SF 2505

as introduced - 88th Legislature (2013 - 2014) Posted on 03/11/2014 09:53am

A bill for an act
relating to human services; modifying provisions governing community first
services and supports; amending Minnesota Statutes 2013 Supplement, section
256B.85, subdivisions 1, 2, 7.

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

Section 1.

Minnesota Statutes 2013 Supplement, section 256B.85, subdivision 1, is
amended to read:

Subdivision 1.

Basis and scope.

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

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

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

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

Sec. 2.

Minnesota Statutes 2013 Supplement, section 256B.85, subdivision 2, is
amended to read:

Subd. 2.

Definitions.

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

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

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

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

(1) Level I behavior;

(2) increased vulnerability due to cognitive deficits or socially inappropriate
behavior; or

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

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

(1) tube feedings requiring:

(i) a gastrojejunostomy tube; or

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

(2) wounds described as:

(i) stage III or stage IV;

(ii) multiple wounds;

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

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

(3) parenteral therapy described as:

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

(ii) total parenteral nutrition (TPN) daily;

(4) respiratory interventions, including:

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

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

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

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

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

(vi) ventilator dependence under section 256B.0652;

(5) insertion and maintenance of catheter, including:

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

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

(iii) bladder irrigations;

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

(7) neurological intervention, including:

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

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

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

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

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

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

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

(j) "Extended CFSS" means CFSS services and supports under the agency-provider
model included in a service plan through one of the home and community-based services
waivers authorized under sections 256B.0915; 256B.092, subdivision 5; and 256B.49,
which exceed the amount, duration, and frequency of the state plan CFSS services for
participants.

(k) "Financial management services contractor or vendor" means a qualified
organization having a written contract with the department to provide services necessary to
use the budget model under subdivision 13 that include but are not limited to: participant
education and technical assistance; CFSS service delivery planning and budgeting; billing,
making payments, and monitoring of spending; and assisting the participant in fulfilling
employer-related requirements in accordance with Section 3504 of the Internal Revenue
Code and the Internal Revenue Service Revenue Procedure 70-6.

(l) "Budget model" means a service delivery method of CFSS that allows the use of
an individualized CFSS service delivery plan and service budget and provides assistance
from the financial management services contractor to facilitate participant employment of
support workers and the acquisition of supports and goods.

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

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

(o) "Legal representative" means parent of a minor, a court-appointed guardian, or
another representative with legal authority to make decisions about services and supports
for the participant. Other representatives with legal authority to make decisions include
but are not limited to a health care agent or an attorney-in-fact authorized through a health
care directive or power of attorney.

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

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

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

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

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

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

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

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

(r) "Person-centered planning process" means a process that is directed by the
participant to plan for services and supports. The person-centered planning process must:

(1) include people chosen by the participant;

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

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

(4) reflect cultural considerations of the participant;

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

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

(7) include a method for the participant to request updates to the plan; and

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

(s) "Shared services" means the provision of CFSS services by the same CFSS
support worker to two or three participants who voluntarily enter into an agreement to
receive services at the same time and in the same setting by the same provider.

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

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

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

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

(u) "Support worker" means an employee of the agency provider or of the participant
who has direct contact with the participant and provides services as specified within the
participant's service delivery plan.

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

Sec. 3.

Minnesota Statutes 2013 Supplement, section 256B.85, subdivision 7, is
amended to read:

Subd. 7.

Community first services and supports; covered services.

Within the
service unit authorization or budget allocation, services and supports covered under
CFSS include:

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

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

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

(i) relate to a need identified in a participant's CFSS service delivery plan;

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

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

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

(ii) increased vulnerability due to cognitive deficits or socially inappropriate
behavior; or

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

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

(6) transition costs, including:

(i) deposits for rent and utilities;

(ii) first month's rent and utilities;

(iii) bedding;

(iv) basic kitchen supplies;

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

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

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