SF 2231

as introduced - 85th Legislature (2007 - 2008) Posted on 12/15/2009 12:00am

A bill for an act
relating to human services; making changes to continuing care provisions;
amending data practices; changing long-term care provisions; allowing electronic
meetings; altering service standards; amending Medicaid waivers for elderly
services; modifying personal care assistant services; providing penalties;
amending Minnesota Statutes 2006, sections 13.46, subdivision 2; 144A.071,
subdivision 3; 144A.351; 256.9741, subdivisions 1, 3; 256.9742, subdivisions 3,
4, 6; 256.975, by adding a subdivision; 256B.0655, subdivisions 1, 1c, 1f, 1g,
2, by adding subdivisions; 256B.0911, subdivisions 3a, 4b, 6, 7, by adding a
subdivision; 256B.0913, subdivisions 4, 5a; 256B.0915; 256B.27, subdivision
2a; 256B.49, subdivisions 13, 14; repealing Minnesota Statutes 2006, section
256.9743; Minnesota Rules, part 9505.0335.

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

Section 1.

Minnesota Statutes 2006, section 13.46, subdivision 2, is amended to read:

Subd. 2.

General.

(a) new text begin Data may be obtained from another responsible authority by
a responsible authority in the welfare system, pursuant to subdivision 10, including for
the purposes specified in this subdivision. new text end Unless the data is summary data or a statute
specifically provides a different classification, data on individuals collected, maintained,
used, or disseminated by the welfare system is private data on individuals, and shall
not be disclosed except:

(1) according to section 13.05;

(2) according to court order;

(3) according to a statute specifically authorizing access to the private data;

(4) to an agent of the welfare system, including a law enforcement person, attorney,
or investigator acting for it in the investigation or prosecution of a criminal or civil
proceeding relating to the administration of a program;

(5) to personnel of the welfare system who require the data to verify an individual's
identity; determine eligibility, amount of assistance, and the need to provide services to
an individual or family across programs; evaluate the effectiveness of programs; and
investigate suspected fraud;

(6) to administer federal funds or programs;

(7) between personnel of the welfare system working in the same program;

(8) to the Department of Revenue to administer and evaluate tax refund or tax credit
programs and to identify individuals who may benefit from these programs. The following
information may be disclosed under this paragraph: an individual's and their dependent's
names, dates of birth, Social Security numbers, income, addresses, and other data as
required, upon request by the Department of Revenue. Disclosures by the commissioner
of revenue to the commissioner of human services for the purposes described in this clause
are governed by section 270B.14, subdivision 1. Tax refund or tax credit programs include,
but are not limited to, the dependent care credit under section 290.067, the Minnesota
working family credit under section 290.0671, the property tax refund and rental credit
under section 290A.04, and the Minnesota education credit under section 290.0674;

(9) between the Department of Human Services, deleted text begin the Department of Education,
and deleted text end the Department of Employment and Economic Development deleted text begin for the purpose of
monitoring deleted text end new text begin , and, when applicable, the Department of Education, for the following
purposes:
new text end

new text begin (i) to monitor new text end the eligibility of the data subject for unemployment benefits, for any
employment or training program administered, supervised, or certified by that agency deleted text begin ,
for the purpose of administering deleted text end new text begin ;
new text end

new text begin (ii) to administer new text end any rehabilitation program or child care assistance program,
whether alone or in conjunction with the welfare system deleted text begin , or deleted text end new text begin ;
new text end

new text begin (iii) new text end to monitor and evaluate the Minnesota family investment program by
exchanging data on recipients and former recipients of food support, cash assistance under
chapter 256, 256D, 256J, or 256K, child care assistance under chapter 119B, or medical
programs under chapter 256B, 256D, or 256L; new text begin and
new text end

new text begin (iv) to analyze current processes and outcomes relating to public assistance programs
affecting employment, including eligibility determination, service utilization, program
cost, and program effectiveness, as implemented under the authority established in Title
II, Sections 201-204 of the Ticket to Work and Work Incentives Improvement Act of
1999, Public Law 106-170;
new text end

(10) to appropriate parties in connection with an emergency if knowledge of
the information is necessary to protect the health or safety of the individual or other
individuals or persons;

(11) data maintained by residential programs as defined in section 245A.02 may
be disclosed to the protection and advocacy system established in this state according
to Part C of Public Law 98-527 to protect the legal and human rights of persons with
developmental disabilities or other related conditions who live in residential facilities for
these persons if the protection and advocacy system receives a complaint by or on behalf
of that person and the person does not have a legal guardian or the state or a designee of
the state is the legal guardian of the person;

(12) to the county medical examiner or the county coroner for identifying or locating
relatives or friends of a deceased person;

(13) data on a child support obligor who makes payments to the public agency
may be disclosed to the Minnesota Office of Higher Education to the extent necessary to
determine eligibility under section 136A.121, subdivision 2, clause (5);

(14) participant Social Security numbers and names collected by the telephone
assistance program may be disclosed to the Department of Revenue to conduct an
electronic data match with the property tax refund database to determine eligibility under
section 237.70, subdivision 4a;

(15) the current address of a Minnesota family investment program participant
may be disclosed to law enforcement officers who provide the name of the participant
and notify the agency that:

(i) the participant:

(A) is a fugitive felon fleeing to avoid prosecution, or custody or confinement after
conviction, for a crime or attempt to commit a crime that is a felony under the laws of the
jurisdiction from which the individual is fleeing; or

(B) is violating a condition of probation or parole imposed under state or federal law;

(ii) the location or apprehension of the felon is within the law enforcement officer's
official duties; and

(iii) the request is made in writing and in the proper exercise of those duties;

(16) the current address of a recipient of general assistance or general assistance
medical care may be disclosed to probation officers and corrections agents who are
supervising the recipient and to law enforcement officers who are investigating the
recipient in connection with a felony level offense;

(17) information obtained from food support applicant or recipient households may
be disclosed to local, state, or federal law enforcement officials, upon their written request,
for the purpose of investigating an alleged violation of the Food Stamp Act, according
to Code of Federal Regulations, title 7, section 272.1(c);

(18) the address, Social Security number, and, if available, photograph of any
member of a household receiving food support shall be made available, on request, to a
local, state, or federal law enforcement officer if the officer furnishes the agency with the
name of the member and notifies the agency that:

(i) the member:

(A) is fleeing to avoid prosecution, or custody or confinement after conviction, for a
crime or attempt to commit a crime that is a felony in the jurisdiction the member is fleeing;

(B) is violating a condition of probation or parole imposed under state or federal
law; or

(C) has information that is necessary for the officer to conduct an official duty related
to conduct described in subitem (A) or (B);

(ii) locating or apprehending the member is within the officer's official duties; and

(iii) the request is made in writing and in the proper exercise of the officer's official
duty;

(19) the current address of a recipient of Minnesota family investment program,
general assistance, general assistance medical care, or food support may be disclosed to
law enforcement officers who, in writing, provide the name of the recipient and notify the
agency that the recipient is a person required to register under section 243.166, but is not
residing at the address at which the recipient is registered under section 243.166;

(20) certain information regarding child support obligors who are in arrears may be
made public according to section 518A.74;

(21) data on child support payments made by a child support obligor and data on
the distribution of those payments excluding identifying information on obligees may be
disclosed to all obligees to whom the obligor owes support, and data on the enforcement
actions undertaken by the public authority, the status of those actions, and data on the
income of the obligor or obligee may be disclosed to the other party;

(22) data in the work reporting system may be disclosed under section 256.998,
subdivision 7;

(23) to the Department of Education for the purpose of matching Department of
Education student data with public assistance data to determine students eligible for free
and reduced price meals, meal supplements, and free milk according to United States
Code, title 42, sections 1758, 1761, 1766, 1766a, 1772, and 1773; to allocate federal and
state funds that are distributed based on income of the student's family; and to verify
receipt of energy assistance for the telephone assistance plan;

(24) the current address and telephone number of program recipients and emergency
contacts may be released to the commissioner of health or a local board of health as
defined in section 145A.02, subdivision 2, when the commissioner or local board of health
has reason to believe that a program recipient is a disease case, carrier, suspect case, or at
risk of illness, and the data are necessary to locate the person;

(25) to other state agencies, statewide systems, and political subdivisions of this
state, including the attorney general, and agencies of other states, interstate information
networks, federal agencies, and other entities as required by federal regulation or law for
the administration of the child support enforcement program;

(26) to personnel of public assistance programs as defined in section 256.741, for
access to the child support system database for the purpose of administration, including
monitoring and evaluation of those public assistance programs;

(27) to monitor and evaluate the Minnesota family investment program by
exchanging data between the Departments of Human Services and Education, on
recipients and former recipients of food support, cash assistance under chapter 256, 256D,
256J, or 256K, child care assistance under chapter 119B, or medical programs under
chapter 256B, 256D, or 256L;

(28) to evaluate child support program performance and to identify and prevent
fraud in the child support program by exchanging data between the Department of Human
Services, Department of Revenue under section 270B.14, subdivision 1, paragraphs (a)
and (b), without regard to the limitation of use in paragraph (c), Department of Health,
Department of Employment and Economic Development, and other state agencies as is
reasonably necessary to perform these functions; or

(29) counties operating child care assistance programs under chapter 119B may
disseminate data on program participants, applicants, and providers to the commissioner
of education.

(b) Information on persons who have been treated for drug or alcohol abuse may
only be disclosed according to the requirements of Code of Federal Regulations, title
42, sections 2.1 to 2.67.

(c) Data provided to law enforcement agencies under paragraph (a), clause (15),
(16), (17), or (18), or paragraph (b), are investigative data and are confidential or protected
nonpublic while the investigation is active. The data are private after the investigation
becomes inactive under section 13.82, subdivision 5, paragraph (a) or (b).

(d) Mental health data shall be treated as provided in subdivisions 7, 8, and 9, but is
not subject to the access provisions of subdivision 10, paragraph (b).

For the purposes of this subdivision, a request will be deemed to be made in writing
if made through a computer interface system.

Sec. 2.

Minnesota Statutes 2006, section 144A.071, subdivision 3, is amended to read:

Subd. 3.

Exceptions authorizing an increase in beds.

The commissioner of health,
in coordination with the commissioner of human services, may approve the addition
of a new certified bed or the addition of a new licensed nursing home bed, under the
following conditions:

(a) to license or certify a new bed in place of one decertified after July 1, 1993, as
long as the number of certified plus newly certified or recertified beds does not exceed the
number of beds licensed or certified on July 1, 1993, or to address an extreme hardship
situation, in a particular county that deleted text begin , deleted text end new text begin has fewer than 75 percent of the national average of
nursing home beds per 1,000 elderly individuals, or that has fewer than 85 percent of the
national average of nursing home beds per 1,000 elderly individuals and new text end together with
all new text begin of that county's new text end contiguous Minnesota counties, has fewer nursing home beds per 1,000
elderly than deleted text begin the number that is ten percent higher than deleted text end new text begin 120 percent of new text end the national average
of nursing home beds per 1,000 elderly individuals. For the purposes of this section, the
national average of nursing home beds shall be the most recent figure that can be supplied
by the federal Centers for Medicare and Medicaid Services and the number of elderly in
the county or the nation shall be determined by the most recent federal census or the
most recent estimate of the state demographer as of July 1, of each year of persons age
65 and older, whichever is the most recent at the time of the request for replacement. An
extreme hardship situation can only be found after the county documents the existence of
unmet deleted text begin medical deleted text end needs new text begin for nursing home placement new text end that cannot be addressed by any other
alternatives new text begin . The number of new beds that the commissioner may authorize in the event
of an extreme hardship situation shall not exceed: (1) the number necessary to increase
the county's number of beds per 1,000 elderly to 90 percent of the national average, and
(2) the number of beds that are delicensed while the planned closure program in section
256B.437 is suspended.
new text end

new text begin Operating payment rates of nursing facilities adding beds under this paragraph shall
not change when the new beds are licensed. Adjustments to the property payment rate
shall be determined according to section 256B.434, subdivision 4f new text end ;

(b) to certify or license new beds in a new facility that is to be operated by the
commissioner of veterans affairs or when the costs of constructing and operating the new
beds are to be reimbursed by the commissioner of veterans affairs or the United States
Veterans Administration;

(c) to license or certify beds in a facility that has been involuntarily delicensed
or decertified for participation in the medical assistance program, provided that an
application for relicensure or recertification is submitted to the commissioner within 120
days after delicensure or decertification;

(d) to certify two existing beds in a facility with 66 licensed beds on January 1, 1994,
that had an average occupancy rate of 98 percent or higher in both calendar years 1992 and
1993, and which began construction of four attached assisted living units in April 1993; or

(e) to certify four existing beds in a facility in Winona with 139 beds, of which 129
beds are certified.

Sec. 3.

Minnesota Statutes 2006, section 144A.351, is amended to read:

144A.351 BALANCING LONG-TERM CARE: REPORT REQUIRED.

The commissioners of health and human services, with the cooperation of counties
and regional entities, shall prepare a report to the legislature by deleted text begin January deleted text end new text begin August new text end 15, 2004,
and biennially thereafter, regarding the status of the full range of long-term care services
for the elderly in Minnesota. The report shall address:

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

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

(3) status of long-term care services by county and region including:

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

(ii) access problems regarding long-term care; and

(iii) comparative measures of long-term care availability and progress over time; and

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

Sec. 4.

Minnesota Statutes 2006, section 256.9741, subdivision 1, is amended to read:

Subdivision 1.

Long-term care facility.

"Long-term care facility" means a nursing
home licensed under sections 144A.02 to 144A.10 deleted text begin or deleted text end new text begin ; a new text end boarding care home licensed
under sections 144.50 to 144.56 new text begin ; or a licensed or registered residential setting which
provides or arranges for the provision of home care services new text end .

Sec. 5.

Minnesota Statutes 2006, section 256.9741, subdivision 3, is amended to read:

Subd. 3.

Client.

"Client" means an individual who requests, or on whose behalf a
request is made for, ombudsman services and is (a) a resident of a long-term care facility
or (b) a Medicare beneficiary who requests assistance relating to access, discharge, or
denial of inpatient or outpatient services, or (c) an individual reserving new text begin , receiving, new text end or
requesting a home care service.

Sec. 6.

Minnesota Statutes 2006, section 256.9742, subdivision 3, is amended to read:

Subd. 3.

Posting.

Every long-term care facility and acute care facility shall post in a
conspicuous place the address and telephone number of the office. A home care service
provider shall provide all recipients, including those in deleted text begin elderly deleted text end housing with services
under chapter 144D, with the address and telephone number of the office. Counties shall
provide clients receiving deleted text begin a consumer support grant or a service allowance deleted text end new text begin long-term care
consultation services under section 256B.0911 or home and community-based services
through a state or federally funded program new text end with the name, address, and telephone number
of the office. The posting or notice is subject to approval by the ombudsman.

Sec. 7.

Minnesota Statutes 2006, section 256.9742, subdivision 4, is amended to read:

Subd. 4.

Access to long-term care and acute care facilities and clients.

The
ombudsman or designee may:

(1) enter any long-term care facility without notice at any time;

(2) enter any acute care facility without notice during normal business hours;

(3) enter any acute care facility without notice at any time to interview a patient or
observe services being provided to the patient as part of an investigation of a matter that is
within the scope of the ombudsman's authority, but only if the ombudsman's or designee's
presence does not intrude upon the privacy of another patient or interfere with routine
hospital services provided to any patient in the facility;

(4) communicate privately and without restriction with any client deleted text begin in accordance
with section 144.651 deleted text end , as long as the ombudsman has the client's consent for such
communication;

(5) inspect records of a long-term care facility, home care service provider, or acute
care facility that pertain to the care of the client according to deleted text begin sections deleted text end new text begin section new text end 144.335 deleted text begin and
144.651 deleted text end ; and

(6) with the consent of a client or client's legal guardian, the ombudsman or
designated staff shall have access to review records pertaining to the care of the client
according to deleted text begin sections deleted text end new text begin section new text end 144.335 deleted text begin and 144.651 deleted text end . If a client cannot consent and has no
legal guardian, access to the records is authorized by this section.

A person who denies access to the ombudsman or designee in violation of this
subdivision or aids, abets, invites, compels, or coerces another to do so is guilty of a
misdemeanor.

Sec. 8.

Minnesota Statutes 2006, section 256.9742, subdivision 6, is amended to read:

Subd. 6.

Prohibition against discrimination or retaliation.

(a) No entity shall take
discriminatory, disciplinary, or retaliatory action against an employee or volunteer, or a
patient, resident, or guardian or family member of a patient, resident, or guardian for filing
in good faith a complaint with or providing information to the ombudsman or designee
including volunteers. A person who violates this subdivision or who aids, abets, invites,
compels, or coerces another to do so is guilty of a misdemeanor.

(b) There shall be a rebuttable presumption that any adverse action, as defined below,
within 90 days of report, is discriminatory, disciplinary, or retaliatory. For the purpose
of this clause, the term "adverse action" refers to action taken by the entity involved in a
report against the person making the report or the person with respect to whom the report
was made because of the report, and includes, but is not limited to:

(1) discharge or transfer from a facility;

(2) termination of service;

(3) restriction or prohibition of access to the facility or its residents;

(4) discharge from or termination of employment;

(5) demotion or reduction in remuneration for services; and

(6) any restriction of rights set forth in section 144.651 deleted text begin or deleted text end new text begin , new text end 144A.44 new text begin , or 144A.751 new text end .

Sec. 9.

Minnesota Statutes 2006, section 256.975, is amended by adding a subdivision
to read:

new text begin Subd. 2a. new text end

new text begin Electronic meetings. new text end

new text begin (a) Notwithstanding section 13D.01, the Minnesota
Board on Aging may conduct a meeting of its members by telephone or other electronic
means so long as the following conditions are met:
new text end

new text begin (1) all members of the board participating in the meeting, wherever their physical
location, can hear one another and can hear all discussion and testimony;
new text end

new text begin (2) members of the public present at the regular meeting location of the board can
hear all discussion and testimony and all votes of members of the board;
new text end

new text begin (3) at least one member of the board is physically present at the regular meeting
location; and
new text end

new text begin (4) all votes are conducted by roll call, so that each member's vote on each issue
can be identified and recorded.
new text end

new text begin (b) Each member of the board participating in a meeting by telephone or other
electronic means is considered present at the meeting for purposes of determining a
quorum and participating in all proceedings.
new text end

new text begin (c) If telephone or other electronic means is used to conduct a meeting, the board,
to the extent practical, shall allow a person to monitor the meeting electronically from
a remote location. The board may require the person making a connection to pay for
documented marginal costs that the board incurs as a result of the additional connection.
new text end

new text begin (d) If telephone or other electronic means is used to conduct a regular, special, or
emergency meeting, the board shall provide notice of the regular meeting location, of the
fact that some members may participate by telephone or other electronic means, and of
the provisions of paragraph (c). The timing and method of providing notice is governed
by section 13D.04.
new text end

Sec. 10.

Minnesota Statutes 2006, section 256B.0655, subdivision 1, is amended to
read:

Subdivision 1.

Definitions.

For purposes of this section and sections 256B.0651,
256B.0653, 256B.0654, and 256B.0656, the terms defined in subdivisions 1a to deleted text begin 1i deleted text end new text begin 1l new text end have
the meanings given them unless otherwise provided or indicated by the context.

Sec. 11.

Minnesota Statutes 2006, section 256B.0655, subdivision 1c, is amended to
read:

Subd. 1c.

Care plan.

"Care plan" means a written description of personal care
assistant services developed by the qualified professional or the recipient's physician with
the recipient or responsible party to be used by the personal care assistant with a copy
provided to the recipient or responsible party. new text begin "Care plan" includes a plan of personal
care services.
new text end

Sec. 12.

Minnesota Statutes 2006, section 256B.0655, subdivision 1f, is amended to
read:

Subd. 1f.

Personal care assistant.

new text begin (a) new text end "Personal care assistant" means a person who:

(1) is at least 18 years old, except for persons 16 to 18 years of age who participated
in a related school-based job training program or have completed a certified home health
aide competency evaluation;

(2) is able to effectively communicate with the recipient and personal care provider
organization;

(3) effective July 1, 1996, has completed one of the training requirements as
specified deleted text begin in Minnesota Rules, part 9505.0335, subpart 3, items A to E deleted text end new text begin in paragraph (b) new text end ;

(4) has the ability to, and provides covered personal care assistant services according
to the recipient's care plan, responds appropriately to recipient needs, and reports changes
in the recipient's condition to the supervising qualified professional or physician;

(5) is not a consumer of personal care assistant services;

(6) maintains daily written records detailing:

(i) the actual services provided to the recipient; and

(ii) the amount of time spent providing the services; and

(7) is subject to criminal background checks and procedures specified in chapter
245C.

new text begin (b) Personal care assistant training must include successful completion of one or
more training requirement in:
new text end

new text begin (1) a nursing assistant training program or its equivalent for which competency as a
nursing assistant is determined according to a test administered by the Minnesota State
Board of Technical Colleges;
new text end

new text begin (2) a homemaker home health aide preservice training program using a curriculum
recommended by the Department of Health;
new text end

new text begin (3) an accredited educational program for registered nurses or licensed practical
nurses;
new text end

new text begin (4) a training program that provides the assistant with skills required to perform
personal care assistant services specified in subdivision 2, paragraph (d); or
new text end

new text begin (5) a determination by the personal care provider that the assistant has, through
training or experience, the skills required to perform the personal care services specified in
subdivision 2.
new text end

Sec. 13.

Minnesota Statutes 2006, section 256B.0655, subdivision 1g, is amended to
read:

Subd. 1g.

Personal care provider organization.

new text begin (a) new text end "Personal care provider
organization" new text begin or "personal care provider" new text end means an organization enrolled to provide
personal care assistant services under the medical assistance program that complies with
the following:

(1) owners who have a five percent interest or more, and managerial officials are
subject to a background study as provided in chapter 245C. This applies to currently
enrolled personal care provider organizations and those agencies seeking enrollment as a
personal care provider organization. An organization will be barred from enrollment if an
owner or managerial official of the organization has been convicted of a crime specified
in chapter 245C, or a comparable crime in another jurisdiction, unless the owner or
managerial official meets the reconsideration criteria specified in chapter 245C;

(2) the organization must maintain a surety bond and liability insurance throughout
the duration of enrollment and provides proof thereof. The insurer must notify the
Department of Human Services of the cancellation or lapse of policy and the organization
must maintain documentation of services as specified in Minnesota Rules, part 9505.2175,
subpart 7, as well as evidence of compliance with personal care assistant training
requirements;

(3) the organization must maintain documentation and a recipient file and satisfy
communication requirements in section 256B.0655, subdivision 2, paragraph (f); and

(4) the organization must comply with all laws and rules governing the provision of
personal care assistant services.

new text begin (b) As required by subdivision 13, before employing a person as a personal care
assistant of a qualified recipient, the personal care provider shall require from the applicant
full disclosure of conviction and criminal history records pertaining to any crime related to
the provision of health services or to the occupation of a personal care assistant.
new text end

Sec. 14.

Minnesota Statutes 2006, section 256B.0655, is amended by adding a
subdivision to read:

new text begin Subd. 1j. new text end

new text begin Directing care. new text end

new text begin "Capable of directing the recipient's own care" refers
to a recipient's functional impairment status as determined by the recipient's ability to
communicate:
new text end

new text begin (1) orientation to person, place, and time;
new text end

new text begin (2) an understanding of the recipient's plan of care, including medications and
medication schedule;
new text end

new text begin (3) needs; and
new text end

new text begin (4) an understanding of safety issues, including how to access emergency assistance.
new text end

Sec. 15.

Minnesota Statutes 2006, section 256B.0655, is amended by adding a
subdivision to read:

new text begin Subd. 1k. new text end

new text begin Independent living. new text end

new text begin "Independent living" or "live independently"
refers to the situation of a recipient living in the recipient's own residence and having
the opportunity to control basic decisions about the recipient's life to the fullest extent
possible. For purposes of this section, "residence" does not include a long-term care
facility or an inpatient hospital.
new text end

Sec. 16.

Minnesota Statutes 2006, section 256B.0655, is amended by adding a
subdivision to read:

new text begin Subd. 1l. new text end

new text begin Qualified recipient. new text end

new text begin "Qualified recipient" means a recipient who needs
personal care services to live independently in the community, is in a stable medical
condition, and does not have acute care needs that require inpatient hospitalization or
cannot be met in the recipient's residence by a nursing service as defined by section
148.171, subdivision 15.
new text end

Sec. 17.

Minnesota Statutes 2006, section 256B.0655, subdivision 2, is amended to
read:

Subd. 2.

Personal care assistant services.

(a) The personal care assistant services
that are eligible for payment are services and supports furnished to an individual, as
needed, to assist in accomplishing activities of daily living; instrumental activities of daily
living; health-related functions through hands-on assistance, supervision, and cuing; and
redirection and intervention for behavior including observation and monitoring. new text begin Personal
care assistant services include services to a recipient to maintain the recipient in the
recipient's residence. Personal care service includes either private personal care service or
shared personal care service. "Private personal care service" means personal care service
that is not a shared personal care service.
new text end

new text begin (b) To be eligible for medical assistance payment, a personal care service that begins
or is increased on or after January 1, 1988, must be given to a recipient who meets the
criteria in clauses (1) to (4), and according to a plan of personal care services. The criteria
are as follows:
new text end

new text begin (1) the recipient meets the criteria specified in Minnesota Rules, part 9505.0295,
subpart 3;
new text end

new text begin (2) the recipient is a qualified recipient;
new text end

new text begin (3) the recipient or the recipient's responsible party is capable of directing the
recipient's own care; and
new text end

new text begin (4) the recipient has a plan of personal care services developed:
new text end

new text begin (i) by the supervising qualified professional;
new text end

new text begin (ii) by the recipient and the qualified professional; or
new text end

new text begin (iii) together with the recipient and the physician that specifies the personal care
services required.
new text end

deleted text begin (b) deleted text end new text begin (c) new text end Payment for services will be made within the limits approved using the
prior authorized process established in subdivisions 3 and 4, and sections 256B.0651,
subdivisions 4 to 12, and 256B.0654, subdivision 2.

deleted text begin (c) deleted text end new text begin (d) new text end The amount and type of services authorized shall be based on an assessment
of the recipient's needs in these areas:

(1) bowel and bladder care;

(2) skin care to maintain the health of the skin new text begin , including, but not limited to,
prophylactic routine and palliative measures documented in the plan of care that are done
to maintain the health of the skin, for example, exposure to air; use of nondurable medical
equipment; application of lotions, powders, and ointments; and other similar treatments
such as heat lamp and foot soaks new text end ;

(3) repetitive maintenance range of motion, muscle strengthening exercises, and
other tasks specific to maintaining a recipient's optimal level of function;

(4) respiratory assistance;

(5) transfers and ambulation;

(6) bathing, grooming, and hairwashing necessary for personal hygiene;

(7) turning and positioning;

(8) assistance with furnishing medication that is self-administered;

(9) application and maintenance of prosthetics and orthotics;

(10) cleaning medical equipment;

(11) dressing or undressing;

(12) assistance with eating deleted text begin and deleted text end new text begin , new text end meal preparation new text begin , new text end and necessary grocery shopping new text begin ,
including assistance with food, nutrition, and diet activities new text end ;

(13) new text begin (i) new text end accompanying a recipient to obtain medical diagnosis or treatment deleted text begin ; deleted text end new text begin and to
attend other activities such as church and school if the personal care assistant is needed to
provide personal care services while the recipient is absent from the recipient's residence;
and
new text end

new text begin (ii) performing other services essential to the effective performance of the duties in
clauses (1) to (13);
new text end

(14) assisting, monitoring, or prompting the recipient to complete the services in
clauses (1) to (13);

(15) redirection, monitoring, and observation that are medically necessary and an
integral part of completing the personal care assistant services described in clauses (1) to
(14);

(16) redirection and intervention for behavior, including observation and monitoring;

(17) interventions for seizure disorders, including monitoring and observation if the
recipient has had a seizure that requires intervention within the past three months;

(18) tracheostomy suctioning using a clean procedure if the procedure is properly
delegated by a registered nurse. Before this procedure can be delegated to a personal
care assistant, a registered nurse must determine that the tracheostomy suctioning can be
accomplished utilizing a clean rather than a sterile procedure and must ensure that the
personal care assistant has been taught the proper procedure; and

(19) incidental household services that are an integral part of a personal care service
described in clauses (1) to (18).

For purposes of this subdivision, monitoring and observation means watching for outward
visible signs that are likely to occur and for which there is a covered personal care service
or an appropriate personal care intervention. For purposes of this subdivision, a clean
procedure refers to a procedure that reduces the numbers of microorganisms or prevents or
reduces the transmission of microorganisms from one person or place to another. A clean
procedure may be used beginning 14 days after insertion.

deleted text begin (d) deleted text end new text begin (e) new text end The personal care assistant services that are not eligible for payment are
the following:

(1) services provided without a physician's statement of need as required by section
256B.0625, subdivision 19c, and included in the personal care provider agency's file for
the recipient;

(2) assessments by personal care assistant provider organizations or by independently
enrolled registered nurses;

(3) services that are not in the service plan;

(4) services provided by the recipient's spouse, legal guardian for an adult or child
recipient, or parent of a recipient under age 18;

(5) services provided by a foster care provider of a recipient who cannot direct the
recipient's own care, unless monitored by a county or state case manager under section
256B.0625, subdivision 19a;

(6) services provided by the residential or program license holder in a residence for
more than four persons;

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

(8) sterile procedures;

(9) injections of fluids into veins, muscles, or skin;

(10) homemaker services that are not an integral part of a personal care assistant
services;

(11) home maintenance or chore services;

(12) services not specified under paragraph (a); deleted text begin and
deleted text end

(13) services not authorized by the commissioner or the commissioner's designee deleted text begin . deleted text end new text begin ;
new text end

new text begin (14) a health service provided by and billed by a provider who is not a personal
care provider;
new text end

new text begin (15) a homemaking or social service except as provided in paragraph (d), clause
(13), item (i), or subdivision 5; and
new text end

new text begin (16) personal care service that is provided by a person who is the recipient's paid
legal guardian or related to the recipient as spouse, parent of a minor child, or child
whether by blood, marriage, or adoption.
new text end

deleted text begin (e) deleted text end new text begin (f) new text end The recipient or responsible party may choose to supervise the personal care
assistant or to have a qualified professional, as defined in section 256B.0625, subdivision
19c, provide the supervision. As required under section 256B.0625, subdivision 19c,
the county public health nurse, as a part of the assessment, will assist the recipient or
responsible party to identify the most appropriate person to provide supervision of the
personal care assistant. Health-related delegated tasks performed by the personal care
assistant will be under the supervision of a qualified professional or the direction of the
recipient's physician. If the recipient has a qualified professional, deleted text begin Minnesota Rules, part
9505.0335, subpart 4, deleted text end new text begin then subdivision 14 new text end applies.

deleted text begin (f) deleted text end new text begin (g) new text end In order to be paid for personal care assistant services, personal care provider
organizations, and personal care assistant choice providers are required:

(1) to maintain a recipient file for each recipient for whom services are being billed
that contains:

(i) the current physician's statement of need as required by section 256B.0625,
subdivision 19c;

(ii) the service plan, including the monthly authorized hours, or flexible use plan;

(iii) the care plan, signed by the recipient and the qualified professional, if required
or designated, detailing the personal care assistant services to be provided;

(iv) documentation, on a form approved by the commissioner and signed by the
personal care assistant, specifying the day, month, year, arrival, and departure times, with
AM and PM notation, for all services provided to the recipient. The form must include a
notice that it is a federal crime to provide false information on personal care service
billings for medical assistance payment; and

(v) all notices to the recipient regarding personal care service use exceeding
authorized hours; and

(2) to communicate, by telephone if available, and in writing, with the recipient or
the responsible party about the schedule for use of authorized hours and to notify the
recipient and the county public health nurse in advance and as soon as possible, on a form
approved by the commissioner, if the monthly number of hours authorized is likely to be
exceeded for the month.

deleted text begin (g) deleted text end new text begin (h) new text end The commissioner shall establish an ongoing audit process for potential
fraud and abuse for personal care assistant services. The audit process must include, at
a minimum, a requirement that the documentation of hours of care provided be on a
form approved by the commissioner and include the personal care assistant's signature
attesting that the hours shown on each bill were provided by the personal care assistant on
the dates and the times specified.

Sec. 18.

Minnesota Statutes 2006, section 256B.0655, is amended by adding a
subdivision to read:

new text begin Subd. 11. new text end

new text begin Personal care provider; eligibility. new text end

new text begin The department may contract
with an agency to provide personal care services to qualified recipients. To be eligible
to contract with the department as a personal care provider, an agency must meet the
criteria in clauses (1) to (7):
new text end

new text begin (1) possess the capacity to enter into a legally binding contract;
new text end

new text begin (2) possess demonstrated ability to fulfill the responsibilities in this subdivision
and subdivision 12;
new text end

new text begin (3) demonstrate the cost-effectiveness of its proposal for the provision of personal
care services;
new text end

new text begin (4) comply with Minnesota Rules, part 9505.0210;
new text end

new text begin (5) demonstrate a knowledge of, sensitivity to, and experience with the special
needs, including communication needs and independent living needs, of the condition of
the recipient;
new text end

new text begin (6) ensure that personal care services are provided in a manner consistent with the
recipient's ability to live independently;
new text end

new text begin (7) provide a quality assurance mechanism;
new text end

new text begin (8) demonstrate the financial ability to produce a cash flow sufficient to cover
operating expenses for 30 days;
new text end

new text begin (9) disclose fully the names of persons with an ownership or control interest of five
percent or more in the contracting agency;
new text end

new text begin (10) demonstrate an accounting or financial system that complies with generally
accepted accounting principles;
new text end

new text begin (11) demonstrate a system of personnel management; and
new text end

new text begin (12) if offering personal care services to a ventilator dependent recipient,
demonstrate the ability to train and to supervise the personal care assistant and the
recipient in ventilator operation and maintenance.
new text end

Sec. 19.

Minnesota Statutes 2006, section 256B.0655, is amended by adding a
subdivision to read:

new text begin Subd. 12. new text end

new text begin Personal care provider responsibilities. new text end

new text begin The personal care provider
shall:
new text end

new text begin (1) employ or contract with services staff to provide personal care services and to
train services staff as necessary;
new text end

new text begin (2) supervise the personal care services as provided in subdivision 2, paragraph (f);
new text end

new text begin (3) employ a personal care assistant that a qualified recipient brings to the personal
care provider as the recipient's choice of assistant and who meets the employment
qualifications of the provider, except that a personal care provider who must comply with
the requirements of a governmental personnel administration system is exempt from
this clause;
new text end

new text begin (4) bill the medical assistance program for a personal care service by the personal
care assistant and a visit by the qualified professional supervising the personal care
assistant;
new text end

new text begin (5) establish a grievance mechanism to resolve consumer complaints about personal
care services, including the personal care provider's decision whether to employ the
qualified recipient's choice of a personal care assistant;
new text end

new text begin (6) keep records as required in Minnesota Rules, parts 9505.2160 to 9505.2195;
new text end

new text begin (7) perform functions and provide services specified in the personal care provider's
contract;
new text end

new text begin (8) comply with applicable rules and statutes; and
new text end

new text begin (9) perform other functions as necessary to carry out the responsibilities in clauses
(1) to (9).
new text end

Sec. 20.

Minnesota Statutes 2006, section 256B.0655, is amended by adding a
subdivision to read:

new text begin Subd. 13. new text end

new text begin Personal care provider; employment prohibition. new text end

new text begin A personal care
provider shall not employ a person to provide personal care service for a qualified
recipient if the person:
new text end

new text begin (1) refuses to provide full disclosure of criminal history records as specified in
subdivision 1g, paragraph (b);
new text end

new text begin (2) has been convicted of a crime that directly relates to the occupation of providing
personal care services to a qualified recipient;
new text end

new text begin (3) has jeopardized the health or welfare of a vulnerable adult through physical
abuse, sexual abuse, or neglect as defined in section 626.557; or
new text end

new text begin (4) is misusing or is dependent on mood-altering chemicals, including alcohol, to
the extent that the personal care provider knows or has reason to believe that the use of
chemicals has a negative effect on the person's ability to provide personal care services
or the use of chemicals is apparent during the hours the person is providing personal
care services.
new text end

Sec. 21.

Minnesota Statutes 2006, section 256B.0655, is amended by adding a
subdivision to read:

new text begin Subd. 14. new text end

new text begin Supervision of personal care services. new text end

new text begin A personal care service to a
qualified recipient as described in subdivision 4 shall be under the supervision of a
qualified professional who shall have the following duties:
new text end

new text begin (1) ensure that the personal care assistant is capable of providing the required
personal care services through direct observation of the assistant's work or through
consultation with the qualified recipient;
new text end

new text begin (2) ensure that the personal care assistant is knowledgeable about the plan of
personal care services before the personal care assistant performs personal care services;
new text end

new text begin (3) ensure that the personal care assistant is knowledgeable about essential
observations of the recipient's health, and about any conditions that should be immediately
brought to the attention of either the qualified professional or the attending physician;
new text end

new text begin (4) evaluate the personal care services of a recipient through direct observation of
the personal care assistant's work or through consultation with the qualified recipient.
Evaluation shall be made:
new text end

new text begin (i) within 14 days after the placement of a personal care assistant with the qualified
recipient;
new text end

new text begin (ii) at least once every 30 days during the first 90 days after the qualified recipient
first receives personal care services according to the plan of personal care service; and
new text end

new text begin (iii) at least once every 120 days following the period of evaluations in item (ii). The
qualified professional shall record in writing the results of the evaluation and actions taken
to correct any deficiencies in the work of the personal care assistant;
new text end

new text begin (5) review, together with the recipient, and revise, as necessary, the plan of
personal care services at least once every 120 days after a plan of personal care services
is developed;
new text end

new text begin (6) ensure that the personal care assistant and recipient are knowledgeable about a
change in the plan of personal care services;
new text end

new text begin (7) ensure that records are kept, showing the services provided to the recipient
by the personal care assistant as described in subdivision 2, paragraph (f), and the time
spent providing the services;
new text end

new text begin (8) determine that a qualified recipient is still capable of directing the recipient's
own care or has a responsible party; and
new text end

new text begin (9) determine with a physician that a recipient is a qualified recipient.
new text end

Sec. 22.

Minnesota Statutes 2006, section 256B.0655, is amended by adding a
subdivision to read:

new text begin Subd. 15. new text end

new text begin Overutilization of personal care services. new text end

new text begin A personal care provider who
is found to be providing personal care services that are not medically necessary shall be
prohibited from participating in the medical assistance program. The determination of
whether excess services are provided shall be made by a screening team or according to
Minnesota Rules, parts 9505.2160 to 9505.2245. The termination of the personal care
provider shall be consistent with the contract between the provider and the department.
new text end

Sec. 23.

Minnesota Statutes 2006, 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 new text begin ,
including persons who need assessment in order to determine waiver or alternative care
program eligibility, new text end must be visited by a long-term care consultation team within ten
working days after the date on which an assessment was requested or recommended.
Assessments must be conducted according to paragraphs (b) to deleted text begin (g) deleted text end new text begin (i) new text end .

(b) The county may utilize a team of either the social worker or public health nurse,
or both, 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 long-term care consultation team must assess the health and social needs of
the person, using an assessment form provided by the commissioner.

(d) The team must conduct the assessment in a face-to-face interview with the
person being assessed and the person's legal representative, if applicable.

(e) The team must provide the person, or the person's legal representative, with
written recommendations for facility- or community-based services. The team must
document that the most cost-effective alternatives available were offered to the individual.
For purposes of this requirement, "cost-effective alternatives" means community services
and living arrangements that cost the same as or less than nursing facility care.

(f) If the person chooses to use community-based services, the team must provide
the person or the person's legal representative with a written community support plan,
regardless of whether the individual is eligible for Minnesota health care programs.
The person may request assistance in developing a community support plan without
participating in a complete assessment.

(g) new text begin The person has the right to make the final decision between nursing facility
placement and community placement after the screening team's recommendation, except
as provided in subdivision 4a, paragraph (c).
new text end

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

(1) the new text begin need for and new text end purpose of preadmission screening deleted text begin and assessment deleted text end new text begin if the person
selects nursing facility placement new text end ;

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

deleted text begin (2) deleted text end new text begin (3) new text end information about Minnesota health care programs;

deleted text begin (3) deleted text end new text begin (4) new text end the person's freedom to accept or reject the recommendations of the team;

deleted text begin (4) deleted text end new text begin (5) new text end the person's right to confidentiality under the Minnesota Government Data
Practices Act, chapter 13; and

new text begin (6) the long term care consultant's decision regarding the person's need for nursing
facility level of care;
new text end

deleted text begin (5) deleted text end new text begin (7) new text end 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.

new text begin (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.
new text end

Sec. 24.

Minnesota Statutes 2006, section 256B.0911, subdivision 4b, is amended to
read:

Subd. 4b.

Exemptions and emergency admissions.

(a) Exemptions from the
federal screening requirements outlined in subdivision 4a, paragraphs (b) and (c), are
limited to:

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

(2) a person transferring from one certified nursing facility in Minnesota to another
certified nursing facility in Minnesota; and

(3) a person, 21 years of age or older, who satisfies the following criteria, as specified
in Code of Federal Regulations, title 42, section 483.106(b)(2):

(i) the person is admitted to a nursing facility directly from a hospital after receiving
acute inpatient care at the hospital;

(ii) the person requires nursing facility services for the same condition for which
care was provided in the hospital; and

(iii) the attending physician has certified before the nursing facility admission that
the person is likely to receive less than 30 days of nursing facility services.

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

(1) persons described in paragraph (a);

(2) an individual who has a contractual right to have nursing facility care paid for
indefinitely by the veterans' administration;

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

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

deleted text begin (5) individuals admitted to a certified nursing facility for a short-term stay, which
is expected to be 14 days or less in duration based upon a physician's certification, and
who have been assessed and approved for nursing facility admission within the previous
six months. This exemption applies only if the consultation team member determines at
the time of the initial assessment of the six-month period that it is appropriate to use the
nursing facility for short-term stays and that there is an adequate plan of care for return to
the home or community-based setting. If a stay exceeds 14 days, the individual must be
referred no later than the first county working day following the 14th resident day for a
screening, which must be completed within five working days of the referral. The payment
limitations in subdivision 7 apply to an individual found at screening to not meet the level
of care criteria for admission to a certified nursing facility.
deleted text end

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

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

(1) a person is admitted from the community to a certified nursing or certified
boarding care facility during county nonworking hours;

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

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

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

(5) the county is contacted on the first working day following the emergency
admission.

Transfer of a patient from an acute care hospital to a nursing facility is not considered
an emergency except for a person who has received hospital services in the following
situations: hospital admission for observation, care in an emergency room without hospital
admission, or following hospital 24-hour bed care.

(e) A nursing facility must provide deleted text begin a deleted text end written deleted text begin notice to persons who satisfy the criteria
in paragraph (a), clause (3), deleted text end new text begin information to all persons admitted new text end regarding the person's
right to request and receive long-term care consultation services as defined in subdivision
1a. The deleted text begin notice deleted text end new text begin information new text end must be provided prior to the person's discharge from the
facility and in a format specified by the commissioner.

Sec. 25.

Minnesota Statutes 2006, section 256B.0911, subdivision 6, is amended to
read:

Subd. 6.

Payment for long-term care consultation services.

(a) The total payment
for each county must be paid monthly by certified nursing facilities in the county. The
monthly amount to be paid by each nursing facility for each fiscal year must be determined
by dividing the county's annual allocation for long-term care consultation services by 12
to determine the monthly payment and allocating the monthly payment to each nursing
facility based on the number of licensed beds in the nursing facility. Payments to counties
in which there is no certified nursing facility must be made by increasing the payment
rate of the two facilities located nearest to the county seat.

(b) The commissioner shall include the total annual payment determined under
paragraph (a) for each nursing facility reimbursed under section 256B.431 or 256B.434
according to section 256B.431, subdivision 2b, paragraph (g) deleted text begin , or 256B.435 deleted text end .

(c) In the event of the layaway, delicensure and decertification, or removal from
layaway of 25 percent or more of the beds in a facility, the commissioner may adjust
the per diem payment amount in paragraph (b) and may adjust the monthly payment
amount in paragraph (a). The effective date of an adjustment made under this paragraph
shall be on or after the first day of the month following the effective date of the layaway,
delicensure and decertification, or removal from layaway.

(d) Payments for long-term care consultation services are available to the county
or counties to cover staff salaries and expenses to provide the services described in
subdivision 1a. The county shall employ, or contract with other agencies to employ, within
the limits of available funding, sufficient personnel to provide long-term care consultation
services while meeting the state's long-term care outcomes and objectives as defined in
section 256B.0917, subdivision 1. The county shall be accountable for meeting local
objectives as approved by the commissioner in the biennial home and community-based
services quality assurance plan on a form provided by the commissioner.

(e) Notwithstanding section 256B.0641, overpayments attributable to payment of the
screening costs under the medical assistance program may not be recovered from a facility.

(f) The commissioner of human services shall amend the Minnesota medical
assistance plan to include reimbursement for the local consultation teams.

(g) The county may bill, as case management services, assessments, support
planning, and follow-along provided to persons determined to be eligible for case
management under Minnesota health care programs. No individual or family member
shall be charged for an initial assessment or initial support plan development provided
under subdivision 3a or 3b.

Sec. 26.

Minnesota Statutes 2006, section 256B.0911, is amended by adding a
subdivision to read:

new text begin Subd. 6a. new text end

new text begin Withholding. new text end

new text begin If any provider obligated to pay the long-term care
consultation amount as described in subdivision 6 is more than two months delinquent in
the timely payment of the monthly installment, the commissioner may withhold payments,
penalties, and interest in accordance with the methods outlined in section 256.9657,
subdivision 7a. Any amount withheld under this provision must be returned to the county
to whom the delinquent payments were due.
new text end

Sec. 27.

Minnesota Statutes 2006, section 256B.0911, subdivision 7, is amended to
read:

Subd. 7.

Reimbursement for certified nursing facilities.

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

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

deleted text begin (c) The commissioner shall make a request to the Centers for Medicare and Medicaid
Services for a waiver allowing team approval of Medicaid payments for certified nursing
facility care. An individual has a choice and makes the final decision between nursing
facility placement and community placement after the screening team's recommendation,
except as provided in subdivision 4a, paragraph (c).
deleted text end

Sec. 28.

Minnesota Statutes 2006, section 256B.0913, subdivision 4, is amended to
read:

Subd. 4.

Eligibility for funding for services for nonmedical assistance recipients.

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

(1) the person has been determined by a community assessment under section
256B.0911 to be a person who would require the level of care provided in a nursing
facility, but for the provision of services under the alternative care program;

(2) the person is age 65 or older;

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

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

(5) the person needs services that are not funded through other state or federal
funding;

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

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

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

(i) the appointment of a representative payee;

(ii) automatic payment from a financial account;

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

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

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

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

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

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

Sec. 29.

Minnesota Statutes 2006, section 256B.0913, subdivision 5a, is amended to
read:

Subd. 5a.

Services; service definitions; service standards.

(a) Unless specified in
statute, the services, service definitions, and standards for alternative care services shall
be the same as the services, service definitions, and standards specified in the federally
approved elderly waiver plan, except deleted text begin for deleted text end new text begin alternative care does not cover new text end transitional
support services, assisted living services, adult foster care services, and residential care
deleted text begin services deleted text end new text begin and benefits defined under section 256B.0625 that meet primary and acute
health care needs new text end .

(b) The county agency must ensure that the funds are not used to supplant new text begin or
supplement new text end services available through other public assistance or services programs deleted text begin . deleted text end new text begin ,
including supplementation of client co-pays, deductibles, premiums, or other cost-sharing
arrangements for health-related benefits and services or entitlement programs and services
that are available to the person, but in which they have elected not to enroll. new text end For a provider
of supplies and equipment when the monthly cost of the supplies and equipment is less
than $250, persons or agencies must be employed by or under a contract with the county
agency or the public health nursing agency of the local board of health in order to receive
funding under the alternative care program. Supplies and equipment may be purchased
from a vendor not certified to participate in the Medicaid program if the cost for the
item is less than that of a Medicaid vendor.

(c) Personal care services must meet the service standards defined in the federally
approved elderly waiver plan, except that a county agency may contract with a client's
relative who meets the relative hardship waiver requirements or a relative who meets the
criteria and is also the responsible party under an individual service plan that ensures the
client's health and safety and supervision of the personal care services by a qualified
professional as defined in section 256B.0625, subdivision 19c. Relative hardship is
established by the county when the client's care causes a relative caregiver to do any of the
following: resign from a paying job, reduce work hours resulting in lost wages, obtain a
leave of absence resulting in lost wages, incur substantial client-related expenses, provide
services to address authorized, unstaffed direct care time, or meet special needs of the
client unmet in the formal service plan.

Sec. 30.

Minnesota Statutes 2006, section 256B.0915, is amended to read:

256B.0915 MEDICAID WAIVER FOR ELDERLY SERVICES.

Subdivision 1.

Authority.

The commissioner is authorized to apply for a home
and community-based services waiver for the elderly, authorized under section 1915(c)
of the Social Security Act, in order to obtain federal financial participation to expand
the availability of services for persons who are eligible for medical assistance. The
commissioner may apply for additional waivers or pursue other federal financial
participation which is advantageous to the state for funding home care services for the
frail elderly who are eligible for medical assistance. The provision of waivered services
to elderly and disabled medical assistance recipients must comply with the criteria new text begin for
service definitions and provider standards new text end approved in the waiver.

Subd. 1a.

Elderly waiver case management services.

(a) Elderly case management
services under the home and community-based services waiver for elderly individuals are
available from providers meeting qualification requirements and the standards specified
in subdivision 1b. Eligible recipients may choose any qualified provider of elderly case
management services.

new text begin Case management services assist individuals who receive waiver services in gaining
access to needed waiver and other state plan services, as well as needed medical, social,
educational, and other services regardless of the funding source for the services to which
access is gained.
new text end

new text begin A case aide shall provide assistance to the case manager in carrying out
administrative activities of the case management function. The case aide may not assume
responsibilities that require professional judgment including assessments, reassessments,
and care plan development. The case manager is responsible for providing oversight of
the case aide.
new text end

new text begin Case managers shall be responsible for ongoing monitoring of the provision of
services included in the individual's plan of care. Case managers shall initiate and oversee
the process of assessment and reassessment of the individual's care and review plan of
care at intervals specified in the federally approved waiver plan.
new text end

(b) The county of service or tribe must provide access to and arrange for case
management services. new text begin County of service has the meaning given it in Minnesota Rules,
part 9505.0015, subpart 11.
new text end

Subd. 1b.

Provider qualifications and standards.

The commissioner must
enroll qualified providers of elderly case management services under the home
and community-based waiver for the elderly under section 1915(c) of the Social
Security Act. The enrollment process shall ensure the provider's ability to meet the
qualification requirements and standards in this subdivision and other federal and state
requirements of this service. An elderly case management provider is an enrolled medical
assistance provider who is determined by the commissioner to have all of the following
characteristics:

(1) the demonstrated capacity and experience to provide the components of
case management to coordinate and link community resources needed by the eligible
population;

(2) administrative capacity and experience in serving the target population for
whom it will provide services and in ensuring quality of services under state and federal
requirements;

(3) a financial management system that provides accurate documentation of services
and costs under state and federal requirements;

(4) the capacity to document and maintain individual case records under state and
federal requirements; and

(5) the deleted text begin county deleted text end new text begin lead agency new text end may allow a case manager employed by the deleted text begin county deleted text end new text begin lead
agency new text end to delegate certain aspects of the case management activity to another individual
employed by the deleted text begin county deleted text end new text begin lead agency new text end provided there is oversight of the individual by
the case manager. The case manager may not delegate those aspects which require
professional judgment including assessments, reassessments, and care plan development. new text begin
Lead agencies include counties, health plans, and federally recognized tribes who
authorize services under this section.
new text end

deleted text begin Subd. 1c. deleted text end

deleted text begin Case management activities under the state plan. deleted text end

deleted text begin The commissioner
shall seek an amendment to the home and community-based services waiver for the
elderly to implement the provisions of subdivisions 1a and 1b. If the commissioner
is unable to secure the approval of the secretary of health and human services for the
requested waiver amendment by December 31, 1993, the commissioner shall amend
the medical assistance state plan to provide that case management provided under the
home and community-based services waiver for the elderly is performed by counties
as an administrative function for the proper and effective administration of the state
medical assistance plan. The state shall reimburse counties for the nonfederal share of
costs for case management performed as an administrative function under the home and
community-based services waiver for the elderly.
deleted text end

Subd. 1d.

Posteligibility treatment of income and resources for elderly waiver.

Notwithstanding the provisions of section 256B.056, the commissioner shall make the
following amendment to the medical assistance elderly waiver program effective July 1,
1999, or upon federal approval, whichever is later.

A recipient's maintenance needs will be an amount equal to the Minnesota
supplemental aid equivalent rate as defined in section 256I.03, subdivision 5, plus the
medical assistance personal needs allowance as defined in section 256B.35, subdivision
1, paragraph (a), when applying posteligibility treatment of income rules to the gross
income of elderly waiver recipients, except for individuals whose income is in excess of
the special income standard according to Code of Federal Regulations, title 42, section
435.236. Recipient maintenance needs shall be adjusted under this provision each July 1.

Subd. 2.

Spousal impoverishment policies.

The commissioner shall deleted text begin seek to amend
the federal waiver and the medical assistance state plan to allow deleted text end new text begin apply:
new text end

new text begin (1) the new text end spousal impoverishment criteria as authorized under United States Code, title
42, section 1396r-5, and as implemented in sections 256B.0575, 256B.058, and 256B.059 deleted text begin ,
except that the amendment shall seek to add to deleted text end new text begin ;
new text end

new text begin (2) new text end the personal needs allowance permitted in section 256B.0575 deleted text begin , deleted text end new text begin ; and new text end

new text begin (3) new text end an amount equivalent to the group residential housing rate as set by section
256I.03, subdivision 5 new text begin , and according to the approved federal waiver and medical
assistance state plan new text end .

Subd. 3.

Limits of cases.

The number of medical assistance waiver recipients that
a deleted text begin county deleted text end new text begin lead agency new text end may serve must be allocated according to the number of medical
assistance waiver cases open on July 1 of each fiscal year. Additional recipients may be
served with the approval of the commissioner.

Subd. 3a.

Elderly waiver cost limits.

(a) The monthly limit for the cost of waivered
services to an individual elderly waiver client shall be the weighted average monthly
nursing facility rate of the case mix resident class to which the elderly waiver client would
be assigned under Minnesota Rules, parts 9549.0050 to 9549.0059, less the recipient's
maintenance needs allowance as described in subdivision 1d, paragraph (a), until the first
day of the state fiscal year in which the resident assessment system as described in section
256B.437 for nursing home rate determination is implemented. Effective on the first day
of the state fiscal year in which the resident assessment system as described in section
256B.437 for nursing home rate determination is implemented and the first day of each
subsequent state fiscal year, the monthly limit for the cost of waivered services to an
individual elderly waiver client shall be the rate of the case mix resident class to which the
waiver client would be assigned under Minnesota Rules, parts 9549.0050 to 9549.0059,
in effect on the last day of the previous state fiscal year, adjusted by the greater of any
legislatively adopted home and community-based services percentage rate increase or the
average statewide percentage increase in nursing facility payment rates.

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

Subd. 3b.

Cost limits for elderly waiver applicants who reside in a nursing
facility.

(a) For a person who is a nursing facility resident at the time of requesting a
determination of eligibility for elderly waivered services, a monthly conversion limit for
the cost of elderly waivered services may be requested. The monthly conversion limit for
the cost of elderly waiver services shall be the resident class assigned under Minnesota
Rules, parts 9549.0050 to 9549.0059, for that resident in the nursing facility where
the resident currently resides until July 1 of the state fiscal year in which the resident
assessment system as described in section 256B.437 for nursing home rate determination
is implemented. Effective on July 1 of the state fiscal year in which the resident
assessment system as described in section 256B.437 for nursing home rate determination
is implemented, the monthly conversion limit for the cost of elderly waiver services
shall be the per diem nursing facility rate as determined by the resident assessment
system as described in section 256B.437 for that resident in the nursing facility where
the resident currently resides multiplied by 365 and divided by 12, less the recipient's
maintenance needs allowance as described in subdivision 1d. The initially approved
conversion rate may be adjusted by the greater of any subsequent legislatively adopted
home and community-based services percentage rate increase or the average statewide
percentage increase in nursing facility payment rates. The limit under this subdivision
only applies to persons discharged from a nursing facility after a minimum 30-day stay
and found eligible for waivered services on or after July 1, 1997. new text begin For conversions from the
nursing home to the elderly waiver with consumer directed community support services,
the conversion rate limit is equal to the nursing facility rate reduced by a percentage equal
to the percentage difference between the consumer directed services budget limit that
would be assigned according to the federally approved waiver plan and the corresponding
community case mix cap, but not to exceed 50 percent.
new text end

(b) The following costs must be included in determining the total monthly costs
for the waiver client:

(1) cost of all waivered services, including extended medical supplies and equipment
and environmental modifications new text begin and adaptations new text end ; and

(2) cost of skilled nursing, home health aide, and personal care services reimbursable
by medical assistance.

Subd. 3c.

Service approval and contracting provisions.

(a) Medical assistance
funding for skilled nursing services, private duty nursing, home health aide, and personal
care services for waiver recipients must be approved by the case manager and included in
the individual care plan.

(b) A deleted text begin county deleted text end new text begin lead agency new text end is not required to contract with a provider of supplies and
equipment if the monthly cost of the supplies and equipment is less than $250.

Subd. 3d.

Adult foster care rate.

The adult foster care rate shall be considered
a difficulty of care payment and shall not include room and board. The adult foster
care service rate shall be negotiated between the deleted text begin county deleted text end new text begin lead new text end agency and the foster care
provider. The elderly waiver payment for the foster care service in combination with
the payment for all other elderly waiver services, including case management, must not
exceed the limit specified in subdivision 3a, paragraph (a).

Subd. 3e.

deleted text begin Assisted living deleted text end new text begin Customized living new text end service rate.

(a) Payment for deleted text begin assisted
living service deleted text end new text begin customize living services new text end shall be a monthly rate negotiated and authorized
by the deleted text begin county agency based on an individualized service plan for each resident and may
not cover direct rent or food costs. deleted text end new text begin lead agency within the parameters established by
the commissioner. The payment agreement must delineate the services that have been
customized for each recipient and specify the amount of each service to be provided. The
lead agency shall ensure that there is a documented need for all services authorized.
Customized living services must not include rent or raw food costs. The negotiated
payment rate must be based on services to be provided. Negotiated rates must not exceed
payment rates for comparable elderly waiver or medical assistance services and must
reflect economies of scale.
new text end

(b) The individualized monthly negotiated payment for deleted text begin assisted living deleted text end new text begin customized
living new text end services deleted text begin as described in section 256B.0913, subdivisions 5d to 5f, and residential
care services as described in section 256B.0913, subdivision 5c, deleted text end shall not exceed the
nonfederal share, in effect on July 1 of the state fiscal year for which the rate limit
is being calculated, of the greater of either the statewide or any of the geographic
groups' weighted average monthly nursing facility rate of the case mix resident class
to which the elderly waiver eligible client would be assigned under Minnesota Rules,
parts 9549.0050 to 9549.0059, less the maintenance needs allowance as described in
subdivision 1d, paragraph (a), until the July 1 of the state fiscal year in which the resident
assessment system as described in section 256B.437 for nursing home rate determination
is implemented. Effective on July 1 of the state fiscal year in which the resident
assessment system as described in section 256B.437 for nursing home rate determination
is implemented and July 1 of each subsequent state fiscal year, the individualized monthly
negotiated payment for the services described in this clause shall not exceed the limit
described in this clause which was in effect on June 30 of the previous state fiscal year
and which has been adjusted by the greater of any legislatively adopted home and
community-based services cost-of-living percentage increase or any legislatively adopted
statewide percent rate increase for nursing facilities.

(c) deleted text begin The individualized monthly negotiated payment for assisted deleted text end new text begin Customized new text end living
services deleted text begin described in section 144A.4605 and deleted text end new text begin are new text end delivered by a provider licensed by the
Department of Health as a class A new text begin or class F new text end home care provider deleted text begin or an assisted living
home care provider deleted text end and provided in a building that is registered as a housing with services
establishment under chapter 144D deleted text begin and that provides 24-hour supervision in combination
with the payment for other elderly waiver services, including case management, must not
exceed the limit specified in subdivision 3a deleted text end .

Subd. 3f.

Individual service rates; expenditure forecasts.

(a) The deleted text begin county deleted text end new text begin lead
agency new text end shall negotiate individual service rates with vendors and may authorize payment
for actual costs up to the deleted text begin county's deleted text end new text begin lead agency's new text end current approved rate. Persons or agencies
must be employed by or under a contract with the deleted text begin county deleted text end new text begin lead new text end agency or the public health
nursing agency of the local board of health in order to receive funding under the elderly
waiver program, except as a provider of supplies and equipment when the monthly cost of
the supplies and equipment is less than $250.

(b) Reimbursement for the medical assistance recipients under the approved waiver
shall be made from the medical assistance account through the invoice processing
procedures of the department's Medicaid Management Information System (MMIS),
only with the approval of the client's case manager. The budget for the state share of the
Medicaid expenditures shall be forecasted with the medical assistance budget, and shall
be consistent with the approved waiver.

Subd. 3g.

Service rate limits; state assumption of costs.

(a) To improve access
to community services and eliminate payment disparities between the alternative care
program and the elderly waiver, the commissioner shall establish statewide maximum
service rate limits and eliminate deleted text begin county-specific deleted text end new text begin lead agency-specific new text end service rate limits.

(b) Effective July 1, 2001, for service rate limits, except those described or defined in
subdivisions 3d and 3e, the rate limit for each service shall be the greater of the alternative
care statewide maximum rate or the elderly waiver statewide maximum rate.

(c) deleted text begin Counties deleted text end new text begin Lead agencies new text end may negotiate individual service rates with vendors for
actual costs up to the statewide maximum service rate limit.

Subd. 4.

Termination notice.

The case manager must give the individual a ten-day
written notice of any denial, reduction, or termination of waivered services.

Subd. 5.

Assessments and reassessments for waiver clients.

Each client shall
receive an initial assessment of strengths, informal supports, and need for services in
accordance with section 256B.0911, subdivisions 3, 3a, and 3b. A reassessment of a
client served under the elderly waiver must be conducted at least every 12 months and
at other times when the case manager determines that there has been significant change
in the client's functioning. This may include instances where the client is discharged
from the hospital.

Subd. 6.

Implementation of care plan.

Each elderly waiver client shall be provided
a copy of a written care plan that meets the requirements outlined in section 256B.0913,
subdivision 8. The care plan must be implemented by the county deleted text begin administering waivered
services deleted text end new text begin of service new text end when it is different than the county of financial responsibility. The
county new text begin of service new text end administering waivered services must notify the county of financial
responsibility of the approved care plan.

Subd. 7.

Prepaid elderly waiver services.

An individual for whom a prepaid health
plan is liable for nursing home services or elderly waiver services according to section
256B.69, subdivision 6a, is not eligible to new text begin also new text end receive county-administered elderly waiver
services deleted text begin under this section deleted text end .

Subd. 8.

Services and supports.

(a) Services and supports shall meet the
requirements set out in United States Code, title 42, section 1396n.

(b) Services and supports shall promote consumer choice and be arranged and
provided consistent with individualized, written care plans.

(c) The state of Minnesota, county, new text begin managed care organization, new text end or tribal government
under contract to administer the elderly waiver shall not be liable for damages, injuries,
or liabilities sustained through the purchase of direct supports or goods by the person,
the person's family, or the authorized representatives with funds received through
consumer-directed community support services under the federally approved waiver plan.
Liabilities include, but are not limited to, workers' compensation liability, the Federal
Insurance Contributions Act (FICA), or the Federal Unemployment Tax Act (FUTA).

Subd. 9.

Tribal management of elderly waiver.

Notwithstanding contrary
provisions of this section, or those in other state laws or rules, the commissioner may
develop a model for tribal management of the elderly waiver program and implement this
model through a contract between the state and any of the state's federally recognized tribal
governments. The model shall include the provision of tribal waiver case management,
assessment for personal care assistance, and administrative requirements otherwise carried
out by deleted text begin counties deleted text end new text begin lead agencies new text end but shall not include tribal financial eligibility determination
for medical assistance.

Sec. 31.

Minnesota Statutes 2006, section 256B.27, subdivision 2a, is amended to read:

Subd. 2a.

On-site audits.

deleted text begin Each year deleted text end The commissioner shall provide for deleted text begin the on-site deleted text end
new text begin an new text end audit of the cost deleted text begin reports deleted text end new text begin and statistical data new text end of nursing deleted text begin homes deleted text end new text begin facilities new text end participating
as vendors of medical assistance. The commissioner shall select for audit at least 15
percent of these nursing deleted text begin homes deleted text end new text begin facilities new text end at random or using factors including, but not
limited to: change in ownership; frequent changes in administration in excess of normal
turnover rates; complaints to the commissioner of health about care, safety, or rights;
where previous inspections or reinspections under section 144A.10 have resulted in
correction orders related to care, safety, or rights; or where persons involved in ownership
or administration of the facility have been indicted for alleged criminal activity.

new text begin The commissioner shall meet the 15 percent requirement by either conducting an
audit focused on an individual nursing facility, a group of facilities, or targeting specific
data categories in multiple nursing facilities. These audits may be conducted on-site
at the nursing facility, at office space used by a nursing facility or a nursing facility's
parent organization, or at the commissioner's office. Data being audited may be collected
electronically, in person, or by any other means the commissioner finds acceptable.
new text end

Sec. 32.

Minnesota Statutes 2006, section 256B.49, subdivision 13, is amended to read:

Subd. 13.

Case management.

(a) Each recipient of a home and community-based
waiver shall be provided case management services by qualified vendors as described
in the federally approved waiver application. The case management service activities
provided will include:

(1) assessing the needs of the individual deleted text begin within 20 working days of a recipient's
request deleted text end ;

(2) developing the written individual service plan within ten working days after the
assessment is completed;

(3) informing the recipient or the recipient's legal guardian or conservator of service
options;

(4) assisting the recipient in the identification of potential service providers;

(5) assisting the recipient to access services;

(6) coordinating, evaluating, and monitoring of the services identified in the service
plan;

(7) completing the annual reviews of the service plan; and

(8) informing the recipient or legal representative of the right to have assessments
completed and service plans developed within specified time periods, and to appeal county
action or inaction under section 256.045, subdivision 3.

(b) The case manager may delegate certain aspects of the case management service
activities to another individual provided there is oversight by the case manager. The case
manager may not delegate those aspects which require professional judgment including
assessments, reassessments, and care plan development.

Sec. 33.

Minnesota Statutes 2006, section 256B.49, subdivision 14, is amended to read:

Subd. 14.

Assessment and reassessment.

(a) Assessments of each recipient's
strengths, informal support systems, and need for services shall be completed deleted text begin within
20 working days of the recipient's request deleted text end . Reassessment of each recipient's strengths,
support systems, and need for services shall be conducted at least every 12 months and at
other times when there has been a significant change in the recipient's functioning.

(b) Persons with developmental disabilities who apply for services under the nursing
facility level waiver programs shall be screened for the appropriate level of care according
to section 256B.092.

(c) Recipients who are found eligible for home and community-based services under
this section before their 65th birthday may remain eligible for these services after their
65th birthday if they continue to meet all other eligibility factors.

Sec. 34. new text begin REPEALER.
new text end

new text begin (a) Minnesota Statutes 2006, section 256.9743, new text end new text begin is repealed.
new text end

new text begin (b) Minnesota Rules, part 9505.0335, new text end new text begin is repealed.
new text end