SF 1708

1st Engrossment - 89th Legislature (2015 - 2016) Posted on 08/21/2015 04:24pm

A bill for an act
relating to human services; providing for human services policy modifications
relating to the community first services and supports program; amending
Minnesota Statutes 2014, section 256B.85.

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

Section 1.

Minnesota Statutes 2014, section 256B.85, is amended to read:

256B.85 COMMUNITY FIRST SERVICES AND SUPPORTS.

Subdivision 1.

Basis and scope.

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

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

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

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

Subd. 2.

Definitions.

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

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

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

(d) "Behavior" means a description of a need for services and supports used to
determine the home care rating and additional service units. The presence of Level I
behavior is used to determine the home care rating. deleted text begin "Level I behavior" means physical
aggression towards self or others or destruction of property that requires the immediate
response of another person. If qualified for a home care rating as described in subdivision
8, additional service units can be added as described in subdivision 8, paragraph (f), for
the following behaviors:
deleted text end

deleted text begin (1) Level I behavior;
deleted text end

deleted text begin (2) increased vulnerability due to cognitive deficits or socially inappropriate
behavior; or
deleted text end

deleted text begin (3) increased need for assistance for participants who are verbally aggressive or
resistive to care so that time needed to perform activities of daily living is increased.
deleted text end

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

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

(1) tube feedings requiring:

(i) a gastrojejunostomy tube; or

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

(2) wounds described as:

(i) stage III or stage IV;

(ii) multiple wounds;

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

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

(3) parenteral therapy described as:

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

(ii) total parenteral nutrition (TPN) daily;

(4) respiratory interventions, including:

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

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

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

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

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

(vi) ventilator dependence under section deleted text begin 256B.0652 deleted text end new text begin 256B.0651 new text end ;

(5) insertion and maintenance of catheter, including:

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

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

(iii) bladder irrigations;

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

(7) neurological intervention, including:

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

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

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

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

(h) "Community first services and supports service delivery plan" or " new text begin CFSS new text end service
delivery plan" means a written document detailing the services and supports chosen
by the participant to meet assessed needs that are within the approved CFSS service
authorization deleted text begin amount deleted text end new text begin , as determined in subdivision 8 new text end . Services and supports are based
on the deleted text begin community support plan identified in section 256B.0911 and deleted text end coordinated deleted text begin services deleted text end new text begin
service new text end and support plan deleted text begin and budget deleted text end identified in section 256B.0915, subdivision 6 deleted text begin , if
applicable, that is determined by the participant to meet the assessed needs, using a
person-centered planning process deleted text end .

(i) "Consultation services" means a Minnesota health care program enrolled provider
organization that deleted text begin is under contract with the department and has the knowledge, skills,
and ability to assist CFSS participants in using either the agency-provider model under
subdivision 11 or the budget model under subdivision 13. deleted text end new text begin provides assistance to the
participant in making informed choices about CFSS services in general and self-directed
tasks in particular, and in developing a person-centered CFSS service delivery plan to
achieve quality service outcomes.
new text end

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

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

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

(m) "Financial management services deleted text begin contractor or vendor deleted text end new text begin provider new text end " or "FMS
deleted text begin contractor deleted text end new text begin provider new text end " means a qualified organization required for participants using the
budget model under subdivision 13 that deleted text begin has a written contract deleted text end new text begin is an enrolled provider new text end with
the department to provide vendor fiscal/employer agent financial management services
(FMS). deleted text begin Services include but are not limited to: filing and payment of federal and state
payroll taxes on behalf of the participant; initiating criminal background checks; billing
for approved CFSS services with authorized funds; monitoring expenditures; accounting
for and disbursing CFSS funds; providing assistance in obtaining and filing for liability,
workers' compensation, and unemployment coverage; and providing participant instruction
and technical assistance to the participant in fulfilling employer-related requirements in
accordance with Section 3504 of the Internal Revenue Code and related regulations and
interpretations, including Code of Federal Regulations, title 26, section 31.3504-1.
deleted text end

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

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

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

deleted text begin (p) deleted text end new text begin (q) new text end "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 begin (r) "Level I behavior" means physical aggression towards self or others or
destruction of property that requires the immediate response of another person.
new text end

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

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

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

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

new text begin (t) "Participant" means a person who is eligible for CFSS.
new text end

deleted text begin (r) deleted text end new text begin (u) new text end "Participant's representative" means a parent, family member, advocate,
or other adult authorized by the participant new text begin or participant's legal representative, if any,
new text end to serve as a representative in connection with the provision of CFSS new text begin as described in
subdivision 20b new text end . This authorization must be in writing or by another method that clearly
indicates the participant's free choice new text begin and may be withdrawn at any time new text end . The participant's
representative must have no financial interest in the provision of any services included in
the participant's new text begin CFSS new text end service delivery plan and must be capable of providing the support
necessary to assist the participant in the use of CFSS. If through the assessment process
described in subdivision 5 a participant is determined to be in need of a participant's
representative, one must be selected. If the participant is unable to assist in the selection of
a participant's representative, the legal representative shall appoint one. Two persons may
be designated as a participant's representative for reasons such as divided households and
court-ordered custodies. Duties of a participant's representatives may include:

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

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

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

deleted text begin (s) deleted text end new text begin (v) new text end "Person-centered planning process" means a process that is directed by the
participant to plan for new text begin CFSS new text end services and supports. deleted text begin The person-centered planning process
must:
deleted text end

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

deleted 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;
deleted text end

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

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

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

deleted text begin (6) provide the participant choices of the services and supports they receive and the
staff providing those services and supports;
deleted text end

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

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

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

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

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

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

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

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

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

Subd. 3.

Eligibility.

(a) CFSS is available to a person who meets one of the
following:

(1) is an enrollee of medical assistance as determined under section 256B.055,
256B.056, or 256B.057, subdivisions 5 and 9;

(2) is a participant in the alternative care program under section 256B.0913;

(3) is a waiver participant as defined under section 256B.0915, 256B.092, 256B.093,
or 256B.49; or

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

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

(1) require assistance and be determined dependent in one activity of daily living or
Level I behavior based on assessment under section 256B.0911; and

(2) is not a participant under a family support grant under section 252.32.

Subd. 4.

Eligibility for other services.

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

Subd. 5.

Assessment requirements.

(a) The assessment of functional need must:

(1) be conducted by a certified assessor according to the criteria established in
section 256B.0911, subdivision 3a;

(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, or at the request of the participant when the participant experiences a change
in condition or needs a change in the services or supports; and

(3) be completed using the format established by the commissioner.

(b) 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
FMS deleted text begin contractor deleted text end new text begin provider new text end chosen by the participant within 40 calendar days and must
include the participant's right to appeal under section 256.045, subdivision 3.

(c) The lead agency assessor may authorize a temporary authorization for CFSS
services to be provided under the agency-provider model. Authorization for a temporary
level of CFSS services under the agency-provider model is limited to the time specified by
the commissioner, but shall not exceed 45 days. The level of services authorized under
this paragraph shall have no bearing on a future authorization. Participants approved for a
temporary authorization shall access the consultation service to complete their orientation
and selection of a service model.

Subd. 6.

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

(a) The CFSS service delivery plan must be developed 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 consultation services provider. 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 deleted text begin community support plan under section 256B.0911, subdivision 3, or the deleted text end
coordinated deleted text begin services deleted text end new text begin service new text end and support plan identified in section 256B.0915, subdivision
6 deleted text begin , if applicable deleted text end . The CFSS service delivery plan must be reviewed by the participant, the
consultation services provider, and the agency-provider or FMS deleted text begin contractor deleted text end new text begin provider new text end prior
to starting services and 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.

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

(c) The CFSS service delivery plan must be person-centered and:

(1) specify the consultation services provider, agency-provider, or FMS deleted text begin contractor deleted text end new text begin
provider new text end selected by the participant;

(2) reflect the setting in which the participant resides that is chosen by the participant;

(3) reflect the participant's strengths and preferences;

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

(5) include deleted text begin individually deleted text end new text begin the participant's new text end identified goals and desired outcomes;

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

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

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

(9) be understandable to the participant and the individuals providing support;

(10) identify the individual or entity responsible for monitoring the plan;

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

(12) be distributed to the participant and other people involved in the plan;

(13) prevent the provision of unnecessary or inappropriate care;

(14) include a detailed budget for expenditures for budget model participants or
participants under the agency-provider model if purchasing goods; and

(15) include a plan for worker training and development new text begin provided according to
subdivision 18a new text end detailing what service components will be used, when the service
components will be used, how they will be provided, and how these service components
relate to the participant's individual needs and CFSS support worker services.

(d) The total units of agency-provider services or the service budget amount for the
budget model include both annual totals and a monthly average amount that cover the
number of months of the service deleted text begin authorization deleted text end new text begin agreement new text end . The amount used each month
may vary, but additional funds must not be provided above the annual service authorization
amount new text begin , determined according to subdivision 8, new text end unless a change in condition is assessed
and authorized by the certified assessor and documented in the deleted text begin community support plan, deleted text end
coordinated deleted text begin services deleted text end new text begin service new text end and deleted text begin supports deleted text end new text begin support new text end plan deleted text begin , deleted text end and CFSS service delivery plan.

(e) In assisting with the development or modification of the new text begin CFSS service delivery
new text end plan during the authorization time period, the consultation services provider shall:

(1) consult with the FMS deleted text begin contractor deleted text end new text begin provider new text end on the spending budget when
applicable; and

(2) consult with the participant or participant's representative, agency-provider, and
case manager/care coordinator.

(f) The new text begin CFSS new text end service new text begin delivery new text end plan must be approved by the consultation services
provider for participants without a case deleted text begin manager/care deleted text end new text begin manager or care new text end coordinator new text begin who is
responsible for authorizing services new text end . A case deleted text begin manager/care deleted text end new text begin manager or care new text end coordinator
must approve the plan for a waiver or alternative care program participant.

new text begin Subd. 6a. new text end

new text begin Person-centered planning process. new text end

new text begin 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 times and locations convenient to the participant;
new text end

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

new text begin (5) include within the process strategies for solving conflict or disagreement,
including clear conflict-of-interest guidelines as identified in Code of Federal Regulations,
title 42, section 441.500, for all planning;
new text end

new text begin (6) provide the participant choices of the services and supports the participant
receives and the staff providing those services and supports;
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

Subd. 7.

Community first services and supports; covered services.

deleted text begin Within the
service unit authorization or service budget amount, deleted text end Services and supports covered under
CFSS include:

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

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

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

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

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

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

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

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

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

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

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

(7) services provided by an FMS deleted text begin contractor under contract deleted text end new text begin provider as defined
under subdivision 13a, that is an enrolled provider new text end with the department deleted text begin as defined under
subdivision 13 deleted text end ;

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

(9) worker training and development services as deleted text begin defined in subdivision 2, paragraph
(w), and deleted text end described in subdivision 18a.

Subd. 8.

Determination of CFSS service deleted text begin methodology deleted text end new text begin authorization amount new text end .

(a)
All community first services and supports must be authorized by the commissioner or the
commissioner's designee before services begin deleted text begin , except for the assessments established in
section 256B.0911 deleted text end . The authorization for CFSS must be completed as soon as possible
following an assessment but no later than 40 calendar days from the date of the assessment.

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

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

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

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

(3) the presence of Level I behavior deleted text begin as defined in subdivision 2, paragraph (d) deleted text end .

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

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

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

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

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

(4) S home care rating requires four to six dependencies in ADLs and qualifies deleted text begin one deleted text end new text begin
the person new text end for ten service units;

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

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

(7) V home care rating requires seven to eight dependencies in ADLs and qualifies
deleted text begin one deleted text end new text begin the person new text end for 17 service units;

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

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

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

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

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

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

(3) 30 additional minutes per day deleted text begin for each behavior issue as defined in subdivision
2, paragraph (d). deleted text end new text begin when the behavior requires assistance at least four times per week for
one or more of the following behaviors:
new text end

new text begin (i) level I behavior;
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 participants who are verbally aggressive or
resistive to care so that the time needed to perform activities of daily living is increased.
new text end

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

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

(2) an adjustment needed for administrative expenses.

Subd. 9.

Noncovered services.

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

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

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

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

(4) supplant natural unpaid supports that appropriately meet a need in the new text begin CFSS
new text end service new text begin delivery new text end plan, are provided voluntarily to the participant, and are selected by the
participant in lieu of other services and supports;

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

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

(b) Additional services, goods, or supports that are not covered include:

(1) those that are not for the direct benefit of the participant, except that services for
caregivers such as training to improve the ability to provide CFSS are considered to directly
benefit the participant if chosen by the participant and approved in the support plan;

(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;

(3) insurance, except for insurance costs related to employee coverage;

(4) room and board costs for the participant;

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

(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;

(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;

(8) medical supplies and equipment covered under medical assistance;

(9) environmental modifications, except as specified in subdivision 7;

(10) expenses for travel, lodging, or meals related to training the participant or the
participant's representative or legal representative;

(11) experimental treatments;

(12) any service or good covered by other deleted text begin medical assistance deleted text end state plan services,
including prescription and over-the-counter medications, compounds, and solutions and
related fees, including premiums and co-payments;

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

(14) vacation expenses other than the cost of direct services;

(15) vehicle maintenance or modifications not related to the disability, health
condition, or physical need;

(16) tickets and related costs to attend sporting or other recreational or entertainment
events;

(17) services provided and billed by a provider who is not an enrolled CFSS provider;

(18) CFSS provided by a participant's representative or paid legal guardian;

(19) services that are used solely as a child care or babysitting service;

(20) services that are the responsibility or in the daily rate of a residential or program
license holder under the terms of a service agreement and administrative rules;

(21) sterile procedures;

(22) giving of injections into veins, muscles, or skin;

(23) homemaker services that are not an integral part of the assessed CFSS service;

(24) home maintenance or chore services;

(25) home care services, including hospice services if elected by the participant,
covered by Medicare or any other insurance held by the participant;

(26) services to other members of the participant's household;

(27) services not specified as covered under medical assistance as CFSS;

(28) application of restraints or implementation of deprivation procedures;

(29) assessments by CFSS provider organizations or by independently enrolled
registered nurses;

(30) services provided in lieu of legally required staffing in a residential or child
care setting; and

(31) services provided by the residential or program license holder in a residence
for more than four deleted text begin persons deleted text end new text begin participants new text end .

Subd. 10.

Agency-provider and FMS deleted text begin contractor deleted text end new text begin provider new text end qualifications deleted text begin ,
general requirements, deleted text end and duties.

(a) Agency-providers deleted text begin delivering services under the
agency-provider model under deleted text end new text begin identified in new text end subdivision 11 deleted text begin or deleted text end new text begin and new text end FMS deleted text begin contractors under deleted text end new text begin
providers identified in new text end subdivision deleted text begin 13 deleted text end new text begin 13a new text end shall:

(1) enroll as a medical assistance Minnesota health care programs provider and meet
all applicable provider standards and requirements;

(2) demonstrate compliance with federal and state laws and policies for CFSS as
determined by the commissioner;

(3) comply with background study requirements under chapter 245C and maintain
documentation of background study requests and results;

(4) verify and maintain records of all services and expenditures by the participant,
including hours worked by support workers;

(5) not engage in any agency-initiated direct contact or marketing in person, by
telephone, or other electronic means to potential participants, guardians, family members,
or participants' representatives;

(6) directly provide services and not use a subcontractor or reporting agent;

(7) meet the financial requirements established by the commissioner for financial
solvency;

(8) have never had a lead agency contract or provider agreement discontinued due to
fraud, or have never had an owner, board member, or manager fail a state or FBI-based
criminal background check while enrolled or seeking enrollment as a Minnesota health
care programs provider; new text begin and
new text end

deleted text begin (9) have established business practices that include written policies and procedures,
internal controls, and a system that demonstrates the organization's ability to deliver
quality CFSS; and
deleted text end

deleted text begin (10) deleted text end new text begin (9) new text end have an office located in Minnesota.

(b) In conducting general duties, agency-providers and FMS deleted text begin contractors deleted text end new text begin providers new text end
shall:

(1) pay support workers based upon actual hours of services provided;

(2) pay for worker training and development services based upon actual hours of
services provided or the unit cost of the training session purchased;

(3) withhold and pay all applicable federal and state payroll taxes;

(4) make arrangements and pay unemployment insurance, taxes, workers'
compensation, liability insurance, and other benefits, if any;

(5) 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 deleted text begin using a format established by the commissioner deleted text end ;

(6) report maltreatment as required under sections 626.556 and 626.557; new text begin and
new text end

deleted text begin (7) provide the participant with a copy of the service-related rights under subdivision
20 at the start of services and supports; and
deleted text end

deleted text begin (8) deleted text end new text begin (7) new text end comply with any data requests from the department consistent with the
Minnesota Government Data Practices Act under chapter 13.

Subd. 11.

Agency-provider model.

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

(b) The agency-provider shall allow the participant 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 participant's new text begin CFSS new text end service delivery plan.

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

(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.

(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 worker training and development services and the reasonable costs associated with
the worker training and development services must not be used in making this calculation.

(f) The agency-provider model must be used by individuals who deleted text begin have been deleted text end new text begin are new text end
restricted by the Minnesota restricted recipient program under Minnesota Rules, parts
9505.2160 to 9505.2245.

(g) Participants purchasing goods under this model, along with support worker
services, must:

(1) specify the goods in the new text begin CFSS new text end service delivery plan and detailed budget for
expenditures that must be approved by the consultation services provider deleted text begin or the deleted text end new text begin , new text end case
deleted text begin manager/care deleted text end new text begin manager, or care new text end coordinator; and

(2) use the FMS deleted text begin contractor deleted text end new text begin provider new text end for the billing and payment of such goods.

new text begin Subd. 11a. new text end

new text begin Agency-provider model; evaluation of CFSS services. new text end

new text begin (a) The
agency-provider is responsible to work with the participant and the participant's
representative, if any, in the evaluation of the CFSS goals and CFSS service delivery
plan as identified in subdivision 18a, paragraph (c), clause (4). The agency-provider
must complete an evaluation of CFSS services within 90 days of service initiation and at
least quarterly thereafter. Quarterly evaluations during the first year must be completed
in person. Following the first year of service, at least one quarterly evaluation each year
must be completed in person. An in-person evaluation must also be completed within 30
calendar days of the discovery or receipt of information of any changes in the participant's
condition for which CFSS is provided.
new text end

new text begin (b) Each CFSS evaluation required in paragraph (a) must evaluate and document
the required elements in clauses (1) to (5):
new text end

new text begin (1) whether the CFSS service delivery plan accurately identifies the participant's
current service needs;
new text end

new text begin (2) whether services are supporting accomplishment of the goals identified in the
CFSS service delivery plan;
new text end

new text begin (3) whether workers are competent in providing services identified in the CFSS
service delivery plan;
new text end

new text begin (4) whether the agency-provider, the participant, or the participant's representative,
if any, has any additional concerns with the CFSS service delivery plan, goals, service
delivery, or worker competency not identified in clauses (1) to (3); and
new text end

new text begin (5) based on the evaluation required in clauses (1) to (4), whether revisions are
needed to the CFSS service delivery plan or goals or how CFSS is used or delivered,
whether there is a need for additional worker training, or whether any other actions are
needed to support the participant's use of CFSS and who will take the action.
new text end

new text begin If changes are needed based on the results of the evaluation, a revised CFSS service
delivery plan must be completed and provided to the participant or participant's
representative, if any, within 30 calendar days of the evaluation.
new text end

new text begin Subd. 11b. new text end

new text begin Agency-provider model; support worker competency. new text end

new text begin (a) The
agency-provider must ensure that support workers are competent to meet the participant's
assessed needs, goals, and additional requirements as written in the CFSS service
delivery plan. Within 30 days of any support worker beginning to provide services for
a participant, the agency-provider must evaluate the competency of the worker through
direct observation of the support worker's performance of the job functions in a setting
where the participant is using CFSS.
new text end

new text begin (b) The agency-provider must verify and maintain evidence of support worker
competency, including documentation of the support worker's:
new text end

new text begin (1) education and experience relevant to the job responsibilities assigned to the
support worker and the needs of the participant;
new text end

new text begin (2) relevant training received from sources other than the agency-provider;
new text end

new text begin (3) orientation and instruction to implement services and supports to participant
needs and preferences as identified in the CFSS service delivery plan; and
new text end

new text begin (4) periodic performance reviews completed by the agency-provider at least
annually, including any evaluations required under subdivision 11a, paragraph (a).
new text end

new text begin If a support worker is a minor, all evaluations of worker competency must be completed in
person and in a setting where the participant is using CFSS.
new text end

new text begin (c) The agency-provider must develop a worker training and development plan
with the participant to ensure support worker competency. The worker training and
development plan must be updated when:
new text end

new text begin (1) the support worker begins providing services;
new text end

new text begin (2) there is any change in condition or a modification to the CFSS service delivery
plan; or
new text end

new text begin (3) a performance review indicates that additional training is needed.
new text end

Subd. 12.

Requirements for enrollment of CFSS agency-providers.

(a) All CFSS
agency-providers must provide, at the time of enrollment, reenrollment, and revalidation
as a CFSS agency-provider in a format determined by the commissioner, information and
documentation that includes, but is not limited to, the following:

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

(2) proof of surety bond coverage. Upon new enrollment, or if the agency-provider's
Medicaid revenue in the previous calendar year is less than or equal to $300,000, the
agency-provider must purchase a surety bond of $50,000. If the agency-provider's
Medicaid revenue in the previous calendar year is greater than $300,000, the
agency-provider must purchase a surety bond of $100,000. The surety bond must be in
a form approved by the commissioner, must be renewed annually, and must allow for
recovery of costs and fees in pursuing a claim on the bond;

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

(4) proof of workers' compensation insurance coverage;

(5) proof of liability insurance;

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

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

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

(i) a copy of the CFSS agency-provider's time sheet deleted text begin 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 agency-provider's nonstandard time sheet deleted text end ; and

(ii) a copy of the participant's individual CFSS service delivery plan;

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

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

(11) documentation of the agency-provider's marketing practices;

(12) disclosure of ownership, leasing, or management of all residential properties
that are used or could be used for providing home care services;

(13) documentation that the agency-provider will use at least the following
percentages of revenue generated from the medical assistance rate paid for CFSS services
for CFSS support worker wages and benefits: 72.5 percent of revenue from CFSS
providers. The revenue generated by the worker training and development services and
the reasonable costs associated with the worker training and development services shall
not be used in making this calculation; and

(14) documentation that the agency-provider does not burden participants' free
exercise of their right to choose service providers by requiring CFSS support workers to
sign an agreement not to work with any particular CFSS participant or for another CFSS
agency-provider after leaving the agency and that the agency is not taking action on any
such agreements or requirements regardless of the date signed.

(b) CFSS agency-providers shall provide to the commissioner the information
specified in paragraph (a).

(c) All CFSS agency-providers 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 agency-provider 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 agency-provider 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.

(d) The commissioner shall send annual review notifications to agency-providers 30
days prior to renewal. The notification must:

(1) list the materials and information the agency-provider is required to submit;

(2) provide instructions on submitting information to the commissioner; and

(3) provide a due date by which the commissioner must receive the requested
information.

Agency-providers shall submit deleted text begin the deleted text end new text begin all new text end required documentation for annual review within
30 days of notification from the commissioner. deleted text begin If no documentation is submitted,
the agency-provider enrollment number must be terminated or suspended deleted text end new text begin If an
agency-provider fails to submit all the required documentation, the commissioner may
take action under subdivision 23a new text end .

new text begin Subd. 12a. new text end

new text begin CFSS agency-provider requirements; policies for complaint process
and incident response. new text end

new text begin (a) The CFSS agency-provider must establish policies and
procedures that promote service recipient rights by providing a simple complaint process
for participants served by the program and their authorized representatives to bring a
grievance. The complaint process must:
new text end

new text begin (1) provide staff assistance with the complaint process when requested;
new text end

new text begin (2) allow the participant to bring the complaint to the highest level of authority in
the program if the grievance cannot be resolved by other staff members, and provide the
name, address, and telephone number of that person;
new text end

new text begin (3) provide the addresses and telephone numbers of outside agencies to assist the
participant;
new text end

new text begin (4) require a prompt response to all complaints affecting a participant's health and
safety and a timely response to all other complaints;
new text end

new text begin (5) require an evaluation of whether:
new text end

new text begin (i) related policies and procedures were followed and adequate;
new text end

new text begin (ii) there is a need for additional staff training;
new text end

new text begin (iii) the complaint is similar to past complaints with the persons, staff, or services
involved; and
new text end

new text begin (iv) there is a need for corrective action by the agency-provider to protect the health
and safety of participants receiving services;
new text end

new text begin (6) provide a written summary of the complaint and a notice of the complaint
resolution to the participant and, if applicable, case manager or care coordinator; and
new text end

new text begin (7) require that the complaint summary and resolution notice be maintained in
the participant's service record.
new text end

new text begin (b) The CFSS agency-provider must establish policies and procedures for responding
to incidents that occur while services are being provided. When a participant has a
legal representative or a participant's representative, incidents must be reported to these
representatives. For the purposes of this paragraph, "incident" means an occurrence that
involves a participant and requires a response that is not a part of the ordinary provision of
the services to that participant, and includes:
new text end

new text begin (1) serious injury of a participant as determined by section 245.91, subdivision 6;
new text end

new text begin (2) a participant's death;
new text end

new text begin (3) any medical emergency, unexpected serious illness, or significant unexpected
change in a participant's illness or medical condition that requires a call to 911, physician
treatment, or hospitalization;
new text end

new text begin (4) any mental health crisis that requires a call to 911 or a mental health crisis
intervention team;
new text end

new text begin (5) an act or situation involving a participant that requires a call to 911, law
enforcement, or the fire department;
new text end

new text begin (6) a participant's unexplained absence;
new text end

new text begin (7) behavior that creates an imminent risk of harm to the participant or another; and
new text end

new text begin (8) a report of alleged or suspected child or vulnerable adult maltreatment under
section 626.556 or 626.557.
new text end

new text begin Subd. 12b. new text end

new text begin CFSS agency-provider requirements; notice regarding termination
of services. new text end

new text begin (a) An agency-provider must provide written notice when it intends to
terminate services with a participant at least ten calendar days before the proposed service
termination is to become effective, except in cases where:
new text end

new text begin (1) the participant engages in conduct that significantly alters the terms of the CFSS
service delivery plan with the agency-provider;
new text end

new text begin (2) the participant or other persons at the setting where services are being provided
engage in conduct that creates an imminent risk of harm to the support worker or other
agency-provider staff; or
new text end

new text begin (3) an emergency or a significant change in the participant's condition occurs within
a 24-hour period that results in the participant's service needs exceeding the participant's
identified needs in the current CFSS service delivery plan so that the agency-provider
cannot safely meet the participant's needs.
new text end

new text begin (b) When a participant initiates a request to terminate CFSS services with the
agency-provider, the agency-provider must give the participant a written acknowledgement
of the participant's service termination request that includes the date the request was
received by the agency-provider and the requested date of termination.
new text end

new text begin (c) The agency-provider must participate in a coordinated transfer of the participant
to a new agency-provider to ensure continuity of care.
new text end

Subd. 13.

Budget model.

(a) Under the budget model participants deleted text begin may deleted text end exercise
responsibility and control over the services and supports described and budgeted within
the CFSS service delivery plan. Participants must use services new text begin specified in subdivision
13a new text end provided by an FMS deleted text begin contractor as defined in subdivision 2, paragraph (m) deleted text end new text begin provider new text end .
Under this model, participants may use their approved service budget allocation to:

(1) directly employ support workers, and pay wages, federal and state payroll taxes,
and premiums for workers' compensation, liability, and health insurance coverage; and

(2) obtain supports and goods as defined in subdivision 7.

(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.

(c) The commissioner shall disenroll or exclude participants from the budget model
and transfer them to the agency-provider model under, but not limited to, the following
circumstances:

(1) when a participant has been restricted by the Minnesota restricted recipient
program, in which case the participant may be excluded for a specified time period under
Minnesota Rules, parts 9505.2160 to 9505.2245;

(2) when a participant exits the budget model during the participant's service plan
year. Upon transfer, the participant shall not access the budget model for the remainder of
that service plan year; or

(3) when the department determines that the participant or participant's representative
or legal representative deleted text begin cannot manage participant deleted text end new text begin is unable to fulfill the new text end responsibilities
under the budget model new text begin , as specified in subdivision 14 new text end . deleted text begin The commissioner must develop
policies for determining if a participant is unable to manage responsibilities under the
budget model.
deleted text end

(d) A participant may appeal in writing to the department under section 256.045,
subdivision 3, to contest the department's decision under paragraph (c), clause (3), to
disenroll or exclude the participant from the budget model.

new text begin Subd. 13a. new text end

new text begin Financial management services. new text end

new text begin (a) Services provided by an FMS
provider include but are not limited to: filing and payment of federal and state payroll taxes
on behalf of the participant; initiating criminal background checks; billing for approved
CFSS services with authorized funds; monitoring expenditures; accounting for and
disbursing CFSS funds; providing assistance in obtaining and filing for liability, workers'
compensation, and unemployment coverage; and providing participant instruction and
technical assistance to the participant in fulfilling employer-related requirements in
accordance with section 3504 of the Internal Revenue Code and related regulations and
interpretations, including Code of Federal Regulations, title 26, section 31.3504-1.
new text end

deleted text begin (e) The FMS contractor shall not provide CFSS services and supports under the
agency-provider service model deleted text end new text begin (b) Agency-provider services shall not be provided by
the FMS provider new text end .

deleted text begin (f) deleted text end new text begin (c) new text end The FMS deleted text begin contractor deleted text end new text begin provider new text end shall provide service functions as determined by
the commissioner for budget model participants that include but are not limited to:

(1) assistance with the development of the detailed budget for expenditures portion
of the new text begin CFSS new text end service delivery plan as requested by the consultation services provider
or participant;

deleted text begin (2) billing and making payments for budget model expenditures;
deleted text end

deleted text begin (3) assisting participants in fulfilling employer-related requirements according to
section 3504 of the Internal Revenue Code and related regulations and interpretations,
including Code of Federal Regulations, title 26, section 31.3504-1, which includes
assistance with filing and paying payroll taxes, and obtaining worker compensation
coverage;
deleted text end

deleted text begin (4) deleted text end new text begin (2) new text end data recording and reporting of participant spending;

deleted text begin (5) deleted text end new text begin (3) new text end other duties established deleted text begin in the contract with deleted text end new text begin by new text end the department, including
with respect to providing assistance to the participant, participant's representative, or
legal representative in performing deleted text begin their deleted text end employer responsibilities regarding support
workers. The support worker shall not be considered the employee of the FMS deleted text begin contractor deleted text end new text begin
provider new text end ; and

deleted text begin (6) deleted text end new text begin (4) new text end billing, payment, and accounting of approved expenditures for goods deleted text begin for
agency-provider participants deleted text end .

new text begin (d) The FMS provider shall obtain an assurance statement from the participant
employer agreeing to follow state and federal regulations and CFSS policies regarding
employment of support workers.
new text end

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

(1) not limit or restrict the participant's choice of service or support providers or
service delivery models consistent with any applicable state and federal requirements;

(2) provide the participant, consultation services provider, and deleted text begin the deleted text end case manager
or care coordinator, if applicable, with a monthly written summary of the spending for
services and supports that were billed against the spending budget;

(3) be knowledgeable of state and federal employment regulations, including those
under the Fair Labor Standards Act of 1938, and comply with the requirements under
section 3504 of the Internal Revenue Code and related regulations and interpretations,
including Code of Federal Regulations, title 26, section 31.3504-1, regarding agency
employer tax liability for vendor deleted text begin or fiscal employer deleted text end new text begin fiscal/employer new text end 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;

(4) have current and adequate liability insurance and bonding and sufficient cash
flow as determined by the commissioner and have on staff or under contract a certified
public accountant or an individual with a baccalaureate degree in accounting;

(5) assume fiscal accountability for state funds designated for the program and be
held liable for any overpayments or violations of applicable statutes or rules, including but
not limited to the Minnesota False Claims Act, chapter 15C; and

(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 deleted text begin contractor deleted text end new text begin provider new text end to the commissioner
for payment must correspond with services, amounts, and time periods as authorized in
the participant's service budget and service plan and must contain specific identifying
information as determined by the commissioner.

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

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

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

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

Subd. 14.

Participant's responsibilities deleted text begin under budget model deleted text end .

(a) deleted text begin A participant
using the budget model must use an 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. deleted text end new text begin The participant or participant's
representative is responsible for:
new text end

new text begin (1) orienting support workers to individual needs and preferences and providing
direction during the delivery of services;
new text end

new text begin (2) tracking the services provided and all expenditures for goods or other supports;
new text end

new text begin (3) preparing, verifying, and submitting time sheets according to the requirements
in subdivision 15;
new text end

new text begin (4) reporting any problems resulting from the failure of the CFSS service delivery
plan to be implemented or the quality of services rendered by the support worker to the
agency-provider, consultation services provider, FMS provider, and case manager or care
coordinator if applicable;
new text end

new text begin (5) notifying the agency-provider or the FMS provider within ten days of any
changes in circumstances affecting the CFSS service delivery plan, including but not
limited to changes in the participant's place of residence or hospitalization; and
new text end

new text begin (6) under the agency-provider model, participating in the evaluation of CFSS
services and support workers according to subdivision 11a.
new text end

(b) deleted text begin When the participant, participant's representative, or legal representative
chooses to be the employer of the support worker, they are responsible for the hiring and
supervision of the support worker, including but not limited to recruiting, interviewing,
training, scheduling, and discharging the support worker consistent with federal and
state laws and regulations. deleted text end new text begin For a participant using the budget model, the participant or
participant's representative is responsible for:
new text end

new text begin (1) using an FMS provider that is enrolled with the department. Upon a
determination of eligibility and completion of the assessment and community and services
support plan, the participant shall choose an FMS provider from a list of eligible providers
maintained by the department;
new text end

new text begin (2) complying with policies and procedures of the FMS provider as required to meet
state and federal regulations for CFSS and the employment of support workers;
new text end

new text begin (3) the hiring and supervision of the support worker, including but not limited
to recruiting, interviewing, training, scheduling, and discharging the support worker
consistent with federal and state laws and regulations;
new text end

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

new text begin (5) ensuring that support workers are competent to meet the participant's assessed
needs and additional requirements as written in the CFSS service delivery plan;
new text end

new text begin (6) determining the competency of the support worker through evaluation within
30 days of any support worker beginning to provide services and with any change in the
participant's condition or modification to the CFSS service delivery plan;
new text end

new text begin (7) verifying and maintaining evidence of support worker competency, including
documentation of the support worker's:
new text end

new text begin (i) education and experience relevant to the job responsibilities assigned to the
support worker and the needs of the participant;
new text end

new text begin (ii) training received from sources other than the participant;
new text end

new text begin (iii) orientation and instruction to implement defined services and supports to meet
participant needs and preferences as detailed in the CFSS service delivery plan; and
new text end

new text begin (iv) periodic written performance reviews completed by the participant at least
annually based on the direct observation of the support worker's ability to perform the
job functions;
new text end

new text begin (8) developing and communicating to each support worker a worker training and
development plan to ensure the support worker is competent when:
new text end

new text begin (i) the support worker begins providing services;
new text end

new text begin (ii) there is any change in the participant's condition or modification to the CFSS
service delivery plan; or
new text end

new text begin (iii) a performance review indicates that additional training is needed; and
new text end

new text begin (9) participating in the evaluation of CFSS services.
new text end

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

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

deleted 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;
deleted text end

deleted 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;
deleted text end

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

deleted 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 assistance of
the FMS contractor, the participant shall report the situation to the department.
deleted text end

Subd. 15.

Documentation of support services provided new text begin ; time sheets new text end .

(a) deleted text begin Support deleted text end new text begin
CFSS new text end services provided to a participant by a support worker employed by either an
agency-provider or the participant deleted text begin acting as the deleted text end employer must be documented daily by each
support worker, on a time sheet deleted text begin form approved by the commissioner deleted text end . deleted text begin All documentation
may be Web-based, electronic, or paper documentation. The completed form must be
submitted on a regular 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 participant's record. deleted text end new text begin Time sheets may be created, submitted,
and maintained electronically. Time sheets must be submitted by the support worker to the:
new text end

new text begin (1) agency-provider when the participant is using the agency-provider model. The
agency-provider must maintain a record of the time sheet and provide a copy of the time
sheet to the participant; or
new text end

new text begin (2) participant and the participant's FMS provider when the participant is using
the budget model. The participant and the FMS provider must maintain a record of the
time sheet.
new text end

(b) The deleted text begin activity deleted text end documentation new text begin on the time sheet new text end must correspond to the deleted text begin written
service delivery plan and be reviewed by the agency-provider or the participant and the
FMS contractor when the participant is the employer of the support worker. deleted text end new text begin participant's
assessed needs within the scope of CFSS covered services. The accuracy of the time
sheets must be verified by the:
new text end

new text begin (1) agency-provider when the participant is using the agency-provider model; or
new text end

new text begin (2) participant employer and the participant's FMS provider when the participant is
using the budget model.
new text end

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

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

(2) deleted text begin agency-provider deleted text end new text begin the agency-provider's new text end name and telephone numbers, deleted text begin if deleted text end new text begin when new text end
responsible for new text begin the CFSS service new text end delivery deleted text begin services under the written service deleted text end plan;

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

(4) deleted text begin consecutive deleted text end new text begin the new text end dates new text begin within the pay period established by the agency-provider or
FMS provider new text end , including month, day, and year, and arrival and departure times with a.m.
or p.m. notations new text begin for days worked within the established pay period new text end ;

new text begin (5) the covered services provided to the participant on each date of service;
new text end

deleted text begin (5) signatures of deleted text end new text begin (6) a signature line for new text end the participant or the participant's
representative new text begin and a statement that the participant's or participant's representative's
signature is verification of the time sheet's accuracy new text end ;

deleted text begin (6) deleted text end new text begin (7) the new text end personal signature of the support worker;

deleted text begin (7) deleted text end new text begin (8) new text end any shared care provided, if applicable;

deleted text begin (8) deleted text end new text begin (9) new text end a statement that it is a federal crime to provide false information on CFSS
billings for medical assistance payments; and

deleted text begin (9) deleted text end new text begin (10) new text end dates and location of participant stays in a hospital, care facility, or
incarceration new text begin occurring within the established pay period new text end .

Subd. 16.

Support workers requirements.

(a) Support workers shall:

(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 begin the support worker new text end :

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

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

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

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

deleted text begin (4) not be a participant of CFSS, unless the support services provided by the support
worker differ from those provided to the support worker;
deleted text end

deleted text begin (5) deleted text end new text begin (4) new text end complete the basic standardized new text begin CFSS new text end 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. new text begin CFSS
new text end 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, orientation to responding to a mental health crisis, 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;

deleted text begin (6) deleted text end new text begin (5) new text end complete new text begin employer-directed new text end training and orientation on the participant's
individual needs; deleted text begin and
deleted text end

deleted text begin (7) deleted text end new text begin (6) new text end maintain the privacy and confidentiality of the participant deleted text begin , deleted text end new text begin ; new text end and

new text begin (7) new text end not independently determine the medication dose or time for medications for
the participant.

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

(1) deleted text begin lacks the skills, knowledge, or ability to adequately or safely perform the
required work deleted text end new text begin does not meet the requirements in paragraph (a) new text end ;

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

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

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

(5) has been excluded as a provider by the commissioner of human services, or new text begin by
new text end 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.

(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.

(d) A support worker must not provide or be paid for more than 275 hours of
CFSS per month, regardless of the number of participants the support worker serves or
the number of agency-providers or participant employers by which the support worker
is employed. The department shall not disallow the number of hours per day a support
worker works unless it violates other law.

Subd. 16a.

Exception to support worker requirements for continuity of services.

The support worker for a participant may be allowed to enroll with a different CFSS
agency-provider or FMS deleted text begin contractor deleted text end new text begin provider new text end upon initiation, rather than completion, of a
new background study according to chapter 245C, if the following conditions are met:

(1) the commissioner determines that the support worker's change in enrollment or
affiliation is needed to ensure continuity of services and protect the health and safety
of the participant;

(2) the chosen agency-provider or FMS deleted text begin contractor deleted text end new text begin provider new text end has been continuously
enrolled as a CFSS agency-provider or FMS deleted text begin contractor deleted text end new text begin provider new text end for at least two years or
since the inception of the CFSS program, whichever is shorter;

(3) the participant served by the support worker chooses to transfer to the CFSS
agency-provider or the FMS deleted text begin contractor deleted text end new text begin provider new text end to which the support worker is transferring;

(4) the support worker has been continuously enrolled with the former CFSS
agency-provider or FMS deleted text begin contractor deleted text end new text begin provider new text end since the support worker's last background
study was completed; and

(5) the support worker continues to meet requirements of subdivision 16, excluding
paragraph (a), clause (1).

Subd. 17.

Consultation services deleted text begin description and deleted text end duties.

deleted text begin (a) Consultation services
means providing assistance to the participant in making informed choices regarding
CFSS services in general, and self-directed tasks in particular, and in developing a
person-centered service delivery plan to achieve quality service outcomes.
deleted text end

deleted text begin (b) deleted text end Consultation services is a required service deleted text begin that may include but is not limited to deleted text end new text begin
that includes new text end :

new text begin (1) entering into a written agreement with the participant, participant's representative,
or legal representative that includes but is not limited to the details of services, service
delivery methods, dates of services, and contact information;
new text end

deleted text begin (1) deleted text end new text begin (2) providing new text end an initial and annual orientation to CFSS information and policies,
including selecting a service model;

new text begin (3) assisting with accessing FMS providers or agency-providers;
new text end

deleted text begin (2) deleted text end new text begin (4) providing new text end assistance with the development, implementation, management,
new text begin documentation, new text end and evaluation of the person-centered new text begin CFSS new text end service delivery plan;

deleted text begin (3) consultation on recruiting, selecting, training, managing, directing, evaluating,
and supervising support workers;
deleted text end

deleted text begin (4) reviewing the use of and access to informal and community supports, goods, or
resources;
deleted text end

new text begin (5) approving the CFSS service delivery plan for a participant without a case
manager or care coordinator who is responsible for authorizing services;
new text end

new text begin (6) maintaining documentation of the approved CFSS service delivery plan;
new text end

new text begin (7) distributing copies of the final CFSS service delivery plan to the participant and
to the agency-provider or FMS provider, case manager or care coordinator, and other
designated parties;
new text end

deleted text begin (5) assistance with fulfilling deleted text end new text begin (8) assisting to fulfill new text end responsibilities and requirements of
CFSS, including modifying new text begin CFSS new text end service delivery plans and changing service models; deleted text begin and
deleted text end

deleted text begin (6) assistance with accessing FMS contractors or agency-providers.
deleted text end

deleted text begin (c) Duties of a consultation services provider shall include but are not limited to:
deleted text end

deleted text begin (1) review and finalization of the CFSS service delivery plan by the consultation
services provider organization;
deleted text end

deleted text begin (2) distribution of copies of the final service delivery plan to the participant and
to the agency-provider or FMS contractor, case manager/care coordinator, and other
designated parties;
deleted text end

new text begin (9) if requested, providing consultation or recruiting, selecting, training, managing,
directing, supervising, and evaluating support workers;
new text end

deleted text begin (3) an evaluation of deleted text end new text begin (10) evaluating new text end services upon receiving information from an
FMS deleted text begin contractor deleted text end new text begin provider new text end indicating spending or participant employer concerns;

new text begin (11) reviewing the use of and access to informal and community supports, goods, or
resources;
new text end

deleted text begin (4) deleted text end new text begin (12) new text end a semiannual review of services if the participant does not have a case deleted text begin
manager/care deleted text end new text begin manager or care new text end coordinator and when the support worker is a paid parent of
a minor participant or the participant's spouse;

deleted text begin (5) collection deleted text end new text begin (13) collecting new text end and reporting of data as required by the department; deleted text begin and
deleted text end

deleted text begin (6) deleted text end new text begin (14) new text end providing the participant with a copy of the deleted text begin service-related rights deleted text end new text begin participant
protections new text end under subdivision 20 at the start of consultation services deleted text begin . deleted text end new text begin ;
new text end

new text begin (15) providing assistance to resolve issues of noncompliance with the requirements
of CFSS;
new text end

new text begin (16) providing recommendations to the commissioner for changes to services when
support to participants to resolve issues of noncompliance have been unsuccessful; and
new text end

new text begin (17) other duties as assigned by the commissioner.
new text end

Subd. 17a.

Consultation services provider qualifications and requirements.

deleted text begin The commissioner shall develop the qualifications and requirements for providers of
consultation services under subdivision 17. These deleted text end new text begin Consultation services new text end providers must
deleted text begin satisfy at least deleted text end new text begin meet new text end the following qualifications and requirements:

new text begin (1) meet the requirements under subdivision 10, paragraph (a), excluding clauses
(4) and (5);
new text end

deleted text begin (1) deleted text end new text begin (2) new text end are under contract with the department;

deleted text begin (2) deleted text end new text begin (3) new text end are not the FMS deleted text begin contractor as defined in subdivision 2, paragraph (m) deleted text end new text begin
provider new text end , new text begin the lead agency, or new text end the CFSS or home and community-based services waiver
new text begin vendor or new text end agency-provider deleted text begin or vendor deleted text end to the participant deleted text begin , or a lead agency deleted text end ;

deleted text begin (3) deleted text end new text begin (4) new text end meet the service standards as established by the commissioner;

deleted text begin (4) deleted text end new text begin (5) new text end employ lead professional staff with a minimum of three years of experience
in providing new text begin services such as new text end support planning, support broker, new text begin case management or care
coordination, new text end or consultation services and consumer education to participants using a
self-directed program using FMS under medical assistance;

deleted text begin (5) are knowledgeable about CFSS roles and responsibilities including those of the
certified assessor, FMS contractor, agency-provider, and case manager/care coordinator;
deleted text end

(6) comply with medical assistance provider requirements;

(7) understand the CFSS program and its policies;

(8) are knowledgeable about self-directed principles and the application of the
person-centered planning process;

(9) have general knowledge of the FMS deleted text begin contractor deleted text end new text begin provider new text end duties and deleted text begin participant
employment deleted text end new text begin the vendor fiscal/employer agent new text end model, including all applicable federal,
state, and local laws and regulations regarding tax, labor, employment, and liability and
workers' compensation coverage for household workers; and

(10) have all employees, including lead professional staff, staff in management
and supervisory positions, and owners of the agency who are active in the day-to-day
management and operations of the agency, complete training as specified in the contract
with the department.

Subd. 18.

Service unit and budget allocation requirements and limits.

(a) For the
agency-provider model, services deleted text begin will be deleted text end new text begin are new text end 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 under subdivision 8.

(b) For the budget model, the service budget allocation allowed for services and
supports is defined in subdivision 8, paragraph (g).

Subd. 18a.

Worker training and development services.

(a) The commissioner
shall develop the scope of tasks and functions, service standards, and service limits for
worker training and development services.

(b) Worker training and development deleted text begin services deleted text end new text begin costs new text end are in addition to the participant's
assessed service units or service budget. Services provided according to this subdivision
must:

(1) help support workers obtain and expand the skills and knowledge necessary
to ensure competency in providing quality services as needed and defined in the
participant's new text begin CFSS new text end service delivery plan new text begin ; new text end new text begin and evaluate the support worker as required
under subdivisions 11b and 14 new text end ;

(2) be provided or arranged for by the agency-provider under subdivision 11 new text begin , new text end or
purchased by the participant employer under the budget model deleted text begin under deleted text end new text begin as identified in new text end
subdivision 13; and

(3) be described in the participant's CFSS service delivery plan and documented in
the participant's file.

(c) Services covered under worker training and development shall include:

(1) support worker training on the participant's individual assessed needs deleted text begin , deleted text end new text begin
and new text end condition, deleted text begin or both, deleted text end provided individually or in a group setting by a skilled and
knowledgeable trainer beyond any training the participant or participant's representative
provides;

(2) tuition for professional classes and workshops for the participant's support
workers that relate to the participant's assessed needs deleted text begin , deleted text end new text begin and new text end condition deleted text begin , or both deleted text end ; new text begin and
new text end

(3) direct observation, monitoring, coaching, and documentation of support worker
job skills and tasks, beyond any training the participant or participant's representative
provides, including supervision of health-related tasks or behavioral supports that is
conducted by an appropriate professional based on the participant's assessed needs.
These services must be provided deleted text begin within 14 days of deleted text end new text begin at new text end the start of services or the start of
a new support worker except as provided in paragraph (d) and must be specified in the
participant's new text begin CFSS new text end service delivery plan; and

(4) deleted text begin reporting service and support concerns to the appropriate provider deleted text end new text begin the
activities to evaluate CFSS services and ensure support worker competency described in
subdivisions 11a and 11b new text end .

(d) The services in paragraph (c), clause (3), are not required to be provided for a
new support worker providing services for a participant due to staffing failures, unless the
support worker is expected to provide ongoing backup staffing coverage.

(e) Worker training and development services shall not include:

(1) general agency training, worker orientation, or training on CFSS self-directed
models;

(2) payment for preparation or development time for the trainer or presenter;

(3) payment of the support worker's salary or compensation during the training;

(4) training or supervision provided by the participant, the participant's support
worker, or the participant's informal supports, including the participant's representative; or

(5) services in excess of 96 units per annual service deleted text begin authorization deleted text end new text begin agreement new text end , unless
approved by the department.

deleted text begin Subd. 19. deleted text end

deleted text begin Support system. deleted text end

deleted 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.
deleted text end

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

Subd. 20.

deleted text begin Service-related rights deleted text end new text begin Participant protections new text end .

new text begin (a) All CFSS
participants have the protections identified in this subdivision.
new text end

deleted text begin (a) deleted text end new text begin (b) new text end Participants new text begin or participant's representatives new text end 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. new text begin This information must
be provided by the consultation services provider at the time of the initial or annual
orientation to CFSS, at the time of reassessment, or when requested by the participant or
participant's representative. new text end This deleted text begin support shall include deleted text end information deleted text begin regarding deleted text end new text begin must explain new text end :

(1) person-centered planning;

(2) the range and scope of deleted text begin individual deleted text end new text begin participant new text end choices new text begin , including the differences
between the agency-provider model and the budget model, available CFSS providers, and
other services available in the community to meet the participant's needs new text end ;

(3) the process for changing plans, services, and budgets;

deleted text begin (4) the grievance process;
deleted text end

deleted text begin (5) individual rights;
deleted text end

deleted text begin (6) deleted text end new text begin (4) new text end identifying and assessing appropriate services; new text begin and
new text end

deleted text begin (7) deleted text end new text begin (5) new text end risks new text begin to new text end and responsibilities deleted text begin ; and deleted text end new text begin of the participant under the budget model.
new text end

deleted text begin (8) risk management.
deleted text end

deleted text begin (b) deleted text end new text begin (c) new text end The deleted text begin commissioner deleted text end new text begin consultation services provider new text end must ensure that the
participant deleted text begin has a copy of the most recent community support plan and service delivery
plan deleted text end new text begin chooses freely between the agency-provider model and the budget model and among
available agency-providers and that the participant may change agency-providers after
services have begun new text end .

deleted text begin (c) deleted text end new text begin (d) new text end A participant who appeals a reduction in previously authorized CFSS services
may continue previously authorized services pending an appeal in accordance with section
256.045.

deleted text begin (d) deleted text end new text begin (e) new text end If the units of service or budget allocation for CFSS are reduced, denied, or
terminated, the commissioner must provide notice of the reasons for the reduction in the
participant's notice of denial, termination, or reduction.

deleted text begin (e) deleted text end new text begin (f) new text end If all or part of a new text begin CFSS new text end service delivery plan is denied approval new text begin by the
consultation services provider new text end , the deleted text begin commissioner deleted text end new text begin consultation services provider new text end must
provide a notice that describes the basis of the denial.

new text begin Subd. 20a. new text end

new text begin Notice of participant rights from an agency-provider. new text end

new text begin A participant
receiving CFSS from an agency-provider has the rights identified in this subdivision and
in subdivisions 20b and 20c. The agency-provider must:
new text end

new text begin (1) within five working days of service initiation and annually thereafter, provide
each participant or participant's representative with a written notice that identifies the
service recipient rights in subdivisions 20b and 20c, and an explanation of those rights;
new text end

new text begin (2) make reasonable accommodations to provide this information in other formats or
languages as needed to facilitate understanding of the rights by the participant and the
participant's legal representative, if any;
new text end

new text begin (3) maintain documentation of the receipt of a copy and an explanation of the rights
by the participant or participant's representative; and
new text end

new text begin (4) ensure the exercise and protection of the participant's rights in the services
provided by the agency-provider and as authorized in the CFSS service delivery plan.
new text end

new text begin Subd. 20b. new text end

new text begin Service-related rights under an agency-provider. new text end

new text begin A participant
receiving CFSS from an agency-provider has service-related rights to:
new text end

new text begin (1) participate in and approve the initial development and ongoing modification and
evaluation of CFSS services provided to the participant;
new text end

new text begin (2) refuse or terminate services and be informed of the consequences of refusing
or terminating services;
new text end

new text begin (3) before services are initiated, be told the limits to the services available from the
agency-provider, including the agency-provider's knowledge, skill, and ability to meet the
participant's needs identified in the CFSS service delivery plan;
new text end

new text begin (4) a coordinated transfer of services when there will be a change in the
agency-provider;
new text end

new text begin (5) before services are initiated, be told what the agency-provider charges for the
services;
new text end

new text begin (6) before services are initiated, be told to what extent payment may be expected
from health insurance, public programs, or other sources, if known; and what charges the
participant may be responsible for paying;
new text end

new text begin (7) receive services from an individual who is competent and trained, who has
professional certification or licensure, as required, and who meets additional qualifications
identified in the participant's CFSS service delivery plan;
new text end

new text begin (8) have the participant's preferences for support workers identified and documented,
and have those preferences met when possible; and
new text end

new text begin (9) before services are initiated, be told the choices that are available from the
agency-provider for meeting the participant's assessed needs identified in the CFSS service
delivery plan, including but not limited to which support worker staff will be providing
services and the proposed frequency and schedule of visits.
new text end

new text begin Subd. 20c. new text end

new text begin Protection-related rights under an agency-provider or through an
FMS provider. new text end

new text begin A participant receiving CFSS from an agency-provider or through an
FMS provider has protection-related rights to:
new text end

new text begin (1) access records and recorded information about the participant in accordance with
applicable state and federal law, regulation, or rule;
new text end

new text begin (2) know how to contact an individual associated with the agency-provider or FMS
provider who is responsible for handling problems, know the agency-provider's or FMS
provider's policies and procedures for resolving grievances, and have the agency-provider
or FMS provider investigate and attempt to resolve the grievance or complaint;
new text end

new text begin (3) know the name, telephone number, and address of the state or county agency,
the Office of the Ombudsman for Long-Term Care, and the state protection and advocacy
service to contact for additional information or assistance;
new text end

new text begin (4) have personal, financial, and medical information kept private, and be advised
of disclosure of this information by the agency-provider or FMS provider and the
agency-provider's or FMS provider's policies and procedures regarding data privacy;
new text end

new text begin (5) be treated with courtesy and respect, and have the participant's property treated
with respect;
new text end

new text begin (6) be free from maltreatment; and
new text end

new text begin (7) assert these rights personally, or have them asserted by the participant's
representative or by anyone authorized by the participant to act on behalf of the participant,
without retaliation.
new text end

Subd. 21.

Development and Implementation Council.

The commissioner shall
establish a Development and Implementation Council of which the majority of members
are deleted text begin individuals deleted text end new text begin participants new text end with disabilities, elderly deleted text begin individuals deleted text end new text begin participants new text end , and their
representatives. The commissioner shall consult and collaborate with the council when
developing and implementing this section for at least the first five years of operation. deleted text begin The
commissioner, in consultation with the council, shall provide recommendations on how to
improve the quality and integrity of CFSS, reduce the paper documentation required in
subdivisions 10, 12, and 15, make use of electronic means of documentation and online
reporting in order to reduce administrative costs, and improve training to the legislative
chairs of the health and human services policy and finance committees by February 1, 2014.
deleted text end

Subd. 22.

Quality assurance and risk management system.

(a) The commissioner
shall establish quality assurance and risk management measures for use in developing and
implementing CFSS, including those that new text begin : new text end

(1) recognize the roles and responsibilities of those involved in obtaining CFSS deleted text begin , deleted text end new text begin ; new text end 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.

(b) The commissioner shall provide ongoing technical assistance and resource and
educational materials for CFSS participants.

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

deleted text begin (d) Data reporting requirements will be developed in consultation with the council
established in subdivision 21.
deleted text end

Subd. 23.

Commissioner's access.

new text begin (a) new text end 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 new text begin , consultation services provider, new text end or
FMS deleted text begin contractor's deleted text end new text begin provider's new text end 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 deleted text begin agency provider's deleted text end new text begin agency-provider's new text end enrollment new text begin or FMS
provider's enrollment new text end according to section 256B.064 or terminating the deleted text begin FMS contract deleted text end new text begin
consultation services provider contract new text end .

new text begin (b) The commissioner has the authority to request proof of compliance with laws,
rules, and policies from agency-providers, consultation services providers, FMS providers,
and participants.
new text end

new text begin (c) When relevant to an investigation conducted by the commissioner, the
commissioner must be given access to the business office, documents, and records of the
agency-provider, consultation services provider, or FMS provider, including records
maintained in electronic format; participants served by the program; and staff during
regular business hours. The commissioner must be given access without prior notice and
as often as the commissioner considers necessary if the commissioner is investigating an
alleged violation of applicable laws or rules. The commissioner may request and shall
receive assistance from lead agencies and other state, county, and municipal agencies
and departments. The commissioner's access includes being allowed to photocopy,
photograph, and make audio and video recordings at the commissioner's expense.
new text end

new text begin Subd. 23a. new text end

new text begin Sanctions; information for participants upon termination of services.
new text end

new text begin (a) The commissioner may withhold payment from the provider or suspend or terminate
the provider enrollment number if the provider fails to comply fully with applicable laws
or rules. The provider has the right to appeal the decision of the commissioner under
section 256B.064.
new text end

new text begin (b) Notwithstanding subdivision 13, paragraph (c), if a participant employer fails to
comply fully with applicable laws or rules, the commissioner may disenroll the participant
from the budget model. A participant may appeal in writing to the department under
section 256.045, subdivision 3, to contest the department's decision to disenroll the
participant from the budget model.
new text end

new text begin (c) Agency-providers of CFSS services or FMS providers must provide each
participant with a copy of participant protections in subdivision 20c at least 30 days prior
to terminating services to a participant, if the termination results from sanctions under
this subdivision or section 256B.064, such as a payment withhold or a suspension or
termination of the provider enrollment number. If a CFSS agency-provider or FMS
provider determines it is unable to continue providing services to a participant because of
an action under this subdivision or section 256B.064, the agency-provider or FMS provider
must notify the participant, the participant's representative, and the commissioner 30 days
prior to terminating services to the participant, and must assist the commissioner and lead
agency in supporting the participant in transitioning to another CFSS agency-provider or
FMS provider of the participant's choice.
new text end

new text begin (d) In the event the commissioner withholds payment from a CFSS agency-provider
or FMS provider, or suspends or terminates a provider enrollment number of a CFSS
agency-provider or FMS provider under this subdivision or section 256B.064, the
commissioner may inform the Office of Ombudsman for Long-Term Care and the lead
agencies for all participants with active service agreements with the agency-provider or
FMS provider. At the commissioner's request, the lead agencies must contact participants
to ensure that the participants are continuing to receive needed care, and that the
participants have been given free choice of agency-provider or FMS provider if they
transfer to another CFSS agency-provider or FMS provider. In addition, the commissioner
or the commissioner's delegate may directly notify participants who receive care from the
agency-provider or FMS provider that payments have been withheld or that the provider's
participation in medical assistance has been suspended or terminated, if the commissioner
determines that the notification is necessary to protect the welfare of the participants.
new text end

Subd. 24.

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

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

(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 deleted text begin CFSS agency-providers deleted text end new text begin providers new text end and those agencies seeking enrollment deleted text begin as a
CFSS deleted text end deleted text begin agency-provider deleted text end . "Managing employee" has the deleted text begin same deleted text end meaning deleted text begin as deleted text end new text begin given in new text end Code
of Federal Regulations, title 42, section deleted text begin 455 deleted text end new text begin 455.101 new text end . An organization is barred from
enrollment if:

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

(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;

(2) a background study must be initiated and completed for all staff who will have
direct contact with the participant to provide worker training and development; and

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

deleted text begin Subd. 25. deleted text end

deleted text begin Commissioner recommendations required. deleted text end

deleted text begin In consultation with
the Development and Implementation Council described in subdivision 21 and other
stakeholders, the commissioner shall develop recommendations for revisions to
subdivisions 12, 15, and 16 that promote self-direction in the following areas:
deleted text end

deleted text begin (1) CFSS provider and support worker enrollment, qualification, and disqualification
criteria;
deleted text end

deleted text begin (2) documentation requirements that are consistent with state and federal
requirements; and
deleted text end

deleted text begin (3) provisions to maintain program integrity and assure fiscal accountability for
goods and services purchased through CFSS.
deleted text end

deleted text begin The recommendations shall be provided to the chairs and ranking minority members
of the legislative committees and divisions with jurisdiction over health and human
services policy and finance by November 15, 2013.
deleted text end

new text begin Subd. 26. new text end

new text begin Oversight plan. new text end

new text begin In consultation with the Development and
Implementation Council described in subdivision 21 and other stakeholders, the
commissioner shall develop recommendations for the oversight of CFSS.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin The amendments to this section are effective upon federal
approval. The service will begin 90 days after federal approval. The commissioner of
human services shall notify the revisor of statutes when this occurs.
new text end