) neurological intervention, including:

(i) seizures more than two times per week and requiring significant physical assistance
to maintain safety; or

(ii) swallowing disorders diagnosed by a physician and requiring specialized assistance
from another on a daily basis; and

(8) other congenital or acquired diseases creating a need for significantly increased direct
hands-on assistance and interventions in six to eight activities of daily living.

(g) "Community first services and supports" or "CFSS" means the assistance and supports
program under this section needed for accomplishing activities of daily living, instrumental
activities of daily living, and health-related tasks through hands-on assistance to accomplish
the task or deleted text begin constant deleted text end supervision and cueing to accomplish the task, or the purchase of goods
as defined in subdivision 7, clause (3), that replace the need for human assistance.

(h) "Community first services and supports service delivery plan" or "CFSS service
delivery plan" means a written document detailing the services and supports chosen by the
participant to meet assessed needs that are within the approved CFSS service authorization,
as determined in subdivision 8. Services and supports are based on the coordinated service
and support plan identified in section 256B.0915, subdivision 6.

(i) "Consultation services" means a Minnesota health care program enrolled provider
organization that provides assistance to the participant in making informed choices about
CFSS services in general and self-directed tasks in particular, and in developing a
person-centered CFSS service delivery plan to achieve quality service outcomes.

(j) "Critical activities of daily living" means transferring, mobility, eating, and toileting.

(k) "Dependency" in activities of daily living means a person requires hands-on assistance
or deleted text begin constant deleted text end supervision and cueing to accomplish one or more of the activities of daily living
every day or on the days during the week that the activity is performed; however, a child
may not be found to be dependent in an activity of daily living if, because of the child's age,
an adult would either perform the activity for the child or assist the child with the activity
and the assistance needed is the assistance appropriate for a typical child of the same age.

(l) "Extended CFSS" means CFSS services and supports provided under CFSS that are
included in the CFSS service delivery plan through one of the home and community-based
services waivers and as approved and authorized under sections 256B.0915; 256B.092,
subdivision 5; and 256B.49, which exceed the amount, duration, and frequency of the state
plan CFSS services for participants.

(m) "Financial management services provider" or "FMS provider" means a qualified
organization required for participants using the budget model under subdivision 13 that is
an enrolled provider with the department to provide vendor fiscal/employer agent financial
management services (FMS).

(n) "Health-related procedures and tasks" means procedures and tasks related to the
specific assessed health needs of a participant that can be taught or assigned by a
state-licensed health care or mental health professional and performed by a support worker.

(o) "Instrumental activities of daily living" means activities related to living independently
in the community, including but not limited to: meal planning, preparation, and cooking;
shopping for food, clothing, or other essential items; laundry; housecleaning; assistance
with medications; managing finances; communicating needs and preferences during activities;
arranging supports; and assistance with traveling around and participating in the community.

(p) "Lead agency" has the meaning given in section 256B.0911, subdivision 1a, paragraph
(e).

(q) "Legal representative" means parent of a minor, a court-appointed guardian, or
another representative with legal authority to make decisions about services and supports
for the participant. Other representatives with legal authority to make decisions include but
are not limited to a health care agent or an attorney-in-fact authorized through a health care
directive or power of attorney.

(r) "Level I behavior" means physical aggression towards self or others or destruction
of property that requires the immediate response of another person.

(s) "Medication assistance" means providing verbal or visual reminders to take regularly
scheduled medication, and includes any of the following supports listed in clauses (1) to
(3) and other types of assistance, except that a support worker may not determine medication
dose or time for medication or inject medications into veins, muscles, or skin:

(1) under the direction of the participant or the participant's representative, bringing
medications to the participant including medications given through a nebulizer, opening a
container of previously set-up medications, emptying the container into the participant's
hand, opening and giving the medication in the original container to the participant, or
bringing to the participant liquids or food to accompany the medication;

(2) organizing medications as directed by the participant or the participant's representative;
and

(3) providing verbal or visual reminders to perform regularly scheduled medications.

(t) "Participant" means a person who is eligible for CFSS.

(u) "Participant's representative" means a parent, family member, advocate, or other
adult authorized by the participant or participant's legal representative, if any, to serve as a
representative in connection with the provision of CFSS. This authorization must be in
writing or by another method that clearly indicates the participant's free choice and may be
withdrawn at any time. The participant's representative must have no financial interest in
the provision of any services included in the participant's CFSS service delivery plan and
must be capable of providing the support necessary to assist the participant in the use of
CFSS. If through the assessment process described in subdivision 5 a participant is
determined to be in need of a participant's representative, one must be selected. If the
participant is unable to assist in the selection of a participant's representative, the legal
representative shall appoint one. Two persons may be designated as a participant's
representative for reasons such as divided households and court-ordered custodies. Duties
of a participant's representatives may include:

(1) being available while services are provided in a method agreed upon by the participant
or the participant's legal representative and documented in the participant's CFSS service
delivery plan;

(2) monitoring CFSS services to ensure the participant's CFSS service delivery plan is
being followed; and

(3) reviewing and signing CFSS time sheets after services are provided to provide
verification of the CFSS services.

(v) "Person-centered planning process" means a process that is directed by the participant
to plan for CFSS services and supports.

(w) "Service budget" means the authorized dollar amount used for the budget model or
for the purchase of goods.

(x) "Shared services" means the provision of CFSS services by the same CFSS support
worker to two or three participants who voluntarily enter into an agreement to receive
services at the same time and in the same setting by the same employer.

(y) "Support worker" means a qualified and trained employee of the agency-provider
as required by subdivision 11b or of the participant employer under the budget model as
required by subdivision 14 who has direct contact with the participant and provides services
as specified within the participant's CFSS service delivery plan.

(z) "Unit" means the increment of service based on hours or minutes identified in the
service agreement.

(aa) "Vendor fiscal employer agent" means an agency that provides financial management
services.

(bb) "Wages and benefits" means the hourly wages and salaries, the employer's share
of FICA taxes, Medicare taxes, state and federal unemployment taxes, workers' compensation,
mileage reimbursement, health and dental insurance, life insurance, disability insurance,
long-term care insurance, uniform allowance, contributions to employee retirement accounts,
or other forms of employee compensation and benefits.

(cc) "Worker training and development" means services provided according to subdivision
18a for developing workers' skills as required by the participant's individual CFSS service
delivery plan that are arranged for or provided by the agency-provider or purchased by the
participant employer. These services include training, education, direct observation and
supervision, and evaluation and coaching of job skills and tasks, including supervision of
health-related tasks or behavioral supports.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon federal approval. The service will
begin 90 days after federal approval. The commissioner of human services shall notify the
revisor of statutes when federal approval is obtained.
new text end

Sec. 3.

Minnesota Statutes 2016, section 256B.85, subdivision 7, is amended to read:

Subd. 7.

Community first services and supports; covered services.

Services and
supports covered under CFSS include:

(1) assistance to accomplish activities of daily living (ADLs), instrumental activities of
daily living (IADLs), and health-related procedures and tasks through hands-on assistance
to accomplish the task or deleted text begin constant deleted text end supervision and cueing to accomplish the task;

(2) assistance to acquire, maintain, or enhance the skills necessary for the participant to
accomplish activities of daily living, instrumental activities of daily living, or health-related
tasks;

(3) expenditures for items, services, supports, environmental modifications, or goods,
including assistive technology. These expenditures must:

(i) relate to a need identified in a participant's CFSS service delivery plan; and

(ii) increase independence or substitute for human assistance to the extent that
expenditures would otherwise be made for human assistance for the participant's assessed
needs;

(4) observation and redirection for behavior or symptoms where there is a need for
assistance;

(5) back-up systems or mechanisms, such as the use of pagers or other electronic devices,
to ensure continuity of the participant's services and supports;

(6) services provided by a consultation services provider as defined under subdivision
17, that is under contract with the department and enrolled as a Minnesota health care
program provider;

(7) services provided by an FMS provider as defined under subdivision 13a, that is an
enrolled provider with the department;

(8) CFSS services provided by a support worker who is a parent, stepparent, or legal
guardian of a participant under age 18, or who is the participant's spouse. These support
workers shall not provide any medical assistance home and community-based services in
excess of 40 hours per seven-day period regardless of the number of parents providing
services, combination of parents and spouses providing services, or number of children who
receive medical assistance services; and

(9) worker training and development services as described in subdivision 18a.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon federal approval. The service will
begin 90 days after federal approval. The commissioner of human services shall notify the
revisor of statutes when federal approval is obtained.
new text end