SF 2092

as introduced - 87th Legislature (2011 - 2012) Posted on 02/28/2012 08:33am

A bill for an act
relating to human services; modifying parental contributions for certain
disability services; modifying state agency hearings related to the personal care
assistance program; modifying assessment and support planning; modifying
certain congregate rate reductions; modifying consultation for housing with
services; developing the Community First Choice Option; modifying the
foster care licensing moratorium; modifying residential settings for home
and community-based services; amending Minnesota Statutes 2010, sections
252.27, subdivision 2a; 256B.0659, by adding a subdivision; Minnesota Statutes
2011 Supplement, sections 245A.03, subdivision 7; 256.045, subdivision 3;
256B.0911, subdivisions 3a, 3c; Laws 2011, First Special Session chapter 9,
article 10, section 3, subdivision 3; proposing coding for new law in Minnesota
Statutes, chapter 256B.

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

Section 1.

Minnesota Statutes 2011 Supplement, section 245A.03, subdivision 7,
is amended to read:

Subd. 7.

Licensing moratorium.

(a) The commissioner shall not issue an
initial license for child foster care licensed under Minnesota Rules, parts 2960.3000 to
2960.3340, or adult foster care licensed under Minnesota Rules, parts 9555.5105 to
9555.6265, under this chapter for a physical location that will not be the primary residence
of the license holder for the entire period of licensure. If a license is issued during this
moratorium, and the license holder changes the license holder's primary residence away
from the physical location of the foster care license, the commissioner shall revoke the
license according to section 245A.07. Exceptions to the moratorium include:

(1) foster care settings that are required to be registered under chapter 144D;

(2) foster care licenses replacing foster care licenses in existence on May 15, 2009,
and determined to be needed by the commissioner under paragraph (b);

(3) new foster care licenses determined to be needed by the commissioner under
paragraph (b) for the closure of a nursing facility, ICF/MR, or regional treatment center, or
restructuring of state-operated services that limits the capacity of state-operated facilities;

(4) new foster care licenses determined to be needed by the commissioner under
paragraph (b) for persons requiring hospital level care; or

(5) new foster care licenses determined to be needed by the commissioner for the
transition of people from personal care assistance to the home and community-based
services.

(b) The commissioner shall determine the need for newly licensed foster care homes
as defined under this subdivision. As part of the determination, the commissioner shall
consider the availability of foster care capacity in the area in which the licensee seeks to
operate, and the recommendation of the local county board. The determination by the
commissioner must be final. A determination of need is not required for a change in
ownership at the same address.

(c) Residential settings that would otherwise be subject to the moratorium established
in paragraph (a), that are in the process of receiving an adult or child foster care license as
of July 1, 2009, shall be allowed to continue to complete the process of receiving an adult
or child foster care license. For this paragraph, all of the following conditions must be met
to be considered in the process of receiving an adult or child foster care license:

(1) participants have made decisions to move into the residential setting, including
documentation in each participant's care plan;

(2) the provider has purchased housing or has made a financial investment in the
property;

(3) the lead agency has approved the plans, including costs for the residential setting
for each individual;

(4) the completion of the licensing process, including all necessary inspections, is
the only remaining component prior to being able to provide services; and

(5) the needs of the individuals cannot be met within the existing capacity in that
county.

To qualify for the process under this paragraph, the lead agency must submit
documentation to the commissioner by August 1, 2009, that all of the above criteria are
met.

(d) The commissioner shall study the effects of the license moratorium under this
subdivision and shall report back to the legislature by January 15, 2011. This study shall
include, but is not limited to the following:

(1) the overall capacity and utilization of foster care beds where the physical location
is not the primary residence of the license holder prior to and after implementation
of the moratorium;

(2) the overall capacity and utilization of foster care beds where the physical
location is the primary residence of the license holder prior to and after implementation
of the moratorium; and

(3) the number of licensed and occupied ICF/MR beds prior to and after
implementation of the moratorium.

(e) When a foster care recipient moves out of a foster home that is not the primary
residence of the license holder according to section 256B.49, subdivision 15, paragraph
(f), the county shall immediately inform the Department of Human Services Licensing
Division, and the department shall immediately decrease the licensed capacity for the
home new text begin if the license holder has a total capacity of 24 or more beds. License holders who
have their capacity decreased under this paragraph may consolidate homes as necessary new text end .
A decreased licensed capacity according to this paragraph is not subject to appeal under
this chapter.

Sec. 2.

Minnesota Statutes 2010, section 252.27, subdivision 2a, is amended to read:

Subd. 2a.

Contribution amount.

(a) The natural or adoptive parents of a minor
child, including a child determined eligible for medical assistance without consideration of
parental income, must contribute to the cost of services used by making monthly payments
on a sliding scale based on income, unless the child is married or has been married,
parental rights have been terminated, or the child's adoption is subsidized according to
section 259.67 or through title IV-E of the Social Security Act. The parental contribution
is a partial or full payment for medical services provided for diagnostic, therapeutic,
curing, treating, mitigating, rehabilitation, maintenance, and personal care services as
defined in United States Code, title 26, section 213, needed by the child with a chronic
illness or disability.

(b) For households with adjusted gross income equal to or greater than 100 percent
of federal poverty guidelines, the parental contribution shall be computed by applying the
following schedule of rates to the adjusted gross income of the natural or adoptive parents:

(1) if the adjusted gross income is equal to or greater than 100 percent of federal
poverty guidelines and less than 175 percent of federal poverty guidelines, the parental
contribution is $4 per month;

(2) if the adjusted gross income is equal to or greater than 175 percent of federal
poverty guidelines and less than or equal to deleted text begin 545 deleted text end new text begin 525 new text end percent of federal poverty guidelines,
the parental contribution shall be determined using a sliding fee scale established by the
commissioner of human services which begins at one percent of adjusted gross income at
175 percent of federal poverty guidelines and increases to deleted text begin 7.5 deleted text end new text begin eight new text end percent of adjusted
gross income for those with adjusted gross income up to deleted text begin 545 deleted text end new text begin 525 new text end percent of federal
poverty guidelines;

(3) if the adjusted gross income is greater than deleted text begin 545 deleted text end new text begin 525 new text end percent of federal
poverty guidelines and less than 675 percent of federal poverty guidelines, the parental
contribution shall be deleted text begin 7.5 deleted text end new text begin 9.5 new text end percent of adjusted gross income;

(4) if the adjusted gross income is equal to or greater than 675 percent of federal
poverty guidelines and less than deleted text begin 975 deleted text end new text begin 900 new text end percent of federal poverty guidelines, the parental
contribution shall be determined using a sliding fee scale established by the commissioner
of human services which begins at deleted text begin 7.5 deleted text end new text begin 9.5 new text end percent of adjusted gross income at 675 percent
of federal poverty guidelines and increases to deleted text begin ten deleted text end new text begin 12 new text end percent of adjusted gross income for
those with adjusted gross income up to deleted text begin 975 deleted text end new text begin 900 new text end percent of federal poverty guidelines; and

(5) if the adjusted gross income is equal to or greater than deleted text begin 975 deleted text end new text begin 900 new text end percent of
federal poverty guidelines, the parental contribution shall be deleted text begin 12.5 deleted text end new text begin 13.5 new text end percent of adjusted
gross income.

If the child lives with the parent, the annual adjusted gross income is reduced by
$2,400 prior to calculating the parental contribution. If the child resides in an institution
specified in section 256B.35, the parent is responsible for the personal needs allowance
specified under that section in addition to the parental contribution determined under this
section. The parental contribution is reduced by any amount required to be paid directly to
the child pursuant to a court order, but only if actually paid.

(c) The household size to be used in determining the amount of contribution under
paragraph (b) includes natural and adoptive parents and their dependents, including the
child receiving services. Adjustments in the contribution amount due to annual changes
in the federal poverty guidelines shall be implemented on the first day of July following
publication of the changes.

(d) For purposes of paragraph (b), "income" means the adjusted gross income of the
natural or adoptive parents determined according to the previous year's federal tax form,
except, effective retroactive to July 1, 2003, taxable capital gains to the extent the funds
have been used to purchase a home shall not be counted as income.

(e) The contribution shall be explained in writing to the parents at the time eligibility
for services is being determined. The contribution shall be made on a monthly basis
effective with the first month in which the child receives services. Annually upon
redetermination or at termination of eligibility, if the contribution exceeded the cost of
services provided, the local agency or the state shall reimburse that excess amount to
the parents, either by direct reimbursement if the parent is no longer required to pay a
contribution, or by a reduction in or waiver of parental fees until the excess amount is
exhausted. All reimbursements must include a notice that the amount reimbursed may be
taxable income if the parent paid for the parent's fees through an employer's health care
flexible spending account under the Internal Revenue Code, section 125, and that the
parent is responsible for paying the taxes owed on the amount reimbursed.

(f) The monthly contribution amount must be reviewed at least every 12 months;
when there is a change in household size; and when there is a loss of or gain in income
from one month to another in excess of ten percent. The local agency shall mail a written
notice 30 days in advance of the effective date of a change in the contribution amount.
A decrease in the contribution amount is effective in the month that the parent verifies a
reduction in income or change in household size.

(g) Parents of a minor child who do not live with each other shall each pay the
contribution required under paragraph (a). An amount equal to the annual court-ordered
child support payment actually paid on behalf of the child receiving services shall be
deducted from the adjusted gross income of the parent making the payment prior to
calculating the parental contribution under paragraph (b).

(h) The contribution under paragraph (b) shall be increased by an additional five
percent if the local agency determines that insurance coverage is available but not
obtained for the child. For purposes of this section, "available" means the insurance is a
benefit of employment for a family member at an annual cost of no more than five percent
of the family's annual income. For purposes of this section, "insurance" means health
and accident insurance coverage, enrollment in a nonprofit health service plan, health
maintenance organization, self-insured plan, or preferred provider organization.

Parents who have more than one child receiving services shall not be required
to pay more than the amount for the child with the highest expenditures. There shall
be no resource contribution from the parents. The parent shall not be required to pay
a contribution in excess of the cost of the services provided to the child, not counting
payments made to school districts for education-related services. Notice of an increase in
fee payment must be given at least 30 days before the increased fee is due.

(i) The contribution under paragraph (b) shall be reduced by $300 per fiscal year if,
in the 12 months prior to July 1:

(1) the parent applied for insurance for the child;

(2) the insurer denied insurance;

(3) the parents submitted a complaint or appeal, in writing to the insurer, submitted
a complaint or appeal, in writing, to the commissioner of health or the commissioner of
commerce, or litigated the complaint or appeal; and

(4) as a result of the dispute, the insurer reversed its decision and granted insurance.

For purposes of this section, "insurance" has the meaning given in paragraph (h).

A parent who has requested a reduction in the contribution amount under this
paragraph shall submit proof in the form and manner prescribed by the commissioner or
county agency, including, but not limited to, the insurer's denial of insurance, the written
letter or complaint of the parents, court documents, and the written response of the insurer
approving insurance. The determinations of the commissioner or county agency under this
paragraph are not rules subject to chapter 14.

deleted text begin (j) Notwithstanding paragraph (b), for the period from July 1, 2010, to June 30,
2013, the parental contribution shall be computed by applying the following contribution
schedule to the adjusted gross income of the natural or adoptive parents:
deleted text end

deleted text begin (1) if the adjusted gross income is equal to or greater than 100 percent of federal
poverty guidelines and less than 175 percent of federal poverty guidelines, the parental
contribution is $4 per month;
deleted text end

deleted text begin (2) if the adjusted gross income is equal to or greater than 175 percent of federal
poverty guidelines and less than or equal to 525 percent of federal poverty guidelines,
the parental contribution shall be determined using a sliding fee scale established by the
commissioner of human services which begins at one percent of adjusted gross income
at 175 percent of federal poverty guidelines and increases to eight percent of adjusted
gross income for those with adjusted gross income up to 525 percent of federal poverty
guidelines;
deleted text end

deleted text begin (3) if the adjusted gross income is greater than 525 percent of federal poverty
guidelines and less than 675 percent of federal poverty guidelines, the parental contribution
shall be 9.5 percent of adjusted gross income;
deleted text end

deleted text begin (4) if the adjusted gross income is equal to or greater than 675 percent of federal
poverty guidelines and less than 900 percent of federal poverty guidelines, the parental
contribution shall be determined using a sliding fee scale established by the commissioner
of human services which begins at 9.5 percent of adjusted gross income at 675 percent of
federal poverty guidelines and increases to 12 percent of adjusted gross income for those
with adjusted gross income up to 900 percent of federal poverty guidelines; and
deleted text end

deleted text begin (5) if the adjusted gross income is equal to or greater than 900 percent of federal
poverty guidelines, the parental contribution shall be 13.5 percent of adjusted gross
income. If the child lives with the parent, the annual adjusted gross income is reduced by
$2,400 prior to calculating the parental contribution. If the child resides in an institution
specified in section 256B.35, the parent is responsible for the personal needs allowance
specified under that section in addition to the parental contribution determined under this
section. The parental contribution is reduced by any amount required to be paid directly to
the child pursuant to a court order, but only if actually paid.
deleted text end

Sec. 3.

Minnesota Statutes 2011 Supplement, section 256.045, subdivision 3, is
amended to read:

Subd. 3.

State agency hearings.

(a) State agency hearings are available for the
following:

(1) any person applying for, receiving or having received public assistance, medical
care, or a program of social services granted by the state agency or a county agency or
the federal Food Stamp Act whose application for assistance is denied, not acted upon
with reasonable promptness, or whose assistance is suspended, reduced, terminated, or
claimed to have been incorrectly paid;

(2) any patient or relative aggrieved by an order of the commissioner under section
252.27;

(3) a party aggrieved by a ruling of a prepaid health plan;

(4) except as provided under chapter 245C, any individual or facility determined by a
lead investigative agency to have maltreated a vulnerable adult under section 626.557 after
they have exercised their right to administrative reconsideration under section 626.557;

(5) any person whose claim for foster care payment according to a placement of the
child resulting from a child protection assessment under section 626.556 is denied or not
acted upon with reasonable promptness, regardless of funding source;

(6) any person to whom a right of appeal according to this section is given by other
provision of law;

(7) an applicant aggrieved by an adverse decision to an application for a hardship
waiver under section 256B.15;

(8) an applicant aggrieved by an adverse decision to an application or redetermination
for a Medicare Part D prescription drug subsidy under section 256B.04, subdivision 4a;

(9) except as provided under chapter 245A, an individual or facility determined
to have maltreated a minor under section 626.556, after the individual or facility has
exercised the right to administrative reconsideration under section 626.556;

(10) except as provided under chapter 245C, an individual disqualified under
sections 245C.14 and 245C.15, following a reconsideration decision issued under section
245C.23, on the basis of serious or recurring maltreatment; a preponderance of the
evidence that the individual has committed an act or acts that meet the definition of any of
the crimes listed in section 245C.15, subdivisions 1 to 4; or for failing to make reports
required under section 626.556, subdivision 3, or 626.557, subdivision 3. Hearings
regarding a maltreatment determination under clause (4) or (9) and a disqualification under
this clause in which the basis for a disqualification is serious or recurring maltreatment,
shall be consolidated into a single fair hearing. In such cases, the scope of review by
the human services referee shall include both the maltreatment determination and the
disqualification. The failure to exercise the right to an administrative reconsideration shall
not be a bar to a hearing under this section if federal law provides an individual the right to
a hearing to dispute a finding of maltreatment. Individuals and organizations specified in
this section may contest the specified action, decision, or final disposition before the state
agency by submitting a written request for a hearing to the state agency within 30 days
after receiving written notice of the action, decision, or final disposition, or within 90 days
of such written notice if the applicant, recipient, patient, or relative shows good cause why
the request was not submitted within the 30-day time limit; or

(11) any person with an outstanding debt resulting from receipt of public assistance,
medical care, or the federal Food Stamp Act who is contesting a setoff claim by the
Department of Human Services or a county agency. The scope of the appeal is the validity
of the claimant agency's intention to request a setoff of a refund under chapter 270A
against the debt.

(b) The hearing for an individual or facility under paragraph (a), clause (4), (9), or
(10), is the only administrative appeal to the final agency determination specifically,
including a challenge to the accuracy and completeness of data under section 13.04.
Hearings requested under paragraph (a), clause (4), apply only to incidents of maltreatment
that occur on or after October 1, 1995. Hearings requested by nursing assistants in nursing
homes alleged to have maltreated a resident prior to October 1, 1995, shall be held as a
contested case proceeding under the provisions of chapter 14. Hearings requested under
paragraph (a), clause (9), apply only to incidents of maltreatment that occur on or after
July 1, 1997. A hearing for an individual or facility under paragraph (a), clause (9), is
only available when there is no juvenile court or adult criminal action pending. If such
action is filed in either court while an administrative review is pending, the administrative
review must be suspended until the judicial actions are completed. If the juvenile court
action or criminal charge is dismissed or the criminal action overturned, the matter may be
considered in an administrative hearing.

(c) For purposes of this section, bargaining unit grievance procedures are not an
administrative appeal.

(d) The scope of hearings involving claims to foster care payments under paragraph
(a), clause (5), shall be limited to the issue of whether the county is legally responsible
for a child's placement under court order or voluntary placement agreement and, if so,
the correct amount of foster care payment to be made on the child's behalf and shall not
include review of the propriety of the county's child protection determination or child
placement decision.

(e) new text begin The scope of hearings involving appeals related to the reduction, suspension,
denial, or termination of personal care assistance services under section 256B.0659 shall
be limited to the specific issues under written appeal.
new text end

new text begin (f) new text end A vendor of medical care as defined in section 256B.02, subdivision 7, or a
vendor under contract with a county agency to provide social services is not a party and
may not request a hearing under this section, except if assisting a recipient as provided in
subdivision 4.

deleted text begin (f) deleted text end new text begin (g) new text end An applicant or recipient is not entitled to receive social services beyond the
services prescribed under chapter 256M or other social services the person is eligible
for under state law.

deleted text begin (g) deleted text end new text begin (h) new text end The commissioner may summarily affirm the county or state agency's
proposed action without a hearing when the sole issue is an automatic change due to
a change in state or federal law.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for all notices of action dated on or
after July 1, 2012.
new text end

Sec. 4.

Minnesota Statutes 2010, section 256B.0659, is amended by adding a
subdivision to read:

new text begin Subd. 31. new text end

new text begin Appeals. new text end

new text begin (a) A recipient who is adversely affected by the reduction,
suspension, denial, or termination of services under this section may appeal the decision
according to section 256.045. The appeal must be in writing and identify the specific issues
the recipient would like to have considered in the appeal hearing and a summary of the
basis, with supporting professional documentation if available, for contesting the decision.
new text end

new text begin (b) If a recipient has a change in condition or new information after the date of
the assessment, temporary services may be authorized according to section 256B.0652,
subdivision 9, until a new assessment is completed.
new text end

Sec. 5.

Minnesota Statutes 2011 Supplement, section 256B.0911, subdivision 3a,
is amended to read:

Subd. 3a.

Assessment and support planning.

(a) Persons requesting assessment,
services planning, or other assistance intended to support community-based living,
including persons who need assessment in order to determine waiver or alternative care
program eligibility, must be visited by a long-term care consultation team within 15
calendar days after the date on which an assessment was requested or recommended. After
January 1, 2011, these requirements also apply to personal care assistance services, private
duty nursing, and home health agency services, on timelines established in subdivision 5.
Face-to-face assessments must be conducted according to paragraphs (b) to (i).

(b) The county may utilize a team of either the social worker or public health nurse,
or both. After January 1, 2011, lead agencies shall use certified assessors to conduct the
assessment in a face-to-face interview. The consultation team members must confer
regarding the most appropriate care for each individual screened or assessed.

(c) The assessment must be comprehensive and include a person-centered
assessment of the health, psychological, functional, environmental, and social needs of
referred individuals and provide information necessary to develop a support plan that
meets the consumers needs, using an assessment form provided by the commissioner.

(d) The assessment must be conducted in a face-to-face interview with the person
being assessed and the person's legal representative, as required by legally executed
documents, and other individuals as requested by the person, who can provide information
on the needs, strengths, and preferences of the person necessary to develop a support
plan that ensures the person's health and safety, but who is not a provider of service or
has any financial interest in the provision of services. new text begin With the permission of the person
being assessed or the persons' designated or legal representative, the client's provider
of services may submit a copy of the provider's nursing assessment or written report
outlining their recommendations regarding the client's care needs. The person conducting
the assessment will notify the provider of the date by which this information is to be
submitted. This information shall be provided to the person conducting the assessment
and must be considered prior to the finalization of the assessment.
new text end

(e) The person, or the person's legal representative, must be provided with written
recommendations for community-based services, including consumer-directed options,
or institutional care that include documentation that the most cost-effective alternatives
available were offered to the individual, and alternatives to residential settings, including,
but not limited to, foster care settings that are not the primary residence of the license
holder. For purposes of this requirement, "cost-effective alternatives" means community
services and living arrangements that cost the same as or less than institutional care.

(f) If the person chooses to use community-based services, the person or the person's
legal representative must be provided with a written community support plan, regardless
of whether the individual is eligible for Minnesota health care programs. A person may
request assistance in identifying community supports without participating in a complete
assessment. Upon a request for assistance identifying community support, the person must
be transferred or referred to the services available under sections 256.975, subdivision 7,
and 256.01, subdivision 24, for telephone assistance and follow up.

(g) The person has the right to make the final decision between institutional
placement and community placement after the recommendations have been provided,
except as provided in subdivision 4a, paragraph (c).

(h) The team must give the person receiving assessment or support planning, or
the person's legal representative, materials, and forms supplied by the commissioner
containing the following information:

(1) the need for and purpose of preadmission screening if the person selects nursing
facility placement;

(2) the role of the long-term care consultation assessment and support planning in
waiver and alternative care program eligibility determination;

(3) information about Minnesota health care programs;

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

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

(6) the long-term care consultant's decision regarding the person's need for
institutional level of care as determined under criteria established in section 144.0724,
subdivision 11, or 256B.092; and

(7) the person's right to appeal the decision regarding the need for nursing facility
level of care or the county's final decisions regarding public programs eligibility according
to section 256.045, subdivision 3.

(i) Face-to-face assessment completed as part of eligibility determination for
the alternative care, elderly waiver, community alternatives for disabled individuals,
community alternative care, and traumatic brain injury waiver programs under sections
256B.0915, 256B.0917, and 256B.49 is valid to establish service eligibility for no more
than 60 calendar days after the date of assessment. The effective eligibility start date
for these programs can never be prior to the date of assessment. If an assessment was
completed more than 60 days before the effective waiver or alternative care program
eligibility start date, assessment and support plan information must be updated in a
face-to-face visit and documented in the department's Medicaid Management Information
System (MMIS). The effective date of program eligibility in this case cannot be prior to
the date the updated assessment is completed.

Sec. 6.

Minnesota Statutes 2011 Supplement, section 256B.0911, subdivision 3c,
is amended to read:

Subd. 3c.

Consultation for housing with services.

(a) The purpose of long-term
care consultation for registered housing with services is to support persons with current or
anticipated long-term care needs in making informed choices among options that include
the most cost-effective and least restrictive settings. Prospective residents maintain the
right to choose housing with services or assisted living if that option is their preference.

(b) Registered housing with services establishments shall inform all prospective
residents of the availability of long-term care consultation and the need to receive and
verify the consultation prior to signing a lease or contract. Long-term care consultation
for registered housing with services is provided as determined by the commissioner of
human services. The service is delivered under a partnership between lead agencies as
defined in subdivision 1a, paragraph (d), and the Area Agencies on Aging, and is a point
of entry to a combination of telephone-based long-term care options counseling provided
by Senior LinkAge Line and in-person long-term care consultation provided by lead
agencies. The point of entry service must be provided within five working days of the
request of the prospective resident as follows:

(1) the consultation shall be performed in a manner that provides objective and
complete information;

(2) the consultation must include a review of the prospective resident's reasons for
considering housing with services, the prospective resident's personal goals, a discussion
of the prospective resident's immediate and projected long-term care needs, and alternative
community services or housing with services settings that may meet the prospective
resident's needs;

(3) the prospective resident shall be informed of the availability of a face-to-face
visit at no charge to the prospective resident to assist the prospective resident in assessment
and planning to meet the prospective resident's long-term care needs; and

(4) verification of counseling shall be generated and provided to the prospective
resident by Senior LinkAge Line upon completion of the telephone-based counseling.

(c) Housing with services establishments registered under chapter 144D shall:

(1) inform all prospective residents of the availability of and contact information for
consultation services under this subdivision;

(2) except for individuals seeking lease-only arrangements in subsidized housing
settings, receive a copy of the verification of counseling prior to executing a lease or
service contract with the prospective resident, and prior to executing a service contract
with individuals who have previously entered into lease-only arrangements; and

(3) retain a copy of the verification of counseling as part of the resident's file.

new text begin (d) Exemptions from the consultation requirement under paragraph (b) and
emergency admissions to registered housing with services establishments prior to
consultation under paragraph (b) are permitted according to policies established by the
commissioner.
new text end

new text begin (e) Prospective residents who have used financial planning services and created a
long-term care plan in the 12 months prior to signing a lease or contract with a registered
housing with services or assisted living establishment are exempt from the long-term care
consultation requirements under this subdivision. Housing with services establishments
registered under chapter 144D are exempt from the requirements of paragraph (c),
clauses (2) and (3), for prospective residents who are exempt from the requirements
of this subdivision.
new text end

Sec. 7.

new text begin [256B.492] HOME AND COMMUNITY-BASED SETTINGS.
new text end

new text begin (a) For purposes of the home and community-based waiver programs under sections
256B.092 and 256B.49, home and community-based settings include:
new text end

new text begin (1) licensed adult or child foster care settings of four or five, if emergency exception
criteria are met; and
new text end

new text begin (2) other settings that meet the definition of "community-living settings" under
section 256B.49, subdivision 23:
new text end

new text begin (i) in addition to this definition, if a single corporation or entity provides both
housing and services, there must be a distinct separation between the housing and services;
new text end

new text begin (ii) individuals may choose a service provider separate from the housing provider
without being required to move; and
new text end

new text begin (iii) for settings that meet this definition, individuals with disabilities may reside
in up to 20 percent of the units.
new text end

new text begin (b) For purposes of the home and community-based waiver programs under sections
256B.092 and 256B.49, home and community-based settings must not:
new text end

new text begin (1) be located in a building that is also a publicly or privately operated facility that
provides institutional treatment or custodial care;
new text end

new text begin (2) be located in a building on the grounds of, or immediately adjacent to, a public
institution;
new text end

new text begin (3) be a housing complex designed expressly around an individual's diagnosis or
disability;
new text end

new text begin (4) be segregated based on disability, either physically or because of setting
characteristics, from the larger community; or
new text end

new text begin (5) have the qualities of an institution, unless specifically required in the individual's
plan developed with the lead agency case manager and legal guardian. The qualities of an
institution include, but are not limited to:
new text end

new text begin (i) regimented meal and sleep times;
new text end

new text begin (ii) limitations on visitors; and
new text end

new text begin (iii) lack of privacy.
new text end

Sec. 8.

Laws 2011, First Special Session chapter 9, article 10, section 3, subdivision 3,
is amended to read:

Subd. 3. Forecasted Programs

The amounts that may be spent from this
appropriation for each purpose are as follows:

(a) MFIP/DWP Grants

Appropriations by Fund
General	84,680,000	91,978,000
Federal TANF	84,425,000	75,417,000

(b) MFIP Child Care Assistance Grants

55,456,000

30,923,000

(c) General Assistance Grants

49,192,000

46,938,000

General Assistance Standard. The
commissioner shall set the monthly standard
of assistance for general assistance units
consisting of an adult recipient who is
childless and unmarried or living apart
from parents or a legal guardian at $203.
The commissioner may reduce this amount
according to Laws 1997, chapter 85, article
3, section 54.

Emergency General Assistance. The
amount appropriated for emergency general
assistance funds is limited to no more
than $6,689,812 in fiscal year 2012 and
$6,729,812 in fiscal year 2013. Funds
to counties shall be allocated by the
commissioner using the allocation method
specified in Minnesota Statutes, section
256D.06.

(d) Minnesota Supplemental Aid Grants

38,095,000

39,120,000

(e) Group Residential Housing Grants

121,080,000

129,238,000

(f) MinnesotaCare Grants

295,046,000

317,272,000

This appropriation is from the health care
access fund.

(g) Medical Assistance Grants

4,501,582,000

4,437,282,000

Managed Care Incentive Payments. The
commissioner shall not make managed care
incentive payments for expanding preventive
services during fiscal years beginning July 1,
2011, and July 1, 2012.

Reduction of Rates for Congregate
Living for Individuals with Lower Needs.
Beginning October 1, 2011, lead agencies
must reduce rates in effect on January 1,
2011, by ten percent for individuals with
lower needs living in foster care settings
where the license holder does not share
the residence with recipients on the CADI
and DD waivers and customized living
settings for CADI. new text begin Lead agencies may reduce
services for persons with lower needs on the
CADI and DD waivers if appropriate based
on an assessment of needs. This reduction
must be spread proportionately across the
CADI and DD waivers based on the number
of persons enrolled in each waiver. new text end Lead
agencies must adjust contracts within 60
days of the effective date. new text begin However, no foster
care setting shall have their overall Medical
Assistance reimbursement reduced by more
than four percent.
new text end

Reduction of Lead Agency Waiver
Allocations to Implement Rate Reductions
for Congregate Living for Individuals
with Lower Needs. Beginning October 1,
2011, the commissioner shall reduce lead
agency waiver allocations to implement the
reduction of rates for individuals with lower
needs living in foster care settings where the
license holder does not share the residence
with recipients on the CADI and DD waivers
and customized living settings for CADI.

Reduce customized living and 24-hour
customized living component rates.
Effective July 1, 2011, the commissioner
shall reduce elderly waiver customized living
and 24-hour customized living component
service new text begin total new text end spending by five percent through
reductions in component rates and service
rate limits. new text begin Component rates and service rate
limits shall be reduced as follows:
new text end

new text begin (1) customized living and 24-hour
customized living facilities in which 60
percent or more of their residents are
receiving elderly waiver services shall have
their component rates and service rate limits
reduced by three percent;
new text end

new text begin (2) customized living facilities in which more
than ten percent but less than 60 percent of
their residents are receiving elderly waiver
services shall have their component rates and
service rate limits reduced by five percent;
and
new text end

new text begin (3) customized living and 24-hour
customized living facilities in which ten
percent or fewer of their residents are
receiving elderly waiver services shall have
their component rates and service rate limits
reduced by eight percent.
new text end

The commissioner shall adjust the elderly
waiver capitation payment rates for managed
care organizations paid under Minnesota
Statutes, section 256B.69, subdivisions 6a
and 23, to reflect reductions in component
spending for customized living services and
24-hour customized living services under
Minnesota Statutes, section 256B.0915,
subdivisions 3e and 3h, for the contract
period beginning January 1, 2012. To
implement the reduction specified in this
provision, capitation rates paid by the
commissioner to managed care organizations
under Minnesota Statutes, section 256B.69,
shall reflect a ten percent reduction for the
specified services for the period January 1,
2012, to June 30, 2012, and a five percent
reduction for those services on or after July
1, 2012.

Limit Growth in the Developmental
Disability Waiver. The commissioner
shall limit growth in the developmental
disability waiver to six diversion allocations
per month beginning July 1, 2011, through
June 30, 2013, and 15 diversion allocations
per month beginning July 1, 2013, through
June 30, 2015. Waiver allocations shall
be targeted to individuals who meet the
priorities for accessing waiver services
identified in Minnesota Statutes, 256B.092,
subdivision 12. The limits do not include
conversions from intermediate care facilities
for persons with developmental disabilities.
Notwithstanding any contrary provisions in
this article, this paragraph expires June 30,
2015.

Limit Growth in the Community
Alternatives for Disabled Individuals
Waiver. The commissioner shall limit
growth in the community alternatives for
disabled individuals waiver to 60 allocations
per month beginning July 1, 2011, through
June 30, 2013, and 85 allocations per
month beginning July 1, 2013, through
June 30, 2015. Waiver allocations must
be targeted to individuals who meet the
priorities for accessing waiver services
identified in Minnesota Statutes, section
256B.49, subdivision 11a. The limits include
conversions and diversions, unless the
commissioner has approved a plan to convert
funding due to the closure or downsizing
of a residential facility or nursing facility
to serve directly affected individuals on
the community alternatives for disabled
individuals waiver. Notwithstanding any
contrary provisions in this article, this
paragraph expires June 30, 2015.

Personal Care Assistance Relative
Care. The commissioner shall adjust the
capitation payment rates for managed care
organizations paid under Minnesota Statutes,
section 256B.69, to reflect the rate reductions
for personal care assistance provided by
a relative pursuant to Minnesota Statutes,
section 256B.0659, subdivision 11.

(h) Alternative Care Grants

46,421,000

46,035,000

Alternative Care Transfer. Any money
allocated to the alternative care program that
is not spent for the purposes indicated does
not cancel but shall be transferred to the
medical assistance account.

(i) Chemical Dependency Entitlement Grants

94,675,000

93,298,000

Sec. 9. new text begin COMMUNITY FIRST CHOICE OPTION.
new text end

new text begin (a) If the final federal regulations under Community First Choice Option are
determined by the commissioner, after consultation with interested stakeholders in
paragraph (d), to be compatible with Minnesota's fiscal neutrality and policy requirements
for redesigning and simplifying the personal care assistance program, assistance at home
and in the community provided through the home and community-based services with
waivers, state-funded grants, and medical assistance-funded services and programs, the
commissioner shall develop and request a state plan amendment to establish services,
including self-directed options, under section 1915k of the Social Security Act by January
15, 2013, for implementation on July 1, 2013.
new text end

new text begin (b) The commissioner shall develop and provide to the chairs of the health and
human services policy and finance committees, legislation needed to reform and simplify
home care, home and community-based service waivers, and other community support
services under the Community First Choice Option by February 15, 2013.
new text end

new text begin (c) Any savings generated by this option shall accrue to the commissioner for
development and implementation of community support services under the Community
First Choice Option.
new text end

new text begin (d) The commissioner shall consult with stakeholders, including persons with
disabilities and seniors, who represent a range of disabilities, ages, cultures, and
geographic locations, their families and guardians, as well as representatives of advocacy
organizations, lead agencies, direct support staff, and a variety of service provider groups.
new text end