SF 1155

1st Engrossment - 86th Legislature (2009 - 2010) Posted on 02/09/2010 02:18am

A bill for an act
relating to human services; changing capacity requirements for certain residential
programs; requiring the commissioner to request federal waivers; amending
Minnesota Statutes 2008, sections 245A.11, subdivision 2a; 256B.092, by adding
a subdivision; 256B.49, subdivision 17; repealing Minnesota Statutes 2008,
section 256B.092, subdivision 5a.

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

Section 1.

Minnesota Statutes 2008, section 245A.11, subdivision 2a, is amended to
read:

Subd. 2a.

Adult foster care license capacity.

new text begin The commissioner shall issue adult
foster care licenses with a maximum licensed capacity of four beds, including nonstaff
roomers and boarders, except that the commissioner may issue a license with a capacity of
five beds, including roomers and boarders, according to paragraphs (a) to (e).
new text end

(a) An adult foster care license holder may have a maximum license capacity of five
if all persons in care are age 55 or over and do not have a serious and persistent mental
illness or a developmental disability.

(b) The commissioner may grant variances to paragraph (a) to allow a foster care
provider with a licensed capacity of five persons to admit an individual under the age of 55
if the variance complies with section 245A.04, subdivision 9, and approval of the variance
is recommended by the county in which the licensed foster care provider is located.

(c) The commissioner may grant variances to paragraph (a) to allow the use of a fifth
bed for emergency crisis services for a person with serious and persistent mental illness
or a developmental disability, regardless of age, if the variance complies with section
245A.04, subdivision 9, and approval of the variance is recommended by the county in
which the licensed foster care provider is located.

(d) deleted text begin Notwithstanding paragraph (a), deleted text end new text begin If the 2009 legislature adopts a rate reduction
that impacts providers of adult foster care services, new text end the commissioner may issue an adult
foster care license with a capacity of five adults new text begin if the fifth bed does not increase the
overall statewide capacity of licensed adult foster care beds in homes that are not the
primary residence of the license holder, over the licensed capacity in such homes on July
1, 2009, as identified in a plan submitted to the commissioner by the county, new text end when the
capacity is recommended by the county licensing agency of the county in which the
facility is located and if the recommendation verifies that:

(1) the facility meets the physical environment requirements in the adult foster
care licensing rule;

(2) the five-bed living arrangement is specified for each resident in the resident's:

(i) individualized plan of care;

(ii) individual service plan under section 256B.092, subdivision 1b, if required; or

(iii) individual resident placement agreement under Minnesota Rules, part
9555.5105, subpart 19, if required;

(3) the license holder obtains written and signed informed consent from each
resident or resident's legal representative documenting the resident's informed choice to
living in the home and that the resident's refusal to consent would not have resulted in
service termination; and

(4) the facility was licensed for adult foster care before March 1, deleted text begin 2003 deleted text end new text begin 2009 new text end .

(e) The commissioner shall not issue a new adult foster care license under paragraph
(d) after June 30, deleted text begin 2005 deleted text end new text begin 2011 new text end . The commissioner shall allow a facility with an adult foster
care license issued under paragraph (d) before June 30, deleted text begin 2005 deleted text end new text begin 2011 new text end , to continue with a
capacity of five adults if the license holder continues to comply with the requirements in
paragraph (d).

Sec. 2.

Minnesota Statutes 2008, section 256B.092, is amended by adding a
subdivision to read:

new text begin Subd. 5b. new text end

new text begin Revised per diem based on legislated rate reduction. new text end

new text begin Notwithstanding
section 252.28, subdivision 3, paragraph (d), if the 2009 legislature adopts a rate reduction
that impacts payment to providers of adult foster care services, the commissioner may
issue adult foster care licenses that permit a capacity of five adults. The application for a
five-bed license must meet the requirements of section 245A.11, subdivision 2a. Prior to
admission of the fifth recipient of adult foster care services, the county must negotiate a
revised per diem rate for room and board and waiver services that reflects the legislated
rate reduction and results in an overall average per diem reduction for all foster care
recipients in that home. The revised per diem must allow the provider to maintain, as
much as possible, the level of services or enhanced services provided in the residence,
while mitigating the losses of the legislated rate reduction.
new text end

Sec. 3.

Minnesota Statutes 2008, section 256B.49, subdivision 17, is amended to read:

Subd. 17.

Cost of services and supports.

(a) The commissioner shall ensure
that the average per capita expenditures estimated in any fiscal year for home and
community-based waiver recipients does not exceed the average per capita expenditures
that would have been made to provide institutional services for recipients in the absence
of the waiver.

(b) The commissioner shall implement on January 1, 2002, one or more aggregate,
need-based methods for allocating to local agencies the home and community-based
waivered service resources available to support recipients with disabilities in need of
the level of care provided in a nursing facility or a hospital. The commissioner shall
allocate resources to single counties and county partnerships in a manner that reflects
consideration of:

(1) an incentive-based payment process for achieving outcomes;

(2) the need for a state-level risk pool;

(3) the need for retention of management responsibility at the state agency level; and

(4) a phase-in strategy as appropriate.

(c) Until the allocation methods described in paragraph (b) are implemented, the
annual allowable reimbursement level of home and community-based waiver services
shall be the greater of:

(1) the statewide average payment amount which the recipient is assigned under the
waiver reimbursement system in place on June 30, 2001, modified by the percentage of
any provider rate increase appropriated for home and community-based services; or

(2) an amount approved by the commissioner based on the recipient's extraordinary
needs that cannot be met within the current allowable reimbursement level. The
increased reimbursement level must be necessary to allow the recipient to be discharged
from an institution or to prevent imminent placement in an institution. The additional
reimbursement may be used to secure environmental modifications; assistive technology
and equipment; and increased costs for supervision, training, and support services
necessary to address the recipient's extraordinary needs. The commissioner may approve
an increased reimbursement level for up to one year of the recipient's relocation from an
institution or up to six months of a determination that a current waiver recipient is at
imminent risk of being placed in an institution.

(d) Beginning July 1, 2001, medically necessary private duty nursing services will be
authorized under this section as complex and regular care according to sections 256B.0651
and 256B.0653 to 256B.0656. The rate established by the commissioner for registered
nurse or licensed practical nurse services under any home and community-based waiver as
of January 1, 2001, shall not be reduced.

new text begin (e) Notwithstanding section 252.28, subdivision 3, paragraph (d), if the 2009
legislature adopts a rate reduction that impacts payment to providers of adult foster care
services, the commissioner may issue adult foster care licenses that permit a capacity of
five adults. The application for a five-bed license must meet the requirements of section
245A.11, subdivision 2a. Prior to admission of the fifth recipient of adult foster care
services, the county must negotiate a revised per diem rate for room and board and waiver
services that reflects the legislated rate reduction and results in an overall average per
diem reduction for all foster care recipients in that home. The revised per diem must allow
the provider to maintain, as much as possible, the level of services or enhanced services
provided in the residence, while mitigating the losses of the legislated rate reduction.
new text end

Sec. 4. new text begin WAIVER.
new text end

new text begin By December 1, 2009, the commissioner shall request all federal approvals and
waiver amendments to the disability home and community-based waivers to allow properly
licensed adult foster care homes to provide residential services for up to five individuals.
new text end

Sec. 5. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2008, section 256B.092, subdivision 5a, new text end new text begin is repealed.
new text end

Sec. 6. new text begin EFFECTIVE DATE.
new text end

new text begin Sections 1 to 5 are effective July 1, 2009.
new text end