SF 1158

as introduced - 88th Legislature (2013 - 2014) Posted on 03/19/2013 08:51am

A bill for an act
relating to human services; modifying provisions related to continuing care;
redesigning home and community-based services; modifying provisions related
to nursing facility admission and maltreatment; establishing community first
services and supports; requiring a study; amending Minnesota Statutes 2012,
sections 144.0724, subdivision 4; 144A.351; 148E.065, subdivision 4a; 256.01,
subdivisions 2, 24; 256.975, subdivision 7, by adding subdivisions; 256.9754,
subdivision 5, by adding subdivisions; 256B.021, by adding subdivisions;
256B.0911, subdivisions 1, 1a, 3a, 4d, 7, by adding a subdivision; 256B.0913,
subdivision 4, by adding a subdivision; 256B.0915, subdivisions 3a, 5, by
adding a subdivision; 256B.0917, subdivisions 6, 13, by adding subdivisions;
256B.092, by adding a subdivision; 256B.439, subdivisions 1, 2, 3, 4, by adding
a subdivision; 256B.49, subdivisions 12, 14, by adding a subdivision; 256I.05, by
adding a subdivision; 626.557, subdivisions 4, 9, 9e; proposing coding for new
law in Minnesota Statutes, chapter 256B; repealing Minnesota Statutes 2012,
sections 245A.655; 256B.0911, subdivisions 4a, 4b, 4c; 256B.0917, subdivisions
1, 2, 3, 4, 5, 7, 8, 9, 10, 11, 12, 14.

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

Section 1.

Minnesota Statutes 2012, section 144.0724, subdivision 4, is amended to read:

Subd. 4.

Resident assessment schedule.

(a) A facility must conduct and
electronically submit to the commissioner of health case mix assessments that conform
with the assessment schedule defined by Code of Federal Regulations, title 42, section
483.20, and published by the United States Department of Health and Human Services,
Centers for Medicare and Medicaid Services, in the Long Term Care Assessment
Instrument User's Manual, version 3.0, and subsequent updates when issued by the
Centers for Medicare and Medicaid Services. The commissioner of health may substitute
successor manuals or question and answer documents published by the United States
Department of Health and Human Services, Centers for Medicare and Medicaid Services,
to replace or supplement the current version of the manual or document.

(b) The assessments used to determine a case mix classification for reimbursement
include the following:

(1) a new admission assessment must be completed by day 14 following admission;

(2) an annual assessment which must have an assessment reference date (ARD)
within 366 days of the ARD of the last comprehensive assessment;

(3) a significant change assessment must be completed within 14 days of the
identification of a significant change; and

(4) all quarterly assessments must have an assessment reference date (ARD) within
92 days of the ARD of the previous assessment.

(c) In addition to the assessments listed in paragraph (b), the assessments used to
determine nursing facility level of care include the following:

(1) preadmission screening completed under section deleted text begin 256B.0911, subdivision 4a, by a
county, tribe, or managed care organization under contract with the Department of Human
Services deleted text end new text begin 256.975, subdivision 7a, by the Senior LinkAge Line or Disability Linkage Line
or other organization under contract with the Minnesota Board on Aging new text end ; and

(2) new text begin a nursing facility level of care determination as provided for under section
256B.0911, subdivision 4e, as part of new text end a face-to-face long-term care consultation assessment
completed under section 256B.0911, subdivision 3a, 3b, or 4d, by a county, tribe, or
managed care organization under contract with the Department of Human Services.

Sec. 2.

Minnesota Statutes 2012, section 144A.351, is amended to read:

144A.351 BALANCING LONG-TERM CARE SERVICES AND SUPPORTS:
REPORT new text begin AND STUDY new text end REQUIRED.

new text begin Subdivision 1. new text end

new text begin Report requirements. new text end

The commissioners of health and human
services, with the cooperation of counties and in consultation with stakeholders, including
persons who need or are using long-term care services and supports, lead agencies,
regional entities, senior, disability, and mental health organization representatives, service
providers, and community members shall prepare a report to the legislature by August 15,
2013, and biennially thereafter, regarding the status of the full range of long-term care
services and supports for the elderly and children and adults with disabilities and mental
illnesses in Minnesota. The report shall address:

(1) demographics and need for long-term care services and supports in Minnesota;

(2) summary of county and regional reports on long-term care gaps, surpluses,
imbalances, and corrective action plans;

(3) status of long-term care services and related mental health services, housing
options, and supports by county and region including:

(i) changes in availability of the range of long-term care services and housing options;

(ii) access problems, including access to the least restrictive and most integrated
services and settings, regarding long-term care services; and

(iii) comparative measures of long-term care services availability, including serving
people in their home areas near family, and changes over time; and

(4) recommendations regarding goals for the future of long-term care services and
supports, policy and fiscal changes, and resource development and transition needs.

new text begin Subd. 2. new text end

new text begin Critical access study. new text end

new text begin The commissioner shall conduct a onetime study
to assess local capacity and availability of home and community-based services for
older adults and people with disabilities. The study must assess critical access at the
community level and identify potential strategies to build home and community-based
service capacity in critical access areas.
new text end

Sec. 3.

Minnesota Statutes 2012, section 148E.065, subdivision 4a, is amended to read:

Subd. 4a.

City, county, and state social workers.

(a) Beginning July 1, 2016, the
licensure of city, county, and state agency social workers is voluntary, except an individual
who is newly employed by a city or state agency after July 1, 2016, must be licensed
if the individual who provides social work services, as those services are defined in
section 148E.010, subdivision 11, paragraph (b), is presented to the public by any title
incorporating the words "social work" or "social worker."

(b) City, county, and state agencies employing social workers new text begin and staff who are
designated to perform mandated duties under sections 256.975, subdivisions 7 to 7c and
256.01, subdivision 24, new text end are not required to employ licensed social workers.

Sec. 4.

Minnesota Statutes 2012, section 256.01, subdivision 2, is amended to read:

Subd. 2.

Specific powers.

Subject to the provisions of section 241.021, subdivision
2, the commissioner of human services shall carry out the specific duties in paragraphs (a)
through deleted text begin (cc) deleted text end new text begin (dd) new text end :

(a) Administer and supervise all forms of public assistance provided for by state law
and other welfare activities or services as are vested in the commissioner. Administration
and supervision of human services activities or services includes, but is not limited to,
assuring timely and accurate distribution of benefits, completeness of service, and quality
program management. In addition to administering and supervising human services
activities vested by law in the department, the commissioner shall have the authority to:

(1) require county agency participation in training and technical assistance programs
to promote compliance with statutes, rules, federal laws, regulations, and policies
governing human services;

(2) monitor, on an ongoing basis, the performance of county agencies in the
operation and administration of human services, enforce compliance with statutes, rules,
federal laws, regulations, and policies governing welfare services and promote excellence
of administration and program operation;

(3) develop a quality control program or other monitoring program to review county
performance and accuracy of benefit determinations;

(4) require county agencies to make an adjustment to the public assistance benefits
issued to any individual consistent with federal law and regulation and state law and rule
and to issue or recover benefits as appropriate;

(5) delay or deny payment of all or part of the state and federal share of benefits and
administrative reimbursement according to the procedures set forth in section 256.017;

(6) make contracts with and grants to public and private agencies and organizations,
both profit and nonprofit, and individuals, using appropriated funds; and

(7) enter into contractual agreements with federally recognized Indian tribes with
a reservation in Minnesota to the extent necessary for the tribe to operate a federally
approved family assistance program or any other program under the supervision of the
commissioner. The commissioner shall consult with the affected county or counties in
the contractual agreement negotiations, if the county or counties wish to be included,
in order to avoid the duplication of county and tribal assistance program services. The
commissioner may establish necessary accounts for the purposes of receiving and
disbursing funds as necessary for the operation of the programs.

(b) Inform county agencies, on a timely basis, of changes in statute, rule, federal law,
regulation, and policy necessary to county agency administration of the programs.

(c) Administer and supervise all child welfare activities; promote the enforcement of
laws protecting disabled, dependent, neglected and delinquent children, and children born
to mothers who were not married to the children's fathers at the times of the conception
nor at the births of the children; license and supervise child-caring and child-placing
agencies and institutions; supervise the care of children in boarding and foster homes or
in private institutions; and generally perform all functions relating to the field of child
welfare now vested in the State Board of Control.

(d) Administer and supervise all noninstitutional service to disabled persons,
including those who are visually impaired, hearing impaired, or physically impaired
or otherwise disabled. The commissioner may provide and contract for the care and
treatment of qualified indigent children in facilities other than those located and available
at state hospitals when it is not feasible to provide the service in state hospitals.

(e) Assist and actively cooperate with other departments, agencies and institutions,
local, state, and federal, by performing services in conformity with the purposes of Laws
1939, chapter 431.

(f) Act as the agent of and cooperate with the federal government in matters of
mutual concern relative to and in conformity with the provisions of Laws 1939, chapter
431, including the administration of any federal funds granted to the state to aid in the
performance of any functions of the commissioner as specified in Laws 1939, chapter 431,
and including the promulgation of rules making uniformly available medical care benefits
to all recipients of public assistance, at such times as the federal government increases its
participation in assistance expenditures for medical care to recipients of public assistance,
the cost thereof to be borne in the same proportion as are grants of aid to said recipients.

(g) Establish and maintain any administrative units reasonably necessary for the
performance of administrative functions common to all divisions of the department.

(h) Act as designated guardian of both the estate and the person of all the wards of
the state of Minnesota, whether by operation of law or by an order of court, without any
further act or proceeding whatever, except as to persons committed as developmentally
disabled. For children under the guardianship of the commissioner or a tribe in Minnesota
recognized by the Secretary of the Interior whose interests would be best served by
adoptive placement, the commissioner may contract with a licensed child-placing agency
or a Minnesota tribal social services agency to provide adoption services. A contract
with a licensed child-placing agency must be designed to supplement existing county
efforts and may not replace existing county programs or tribal social services, unless the
replacement is agreed to by the county board and the appropriate exclusive bargaining
representative, tribal governing body, or the commissioner has evidence that child
placements of the county continue to be substantially below that of other counties. Funds
encumbered and obligated under an agreement for a specific child shall remain available
until the terms of the agreement are fulfilled or the agreement is terminated.

(i) Act as coordinating referral and informational center on requests for service for
newly arrived immigrants coming to Minnesota.

(j) The specific enumeration of powers and duties as hereinabove set forth shall in no
way be construed to be a limitation upon the general transfer of powers herein contained.

(k) Establish county, regional, or statewide schedules of maximum fees and charges
which may be paid by county agencies for medical, dental, surgical, hospital, nursing and
nursing home care and medicine and medical supplies under all programs of medical
care provided by the state and for congregate living care under the income maintenance
programs.

(l) Have the authority to conduct and administer experimental projects to test methods
and procedures of administering assistance and services to recipients or potential recipients
of public welfare. To carry out such experimental projects, it is further provided that the
commissioner of human services is authorized to waive the enforcement of existing specific
statutory program requirements, rules, and standards in one or more counties. The order
establishing the waiver shall provide alternative methods and procedures of administration,
shall not be in conflict with the basic purposes, coverage, or benefits provided by law, and
in no event shall the duration of a project exceed four years. It is further provided that no
order establishing an experimental project as authorized by the provisions of this section
shall become effective until the following conditions have been met:

(1) the secretary of health and human services of the United States has agreed, for
the same project, to waive state plan requirements relative to statewide uniformity; and

(2) a comprehensive plan, including estimated project costs, shall be approved by
the Legislative Advisory Commission and filed with the commissioner of administration.

(m) According to federal requirements, establish procedures to be followed by
local welfare boards in creating citizen advisory committees, including procedures for
selection of committee members.

(n) Allocate federal fiscal disallowances or sanctions which are based on quality
control error rates for the aid to families with dependent children program formerly
codified in sections 256.72 to 256.87, medical assistance, or food stamp program in the
following manner:

(1) one-half of the total amount of the disallowance shall be borne by the county
boards responsible for administering the programs. For the medical assistance and the
AFDC program formerly codified in sections 256.72 to 256.87, disallowances shall be
shared by each county board in the same proportion as that county's expenditures for the
sanctioned program are to the total of all counties' expenditures for the AFDC program
formerly codified in sections 256.72 to 256.87, and medical assistance programs. For the
food stamp program, sanctions shall be shared by each county board, with 50 percent of
the sanction being distributed to each county in the same proportion as that county's
administrative costs for food stamps are to the total of all food stamp administrative costs
for all counties, and 50 percent of the sanctions being distributed to each county in the
same proportion as that county's value of food stamp benefits issued are to the total of
all benefits issued for all counties. Each county shall pay its share of the disallowance
to the state of Minnesota. When a county fails to pay the amount due hereunder, the
commissioner may deduct the amount from reimbursement otherwise due the county, or
the attorney general, upon the request of the commissioner, may institute civil action
to recover the amount due; and

(2) notwithstanding the provisions of clause (1), if the disallowance results from
knowing noncompliance by one or more counties with a specific program instruction, and
that knowing noncompliance is a matter of official county board record, the commissioner
may require payment or recover from the county or counties, in the manner prescribed in
clause (1), an amount equal to the portion of the total disallowance which resulted from the
noncompliance, and may distribute the balance of the disallowance according to clause (1).

(o) Develop and implement special projects that maximize reimbursements and
result in the recovery of money to the state. For the purpose of recovering state money,
the commissioner may enter into contracts with third parties. Any recoveries that result
from projects or contracts entered into under this paragraph shall be deposited in the
state treasury and credited to a special account until the balance in the account reaches
$1,000,000. When the balance in the account exceeds $1,000,000, the excess shall be
transferred and credited to the general fund. All money in the account is appropriated to
the commissioner for the purposes of this paragraph.

(p) Have the authority to make direct payments to facilities providing shelter
to women and their children according to section 256D.05, subdivision 3. Upon
the written request of a shelter facility that has been denied payments under section
256D.05, subdivision 3, the commissioner shall review all relevant evidence and make
a determination within 30 days of the request for review regarding issuance of direct
payments to the shelter facility. Failure to act within 30 days shall be considered a
determination not to issue direct payments.

(q) Have the authority to establish and enforce the following county reporting
requirements:

(1) the commissioner shall establish fiscal and statistical reporting requirements
necessary to account for the expenditure of funds allocated to counties for human
services programs. When establishing financial and statistical reporting requirements, the
commissioner shall evaluate all reports, in consultation with the counties, to determine if
the reports can be simplified or the number of reports can be reduced;

(2) the county board shall submit monthly or quarterly reports to the department
as required by the commissioner. Monthly reports are due no later than 15 working days
after the end of the month. Quarterly reports are due no later than 30 calendar days after
the end of the quarter, unless the commissioner determines that the deadline must be
shortened to 20 calendar days to avoid jeopardizing compliance with federal deadlines
or risking a loss of federal funding. Only reports that are complete, legible, and in the
required format shall be accepted by the commissioner;

(3) if the required reports are not received by the deadlines established in clause (2),
the commissioner may delay payments and withhold funds from the county board until
the next reporting period. When the report is needed to account for the use of federal
funds and the late report results in a reduction in federal funding, the commissioner shall
withhold from the county boards with late reports an amount equal to the reduction in
federal funding until full federal funding is received;

(4) a county board that submits reports that are late, illegible, incomplete, or not
in the required format for two out of three consecutive reporting periods is considered
noncompliant. When a county board is found to be noncompliant, the commissioner
shall notify the county board of the reason the county board is considered noncompliant
and request that the county board develop a corrective action plan stating how the
county board plans to correct the problem. The corrective action plan must be submitted
to the commissioner within 45 days after the date the county board received notice
of noncompliance;

(5) the final deadline for fiscal reports or amendments to fiscal reports is one year
after the date the report was originally due. If the commissioner does not receive a report
by the final deadline, the county board forfeits the funding associated with the report for
that reporting period and the county board must repay any funds associated with the
report received for that reporting period;

(6) the commissioner may not delay payments, withhold funds, or require repayment
under clause (3) or (5) if the county demonstrates that the commissioner failed to
provide appropriate forms, guidelines, and technical assistance to enable the county to
comply with the requirements. If the county board disagrees with an action taken by the
commissioner under clause (3) or (5), the county board may appeal the action according
to sections 14.57 to 14.69; and

(7) counties subject to withholding of funds under clause (3) or forfeiture or
repayment of funds under clause (5) shall not reduce or withhold benefits or services to
clients to cover costs incurred due to actions taken by the commissioner under clause
(3) or (5).

(r) Allocate federal fiscal disallowances or sanctions for audit exceptions when
federal fiscal disallowances or sanctions are based on a statewide random sample in direct
proportion to each county's claim for that period.

(s) Be responsible for ensuring the detection, prevention, investigation, and
resolution of fraudulent activities or behavior by applicants, recipients, and other
participants in the human services programs administered by the department.

(t) Require county agencies to identify overpayments, establish claims, and utilize
all available and cost-beneficial methodologies to collect and recover these overpayments
in the human services programs administered by the department.

(u) Have the authority to administer a drug rebate program for drugs purchased
pursuant to the prescription drug program established under section 256.955 after the
beneficiary's satisfaction of any deductible established in the program. The commissioner
shall require a rebate agreement from all manufacturers of covered drugs as defined in
section 256B.0625, subdivision 13. Rebate agreements for prescription drugs delivered on
or after July 1, 2002, must include rebates for individuals covered under the prescription
drug program who are under 65 years of age. For each drug, the amount of the rebate shall
be equal to the rebate as defined for purposes of the federal rebate program in United
States Code, title 42, section 1396r-8. The manufacturers must provide full payment
within 30 days of receipt of the state invoice for the rebate within the terms and conditions
used for the federal rebate program established pursuant to section 1927 of title XIX of
the Social Security Act. The manufacturers must provide the commissioner with any
information necessary to verify the rebate determined per drug. The rebate program shall
utilize the terms and conditions used for the federal rebate program established pursuant to
section 1927 of title XIX of the Social Security Act.

(v) Have the authority to administer the federal drug rebate program for drugs
purchased under the medical assistance program as allowed by section 1927 of title XIX
of the Social Security Act and according to the terms and conditions of section 1927.
Rebates shall be collected for all drugs that have been dispensed or administered in an
outpatient setting and that are from manufacturers who have signed a rebate agreement
with the United States Department of Health and Human Services.

(w) Have the authority to administer a supplemental drug rebate program for drugs
purchased under the medical assistance program. The commissioner may enter into
supplemental rebate contracts with pharmaceutical manufacturers and may require prior
authorization for drugs that are from manufacturers that have not signed a supplemental
rebate contract. Prior authorization of drugs shall be subject to the provisions of section
256B.0625, subdivision 13.

(x) Operate the department's communication systems account established in Laws
1993, First Special Session chapter 1, article 1, section 2, subdivision 2, to manage shared
communication costs necessary for the operation of the programs the commissioner
supervises. A communications account may also be established for each regional
treatment center which operates communications systems. Each account must be used
to manage shared communication costs necessary for the operations of the programs the
commissioner supervises. The commissioner may distribute the costs of operating and
maintaining communication systems to participants in a manner that reflects actual usage.
Costs may include acquisition, licensing, insurance, maintenance, repair, staff time and
other costs as determined by the commissioner. Nonprofit organizations and state, county,
and local government agencies involved in the operation of programs the commissioner
supervises may participate in the use of the department's communications technology and
share in the cost of operation. The commissioner may accept on behalf of the state any
gift, bequest, devise or personal property of any kind, or money tendered to the state for
any lawful purpose pertaining to the communication activities of the department. Any
money received for this purpose must be deposited in the department's communication
systems accounts. Money collected by the commissioner for the use of communication
systems must be deposited in the state communication systems account and is appropriated
to the commissioner for purposes of this section.

(y) Receive any federal matching money that is made available through the medical
assistance program for the consumer satisfaction survey. Any federal money received for
the survey is appropriated to the commissioner for this purpose. The commissioner may
expend the federal money received for the consumer satisfaction survey in either year of
the biennium.

(z) Designate community information and referral call centers and incorporate
cost reimbursement claims from the designated community information and referral
call centers into the federal cost reimbursement claiming processes of the department
according to federal law, rule, and regulations. Existing information and referral centers
provided by Greater Twin Cities United Way or existing call centers for which Greater
Twin Cities United Way has legal authority to represent, shall be included in these
designations upon review by the commissioner and assurance that these services are
accredited and in compliance with national standards. Any reimbursement is appropriated
to the commissioner and all designated information and referral centers shall receive
payments according to normal department schedules established by the commissioner
upon final approval of allocation methodologies from the United States Department of
Health and Human Services Division of Cost Allocation or other appropriate authorities.

(aa) Develop recommended standards for foster care homes that address the
components of specialized therapeutic services to be provided by foster care homes with
those services.

(bb) Authorize the method of payment to or from the department as part of the
human services programs administered by the department. This authorization includes the
receipt or disbursement of funds held by the department in a fiduciary capacity as part of
the human services programs administered by the department.

(cc) Have the authority to administer a drug rebate program for drugs purchased for
persons eligible for general assistance medical care under section 256D.03, subdivision 3.
For manufacturers that agree to participate in the general assistance medical care rebate
program, the commissioner shall enter into a rebate agreement for covered drugs as
defined in section 256B.0625, subdivisions 13 and 13d. For each drug, the amount of the
rebate shall be equal to the rebate as defined for purposes of the federal rebate program in
United States Code, title 42, section 1396r-8. The manufacturers must provide payment
within the terms and conditions used for the federal rebate program established under
section 1927 of title XIX of the Social Security Act. The rebate program shall utilize
the terms and conditions used for the federal rebate program established under section
1927 of title XIX of the Social Security Act.

Effective January 1, 2006, drug coverage under general assistance medical care shall
be limited to those prescription drugs that:

(1) are covered under the medical assistance program as described in section
256B.0625, subdivisions 13 and 13d; and

(2) are provided by manufacturers that have fully executed general assistance
medical care rebate agreements with the commissioner and comply with such agreements.
Prescription drug coverage under general assistance medical care shall conform to
coverage under the medical assistance program according to section 256B.0625,
subdivisions 13 to 13g.

The rebate revenues collected under the drug rebate program are deposited in the
general fund.

new text begin (dd) Designate the agencies that operate the Senior LinkAge Line under section
256.975, subdivision 7, and the Disability Linkage Line under subdivision 24 as the state
of Minnesota Aging and the Disability Resource Centers under United States Code, title
42, section 3001, the Older Americans Act Amendments of 2006 and incorporate cost
reimbursement claims from the designated centers into the federal cost reimbursement
claiming processes of the department according to federal law, rule, and regulations. Any
reimbursement must be appropriated to the commissioner and all Aging and Disability
Resource Center designated agencies shall receive payments of grant funding that supports
the activity and generates the federal financial participation according to Board on Aging
administrative granting mechanisms.
new text end

Sec. 5.

Minnesota Statutes 2012, section 256.01, subdivision 24, is amended to read:

Subd. 24.

Disability Linkage Line.

The commissioner shall establish the Disability
Linkage Line, deleted text begin to deleted text end new text begin who shall serve people with disabilities as the designated Aging and
Disability Resource Center under United States Code, title 42, section 3001, the Older
Americans Act Amendments of 2006 in partnership with the Senior LinkAge Line and
shall new text end serve as Minnesota's neutral access point for statewide disability information and
assistance new text begin and must be available during business hours through a statewide toll-free
number and the internet new text end . The Disability Linkage Line shall:

(1) deliver information and assistance based on national and state standards;

(2) provide information about state and federal eligibility requirements, benefits,
and service options;

(3) provide benefits and options counseling;

(4) make referrals to appropriate support entities;

(5) educate people on their options so they can make well-informed choices new text begin and link
them to quality profiles new text end ;

(6) help support the timely resolution of service access and benefit issues;

(7) inform people of their long-term community services and supports;

(8) provide necessary resources and supports that can lead to employment and
increased economic stability of people with disabilities; deleted text begin and
deleted text end

(9) serve as the technical assistance and help center for the Web-based tool,
Minnesota's Disability Benefits 101.org deleted text begin . deleted text end new text begin ; and
new text end

new text begin (10) provide preadmission screening for individuals under 60 years of age who are
admitted to a nursing facility from a hospital using the procedures as defined in section
256.975, subdivisions 7a to 7c, and 256B.0911, subdivision 4d.
new text end

Sec. 6.

Minnesota Statutes 2012, section 256.975, subdivision 7, is amended to read:

Subd. 7.

Consumer information and assistance and long-term care options
counseling; Senior LinkAge Line.

(a) The Minnesota Board on Aging shall operate a
statewide service to aid older Minnesotans and their families in making informed choices
about long-term care options and health care benefits. Language services to persons
with limited English language skills may be made available. The service, known as
Senior LinkAge Line, new text begin shall serve older adults as the designated Aging and Disability
Resource Center under United States Code, title 42, section 3001, the Older Americans
Act Amendments of 2006 in partnership with the Disability LinkAge Line under section
256.01, subdivision 24, and new text end must be available during business hours through a statewide
toll-free number and deleted text begin must also be available through deleted text end the Internet. new text begin The Minnesota Board
on Aging shall consult with, and when appropriate work through, the area agencies on
aging to provide and maintain the telephony infrastructure and related support for the
Aging and Disability Resource Center partners which agree by memorandum to access
the infrastructure, including the designated providers of the Senior LinkAge Line and the
Disability Linkage Line.
new text end

(b) The service must provide long-term care options counseling by assisting older
adults, caregivers, and providers in accessing information and options counseling about
choices in long-term care services that are purchased through private providers or available
through public options. The service must:

(1) develop a comprehensive database that includes detailed listings in both
consumer- and provider-oriented formats;

(2) make the database accessible on the Internet and through other telecommunication
and media-related tools;

(3) link callers to interactive long-term care screening tools and make these tools
available through the Internet by integrating the tools with the database;

(4) develop community education materials with a focus on planning for long-term
care and evaluating independent living, housing, and service options;

(5) conduct an outreach campaign to assist older adults and their caregivers in
finding information on the Internet and through other means of communication;

(6) implement a messaging system for overflow callers and respond to these callers
by the next business day;

(7) link callers with county human services and other providers to receive more
in-depth assistance and consultation related to long-term care options;

(8) link callers with quality profiles for nursing facilities and other new text begin home and
community-based services new text end providers developed by the deleted text begin commissioner deleted text end new text begin commissioners new text end of
health new text begin and human services new text end ;

(9) incorporate information about the availability of housing options, as well as
registered housing with services and consumer rights within the MinnesotaHelp.info
network long-term care database to facilitate consumer comparison of services and costs
among housing with services establishments and with other in-home services and to
support financial self-sufficiency as long as possible. Housing with services establishments
and their arranged home care providers shall provide information that will facilitate price
comparisons, including delineation of charges for rent and for services available. The
commissioners of health and human services shall align the data elements required by
section 144G.06, the Uniform Consumer Information Guide, and this section to provide
consumers standardized information and ease of comparison of long-term care options.
The commissioner of human services shall provide the data to the Minnesota Board on
Aging for inclusion in the MinnesotaHelp.info network long-term care database;

(10) provide long-term care options counseling. Long-term care options counselors
shall:

(i) for individuals not eligible for case management under a public program or public
funding source, provide interactive decision support under which consumers, family
members, or other helpers are supported in their deliberations to determine appropriate
long-term care choices in the context of the consumer's needs, preferences, values, and
individual circumstances, including implementing a community support plan;

(ii) provide Web-based educational information and collateral written materials to
familiarize consumers, family members, or other helpers with the long-term care basics,
issues to be considered, and the range of options available in the community;

(iii) provide long-term care futures planning, which means providing assistance to
individuals who anticipate having long-term care needs to develop a plan for the more
distant future; and

(iv) provide expertise in benefits and financing options for long-term care, including
Medicare, long-term care insurance, tax or employer-based incentives, reverse mortgages,
private pay options, and ways to access low or no-cost services or benefits through
volunteer-based or charitable programs;

(11) using risk management and support planning protocols, provide long-term care
options counseling to current residents of nursing homes deemed appropriate for discharge
by the commissioner new text begin and older adults who request service after consultation with the
Senior LinkAge Line under clause (12) new text end . deleted text begin In order to meet this requirement, deleted text end new text begin The Senior
LinkAge Line shall also receive referrals from the residents or staff of nursing homes. The
Senior LinkAge Line shall identify and contact residents deemed appropriate for discharge
by developing targeting criteria in consultation with new text end the commissioner new text begin who new text end shall provide
designated Senior LinkAge Line contact centers with a list of nursing home residents new text begin that
meet the criteria as being new text end appropriate for discharge planning via a secure Web portal.
Senior LinkAge Line shall provide these residents, if they indicate a preference to
receive long-term care options counseling, with initial assessment deleted text begin , review of risk factors,
independent living support consultation, or deleted text end new text begin and, if appropriate, a new text end referral to:

(i) long-term care consultation services under section 256B.0911;

(ii) designated care coordinators of contracted entities under section 256B.035 for
persons who are enrolled in a managed care plan; or

(iii) the long-term care consultation team for those who are deleted text begin appropriate deleted text end new text begin eligible
new text end for relocation service coordination due to high-risk factors or psychological or physical
disability; and

(12) develop referral protocols and processes that will assist certified health care
homes and hospitals to identify at-risk older adults and determine when to refer these
individuals to the Senior LinkAge Line for long-term care options counseling under this
section. The commissioner is directed to work with the commissioner of health to develop
protocols that would comply with the health care home designation criteria and protocols
available at the time of hospital discharge. The commissioner shall keep a record of the
number of people who choose long-term care options counseling as a result of this section.

Sec. 7.

Minnesota Statutes 2012, section 256.975, is amended by adding a subdivision
to read:

new text begin Subd. 7a. new text end

new text begin Preadmission screening activities related to nursing facility
admissions. new text end

new text begin (a) All individuals seeking admission to Medicaid certified nursing facilities,
including certified boarding care facilities, must be screened prior to admission regardless
of income, assets, or funding sources for nursing facility care, except as described in
subdivision 7b, paragraphs (a) and (b). The purpose of the screening is to determine the
need for nursing facility level of care as described in section 256B.0911, subdivision
4e, and to complete activities required under federal law related to mental illness and
developmental disability as outlined in paragraph (b).
new text end

new text begin (b) A person who has a diagnosis or possible diagnosis of mental illness or
developmental disability must receive a preadmission screening before admission
regardless of the exemptions outlined in subdivision 7b, paragraphs (a) and (b), to identify
the need for further evaluation and specialized services, unless the admission prior to
screening is authorized by the local mental health authority or the local developmental
disabilities case manager, or unless authorized by the county agency according to Public
Law 101-508.
new text end

new text begin (c) The following criteria apply to the preadmission screening:
new text end

new text begin (1) requests for preadmission screenings must be submitted via an online form
developed by the commissioner;
new text end

new text begin (2) the Senior LinkAge Line must use forms and criteria developed by the
commissioner to identify persons who require referral for further evaluation and
determination of the need for specialized services; and
new text end

new text begin (3) the evaluation and determination of the need for specialized services must be
done by:
new text end

new text begin (i) a qualified independent mental health professional, for persons with a primary or
secondary diagnosis of a serious mental illness; or
new text end

new text begin (ii) a qualified developmental disability professional, for persons with a primary or
secondary diagnosis of developmental disability. For purposes of this requirement, a
qualified developmental disability professional must meet the standards for a qualified
developmental disability professional under Code of Federal Regulations, title 42, section
483.430.
new text end

new text begin (d) The local county mental health authority or the state developmental disability
authority under Public Law Numbers 100-203 and 101-508 may prohibit admission to a
nursing facility if the individual does not meet the nursing facility level of care criteria or
needs specialized services as defined in Public Law Numbers 100-203 and 101-508. For
purposes of this section, "specialized services" for a person with developmental disability
means active treatment as that term is defined under Code of Federal Regulations, title
42, section 483.440(a)(1).
new text end

new text begin (e) In assessing a person's needs, the screener shall:
new text end

new text begin (1) use an automated system designated by the commissioner;
new text end

new text begin (2) consult with care transitions coordinators or physician; and
new text end

new text begin (3) consider the assessment of the individual's physician.
new text end

new text begin Other personnel may be included in the level of care determination as deemed
necessary by the screener.
new text end

Sec. 8.

Minnesota Statutes 2012, section 256.975, is amended by adding a subdivision
to read:

new text begin Subd. 7b. new text end

new text begin Exemptions and emergency admissions. new text end

new text begin (a) Exemptions from the federal
screening requirements outlined in subdivision 7a, paragraphs (b) and (c), are limited to:
new text end

new text begin (1) a person who, having entered an acute care facility from a certified nursing
facility, is returning to a certified nursing facility; or
new text end

new text begin (2) a person transferring from one certified nursing facility in Minnesota to another
certified nursing facility in Minnesota.
new text end

new text begin (b) Persons who are exempt from preadmission screening for purposes of level of
care determination include:
new text end

new text begin (1) persons described in paragraph (a);
new text end

new text begin (2) an individual who has a contractual right to have nursing facility care paid for
indefinitely by the Veterans' Administration;
new text end

new text begin (3) an individual enrolled in a demonstration project under section 256B.69,
subdivision 8, at the time of application to a nursing facility; and
new text end

new text begin (4) an individual currently being served under the alternative care program or under
a home and community-based services waiver authorized under section 1915(c) of the
federal Social Security Act.
new text end

new text begin (c) Persons admitted to a Medicaid-certified nursing facility from the community
on an emergency basis as described in paragraph (d) or from an acute care facility on a
nonworking day must be screened the first working day after admission.
new text end

new text begin (d) Emergency admission to a nursing facility prior to screening is permitted when
all of the following conditions are met:
new text end

new text begin (1) a person is admitted from the community to a certified nursing or certified
boarding care facility during Senior LinkAge Line nonworking hours for ages 60 and
older and Disability Linkage Line nonworking hours for under age 60;
new text end

new text begin (2) a physician has determined that delaying admission until preadmission screening
is completed would adversely affect the person's health and safety;
new text end

new text begin (3) there is a recent precipitating event that precludes the client from living safely in
the community, such as sustaining an injury, sudden onset of acute illness, or a caregiver's
inability to continue to provide care;
new text end

new text begin (4) the attending physician has authorized the emergency placement and has
documented the reason that the emergency placement is recommended; and
new text end

new text begin (5) the Senior LinkAge Line or Disability Linkage Line is contacted on the first
working day following the emergency admission.
new text end

new text begin Transfer of a patient from an acute care hospital to a nursing facility is not considered
an emergency except for a person who has received hospital services in the following
situations: hospital admission for observation, care in an emergency room without hospital
admission, or following hospital 24-hour bed care and from whom admission is being
sought on a nonworking day.
new text end

new text begin (e) A nursing facility must provide written information to all persons admitted
regarding the person's right to request and receive long-term care consultation services as
defined in section 256B.0911, subdivision 1a. The information must be provided prior to
the person's discharge from the facility and in a format specified by the commissioner.
new text end

Sec. 9.

Minnesota Statutes 2012, section 256.975, is amended by adding a subdivision
to read:

new text begin Subd. 7c. new text end

new text begin Screening requirements. new text end

new text begin (a) A person may be screened for nursing
facility admission by telephone or in a face-to-face screening interview. The Senior
LinkAge Line shall identify each individual's needs using the following categories:
new text end

new text begin (1) the person needs no face-to-face long-term care consultation assessment
completed under section 256B.0911, subdivision 3a, 3b, or 4d, by a county, tribe, or
managed care organization under contract with the Department of Human Services to
determine the need for nursing facility level of care based on information obtained from
other health care professionals;
new text end

new text begin (2) the person needs an immediate face-to-face long-term care consultation
assessment completed under section 256B.0911, subdivision 3a, 3b, or 4d, by a county,
tribe, or managed care organization under contract with the Department of Human
Services to determine the need for nursing facility level of care and complete activities
required under subdivision 7a; or
new text end

new text begin (3) the person may be exempt from screening requirements as outlined in subdivision
7b, but will need transitional assistance after admission or in-person follow-along after
a return home.
new text end

new text begin (b) Individuals between the ages of 60 and 64 who are admitted to nursing facilities
with only a telephone screening must receive a face-to-face assessment from the long-term
care consultation team member of the county in which the facility is located or from the
recipient's county case manager within 40 calendar days of admission as described in
section 256B.0911, subdivision 4d, paragraph (c).
new text end

new text begin (c) Persons admitted on a nonemergency basis to a Medicaid-certified nursing
facility must be screened prior to admission.
new text end

new text begin (d) Screenings provided by the Senior LinkAge Line must include processes
to identify persons who may require transition assistance described in subdivision 7,
paragraph (b), clause (12), and section 256B.0911, subdivision 3b.
new text end

Sec. 10.

Minnesota Statutes 2012, section 256.975, is amended by adding a subdivision
to read:

new text begin Subd. 7d. new text end

new text begin Payment for preadmission screening. new text end

new text begin Funding for preadmission
screening shall be provided to the Minnesota Board on Aging for the population 60
years of age and older by the Department of Human Services to cover screener salaries
and expenses to provide the services described in subdivisions 7a to 7c. The Minnesota
Board on Aging shall employ, or contract with other agencies to employ, within the limits
of available funding, sufficient personnel to provide preadmission screening and level of
care determination services and shall seek to maximize federal funding for the service as
provided under section 256.01, subdivision 2, paragraph (dd).
new text end

Sec. 11.

Minnesota Statutes 2012, section 256.9754, is amended by adding a
subdivision to read:

new text begin Subd. 3a. new text end

new text begin Priority for other grants. new text end

new text begin The commissioner of health shall give
priority to a grantee selected under subdivision 3 when awarding technology-related
grants, if the grantee is using technology as a part of a proposal. The commissioner
of transportation shall give priority to a grantee selected under subdivision 3 when
distributing transportation-related funds to create transportation options for older adults.
new text end

Sec. 12.

Minnesota Statutes 2012, section 256.9754, is amended by adding a
subdivision to read:

new text begin Subd. 3b. new text end

new text begin State waivers. new text end

new text begin The commissioner of health may waive applicable state
laws and rules on a time-limited basis if the commissioner of health determines that a
participating grantee requires a waiver in order to achieve demonstration project goals.
new text end

Sec. 13.

Minnesota Statutes 2012, section 256.9754, subdivision 5, is amended to read:

Subd. 5.

Grant preference.

The commissioner of human services shall give
preference when awarding grants under this section to areas where nursing facility
closures have occurred or are occurring new text begin or areas with service needs identified by section
144A.351 new text end . The commissioner may award grants to the extent grant funds are available
and to the extent applications are approved by the commissioner. Denial of approval of an
application in one year does not preclude submission of an application in a subsequent
year. The maximum grant amount is limited to $750,000.

Sec. 14.

Minnesota Statutes 2012, section 256B.021, is amended by adding a
subdivision to read:

new text begin Subd. 4a. new text end

new text begin Evaluation. new text end

new text begin The commissioner shall evaluate the projects contained in
subdivision 4, paragraphs (f), clauses (2) and (12), and (h). The evaluation must include:
new text end

new text begin (1) an impact assessment focusing on program outcomes, especially those
experienced directly by the person receiving services;
new text end

new text begin (2) study samples drawn from the population of interest for each project; and
new text end

new text begin (3) a time series analysis to examine aggregate trends in average monthly
utilization, expenditures, and other outcomes in the targeted populations before and after
implementation of the initiatives.
new text end

Sec. 15.

Minnesota Statutes 2012, section 256B.021, is amended by adding a
subdivision to read:

new text begin Subd. 6. new text end

new text begin Work, empower, and encourage independence. new text end

new text begin As provided under
subdivision 4, paragraph (e), upon federal approval, the commissioner shall establish a
demonstration project to provide navigation, employment supports, and benefits planning
services to a targeted group of federally funded Medicaid recipients to begin July 1, 2014.
This demonstration shall promote economic stability, increase independence, and reduce
applications for disability benefits while providing a positive impact on the health and
future of participants.
new text end

Sec. 16.

Minnesota Statutes 2012, section 256B.021, is amended by adding a
subdivision to read:

new text begin Subd. 7. new text end

new text begin Housing stabilization. new text end

new text begin As provided under subdivision 4, paragraph (e),
upon federal approval, the commissioner shall establish a demonstration project to provide
service coordination, outreach, in-reach, tenancy support, and community living assistance
to a targeted group of federally funded Medicaid recipients to begin January 1, 2014. This
demonstration shall promote housing stability, reduce costly medical interventions, and
increase opportunities for independent community living.
new text end

Sec. 17.

Minnesota Statutes 2012, section 256B.0911, subdivision 1, is amended to read:

Subdivision 1.

Purpose and goal.

(a) The purpose of long-term care consultation
services is to assist persons with long-term or chronic care needs in making care
decisions and selecting support and service options that meet their needs and reflect
their preferences. The availability of, and access to, information and other types of
assistance, including assessment and support planning, is also intended to prevent or delay
institutional placements and to provide access to transition assistance after admission.
Further, the goal of these services is to contain costs associated with unnecessary
institutional admissions. Long-term consultation services must be available to any person
regardless of public program eligibility. The commissioner of human services shall seek
to maximize use of available federal and state funds and establish the broadest program
possible within the funding available.

(b) These services must be coordinated with long-term care options counseling
provided under new text begin subdivision 4d, new text end section 256.975, deleted text begin subdivision deleted text end new text begin subdivisions new text end 7 new text begin to 7c new text end , and
section 256.01, subdivision 24. The lead agency providing long-term care consultation
services shall encourage the use of volunteers from families, religious organizations, social
clubs, and similar civic and service organizations to provide community-based services.

Sec. 18.

Minnesota Statutes 2012, section 256B.0911, subdivision 1a, is amended to
read:

Subd. 1a.

Definitions.

For purposes of this section, the following definitions apply:

(a) Until additional requirements apply under paragraph (b), "long-term care
consultation services" means:

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

(2) providing recommendations for and referrals to 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;

deleted text begin (6) federally mandated preadmission screening activities described under
subdivisions 4a and 4b;
deleted text end

deleted text begin (7) deleted text end new text begin (6) new text end determination of home and community-based waiver and other service
eligibility as required under sections 256B.0913, 256B.0915, and 256B.49, including level
of care determination for individuals who need an institutional level of care as determined
under section 256B.0911, subdivision deleted text begin 4a, paragraph (d) deleted text end new text begin 4e new text end , based on assessment and
community support plan development, appropriate referrals to obtain necessary diagnostic
information, and including an eligibility determination for consumer-directed community
supports;

deleted text begin (8) deleted text end new text begin (7) new text end providing recommendations for institutional placement when there are no
cost-effective community services available;

deleted text begin (9) deleted text end new text begin (8) new text end providing access to assistance to transition people back to community settings
after institutional admission; and

deleted text begin (10) deleted text end new text begin (9) new text end providing information about competitive employment, with or without
supports, for school-age youth and working-age adults and referrals to the Disability
Linkage Line and Disability Benefits 101 to ensure that an informed choice about
competitive employment can be made. For the purposes of this subdivision, "competitive
employment" means work in the competitive labor market that is performed on a full-time
or part-time basis in an integrated setting, and for which an individual is compensated at or
above the minimum wage, but not less than the customary wage and level of benefits paid
by the employer for the same or similar work performed by individuals without disabilities.

(b) Upon statewide implementation of lead agency requirements in subdivisions 2b,
2c, and 3a, "long-term care consultation services" also means:

(1) service eligibility determination for state plan home care services identified in:

(i) section 256B.0625, subdivisions 7, 19a, and 19c;

(ii) section 256B.0657; or

(iii) consumer support grants under section 256.476;

(2) notwithstanding provisions in Minnesota Rules, parts 9525.0004 to 9525.0024,
determination of eligibility for case management services available under sections
256B.0621, subdivision 2, paragraph (4), and 256B.0924 and Minnesota Rules, part
9525.0016;

(3) determination of institutional level of care, home and community-based service
waiver, and other service eligibility as required under section 256B.092, determination
of eligibility for family support grants under section 252.32, semi-independent living
services under section 252.275, and day training and habilitation services under section
256B.092; and

(4) obtaining necessary diagnostic information to determine eligibility under clauses
(2) and (3).

(c) "Long-term care options counseling" means the services provided by the linkage
lines as mandated by sections 256.01 new text begin , subdivision 24, new text end and 256.975, subdivision 7, and
also includes telephone assistance and follow up once a long-term care consultation
assessment has been completed.

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

(e) "Lead agencies" means counties administering or tribes and health plans under
contract with the commissioner to administer long-term care consultation assessment and
support planning services.

Sec. 19.

Minnesota Statutes 2012, 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 20
calendar days after the date on which an assessment was requested or recommended.
Upon statewide implementation of subdivisions 2b, 2c, and 5, this requirement also
applies to an assessment of a person requesting personal care assistance services and
private duty nursing. The commissioner shall provide at least a 90-day notice to lead
agencies prior to the effective date of this requirement. Face-to-face assessments must be
conducted according to paragraphs (b) to (i).

(b) The lead agency may utilize a team of either the social worker or public health
nurse, or both. Upon implementation of subdivisions 2b, 2c, and 5, lead agencies shall
use certified assessors to conduct the assessment. The consultation team members must
confer regarding the most appropriate care for each individual screened or assessed. For
a person with complex health care needs, a public health or registered nurse from the
team must be consulted.

(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 community 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, 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 community 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. For persons who are to be assessed for elderly waiver customized living
services under section 256B.0915, with the permission of the person being assessed or
the person's designated or legal representative, the client's current or proposed provider
of services may submit a copy of the provider's nursing assessment or written report
outlining its recommendations regarding the client's care needs. The person conducting
the assessment will notify the provider of the date by which this information is to be
submitted. This information shall be provided to the person conducting the assessment
prior to the assessment.

(e) 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 within 40
calendar days of the assessment visit, regardless of whether the individual is eligible for
Minnesota health care programs. The written community support plan must include:

(1) a summary of assessed needs as defined in paragraphs (c) and (d);

(2) the individual's options and choices to meet identified needs, including all
available options for case management services and providers;

(3) identification of health and safety risks and how those risks will be addressed,
including personal risk management strategies;

(4) referral information; and

(5) informal caregiver supports, if applicable.

For a person determined eligible for state plan home care under subdivision 1a,
paragraph (b), clause (1), the person or person's representative must also receive a copy of
the home care service plan developed by the certified assessor.

(f) 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 long-term care options
counseling 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 new text begin section 256.975, new text end subdivision deleted text begin 4a, paragraph (c) deleted text end new text begin 7a, paragraph (d) new text end .

(h) The lead agency 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) written recommendations for community-based services and consumer-directed
options;

(2) documentation that the most cost-effective alternatives available were offered to
the individual. For purposes of this clause, "cost-effective" means community services and
living arrangements that cost the same as or less than institutional care. For an individual
found to meet eligibility criteria for home and community-based service programs under
section 256B.0915 or 256B.49, "cost-effectiveness" has the meaning found in the federally
approved waiver plan for each program;

(3) the need for and purpose of preadmission screening new text begin conducted by long-term
care options counselors according to section 256.975, subdivisions 7a to 7c, and section
256.01, subdivision 24, new text end if the person selects nursing facility placement new text begin . If the individual
selects nursing facility placement, the lead agency shall forward information needed to
complete the level of care determinations and screening for developmental disability and
mental illness collected during the assessment to the long-term care options counselor
using forms provided by the commissioner new text end ;

(4) the role of long-term care consultation assessment and support planning in
eligibility determination for waiver and alternative care programs, and state plan home
care, case management, and other services as defined in subdivision 1a, paragraphs (a),
clause (7), and (b);

(5) information about Minnesota health care programs;

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

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

(8) the certified assessor's decision regarding the person's need for institutional level
of care as determined under criteria established in section 256B.0911, subdivision deleted text begin 4a,
paragraph (d) deleted text end new text begin 4e new text end , and the certified assessor's decision regarding eligibility for all services
and programs as defined in subdivision 1a, paragraphs (a), clause (7), and (b); and

(9) the person's right to appeal the certified assessor's decision regarding eligibility
for all services and programs as defined in subdivision 1a, paragraphs (a), clause (7), and
(b), and incorporating the decision regarding the need for institutional level of care or the
lead agency'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 brain injury waiver programs under sections 256B.0913,
256B.0915, and 256B.49 is valid to establish service eligibility for no more than 60
calendar days after the date of assessment.

(j) The effective eligibility start date for programs in paragraph (i) 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). Notwithstanding
retroactive medical assistance coverage of state plan services, the effective date of
eligibility for programs included in paragraph (i) cannot be prior to the date the most
recent updated assessment is completed.

Sec. 20.

Minnesota Statutes 2012, section 256B.0911, subdivision 4d, is amended to
read:

Subd. 4d.

Preadmission screening of individuals under deleted text begin 65 deleted text end new text begin 60 new text end years of age.

(a)
It is the policy of the state of Minnesota to ensure that individuals with disabilities or
chronic illness are served in the most integrated setting appropriate to their needs and have
the necessary information to make informed choices about home and community-based
service options.

(b) Individuals under deleted text begin 65 deleted text end new text begin 60 new text end years of age who are admitted to a nursing facility
from a hospital must be screened prior to admission deleted text begin as outlined in subdivisions 4a
through 4c deleted text end new text begin according to the requirements outlined in section 256.975, subdivisions 7a
to 7c. This shall be provided by the Disability Linkage Line as required under section
256.01, subdivision 24 new text end .

(c) Individuals under 65 years of age who are admitted to nursing facilities with
only a telephone screening must receive a face-to-face assessment from the long-term
care consultation team member of the county in which the facility is located or from the
recipient's county case manager within 40 calendar days of admission.

deleted text begin (d) Individuals under 65 years of age who are admitted to a nursing facility
without preadmission screening according to the exemption described in subdivision 4b,
paragraph (a), clause (3), and who remain in the facility longer than 30 days must receive
a face-to-face assessment within 40 days of admission.
deleted text end

deleted text begin (e) deleted text end new text begin (d) new text end At the face-to-face assessment, the long-term care consultation team member
or county case manager must perform the activities required under subdivision 3b.

deleted text begin (f) deleted text end new text begin (e) new text end For individuals under 21 years of age, a screening interview which
recommends nursing facility admission must be face-to-face and approved by the
commissioner before the individual is admitted to the nursing facility.

deleted text begin (g) deleted text end new text begin (f) new text end In the event that an individual under deleted text begin 65 deleted text end new text begin 60 new text end years of age is admitted to a
nursing facility on an emergency basis, the deleted text begin county deleted text end new text begin Disability Linkage Line new text end must be
notified of the admission on the next working day, and a face-to-face assessment as
described in paragraph (c) must be conducted within 40 calendar days of admission.

deleted text begin (h) deleted text end new text begin (g) new text end At the face-to-face assessment, the long-term care consultation team member
or the case manager must present information about home and community-based options,
including consumer-directed options, so the individual can make informed choices. If the
individual chooses home and community-based services, the long-term care consultation
team member or case manager must complete a written relocation plan within 20 working
days of the visit. The plan shall describe the services needed to move out of the facility
and a time line for the move which is designed to ensure a smooth transition to the
individual's home and community.

deleted text begin (i) deleted text end new text begin (h) new text end An individual under 65 years of age residing in a nursing facility shall receive
a face-to-face assessment at least every 12 months to review the person's service choices
and available alternatives unless the individual indicates, in writing, that annual visits are
not desired. In this case, the individual must receive a face-to-face assessment at least
once every 36 months for the same purposes.

deleted text begin (j) deleted text end new text begin (i) new text end Notwithstanding the provisions of subdivision 6, the commissioner may pay
county agencies directly for face-to-face assessments for individuals under 65 years of age
who are being considered for placement or residing in a nursing facility.

new text begin (j) Funding for preadmission screening shall be provided to the Disability Linkage
Line for the under 60 population by the Department of Human Services to cover screener
salaries and expenses to provide the services described in subdivisions 7a to 7c. The
Disability Linkage Line shall employ, or contract with other agencies to employ, within
the limits of available funding, sufficient personnel to provider preadmission screening
and level of care determination services and shall seek to maximize federal funding for the
service as provided under section 256.01, subdivision 2, paragraph (dd).
new text end

Sec. 21.

Minnesota Statutes 2012, section 256B.0911, is amended by adding a
subdivision to read:

new text begin Subd. 4e. new text end

new text begin Determination of institutional level of care. new text end

new text begin The determination of the
need for nursing facility, hospital, and intermediate care facility levels of care must be
made according to criteria developed by the commissioner, and in section 256B.092,
using forms developed by the commissioner. Effective January 1, 2014, for individuals
age 21 and older, the determination of need for nursing facility level of care shall be
based on criteria in section 144.0724, subdivision 11. For individuals under age 21, the
determination of the need for nursing facility level of care must be made according to
criteria developed by the commissioner until criteria in section 144.0724, subdivision 11,
becomes effective on or after October 1, 2019.
new text end

Sec. 22.

Minnesota Statutes 2012, section 256B.0911, subdivision 7, is amended to read:

Subd. 7.

Reimbursement for certified nursing facilities.

(a) Medical assistance
reimbursement for nursing facilities shall be authorized for a medical assistance recipient
only if a preadmission screening has been conducted prior to admission or the county has
authorized an exemption. Medical assistance reimbursement for nursing facilities shall
not be provided for any recipient who the local screener has determined does not meet the
level of care criteria for nursing facility placement in section 144.0724, subdivision 11, or,
if indicated, has not had a level II OBRA evaluation as required under the federal Omnibus
Budget Reconciliation Act of 1987 completed unless an admission for a recipient with
mental illness is approved by the local mental health authority or an admission for a
recipient with developmental disability is approved by the state developmental disability
authority.

(b) The nursing facility must not bill a person who is not a medical assistance
recipient for resident days that preceded the date of completion of screening activities
as required under new text begin section 256.975, new text end subdivisions deleted text begin 4a, 4b, and 4c deleted text end new text begin 7a to 7c new text end . The nursing
facility must include unreimbursed resident days in the nursing facility resident day totals
reported to the commissioner.

Sec. 23.

Minnesota Statutes 2012, section 256B.0913, subdivision 4, is amended to read:

Subd. 4.

Eligibility for funding for services for nonmedical assistance recipients.

(a) Funding for services under the alternative care program is available to persons who
meet the following criteria:

(1) the person has been determined by a community assessment under section
256B.0911 to be a person who would require the level of care provided in a nursing
facility, as determined under section 256B.0911, subdivision deleted text begin 4a, paragraph (d) deleted text end new text begin 4e new text end , but for
the provision of services under the alternative care program;

(2) the person is age 65 or older;

(3) the person would be eligible for medical assistance within 135 days of admission
to a nursing facility;

(4) the person is not ineligible for the payment of long-term care services by the
medical assistance program due to an asset transfer penalty under section 256B.0595 or
equity interest in the home exceeding $500,000 as stated in section 256B.056;

(5) the person needs long-term care services that are not funded through other
state or federal funding, or other health insurance or other third-party insurance such as
long-term care insurance;

(6) except for individuals described in clause (7), the monthly cost of the alternative
care services funded by the program for this person does not exceed 75 percent of the
monthly limit described under section 256B.0915, subdivision 3a. This monthly limit
does not prohibit the alternative care client from payment for additional services, but in no
case may the cost of additional services purchased under this section exceed the difference
between the client's monthly service limit defined under section 256B.0915, subdivision
3, and the alternative care program monthly service limit defined in this paragraph. If
care-related supplies and equipment or environmental modifications and adaptations are or
will be purchased for an alternative care services recipient, the costs may be prorated on a
monthly basis for up to 12 consecutive months beginning with the month of purchase.
If the monthly cost of a recipient's other alternative care services exceeds the monthly
limit established in this paragraph, the annual cost of the alternative care services shall be
determined. In this event, the annual cost of alternative care services shall not exceed 12
times the monthly limit described in this paragraph;

(7) for individuals assigned a case mix classification A as described under section
256B.0915, subdivision 3a, paragraph (a), with (i) no dependencies in activities of daily
living, or (ii) up to two dependencies in bathing, dressing, grooming, walking, and eating
when the dependency score in eating is three or greater as determined by an assessment
performed under section 256B.0911, the monthly cost of alternative care services funded
by the program cannot exceed $593 per month for all new participants enrolled in
the program on or after July 1, 2011. This monthly limit shall be applied to all other
participants who meet this criteria at reassessment. This monthly limit shall be increased
annually as described in section 256B.0915, subdivision 3a, paragraph (a). This monthly
limit does not prohibit the alternative care client from payment for additional services, but
in no case may the cost of additional services purchased exceed the difference between the
client's monthly service limit defined in this clause and the limit described in clause (6)
for case mix classification A; and

(8) the person is making timely payments of the assessed monthly fee.

A person is ineligible if payment of the fee is over 60 days past due, unless the person
agrees to:

(i) the appointment of a representative payee;

(ii) automatic payment from a financial account;

(iii) the establishment of greater family involvement in the financial management of
payments; or

(iv) another method acceptable to the lead agency to ensure prompt fee payments.

The lead agency may extend the client's eligibility as necessary while making
arrangements to facilitate payment of past-due amounts and future premium payments.
Following disenrollment due to nonpayment of a monthly fee, eligibility shall not be
reinstated for a period of 30 days.

(b) Alternative care funding under this subdivision is not available for a person who
is a medical assistance recipient or who would be eligible for medical assistance without a
spenddown or waiver obligation. A person whose initial application for medical assistance
and the elderly waiver program is being processed may be served under the alternative care
program for a period up to 60 days. If the individual is found to be eligible for medical
assistance, medical assistance must be billed for services payable under the federally
approved elderly waiver plan and delivered from the date the individual was found eligible
for the federally approved elderly waiver plan. Notwithstanding this provision, alternative
care funds may not be used to pay for any service the cost of which: (i) is payable by
medical assistance; (ii) is used by a recipient to meet a waiver obligation; or (iii) is used to
pay a medical assistance income spenddown for a person who is eligible to participate in the
federally approved elderly waiver program under the special income standard provision.

(c) Alternative care funding is not available for a person who resides in a licensed
nursing home, certified boarding care home, hospital, or intermediate care facility, except
for case management services which are provided in support of the discharge planning
process for a nursing home resident or certified boarding care home resident to assist with
a relocation process to a community-based setting.

(d) Alternative care funding is not available for a person whose income is greater
than the maintenance needs allowance under section 256B.0915, subdivision 1d, but equal
to or less than 120 percent of the federal poverty guideline effective July 1 in the fiscal
year for which alternative care eligibility is determined, who would be eligible for the
elderly waiver with a waiver obligation.

Sec. 24.

Minnesota Statutes 2012, section 256B.0913, is amended by adding a
subdivision to read:

new text begin Subd. 17. new text end

new text begin Essential community supports grants. new text end

new text begin (a) Notwithstanding subdivisions
1 to 14, the purpose of the essential community supports grant program is to provide
targeted services to persons age 65 and older who need essential community support, but
whose needs do not meet the level of care required for nursing facility placement under
section 144.0724, subdivision 11.
new text end

new text begin (b) Essential community supports grants are available not to exceed $400 per person
per month. Essential community supports service grants may be used as authorized within
an authorization period not to exceed 12 months. Grants must be available to a person who:
new text end

new text begin (1) is age 65 or older;
new text end

new text begin (2) is not eligible for medical assistance;
new text end

new text begin (3) would otherwise be financially eligible for the alternative care program under
subdivision 4;
new text end

new text begin (4) has received a community assessment under section 256B.0911, subdivision 3a
or 3b, and does not require the level of care provided in a nursing facility;
new text end

new text begin (5) has a community support plan; and
new text end

new text begin (6) has been determined by a community assessment under section 256B.0911,
subdivision 3a or 3b, to be a person who would require provision of at least one of the
following services, as defined in the approved elderly waiver plan, in order to maintain
their community residence:
new text end

new text begin (i) caregiver support;
new text end

new text begin (ii) homemaker support;
new text end

new text begin (iii) chores; or
new text end

new text begin (iv) a personal emergency response device or system.
new text end

new text begin (c) The person receiving any of the essential community supports in this subdivision
must also receive service coordination, not to exceed $600 in a 12-month authorization
period, as part of their community support plan.
new text end

new text begin (d) A person who has been determined to be eligible for an essential community
supports grant must be reassessed at least annually and continue to meet the criteria in
paragraph (b) to remain eligible for an essential community supports grant.
new text end

new text begin (e) The commissioner is authorized to use federal matching funds for essential
community supports as necessary and to meet demand for essential community supports
grants as outlined in paragraphs (f) and (g), and that amount of federal funds is
appropriated to the commissioner for this purpose.
new text end

new text begin (f) Upon federal approval and following a reasonable implementation period
determined by the commissioner, essential community supports are available to an
individual who:
new text end

new text begin (1) is receiving nursing facility services or home and community-based long-term
services and supports under section 256B.0915 or 256B.49 on the effective date of
implementation of the revised nursing facility level of care under section 144.0724,
subdivision 11;
new text end

new text begin (2) meets one of the following criteria:
new text end

new text begin (i) due to the implementation of the revised nursing facility level of care, loses
eligibility for continuing medical assistance payment of nursing facility services at the
first reassessment under section 144.0724, subdivision 11, paragraph (b), that occurs on or
after the effective date of the revised nursing facility level of care criteria under section
144.0724, subdivision 11; or
new text end

new text begin (ii) due to the implementation of the revised nursing facility level of care, loses
eligibility for continuing medical assistance payment of home and community-based
long-term services and supports under section 256B.0915 or 256B.49 at the first
reassessment required under those sections that occurs on or after the effective date of
implementation of the revised nursing facility level of care under section 144.0724,
subdivision 11;
new text end

new text begin (3) is not eligible for personal care attendant services; and
new text end

new text begin (4) has an assessed need for one or more of the supportive services offered under
essential community supports.
new text end

new text begin Individuals eligible under this paragraph includes individuals who continue to be
eligible for medical assistance state plan benefits and those who are not or are no longer
financially eligible for medical assistance.
new text end

new text begin (g) Upon federal approval and following a reasonable implementation period
determined by the commissioner, the services available through essential community
supports include the services and grants provided in paragraphs (b) and (c), home-delivered
meals, and community living assistance as defined by the commissioner. These services
are available to all eligible recipients including those outlined in paragraphs (b) and (f).
Recipients are eligible if they have a need for any of these services and meet all other
eligibility criteria.
new text end

Sec. 25.

Minnesota Statutes 2012, section 256B.0915, subdivision 3a, is amended to
read:

Subd. 3a.

Elderly waiver cost limits.

(a) The monthly limit for the cost of
waivered services to an individual elderly waiver client except for individuals described in
deleted text begin paragraph deleted text end new text begin paragraphs new text end (b) new text begin and (d) new text end shall be the weighted average monthly nursing facility
rate of the case mix resident class to which the elderly waiver client would be assigned
under Minnesota Rules, parts 9549.0050 to 9549.0059, less the recipient's maintenance
needs allowance as described in subdivision 1d, paragraph (a), until the first day of the
state fiscal year in which the resident assessment system as described in section 256B.438
for nursing home rate determination is implemented. Effective on the first day of the state
fiscal year in which the resident assessment system as described in section 256B.438 for
nursing home rate determination is implemented and the first day of each subsequent state
fiscal year, the monthly limit for the cost of waivered services to an individual elderly
waiver client shall be the rate of the case mix resident class to which the waiver client
would be assigned under Minnesota Rules, parts 9549.0050 to 9549.0059, in effect on
the last day of the previous state fiscal year, adjusted by any legislatively adopted home
and community-based services percentage rate adjustment.

(b) The monthly limit for the cost of waivered services to an individual elderly
waiver client assigned to a case mix classification A under paragraph (a) with:

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

(2) up to two dependencies in bathing, dressing, grooming, walking, and eating
when the dependency score in eating is three or greater as determined by an assessment
performed under section 256B.0911

shall be $1,750 per month effective on July 1, 2011, for all new participants enrolled in
the program on or after July 1, 2011. This monthly limit shall be applied to all other
participants who meet this criteria at reassessment. This monthly limit shall be increased
annually as described in paragraph (a).

(c) If extended medical supplies and equipment or environmental modifications are
or will be purchased for an elderly waiver client, the costs may be prorated for up to
12 consecutive months beginning with the month of purchase. If the monthly cost of a
recipient's waivered services exceeds the monthly limit established in paragraph (a) or
(b), the annual cost of all waivered services shall be determined. In this event, the annual
cost of all waivered services shall not exceed 12 times the monthly limit of waivered
services as described in paragraph (a) or (b).

new text begin (d) Effective July 1, 2013, the monthly cost limit of waiver services, including
any necessary home care services described in section 256B.0651, subdivision 2, for
individuals who meet the criteria as ventilator-dependent given in section 256B.0651,
subdivision 1, paragraph (g), shall be the average of the monthly medical assistance
amount established for home care services as described in section 256B.0652, subdivision
7, and the annual average contracted amount established by the commissioner for nursing
facility services for ventilator-dependent individuals. This monthly limit shall be increased
annually as described in paragraph (a).
new text end

Sec. 26.

Minnesota Statutes 2012, section 256B.0915, is amended by adding a
subdivision to read:

new text begin Subd. 3j. new text end

new text begin Individual community living support. new text end

new text begin Upon federal approval, there
is established a new service called individual community living support (ICLS) that is
available on the elderly waiver. ICLS providers may not be the landlord of recipients, nor
have any interest in the recipient's housing. ICLS must be delivered in a single-family
home or apartment where the service recipient or their family owns or rents, as
demonstrated by a lease agreement, and maintains control over the individual unit. Case
managers or care coordinators must develop individual ICLS plans in consultation with
the client using a tool developed by the commissioner. The commissioner shall establish
payment rates and mechanisms to align payments with the type and amount of service
provided, assure statewide uniformity, and assure cost-effectiveness. ICLS shall not be
considered home care services for purposes of section 144A.43.
new text end

Sec. 27.

Minnesota Statutes 2012, section 256B.0915, subdivision 5, is amended to read:

Subd. 5.

Assessments and reassessments for waiver clients.

(a) Each client
shall receive an initial assessment of strengths, informal supports, and need for services
in accordance with section 256B.0911, subdivisions 3, 3a, and 3b. A reassessment of a
client served under the elderly waiver must be conducted at least every 12 months and at
other times when the case manager determines that there has been significant change in
the client's functioning. This may include instances where the client is discharged from
the hospital. There must be a determination that the client requires nursing facility level
of care as defined in section 256B.0911, subdivision deleted text begin 4a, paragraph (d) deleted text end new text begin 4e new text end , at initial and
subsequent assessments to initiate and maintain participation in the waiver program.

(b) 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 and 3b, that result in a nursing facility
level of care determination will be accepted for purposes of initial and ongoing access to
waiver service payment.

Sec. 28.

Minnesota Statutes 2012, section 256B.0917, is amended by adding a
subdivision to read:

new text begin Subd. 1a. new text end

new text begin Home and community-based services for older adults. new text end

new text begin (a) The purpose
of projects selected by the commissioner of human services under this section is to
make strategic changes in the long-term services and supports system for older adults
including statewide capacity for local service development and technical assistance, and
statewide availability of home and community-based services for older adult services,
caregiver support and respite care services, and other supports in the state of Minnesota.
These projects are intended to create incentives for new and expanded home and
community-based services in Minnesota in order to:
new text end

new text begin (1) reach older adults early in the progression of their need for long-term services
and supports, providing them with low-cost, high-impact services that will prevent or
delay the use of more costly services;
new text end

new text begin (2) support older adults to live in the most integrated, least restrictive community
setting;
new text end

new text begin (3) support the informal caregivers of older adults;
new text end

new text begin (4) develop and implement strategies to integrate long-term services and supports
with health care services, in order to improve the quality of care and enhance the quality
of life of older adults and their informal caregivers;
new text end

new text begin (5) ensure cost-effective use of financial and human resources;
new text end

new text begin (6) build community-based approaches and community commitment to delivering
long-term services and supports for older adults in their own homes;
new text end

new text begin (7) achieve a broad awareness and use of lower-cost in-home services as an
alternative to nursing homes and other residential services;
new text end

new text begin (8) strengthen and develop additional home and community-based services and
alternatives to nursing homes and other residential services; and
new text end

new text begin (9) strengthen programs that use volunteers.
new text end

new text begin (b) The services provided by these projects are available to older adults who are
eligible for medical assistance and the elderly waiver under section 256B.0915, the
alternative care program under section 256B.0913, or essential community supports grant
under subdivision 14, paragraph (b), and to persons who have their own funds to pay for
services.
new text end

Sec. 29.

Minnesota Statutes 2012, section 256B.0917, is amended by adding a
subdivision to read:

new text begin Subd. 1b. new text end

new text begin Definitions. new text end

new text begin (a) For purposes of this section, the following terms have
the meanings given.
new text end

new text begin (b) "Community" means a town; township; city; or targeted neighborhood within a
city; or a consortium of towns, townships, cities, or specific neighborhoods within a city.
new text end

new text begin (c) "Core home and community-based services provider" means a Faith in Action,
Living at Home Block Nurse, Congregational Nurse, or similar community-based program
that organizes and uses volunteers and paid staff to deliver nonmedical services intended
to assist older adults to identify and manage risks and to maintain their community living
and integration in the community.
new text end

new text begin (d) "Eldercare development partnership" means a team of representatives of county
social service and public health agencies, the area agency on aging, local nursing home
providers, local home care providers, and other appropriate home and community-based
providers in the area agency's planning and service area.
new text end

new text begin (e) "Long-term services and supports" means any service available under the
elderly waiver program or alternative care grant programs; nursing facility services;
transportation services; caregiver support and respite care services; and other home and
community-based services identified as necessary either to maintain lifestyle choices for
older adults or to support them to remain in their own home.
new text end

new text begin (f) "Older adult" refers to an individual who is 65 years of age or older.
new text end

Sec. 30.

Minnesota Statutes 2012, section 256B.0917, is amended by adding a
subdivision to read:

new text begin Subd. 1c. new text end

new text begin Eldercare development partnerships. new text end

new text begin The commissioner of human
services shall select and contract with eldercare development partnerships sufficient to
provide statewide availability of service development and technical assistance using a
request for proposals process. Eldercare development partnerships shall:
new text end

new text begin (1) develop a local long-term services and supports strategy consistent with state
goals and objectives;
new text end

new text begin (2) identify and use existing local skills, knowledge and relationships, and build
on these assets;
new text end

new text begin (3) coordinate planning for funds to provide services to older adults, including funds
received under Title III of the Older Americans Act, Title XX of the Social Security Act,
and the Local Public Health Act;
new text end

new text begin (4) target service development and technical assistance where nursing facility
closures have occurred or are occurring or in areas where service needs have been
identified through activities under section 144A.351;
new text end

new text begin (5) provide sufficient staff for development and technical support in its designated
area; and
new text end

new text begin (6) designate a single public or nonprofit member of the eldercare development
partnerships to apply grant funding and manage the project.
new text end

Sec. 31.

Minnesota Statutes 2012, section 256B.0917, subdivision 6, is amended to read:

Subd. 6.

Caregiver support and respite care projects.

(a) The commissioner
shall establish deleted text begin up to 36 deleted text end projects to expand the deleted text begin respite care network in the state and to
support caregivers in their responsibilities for care. The purpose of each project shall
be to deleted text end new text begin availability of caregiver support and respite care services for family and other
caregivers. The commissioner shall use a request for proposals to select nonprofit entities
to administer the projects. Projects shall new text end :

(1) establish a local coordinated network of volunteer and paid respite workers;

(2) coordinate assignment of respite deleted text begin workers deleted text end new text begin care services new text end to deleted text begin clients and care
receivers and assure the health and safety of the client; and deleted text end new text begin caregivers of older adults;
new text end

deleted text begin (3) provide training for caregivers and ensure that support groups are available
in the community.
deleted text end

new text begin (3) assure the health and safety of the older adults;
new text end

new text begin (4) identify at-risk caregivers;
new text end

new text begin (5) provide information, education, and training for caregivers in the designated
community; and
new text end

new text begin (6) demonstrate the need in the proposed service area particularly where nursing
facility closures have occurred or are occurring or areas with service needs identified
by section 144A.351. Preference must be given for projects that reach underserved
populations.
new text end

deleted text begin (b) The caregiver support and respite care funds shall be available to the four to six
local long-term care strategy projects designated in subdivisions 1 to 5.
deleted text end

deleted text begin (c) The commissioner shall publish a notice in the State Register to solicit proposals
from public or private nonprofit agencies for the projects not included in the four to six
local long-term care strategy projects defined in subdivision 2. A county agency may,
alone or in combination with other county agencies, apply for caregiver support and
respite care project funds. A public or nonprofit agency within a designated SAIL project
area may apply for project funds if the agency has a letter of agreement with the county
or counties in which services will be developed, stating the intention of the county or
counties to coordinate their activities with the agency requesting a grant.
deleted text end

deleted text begin (d) The commissioner shall select grantees based on the following criteria deleted text end new text begin (b)
Projects must clearly describe new text end :

deleted text begin (1) the ability of the proposal to demonstrate need in the area served, as evidenced
by a community needs assessment or other demographic data;
deleted text end

deleted text begin (2) the ability of the proposal to clearly describe how the project deleted text end new text begin (1) how they new text end will
achieve deleted text begin the deleted text end new text begin their new text end purpose deleted text begin defined in paragraph (b) deleted text end ;

deleted text begin (3) the ability of the proposal to reach underserved populations;
deleted text end

deleted text begin (4) the ability of the proposal to demonstrate community commitment to the project,
as evidenced by letters of support and cooperation as well as formation of a community
task force;
deleted text end

deleted text begin (5) the ability of the proposal to clearly describe deleted text end new text begin (2) new text end the process for recruiting,
training, and retraining volunteers; and

deleted text begin (6) the inclusion in the proposal of the deleted text end new text begin (3) their new text end plan to promote the project in the
new text begin designated new text end community, including outreach to persons needing the services.

deleted text begin (e) deleted text end new text begin (c) new text end Funds for all projects under this subdivision may be used to:

(1) hire a coordinator to develop a coordinated network of volunteer and paid respite
care services and assign workers to clients;

(2) recruit and train volunteer providers;

(3) deleted text begin train deleted text end new text begin provide information, training, and education to new text end caregivers;

deleted text begin (4) ensure the development of support groups for caregivers;
deleted text end

deleted text begin (5) deleted text end new text begin (4) new text end advertise the availability of the caregiver support and respite care project; and

deleted text begin (6) deleted text end new text begin (5) new text end purchase equipment to maintain a system of assigning workers to clients.

deleted text begin (f) deleted text end new text begin (d) new text end Project funds may not be used to supplant existing funding sources.

Sec. 32.

Minnesota Statutes 2012, section 256B.0917, is amended by adding a
subdivision to read:

new text begin Subd. 7a. new text end

new text begin Core home and community-based services. new text end

new text begin The commissioner shall
select and contract with core home and community-based services providers for projects
to provide services and supports to older adults both with and without family and other
informal caregivers using a request for proposals process. Projects must:
new text end

new text begin (1) have a credible, public, or private nonprofit sponsor providing ongoing financial
support;
new text end

new text begin (2) have a specific, clearly defined geographic service area;
new text end

new text begin (3) use a practice framework designed to identify high-risk older adults and help them
take action to better manage their chronic conditions and maintain their community living;
new text end

new text begin (4) have a team approach to coordination and care, ensuring that the older adult
participants, their families, and the formal and informal providers are all part of planning
and providing services;
new text end

new text begin (5) provide information, support services, homemaking services, counseling, and
training for the older adults and family caregivers;
new text end

new text begin (6) encourage service area or neighborhood residents and local organizations to
collaborate in meeting the needs of older adults in their geographic service areas;
new text end

new text begin (7) recruit, train, and direct the use of volunteers to provide informal services and
other appropriate support to older adults and their caregivers; and
new text end

new text begin (8) provide coordination and management of formal and informal services to older
adults and their families using less expensive alternatives.
new text end

Sec. 33.

Minnesota Statutes 2012, section 256B.0917, subdivision 13, is amended to
read:

Subd. 13.

Community service grants.

The commissioner shall award contracts
for grants to public and private nonprofit agencies to establish services that strengthen
a community's ability to provide a system of home and community-based services
for elderly persons. The commissioner shall use a request for proposal process. The
commissioner shall give preference when awarding grants under this section to areas
where nursing facility closures have occurred or are occurring new text begin or to areas with service
needs identified under section 144A.351 new text end . deleted text begin The commissioner shall consider grants for:
deleted text end

deleted text begin (1) caregiver support and respite care projects under subdivision 6;
deleted text end

deleted text begin (2) the living-at-home/block nurse grant under subdivisions 7 to 10; and
deleted text end

deleted text begin (3) services identified as needed for community transition.
deleted text end

Sec. 34.

Minnesota Statutes 2012, section 256B.092, is amended by adding a
subdivision to read:

new text begin Subd. 14. new text end

new text begin Reduce avoidable behavioral crisis emergency room, psychiatric
inpatient hospitalizations, and commitments to institutions. new text end

new text begin (a) Persons receiving
home and community-based services authorized under this section who have had two
or more admissions within a calendar year to an emergency room, psychiatric unit,
or institution must receive consultation from a mental health professional as defined in
section 245.462, subdivision 18, or a behavioral professional as defined in the home and
community-based services state plan within 30 days of discharge. The mental health
professional or behavioral professional must:
new text end

new text begin (1) conduct a functional assessment of the crisis incident as defined in section
245D.02, subdivision 11, which led to the hospitalization with the goal of developing
proactive strategies as well as necessary reactive strategies to reduce the likelihood of
future avoidable hospitalizations due to a behavioral crisis;
new text end

new text begin (2) use the results of the functional assessment to amend the coordinated service and
support plan set forth in section 245D.02, subdivision 4b, to address the potential need
for additional staff training, increased staffing, access to crisis mobility services, mental
health services, use of technology, and crisis stabilization services in section 256B.0624,
subdivision 7; and
new text end

new text begin (3) identify the need for additional consultation, testing, and mental health crisis
intervention team services as defined in section 245D.02, subdivision 20, psychotropic
medication use and monitoring under section 245D.051, as well as the frequency and
duration of ongoing consultation.
new text end

new text begin (b) For the purposes of this subdivision, "institution" includes, but is not limited to,
the Anoka-Metro Regional Treatment Center and the Minnesota Security Hospital.
new text end

Sec. 35.

Minnesota Statutes 2012, section 256B.439, subdivision 1, is amended to read:

Subdivision 1.

Development and implementation of quality profiles.

(a) The
commissioner of human services, in cooperation with the commissioner of health,
shall develop and implement deleted text begin a deleted text end quality deleted text begin profile system deleted text end new text begin profiles new text end for nursing facilities and,
beginning not later than July 1, deleted text begin 2004 deleted text end new text begin 2014 new text end , other providers of long-term care services,
except when the quality profile system would duplicate requirements under section
256B.5011, 256B.5012, or 256B.5013. The deleted text begin system deleted text end new text begin quality profiles new text end must be developed
deleted text begin and implemented to the extent possible without the collection of significant amounts of
new data. To the extent possible, the system deleted text end new text begin using existing data sets maintained by the
commissioners of health and human services to the extent possible. The profiles new text end must
incorporate or be coordinated with information on quality maintained by area agencies on
aging, long-term care trade associations, new text begin the ombudsman offices, counties, tribes, health
plans, new text end and other entities new text begin and the long-term care database maintained under section 256.975,
subdivision 7 new text end . The deleted text begin system deleted text end new text begin profiles new text end must be designed to provide information on quality to:

(1) consumers and their families to facilitate informed choices of service providers;

(2) providers to enable them to measure the results of their quality improvement
efforts and compare quality achievements with other service providers; and

(3) public and private purchasers of long-term care services to enable them to
purchase high-quality care.

(b) The deleted text begin system deleted text end new text begin profiles new text end must be developed in consultation with the long-term care
task force, area agencies on aging, and representatives of consumers, providers, and labor
unions. Within the limits of available appropriations, the commissioners may employ
consultants to assist with this project.

Sec. 36.

Minnesota Statutes 2012, section 256B.439, subdivision 2, is amended to read:

Subd. 2.

Quality measurement tools.

The commissioners shall identify and apply
existing quality measurement tools to:

(1) emphasize quality of care and its relationship to quality of life; and

(2) address the needs of various users of long-term care services, including, but not
limited to, short-stay residents, persons with behavioral problems, persons with dementia,
and persons who are members of minority groups.

The tools must be identified and applied, to the extent possible, without requiring
providers to supply information beyond deleted text begin current deleted text end state and federal requirements.

Sec. 37.

Minnesota Statutes 2012, section 256B.439, subdivision 3, is amended to read:

Subd. 3.

Consumer surveys new text begin of nursing facilities residents new text end .

Following
identification of the quality measurement tool, the commissioners shall conduct surveys
of long-term care service consumers new text begin of nursing facilities new text end to develop quality profiles
of providers. To the extent possible, surveys must be conducted face-to-face by state
employees or contractors. At the discretion of the commissioners, surveys may be
conducted by telephone or by provider staff. Surveys must be conducted periodically to
update quality profiles of individual deleted text begin service deleted text end new text begin nursing facilities new text end providers.

Sec. 38.

Minnesota Statutes 2012, section 256B.439, is amended by adding a
subdivision to read:

new text begin Subd. 3a. new text end

new text begin Home and community-based services report card in cooperation with
the commissioner of health. new text end

new text begin The profiles developed for home and community-based
services providers under this section shall be incorporated into a report card and
maintained by the Minnesota Board on Aging pursuant to section 256.975, subdivision
7, paragraph (b), clause (2), as data becomes available. The commissioner, in
cooperation with the commissioner of health, shall use consumer choice, quality of life,
care approaches, and cost or flexible purchasing categories to organize the consumer
information in the profiles. The final categories used shall include consumer input and
survey data to the extent that is available through the state agencies. The commissioner
shall develop and disseminate the qualify profiles for a limited number of provider types
initially, and develop quality profiles for additional provider types as measurement tools
are developed and data becomes available. This includes providers of services to older
adults and people with disabilities, regardless of payor source.
new text end

Sec. 39.

Minnesota Statutes 2012, section 256B.439, subdivision 4, is amended to read:

Subd. 4.

Dissemination of quality profiles.

By July 1, deleted text begin 2003 deleted text end new text begin 2014 new text end , the
commissioners shall implement a deleted text begin system deleted text end new text begin public awareness effort new text end to disseminate the quality
profiles deleted text begin developed from consumer surveys using the quality measurement tool deleted text end . Profiles
may be disseminated deleted text begin to deleted text end new text begin through new text end the Senior LinkAge Line new text begin and Disability Linkage Line new text end and
to consumers, providers, and purchasers of long-term care services deleted text begin through all feasible
printed and electronic outlets. The commissioners may conduct a public awareness
campaign to inform potential users regarding profile contents and potential uses deleted text end .

Sec. 40.

Minnesota Statutes 2012, section 256B.49, subdivision 12, is amended to read:

Subd. 12.

Informed choice.

Persons who are determined likely to require the level
of care provided in a nursing facility as determined under section 256B.0911 new text begin , subdivision
4e, new text end or a hospital shall be informed of the home and community-based support alternatives
to the provision of inpatient hospital services or nursing facility services. Each person
must be given the choice of either institutional or home and community-based services
using the provisions described in section 256B.77, subdivision 2, paragraph (p).

Sec. 41.

Minnesota Statutes 2012, section 256B.49, subdivision 14, is amended to read:

Subd. 14.

Assessment and reassessment.

(a) Assessments and reassessments
shall be conducted by certified assessors according to section 256B.0911, subdivision 2b.
With the permission of the recipient or the recipient's designated legal representative,
the recipient's current provider of services may submit a written report outlining their
recommendations regarding the recipient's care needs prepared by a direct service
employee with at least 20 hours of service to that client. The person conducting the
assessment or reassessment must notify the provider of the date by which this information
is to be submitted. This information shall be provided to the person conducting the
assessment and the person or the person's legal representative and must be considered
prior to the finalization of the assessment or reassessment.

(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 256B.0911, subdivision deleted text begin 4a, paragraph
(d) deleted text end new text begin 4e new text end , 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) 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.

(e) The commissioner shall develop criteria to identify recipients whose level of
functioning is reasonably expected to improve and reassess these recipients to establish
a baseline assessment. Recipients who meet these criteria must have a comprehensive
transitional service plan developed under subdivision 15, paragraphs (b) and (c), and be
reassessed every six months until there has been no significant change in the recipient's
functioning for at least 12 months. After there has been no significant change in the
recipient's functioning for at least 12 months, reassessments of the recipient's strengths,
informal 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. Counties, case managers, and service providers are responsible for
conducting these reassessments and shall complete the reassessments out of existing funds.

Sec. 42.

Minnesota Statutes 2012, section 256B.49, is amended by adding a
subdivision to read:

new text begin Subd. 25. new text end

new text begin Reduce avoidable behavioral crisis emergency room, psychiatric
inpatient hospitalizations, and commitments to institutions. new text end

new text begin (a) Persons receiving
home and community-based services authorized under this section who have two or more
admissions within a calendar year to an emergency room, psychiatric unit, or institution
must receive consultation from a mental health professional as defined in section 245.462,
subdivision 18, or a behavioral professional as defined in the home and community-based
services state plan within 30 days of discharge. The mental health professional or
behavioral professional must:
new text end

new text begin (1) conduct a functional assessment of the crisis incident as defined in section
245D.02, subdivision 11, which led to the hospitalization with the goal of developing
proactive strategies as well as necessary reactive strategies to reduce the likelihood of
future avoidable hospitalizations due to a behavioral crisis;
new text end

new text begin (2) use the results of the functional assessment to amend the coordinated service and
support plan in section 245D.02, subdivision 4b, to address the potential need for additional
staff training, increased staffing, access to crisis mobility services, mental health services,
use of technology, and crisis stabilization services in section 256B.0624, subdivision 7; and
new text end

new text begin (3) identify the need for additional consultation, testing, mental health crisis
intervention team services as defined in section 245D.02, subdivision 20, psychotropic
medication use and monitoring under section 245D.051, as well as the frequency and
duration of ongoing consultation.
new text end

new text begin (b) For the purposes of this subdivision, "institution" includes, but is not limited to,
the Anoka-Metro Regional Treatment Center and the Minnesota Security Hospital.
new text end

Sec. 43.

new text begin [256B.85] COMMUNITY FIRST SERVICES AND SUPPORTS.
new text end

new text begin Subdivision 1. new text end

new text begin Basis and scope. new text end

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

new text begin (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 acting as the employer of record with the necessary supports
to perform that function.
new text end

new text begin (c) CFSS is available statewide to eligible individuals 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 complete the task or
supervision and cueing to complete 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.
new text end

new text begin (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 end

new text begin Subd. 2. new text end

new text begin Definitions. new text end

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

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

new text begin (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 including employing workers specifically selected by the participant.
new text end

new text begin (d) "Behavior" means a category to determine the home care rating and is based on the
criteria in section 256B.0659. "Level I behavior" means physical aggression towards self,
others, or destruction of property that requires the immediate response of another person.
new text end

new text begin (e) "Complex health-related needs" means a category to determine the home care
rating and is based on the criteria in section 256B.0659.
new text end

new text begin (f) "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 complete the task or supervision and cueing to complete the task, or the purchase of
goods as defined in subdivision 7, paragraph (a), clause (2), that replace the need for
human assistance.
new text end

new text begin (g) "Community first services and supports service delivery plan" or "service delivery
plan" means a written summary of the services and supports, that is based on the community
support plan identified in section 256B.0911 and coordinated services and support plan
and budget identified in section 256B.0915, subdivision 6, if applicable, that is determined
by the participant to meet the assessed needs, using a person-centered planning process.
new text end

new text begin (h) "Critical activities of daily living" means transferring, mobility, eating, and
toileting.
new text end

new text begin (i) "Dependency" in activities of daily living means a person requires assistance to
begin and complete one or more of the activities of daily living.
new text end

new text begin (j) "Financial management services contractor or vendor" means a qualified
organization having a written contract with the department to provide services necessary
to use the flexible spending model under subdivision 13, that include but are not limited
to: participant education and technical assistance; CFSS service delivery planning and
budgeting; billing, making payments, and monitoring of spending; and assisting the
participant in fulfilling regulatory requirements when acting as an employer of record for
support workers or employer agent, that are in accordance with Section 3504 of the IRS
code and the IRS Revenue Procedure 70-6.
new text end

new text begin (k) "Flexible spending model" means a service delivery method of CFSS that uses
an individualized CFSS service delivery plan and service budget and assistance from the
financial management services contractor for the employment of support workers and the
acquisition of supports and goods.
new text end

new text begin (l) "Health-related procedures and tasks" means procedures and tasks related to
the specific needs of an individual that can be delegated or assigned by a state-licensed
healthcare or behavioral health professional and performed by a support worker.
new text end

new text begin (m) "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 money; communicating needs, preferences, and
activities; arranging supports; and assistance with traveling around and participating
in the community.
new text end

new text begin (n) "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.
new text end

new text begin (o) "Medication assistance" means providing verbal or visual reminders to take
regularly scheduled medication and includes any of the following supports:
new text end

new text begin (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;
new text end

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

new text begin (3) providing verbal or visual reminders to perform regularly scheduled medications.
new text end

new text begin (p) "Participant's representative" means a parent, family member, advocate, or
other adult authorized by the participant 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. The participant's representative must
have no financial interest in the provision of any services included in the participant's
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:
new text end

new text begin (1) being available while care is 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;
new text end

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

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

new text begin (q) "Person-centered planning process" means a process that is driven by the
participant for discovering and planning services and supports that ensures the participant
makes informed choices and decisions. The person-centered planning process must:
new text end

new text begin (1) include people chosen by the participant;
new text end

new text begin (2) provide necessary information and support to ensure that the participant directs
the process to the maximum extent possible, and is enabled to make informed choices
and decisions;
new text end

new text begin (3) be timely and occur at time and locations of convenience to the participant;
new text end

new text begin (4) reflect cultural considerations of the participant;
new text end

new text begin (5) include strategies for solving conflict or disagreement within the process,
including clear conflict-of-interest guidelines for all planning;
new text end

new text begin (6) offers choices to the participant regarding the services and supports they receive
and from whom;
new text end

new text begin (7) include a method for the participant to request updates to the plan; and
new text end

new text begin (8) record the alternative home and community-based settings that were considered
by the participant.
new text end

new text begin (r) "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 provider.
new text end

new text begin (s) "Support specialist" means a professional with the skills and ability to assist the
participant using either the agency provider model under subdivision 11 or the flexible
spending model under subdivision 13, in services including, but not limited to:
new text end

new text begin (1) the development, implementation, and evaluation of the CFSS service delivery
plan under subdivision 6;
new text end

new text begin (2) recruitment, training, or supervision, including supervision of health-related
tasks or behavioral supports appropriately delegated by a health care professional, and
evaluation of support workers; and
new text end

new text begin (3) facilitating the use of informal and community supports, goods, or resources.
new text end

new text begin (t) "Support worker" means a regular or temporary employee of the agency-provider,
the financial management services contractor, or the participant who has direct contact
with the participant and provides services as specified within the participant's service
delivery plan.
new text end

new text begin (u) "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, and contributions to
employee retirement accounts.
new text end

new text begin Subd. 3. new text end

new text begin Eligibility. new text end

new text begin CFSS is available to a person who meets one of the following:
new text end

new text begin (1) is a recipient of medical assistance as determined under section 256B.055,
256B.056, or 256B.057, subdivisions 5 and 9;
new text end

new text begin (2) is a recipient of the alternative care program under section 256B.0913;
new text end

new text begin (3) is a waiver recipient as defined under section 256B.0915, 256B.092, 256B.093,
or 256B.49; or
new text end

new text begin (4) has medical services identified in a participant's individualized education
program and is eligible for services as determined in section 256B.0625, subdivision 26.
new text end

new text begin (b) In addition to meeting the eligibility criteria in paragraph (a), a person must also
meet all of the following:
new text end

new text begin (1) is determined eligible based on assessment under section 256B.0911;
new text end

new text begin (2) is not a recipient under the family support grant under section 252.32;
new text end

new text begin (3) lives in the person's own apartment or home including a family foster care setting
licensed under chapter 245A, but not in corporate foster care under chapter 245A; or a
noncertified boarding care or boarding and lodging establishments under chapter 157;
unless transitioning into the community from an institution; and
new text end

new text begin (4) has not been excluded or disenrolled from the flexible spending model.
new text end

new text begin (c) The commissioner shall disenroll or exclude participants from the flexible
spending model and transfer them to the agency-provider model under the following
circumstances that include but are not limited to:
new text end

new text begin (1) when a participant has been restricted by the Minnesota restricted recipient
program, the participant may be excluded for a specified time period;
new text end

new text begin (2) when a participant exits the flexible spending service delivery model during the
participant's service plan year. Upon transfer, the participant shall not access the flexible
spending model for the remainder of that service plan year; or
new text end

new text begin (3) when the department determines that the participant or participant's representative
or legal representative cannot manage participant responsibilities under the service
delivery model. The commissioner must develop policies for determining if a participant
is unable to manage responsibilities under a service model.
new text end

new text begin (d) A participant may appeal in writing to the department to contest the department's
decision under paragraph (c), clause (3), to remove or exclude the participant from the
flexible spending model.
new text end

new text begin Subd. 4. new text end

new text begin Eligibility for other services. new text end

new text begin Selection of CFSS by a participant must not
restrict access to other medically necessary care and services furnished under the state
plan medical assistance benefit or other services available through alternative care.
new text end

new text begin Subd. 5. new text end

new text begin Assessment requirements. new text end

new text begin (a) The assessment of functional need must:
new text end

new text begin (1) be conducted by a certified assessor according to the criteria established in
section 256B.0911;
new text end

new text begin (2) be conducted face-to-face, initially and at least annually thereafter, or when there
is a significant change in the participant's condition or a change in the need for services
and supports; and
new text end

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

new text begin (b) A participant who is residing in a facility may be assessed and choose CFSS for
the purpose of using CFSS to return to the community as described in subdivisions 3
and 7, paragraph (a), clause (5).
new text end

new text begin (c) The results of the assessment and any recommendations and authorizations for
CFSS must be determined and communicated in writing by the lead agency's certified
assessor as defined in section 256B.0911 to the participant and the agency-provider or
financial management services provider chosen by the participant within 40 calendar days
and must include the participant's right to appeal under section 256.045.
new text end

new text begin Subd. 6. new text end

new text begin Community first services and support service delivery plan. new text end

new text begin (a) The
CFSS service delivery plan must be developed, implemented, and evaluated through a
person-centered planning process by the participant, or the participant's representative
or legal representative who may be assisted by a support specialist. The CFSS service
delivery plan must reflect the services and supports that are important to the participant
and for the participant to meet the needs assessed by the certified assessor and identified
in the community support plan under section 256B.0911 or the coordinated services and
support plan identified in section 256B.0915, subdivision 6, if applicable. The CFSS
service delivery plan must be reviewed by the participant and the agency-provider or
financial management services contractor at least annually upon reassessment, or when
there is a significant change in the participant's condition, or a change in the need for
services and supports.
new text end

new text begin (b) The commissioner shall establish the format and criteria for the CFSS service
delivery plan.
new text end

new text begin (c) The CFSS service delivery plan must be person-centered and:
new text end

new text begin (1) specify the agency-provider or financial management services contractor selected
by the participant;
new text end

new text begin (2) reflect the setting in which the participant resides that is chosen by the participant;
new text end

new text begin (3) reflect the participant's strengths and preferences;
new text end

new text begin (4) include the means to address the clinical and support needs as identified through
an assessment of functional needs;
new text end

new text begin (5) include individually identified goals and desired outcomes;
new text end

new text begin (6) reflect the services and supports, paid and unpaid, that will assist the participant
to achieve identified goals, and the providers of those services and supports, including
natural supports;
new text end

new text begin (7) identify the amount and frequency of face-to-face supports and amount and
frequency of remote supports and technology that will be used;
new text end

new text begin (8) identify risk factors and measures in place to minimize them, including
individualized backup plans;
new text end

new text begin (9) be understandable to the participant and the individuals providing support;
new text end

new text begin (10) identify the individual or entity responsible for monitoring the plan;
new text end

new text begin (11) be finalized and agreed to in writing by the participant and signed by all
individuals and providers responsible for its implementation;
new text end

new text begin (12) be distributed to the participant and other people involved in the plan; and
new text end

new text begin (13) prevent the provision of unnecessary or inappropriate care.
new text end

new text begin (d) The total units of agency-provider services or the budget allocation amount for
the flexible spending model include both annual totals and a monthly average amount
that cover the number of months of the service authorization. The amount used each
month may vary, but additional funds must not be provided above the annual service
authorization amount unless a change in condition is assessed and authorized by the
certified assessor and documented in the community support plan, coordinated services
and supports plan, and service delivery plan.
new text end

new text begin Subd. 7. new text end

new text begin Community first services and supports; covered services. new text end

new text begin (a) Services
and supports covered under CFSS include:
new text end

new text begin (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 complete the task or supervision and cueing to complete the task;
new text end

new text begin (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;
new text end

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

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

new text begin (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;
new text end

new text begin (4) observation and redirection for episodes where there is a need for redirection
due to participant behaviors. An assessment of behaviors must meet the criteria in this
clause. A recipient qualifies as having a need for assistance due to behaviors if the
recipient's behavior requires assistance at least four times per week and shows one or
more of the following behaviors:
new text end

new text begin (i) physical aggression towards self or others, or destruction of property that requires
the immediate response of another person;
new text end

new text begin (ii) increased vulnerability due to cognitive deficits or socially inappropriate
behavior; or
new text end

new text begin (iii) increased need for assistance for recipients who are verbally aggressive or
resistive to care so that time needed to perform activities of daily living is increased;
new text end

new text begin (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;
new text end

new text begin (6) transition costs, including:
new text end

new text begin (i) deposits for rent and utilities;
new text end

new text begin (ii) first month's rent and utilities;
new text end

new text begin (iii) bedding;
new text end

new text begin (iv) basic kitchen supplies;
new text end

new text begin (v) other necessities, to the extent that these necessities are not otherwise covered
under any other funding that the participant is eligible to receive; and
new text end

new text begin (vi) other required necessities for an individual to make the transition from a nursing
facility, institution for mental diseases, or intermediate care facility for persons with
developmental disabilities to a community-based home setting where the participant
resides; and
new text end

new text begin (7) services by a support specialist defined under subdivision 2 that are chosen
by the participant.
new text end

new text begin (b) Services and supports received under this section are not home care services for
the purposes of section 144A.43.
new text end

new text begin Subd. 8. new text end

new text begin Determination of CFSS service methodology. new text end

new text begin (a) All community first
services and supports must be authorized by the commissioner or the commissioner's
designee before services begin except for the assessments established in section
256B.0911. The authorization for CFSS must be completed within 30 days after receiving
a complete request.
new text end

new text begin (b) The amount of CFSS authorized must be based on the recipient's home
care rating. 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 recipient:
new text end

new text begin (1) the total number of dependencies of activities of daily living as defined in
subdivision 2;
new text end

new text begin (2) the presence of complex health-related needs as defined in subdivision 2; and
new text end

new text begin (3) the presence of Level I behavior as defined in subdivision 2.
new text end

new text begin (c) For purposes meeting the criteria in paragraph (b), the methodology to determine
the total minutes 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 CFSS program. Each
home care rating has a base number of minutes assigned. Additional minutes are added
through the assessment and identification of the following:
new text end

new text begin (1) 30 additional minutes per day for a dependency in each critical activity of daily
living as defined in subdivision 2;
new text end

new text begin (2) 30 additional minutes per day for each complex health-related function as
defined in subdivision 2; and
new text end

new text begin (3) 30 additional minutes per day for each behavior issue as defined in subdivision 2.
new text end

new text begin Subd. 9. new text end

new text begin Noncovered services. new text end

new text begin (a) Services or supports that are not eligible for
payment under this section include those that:
new text end

new text begin (1) are not authorized by the certified assessor or included in the written service
delivery plan;
new text end

new text begin (2) are provided prior to the authorization of services and the approval of the written
CFSS service delivery plan;
new text end

new text begin (3) are duplicative of other paid services in the written service delivery plan;
new text end

new text begin (4) supplant natural unpaid supports that are provided voluntarily to the participant
and are selected by the participant in lieu of a support worker and appropriately meeting
the participant's needs;
new text end

new text begin (5) are not effective means to meet the participant's needs; and
new text end

new text begin (6) are available through other funding sources, including, but not limited to, funding
through Title IV-E of the Social Security Act.
new text end

new text begin (b) Additional services, goods, or supports that are not covered include:
new text end

new text begin (1) those that are not for the direct benefit of the participant;
new text end

new text begin (2) any fees incurred by the participant, such as Minnesota health care programs 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;
new text end

new text begin (4) room and board costs for the participant with the exception of allowable
transition costs in subdivision 7, clause (6);
new text end

new text begin (5) services, supports, or goods that are not related to the assessed needs;
new text end

new text begin (6) special education and related services provided under the Individuals with
Disabilities Education Act and vocational rehabilitation services provided under the
Rehabilitation Act of 1973;
new text end

new text begin (7) assistive technology devices and assistive technology services other than those
for back-up systems or mechanisms to ensure continuity of service and supports listed in
subdivision 7;
new text end

new text begin (8) medical supplies and equipment;
new text end

new text begin (9) environmental modifications, except as specified in subdivision 7;
new text end

new text begin (10) expenses for travel, lodging, or meals related to training the participant, the
participant's representative, legal representative, or paid or unpaid caregivers that exceed
$500 in a 12-month period;
new text end

new text begin (11) experimental treatments;
new text end

new text begin (12) any service or good 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 (13) membership dues or costs, except when the service is necessary and appropriate
to treat a physical condition or to improve or maintain the participant's physical condition.
The condition must be identified in the participant's CFSS plan and monitored by a
physician enrolled in a Minnesota health care program;
new text end

new text begin (14) vacation expenses other than the cost of direct services;
new text end

new text begin (15) vehicle maintenance or modifications not related to the disability, health
condition, or physical need; and
new text end

new text begin (16) tickets and related costs to attend sporting or other recreational or entertainment
events.
new text end

new text begin Subd. 10. new text end

new text begin Provider qualifications and general requirements. new text end

new text begin (a)
Agency-providers delivering services under the agency-provider model under subdivision
11 or financial management service (FMS) contractors under subdivision 13 shall:
new text end

new text begin (1) enroll as a medical assistance Minnesota health care programs provider and meet
all applicable provider standards;
new text end

new text begin (2) comply with medical assistance provider enrollment requirements;
new text end

new text begin (3) demonstrate compliance with law and policies of CFSS as determined by the
commissioner;
new text end

new text begin (4) comply with background study requirements under chapter 245C;
new text end

new text begin (5) verify and maintain records of all services and expenditures by the participant,
including hours worked by support workers and support specialists;
new text end

new text begin (6) not engage in any agency-initiated direct contact or marketing in person, by
telephone, or other electronic means to potential participants, guardians, family member
or participants' representatives;
new text end

new text begin (7) pay support workers and support specialists based upon actual hours of services
provided;
new text end

new text begin (8) withhold and pay all applicable federal and state payroll taxes;
new text end

new text begin (9) make arrangements and pay unemployment insurance, taxes, workers'
compensation, liability insurance, and other benefits, if any;
new text end

new text begin (10) enter into a written agreement with the participant, participant's representative,
or legal representative that assigns roles and responsibilities to be performed before
services, supports, or goods are provided using a format established by the commissioner;
new text end

new text begin (11) report suspected neglect and abuse to the common entry point according to
sections 256B.0651 and 626.557; and
new text end

new text begin (12) provide the participant with a copy of the service-related rights under
subdivision 19 at the start of services and supports.
new text end

new text begin (b) The commissioner shall develop policies and procedures designed to ensure
program integrity and fiscal accountability for goods and services provided in this section.
new text end

new text begin Subd. 11. new text end

new text begin Agency-provider model. new text end

new text begin (a) The agency-provider model is limited to
the services provided by support workers and support specialists who are employed by
an agency-provider that is licensed according to chapter 245A or meets other criteria
established by the commissioner, including required training.
new text end

new text begin (b) The agency-provider shall allow the participant to retain the ability to have a
significant role in the selection and dismissal of the support workers for the delivery of the
services and supports specified in the service delivery plan.
new text end

new text begin (c) A participant may use authorized units of CFSS services as needed within
a service authorization that is not greater than 12 months. Using authorized units
agency-provider services or the budget allocation amount for the flexible spending model
flexibly does not increase the total amount of services and supports authorized for a
participant or included in the participant's service delivery plan.
new text end

new text begin (d) A participant may share CFSS services. Two or three CFSS participants may
share services at the same time provided by the same support worker.
new text end

new text begin (e) The agency-provider must use a minimum of 72.5 percent of the revenue
generated by the medical assistance payment for CFSS for support worker wages and
benefits. The agency-provider must document how this requirement is being met. The
revenue generated by the support specialist and the reasonable costs associated with the
support specialist must not be used in making this calculation.
new text end

new text begin (f) The agency-provider model must be used by individuals who have been restricted
by the Minnesota restricted recipient program.
new text end

new text begin Subd. 12. new text end

new text begin Requirements for initial enrollment of CFSS provider agencies. new text end

new text begin (a)
All CFSS provider agencies must provide, at the time of enrollment as a CFSS provider
agency in a format determined by the commissioner, information and documentation that
includes, but is not limited to, the following:
new text end

new text begin (1) the CFSS provider agency's current contact information including address,
telephone number, and e-mail address;
new text end

new text begin (2) proof of surety bond coverage in the amount of $50,000 or ten percent of the
provider's payments from Medicaid in the previous year, whichever is less;
new text end

new text begin (3) proof of fidelity bond coverage in the amount of $20,000;
new text end

new text begin (4) proof of workers' compensation insurance coverage;
new text end

new text begin (5) proof of liability insurance;
new text end

new text begin (6) a description of the CFSS provider agency's organization identifying the names
or all owners, managing employees, staff, board of directors, and the affiliations of the
directors, owners, or staff to other service providers;
new text end

new text begin (7) a copy of the CFSS provider agency's written policies and procedures including:
hiring of employees; training requirements; service delivery; and employee and consumer
safety including process for notification and resolution of consumer grievances,
identification and prevention of communicable diseases, and employee misconduct;
new text end

new text begin (8) copies of all other forms the CFSS provider agency uses in the course of daily
business including, but not limited to:
new text end

new text begin (i) a copy of the CFSS provider agency's time sheet if the time sheet varies from
the standard time sheet for CFSS services approved by the commissioner, and a letter
requesting approval of the CFSS provider agency's nonstandard time sheet;
new text end

new text begin (ii) the CFSS provider agency's template for the CFSS care plan; and
new text end

new text begin (iii) the CFSS provider agency's template for the written agreement in subdivision
21 for recipients using the CFSS choice option, if applicable;
new text end

new text begin (9) a list of all training and classes that the CFSS provider agency requires of its
staff providing CFSS services;
new text end

new text begin (10) documentation that the CFSS provider agency and staff have successfully
completed all the training required by this section;
new text end

new text begin (11) documentation of the agency's marketing practices;
new text end

new text begin (12) disclosure of ownership, leasing, or management of all residential properties
that is used or could be used for providing home care services;
new text end

new text begin (13) documentation that the agency will use the following percentages of revenue
generated from the medical assistance rate paid for CFSS services for employee personal
care assistant wages and benefits: 72.5 percent of revenue from CFSS providers. The
revenue generated by the support specialist and the reasonable costs associated with the
support specialist shall not be used in making this calculation; and
new text end

new text begin (14) documentation that the agency does not burden recipients' free exercise of their
right to choose service providers by requiring personal care assistants to sign an agreement
not to work with any particular CFSS recipient or for another CFSS provider agency after
leaving the agency and that the agency is not taking action on any such agreements or
requirements regardless of the date signed.
new text end

new text begin (b) CFSS provider agencies shall provide the information specified in paragraph
(a) to the commissioner.
new text end

new text begin (c) All CFSS provider agencies shall require all employees in management and
supervisory positions and owners of the agency who are active in the day-to-day
management and operations of the agency to complete mandatory training as determined
by the commissioner. Employees in management and supervisory positions and owners
who are active in the day-to-day operations of an agency who have completed the required
training as an employee with a CFSS provider agency do not need to repeat the required
training if they are hired by another agency, if they have completed the training within
the past three years. CFSS provider agency billing staff shall complete training about
CFSS program financial management. Any new owners or employees in management
and supervisory positions involved in the day-to-day operations are required to complete
mandatory training as a requisite of working for the agency. CFSS provider agencies
certified for participation in Medicare as home health agencies are exempt from the
training required in this subdivision.
new text end

new text begin Subd. 13. new text end

new text begin Flexible spending model. new text end

new text begin (a) Under the flexible spending model
participants accept more responsibility and control over the services and supports
described and budgeted within the CFSS service delivery plan. Under this model:
new text end

new text begin (1) using a budget allocation, participants may directly employ and pay support
workers and obtain other supports and goods as defined in subdivision 7; and
new text end

new text begin (2) from the financial management services (FMS) contractor the participant may
choose a range of support assistance for:
new text end

new text begin (i) planning, budgeting, and management of services and support;
new text end

new text begin (ii) the employment, training, supervision, and evaluation of workers;
new text end

new text begin (iii) acquisition and payment and supports and goods; and
new text end

new text begin (iv) evaluation of individual service outcomes as needed for the scope of the
participant's degree of control and responsibility.
new text end

new text begin (b) Participants who are unable to fulfill any of the functions listed in paragraph (a)
may authorize a legal representative or participant's representative to do so on their behalf.
new text end

new text begin (c) The FMS contractor shall not provide CFSS services and supports under the
agency-provider service model. The FMS contractor shall provide service functions as
determined by the commissioner that include but are not limited to:
new text end

new text begin (1) information and consultation about CFSS;
new text end

new text begin (2) assistance with the development of the service delivery plan and flexible
spending model as requested by the participant;
new text end

new text begin (3) billing and making payments for flexible spending model expenditures;
new text end

new text begin (4) employer and employer agent functions according to Internal Revenue Code
Procedure 70-6, section 3504, Agency Employer Tax Liability, regulation 137036-08,
which includes assistance with filing and paying payroll taxes, and obtaining worker
compensation coverage;
new text end

new text begin (5) data recording and reporting of participant spending; and
new text end

new text begin (6) other duties established in the contract with the department.
new text end

new text begin (d) A participant who requests to purchase goods and supports along with support
worker services under the agency-provider model must use flexible spending model
with a service delivery plan that specifies the amount of services to be authorized to the
agency-provider and the expenditures to be paid by the FMS contractor.
new text end

new text begin (e) The FMS contractor shall:
new text end

new text begin (1) not limit or restrict the participant's choice of service or support providers,
including the use of any available employment models;
new text end

new text begin (2) provide the participant and the targeted case manager, if applicable, with a
monthly written summary of the spending for services and supports that were billed
against the spending budget;
new text end

new text begin (3) be knowledgeable of state and federal employment regulations under the Fair
Labor Standards Act of 1938, and comply with the requirements under the Internal
Revenue Service Revenue Code Procedure 70-6, Section 35-4, Agency Employer Tax
Liability for vendor or fiscal employer agent, and any 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 (4) have current and adequate liability insurance and bonding and sufficient cash
flow as determined by the commission and have on staff or under contract a certified
public accountant or an individual with a baccalaureate degree in accounting;
new text end

new text begin (5) assume fiscal accountability for state funds designated for the program; and
new text end

new text begin (6) maintain documentation of receipts, invoices, and bills to track all services and
supports expenditures for any goods purchased and maintain time records of support
workers. The documentation and time records must be maintained for a minimum of
five years from the claim date and be available for audit or review upon request by the
commissioner. Claims submitted by the FMS contractor to the commissioner for payment
must correspond with services, amounts, and time periods as authorized in the participant's
spending budget and service plan.
new text end

new text begin (f) The commissioner of human services shall:
new text end

new text begin (1) establish rates and payment methodology for the FMS contractor;
new text end

new text begin (2) identify a process to ensure quality and performance standards for the FMS
contractor and ensure statewide access to FMS contractors; and
new text end

new text begin (3) establish a uniform protocol for delivering and administering CFSS services
to be used by eligible FMS contractors.
new text end

new text begin (g) Participants who are disenrolled from the model shall be transferred to the
agency-provider model.
new text end

new text begin Subd. 14. new text end

new text begin Participant's responsibilities under flexible spending model. new text end

new text begin (a) A
participant using the flexible spending model must use a FMS contractor or vendor that is
under contract with the department. Upon a determination of eligibility and completion of
the assessment and community support plan, the participant shall choose a FMS contractor
from a list of eligible vendors maintained by the department.
new text end

new text begin (b) When the participant, participant's representative, or legal representative chooses
to be the employer of record for the support worker, they are responsible for recruiting,
interviewing, hiring, training, scheduling, supervising, and discharging direct support
workers.
new text end

new text begin (c) In addition to the employer responsibilities in paragraph (b), the participant,
participant's representative, or legal representative is responsible for:
new text end

new text begin (1) tracking the services provided and all expenditures for goods or other supports;
new text end

new text begin (2) preparing and submitting time sheets, signed by both the participant and support
worker, to the FMS contractor on a regular basis and in a timely manner according to
the FMS contractor's procedures;
new text end

new text begin (3) notifying the FMS contractor within ten days of any changes in circumstances
affecting the CFSS service plan or in the participant's place of residence including, but
not limited to, any hospitalization of the participant or change in the participant's address,
telephone number, or employment;
new text end

new text begin (4) notifying the FMS contractor of any changes in the employment status of each
participant support worker; and
new text end

new text begin (5) reporting any problems resulting from the quality of services rendered by the
support worker to the FMS contractor. If the participant is unable to resolve any problems
resulting from the quality of service rendered by the support worker with the FMS
contractor, the participant shall report the situation to the department.
new text end

new text begin Subd. 15. new text end

new text begin Documentation of support services provided. new text end

new text begin (a) Support services
provided to a participant by a support worker employed by either an agency-provider
or the participant acting as the employer must be documented daily by each support
worker, on a time sheet form approved by the commissioner. All documentation may be
Web-based, electronic, or paper documentation. The completed form must be submitted
on a monthly basis to the provider or the participant and the FMS contractor selected by
the participant to provide assistance with meeting the participant's employer obligations
and kept in the recipient's health record.
new text end

new text begin (b) The activity documentation must correspond to the written service delivery plan
and be reviewed by the agency provider or the participant and the FMS contractor when
the participant is acting as the employer of the support worker.
new text end

new text begin (c) The time sheet must be on a form approved by the commissioner documenting
time the support worker provides services in the home. The following criteria must be
included in the time sheet:
new text end

new text begin (1) full name of the support worker and individual provider number;
new text end

new text begin (2) provider name and telephone numbers, if an agency-provider is responsible for
delivery services under the written service plan;
new text end

new text begin (3) full name of the participant;
new text end

new text begin (4) consecutive dates, including month, day, and year, and arrival and departure
times with a.m. or p.m. notations;
new text end

new text begin (5) signatures of the participant or the participant's representative;
new text end

new text begin (6) personal signature of the support worker;
new text end

new text begin (7) any shared care provided, if applicable;
new text end

new text begin (8) a statement that it is a federal crime to provide false information on CFSS
billings for medical assistance payments; and
new text end

new text begin (9) dates and location of recipient stays in a hospital, care facility, or incarceration.
new text end

new text begin Subd. 16. new text end

new text begin Support workers requirements. new text end

new text begin (a) Support workers shall:
new text end

new text begin (1) enroll with the department as a support worker after a background study under
chapter 245C has been completed and the support worker has received a notice from the
commissioner that:
new text end

new text begin (i) the support worker is not disqualified under section 245C.14; or
new text end

new text begin (ii) is disqualified, but the support worker has received a set-aside of the
disqualification under section 245C.22;
new text end

new text begin (2) have the ability to effectively communicate with the participant or the
participant's representative;
new text end

new text begin (3) have the skills and ability to provide the services and supports according to the
person's CFSS service delivery plan and respond appropriately to the participant's needs;
new text end

new text begin (4) not be a participant of CFSS;
new text end

new text begin (5) complete the basic standardized training as determined by the commissioner
before completing enrollment. The training must be available in languages other than
English and to those who need accommodations due to disabilities. Support worker
training must include successful completion of the following training components:
basic first aid, vulnerable adult, child maltreatment, OSHA universal precautions, basic
roles and responsibilities of support workers including information about basic body
mechanics, emergency preparedness, orientation to positive behavioral practices, fraud
issues, time cards and documentation, and an overview of person-centered planning and
self-direction. Upon completion of the training components, the support worker must pass
the certification test to provide assistance to participants;
new text end

new text begin (6) complete training and orientation on the participant's individual needs; and
new text end

new text begin (7) maintain the privacy and confidentiality of the participant, and not independently
determine the medication dose or time for medications for the participant.
new text end

new text begin (b) The commissioner may deny or terminate a support worker's provider enrollment
and provider number if the support worker:
new text end

new text begin (1) lacks the skills, knowledge, or ability to adequately or safely perform the
required work;
new text end

new text begin (2) fails to provide the authorized services required by the participant employer;
new text end

new text begin (3) has been intoxicated by alcohol or drugs while providing authorized services to
the participant or while in the participant's home;
new text end

new text begin (4) has manufactured or distributed drugs while providing authorized services to the
participant or while in the participant's home; or
new text end

new text begin (5) has been excluded as a provider by the commissioner of human services, or the
United States Department of Health and Human Services, Office of Inspector General,
from participation in Medicaid, Medicare, or any other federal health care program.
new text end

new text begin (c) A support worker may appeal in writing to the commissioner to contest the
decision to terminate the support worker's provider enrollment and provider number.
new text end

new text begin Subd. 17. new text end

new text begin Support specialist requirements and payments. new text end

new text begin The commissioner
shall develop qualifications, scope of functions, and payment rates and service limits for a
support specialist that may provide additional or specialized assistance necessary to plan,
implement, arrange, augment, or evaluate services and supports.
new text end

new text begin Subd. 18. new text end

new text begin Service unit and budget allocation requirements. new text end

new text begin (a) For the
agency-provider model, services will be authorized in units of service. The total service
unit amount must be established based upon the assessed need for CFSS services, and
must not exceed the maximum number of units available as determined by section
256B.0652, subdivision 6. The unit rate established by the commissioner is used with
assessed units to determine the maximum available CFSS allocation.
new text end

new text begin (b) For the flexible spending model, services and supports are authorized under
a budget limit.
new text end

new text begin (c) The maximum available CFSS participant budget allocation shall be established
by multiplying the number of units authorized under subdivision 8 by the payment rate
established by the commissioner.
new text end

new text begin Subd. 19. new text end

new text begin Support system. new text end

new text begin (a) The commissioner shall provide information,
consultation, training, and assistance to ensure the participant is able to manage the
services and supports and budgets, if applicable. This support shall include individual
consultation on how to select and employ workers, manage responsibilities under CFSS,
and evaluate personal outcomes.
new text end

new text begin (b) The commissioner shall provide assistance with the development of risk
management agreements.
new text end

new text begin Subd. 20. new text end

new text begin Service-related rights. new text end

new text begin Participants must be provided with adequate
information, counseling, training, and assistance, as needed, to ensure that the participant
is able to choose and manage services, models, and budgets. This support shall include
information regarding: (1) person-centered planning; (2) the range and scope of individual
choices; (3) the process for changing plans, services and budgets; (4) the grievance
process; (5) individual rights; (6) identifying and assessing appropriate services; (7) risks
and responsibilities; and (8) risk management. A participant who appeals a reduction in
previously authorized CFSS services may continue previously authorized services pending
an appeal under section 256.045. The commissioner must ensure that the participant
has a copy of the most recent service delivery plan that contains a detailed explanation
of which areas of covered CFSS are reduced, and provide notice of the amount of the
budget reduction, and the reasons for the reduction in the participant's notice of denial,
termination, or reduction.
new text end

new text begin Subd. 21. new text end

new text begin Development and Implementation Council. new text end

new text begin The commissioner
shall establish a Development and Implementation Council of which the majority of
members are individuals with disabilities, elderly individuals, and their representatives.
The commissioner shall consult and collaborate with the council when developing and
implementing this section.
new text end

new text begin Subd. 22. new text end

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

new text begin (a) The commissioner
shall establish quality assurance and risk management measures for use in developing and
implementing CFSS including those that (1) recognize the roles and responsibilities of those
involved in obtaining CFSS, and (2) ensure the appropriateness of such plans and budgets
based upon a recipient's resources and capabilities. Risk management measures must
include background studies, and 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 CFSS participants.
new text end

new text begin (c) Performance assessment measures, such as a participant's satisfaction with the
services and supports, and ongoing monitoring of health and well-being shall be identified
in consultation with the council established in subdivision 21.
new text end

new text begin Subd. 23. new text end

new text begin Commissioner's access. new text end

new text begin When the commissioner is investigating a
possible overpayment of Medicaid funds, the commissioner must be given immediate
access without prior notice to the agency provider or FMS contractor's office during
regular business hours and to documentation and records related to services provided and
submission of claims for services provided. Denying the commissioner access to records
is cause for immediate suspension of payment and terminating the agency provider's
enrollment according to section 256B.064 or terminating the FMS contract.
new text end

new text begin Subd. 24. new text end

new text begin CFSS agency-providers; background studies. new text end

new text begin CFSS agency-providers
enrolled to provide personal care assistance services under the medical assistance program
shall comply with the following:
new text end

new text begin (1) owners who have a five percent interest or more and all managing employees
are subject to a background study as provided in chapter 245C. This applies to currently
enrolled CFSS agency-providers and those agencies seeking enrollment as a CFSS
agency-provider. "Managing employee" has the same meaning as Code of Federal
Regulations, title 42, section 455. An organization is barred from enrollment if:
new text end

new text begin (i) the organization has not initiated background studies on owners managing
employees; or
new text end

new text begin (ii) the organization has initiated background studies on owners and managing
employees, but the commissioner has sent the organization a notice that an owner or
managing employee of the organization has been disqualified under section 245C.14, and
the owner or managing employee has not received a set-aside of the disqualification
under section 245C.22;
new text end

new text begin (2) a background study must be initiated and completed for all support specialists; and
new text end

new text begin (3) a background study must be initiated and completed for all support workers.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon federal approval. The
commissioner of human services shall notify the revisor of statutes when this occurs.
new text end

Sec. 44.

Minnesota Statutes 2012, section 256I.05, is amended by adding a subdivision
to read:

new text begin Subd. 1o. new text end

new text begin Supplementary service rate; exemptions. new text end

new text begin A county agency shall not
negotiate a supplementary service rate under this section for any individual that has been
determined to be eligible for Housing Stability Services as approved by the Centers
for Medicare and Medicaid Services, and who resides in an establishment voluntarily
registered under section 144D.025, as a supportive housing establishment or participates
in the Minnesota supportive housing demonstration program under section 256I.04,
subdivision 3, paragraph (a), clause (4).
new text end

Sec. 45.

Minnesota Statutes 2012, section 626.557, subdivision 4, is amended to read:

Subd. 4.

Reporting.

(a) Except as provided in paragraph (b), a mandated reporter
shall immediately make an oral report to the common entry point. new text begin The common entry
point may accept electronic reports submitted through a Web-based reporting system
established by the commissioner. new text end Use of a telecommunications device for the deaf or other
similar device shall be considered an oral report. The common entry point may not require
written reports. To the extent possible, the report must be of sufficient content to identify
the vulnerable adult, the caregiver, the nature and extent of the suspected maltreatment,
any evidence of previous maltreatment, the name and address of the reporter, the time,
date, and location of the incident, and any other information that the reporter believes
might be helpful in investigating the suspected maltreatment. A mandated reporter may
disclose not public data, as defined in section 13.02, and medical records under sections
144.291 to 144.298, to the extent necessary to comply with this subdivision.

(b) A boarding care home that is licensed under sections 144.50 to 144.58 and
certified under Title 19 of the Social Security Act, a nursing home that is licensed under
section 144A.02 and certified under Title 18 or Title 19 of the Social Security Act, or a
hospital that is licensed under sections 144.50 to 144.58 and has swing beds certified under
Code of Federal Regulations, title 42, section 482.66, may submit a report electronically
to the common entry point instead of submitting an oral report. The report may be a
duplicate of the initial report the facility submits electronically to the commissioner of
health to comply with the reporting requirements under Code of Federal Regulations, title
42, section 483.13. The commissioner of health may modify these reporting requirements
to include items required under paragraph (a) that are not currently included in the
electronic reporting form.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2014.
new text end

Sec. 46.

Minnesota Statutes 2012, section 626.557, subdivision 9, is amended to read:

Subd. 9.

Common entry point designation.

(a) deleted text begin Each county board shall designate
a common entry point for reports of suspected maltreatment. Two or more county boards
may jointly designate a single deleted text end new text begin The commissioner of human services shall establish a
new text end common entry point new text begin effective July 1, 2014 new text end . The common entry point is the unit responsible
for receiving the report of suspected maltreatment under this section.

(b) The common entry point must be available 24 hours per day to take calls from
reporters of suspected maltreatment. The common entry point shall use a standard intake
form that includes:

(1) the time and date of the report;

(2) the name, address, and telephone number of the person reporting;

(3) the time, date, and location of the incident;

(4) the names of the persons involved, including but not limited to, perpetrators,
alleged victims, and witnesses;

(5) whether there was a risk of imminent danger to the alleged victim;

(6) a description of the suspected maltreatment;

(7) the disability, if any, of the alleged victim;

(8) the relationship of the alleged perpetrator to the alleged victim;

(9) whether a facility was involved and, if so, which agency licenses the facility;

(10) any action taken by the common entry point;

(11) whether law enforcement has been notified;

(12) whether the reporter wishes to receive notification of the initial and final
reports; and

(13) if the report is from a facility with an internal reporting procedure, the name,
mailing address, and telephone number of the person who initiated the report internally.

(c) The common entry point is not required to complete each item on the form prior
to dispatching the report to the appropriate lead investigative agency.

(d) The common entry point shall immediately report to a law enforcement agency
any incident in which there is reason to believe a crime has been committed.

(e) If a report is initially made to a law enforcement agency or a lead investigative
agency, those agencies shall take the report on the appropriate common entry point intake
forms and immediately forward a copy to the common entry point.

(f) The common entry point staff must receive training on how to screen and
dispatch reports efficiently and in accordance with this section.

(g) The commissioner of human services shall maintain a centralized database
for the collection of common entry point data, lead investigative agency data including
maltreatment report disposition, and appeals data. new text begin The common entry point shall
have access to the centralized database and must log the reports into the database and
immediately identify and locate prior reports of abuse, neglect, or exploitation.
new text end

new text begin (h) When appropriate, the common entry point staff must refer calls that do not
allege the abuse, neglect, or exploitation of a vulnerable adult to other organizations
that might resolve the reporter's concerns.
new text end

new text begin (i) a common entry point must be operated in a manner that enables the
commissioner of human services to:
new text end

new text begin (1) track critical steps in the reporting, evaluation, referral, response, disposition,
and investigative process to ensure compliance with all requirements for all reports;
new text end

new text begin (2) maintain data to facilitate the production of aggregate statistical reports for
monitoring patterns of abuse, neglect, or exploitation;
new text end

new text begin (3) serve as a resource for the evaluation, management, and planning of preventative
and remedial services for vulnerable adults who have been subject to abuse, neglect,
or exploitation;
new text end

new text begin (4) set standards, priorities, and policies to maximize the efficiency and effectiveness
of the common entry point; and
new text end

new text begin (5) track and manage consumer complaints related to the common entry point.
new text end

new text begin (j) The commissioners of human services and health shall collaborate on the creation
of a triage system for investigations. This system shall enable the commissioner of human
services to track critical steps in the reporting, evaluation, referral, response, disposition,
investigation, notification, determination, and appeal processes.
new text end

Sec. 47.

Minnesota Statutes 2012, section 626.557, subdivision 9e, is amended to read:

Subd. 9e.

Education requirements.

(a) The commissioners of health, human
services, and public safety shall cooperate in the development of a joint program for
education of lead investigative agency investigators in the appropriate techniques for
investigation of complaints of maltreatment. This program must be developed by July
1, 1996. The program must include but need not be limited to the following areas: (1)
information collection and preservation; (2) analysis of facts; (3) levels of evidence; (4)
conclusions based on evidence; (5) interviewing skills, including specialized training to
interview people with unique needs; (6) report writing; (7) coordination and referral
to other necessary agencies such as law enforcement and judicial agencies; (8) human
relations and cultural diversity; (9) the dynamics of adult abuse and neglect within family
systems and the appropriate methods for interviewing relatives in the course of the
assessment or investigation; (10) the protective social services that are available to protect
alleged victims from further abuse, neglect, or financial exploitation; (11) the methods by
which lead investigative agency investigators and law enforcement workers cooperate in
conducting assessments and investigations in order to avoid duplication of efforts; and
(12) data practices laws and procedures, including provisions for sharing data.

new text begin (b) The commissioner of human services shall conduct an outreach campaign to
promote the common entry point for reporting vulnerable adult maltreatment. This
campaign shall assist potential reporters, mandated reporters, and vulnerable adults in
finding information on reporting to the common entry point. This campaign shall use the
Internet and other means of communication.
new text end

deleted text begin (b) deleted text end new text begin (c) new text end The commissioners of health, human services, and public safety shall offer at
least annual education to others on the requirements of this section, on how this section is
implemented, and investigation techniques.

deleted text begin (c) deleted text end new text begin (d) new text end The commissioner of human services, in coordination with the commissioner
of public safety shall provide training for the common entry point staff as required in this
subdivision and the program courses described in this subdivision, at least four times
per year. At a minimum, the training shall be held twice annually in the seven-county
metropolitan area and twice annually outside the seven-county metropolitan area. The
commissioners shall give priority in the program areas cited in paragraph (a) to persons
currently performing assessments and investigations pursuant to this section.

deleted text begin (d) deleted text end new text begin (e) new text end The commissioner of public safety shall notify in writing law enforcement
personnel of any new requirements under this section. The commissioner of public
safety shall conduct regional training for law enforcement personnel regarding their
responsibility under this section.

deleted text begin (e) deleted text end new text begin (f) new text end Each lead investigative agency investigator must complete the education
program specified by this subdivision within the first 12 months of work as a lead
investigative agency investigator.

A lead investigative agency investigator employed when these requirements take
effect must complete the program within the first year after training is available or as soon
as training is available.

All lead investigative agency investigators having responsibility for investigation
duties under this section must receive a minimum of eight hours of continuing education
or in-service training each year specific to their duties under this section.

Sec. 48. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2012, sections 245A.655; 256B.0911, subdivisions 4a, 4b, and
4c; and 256B.0917, subdivisions 1, 2, 3, 4, 5, 7, 8, 9, 10, 11, 12, and 14, new text end new text begin are repealed.
new text end