SF 2515

as introduced - 90th Legislature (2017 - 2018) Posted on 02/21/2018 09:02am

A bill for an act
relating to human services; modifying requirements and timelines for completing
community support plans and coordinated service and support plans; amending
Minnesota Statutes 2016, sections 256B.0915, subdivision 6; 256B.092, subdivision
1b; Minnesota Statutes 2017 Supplement, sections 256B.0911, subdivisions 1a,
3a, 3f; 256B.49, subdivision 13.

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

Section 1.

Minnesota Statutes 2017 Supplement, section 256B.0911, subdivision 1a, is
amended to read:

Subd. 1a.

Definitions.

For purposes of this section, the following definitions apply:

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

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

(2) providing recommendations for and referrals to cost-effective community services
that are available to the individual;

(3) development of an individual's person-centered community support plan;

(4) providing information regarding eligibility for Minnesota health care programs;

(5) face-to-face long-term care consultation assessments, which may be completed in a
hospital, nursing facility, intermediate care facility for persons with developmental disabilities
(ICF/DDs), regional treatment centers, or the person's current or planned residence;

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

(7) providing recommendations for institutional placement when there are no
cost-effective community services available;

(8) providing access to assistance to transition people back to community settings after
institutional admission; and

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

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

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

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

(ii) consumer support grants under section 256.476; or

(iii) section 256B.85;

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

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

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

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

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

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

(f) "Person-centered planning" is a process that includes the active participation of a
person in the planning of the person's services, including in making meaningful and informed
choices about the person's own goals, talents, and objectives, as well as making meaningful
and informed choices about the services the person receives. For the purposes of this section,
"informed choice" means a voluntary choice of services by a person from all available
service options based on accurate and complete information concerning all available service
options and concerning the person's own preferences, abilities, goals, and objectives. In
order for a person to make an informed choice, all available options must be developed and
presented to the person to empower the person to make decisions.

Sec. 2.

Minnesota Statutes 2017 Supplement, section 256B.0911, subdivision 3a, is
amended to read:

Subd. 3a.

Assessment and support planning.

(a) Persons requesting assessment, services
planning, or other assistance intended to support community-based living, including persons
who need assessment in order to determine waiver or alternative care program eligibility,
must be visited by a long-term care consultation team within 20 calendar days after the date
on which an assessment was requested or recommended. Upon statewide implementation
of subdivisions 2b, 2c, and 5, this requirement also applies to an assessment of a person
requesting personal care assistance services and home care nursing. The commissioner shall
provide at least a 90-day notice to lead agencies prior to the effective date of this requirement.
Face-to-face assessments must be conducted according to paragraphs (b) to (i).

(b) Upon implementation of subdivisions 2b, 2c, and 5, lead agencies shall use certified
assessors to conduct the assessment. For a person with complex health care needs, a public
health or registered nurse from the team must be consulted.

(c) The MnCHOICES assessment provided by the commissioner to lead agencies must
be used to complete a comprehensive, person-centered assessment. The assessment must
include the health, psychological, functional, environmental, and social needs of the
individual necessary to develop a community support plan that meets the individual's needs
and preferences.

(d) The assessment must be conducted in a face-to-face interview with the person being
assessed deleted text begin and deleted text end new text begin . new text end The person's legal representative new text begin must provide input during the assessment
process and may do so remotely if requested new text end . At the request of the person, other individuals
may participate in the assessment to provide information on the needs, strengths, and
preferences of the person necessary to develop a community support plan that ensures the
person's health and safety. Except for legal representatives or family members invited by
the person, persons participating in the assessment may not be a provider of service or have
any financial interest in the provision of services. For persons who are to be assessed for
elderly waiver customized living or adult day services under section 256B.0915, with the
permission of the person being assessed or the person's designated or legal representative,
the client's current or proposed provider of services may submit a copy of the provider's
nursing assessment or written report outlining its recommendations regarding the client's
care needs. The person conducting the assessment must notify the provider of the date by
which this information is to be submitted. This information shall be provided to the person
conducting the assessment prior to the assessment. For a person who is to be assessed for
waiver services under section 256B.092 or 256B.49, with the permission of the person being
assessed or the person's designated legal representative, the person's current provider of
services may submit a written report outlining recommendations regarding the person's care
needs prepared by a direct service employee with at least 20 hours of service to that client.
The person conducting the assessment or reassessment must notify the provider of the date
by which this information is to be submitted. This information shall be provided to the
person conducting the assessment and the person or the person's legal representative, and
must be considered prior to the finalization of the assessment or reassessment.

(e) The person or the person's legal representative must be provided with a written
community support plan within deleted text begin 40 calendar days of the assessment visit deleted text end new text begin the timelines
established by the commissioner new text end , regardless of whether the individual is eligible for
Minnesota health care programs. new text begin The timeline for completing the community support plan
and any required coordinated service and support plan must not exceed 56 calendar days
from the assessment visit.
new text end

(f) For a person being assessed for elderly waiver services under section 256B.0915, a
provider who submitted information under paragraph (d) shall receive the final written
community support plan when available and the Residential Services Workbook.

(g) The written community support plan must include:

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

(2) the individual's options and choices to meet identified needs, including all available
options for case management services and providers, including service provided in a
non-disability-specific setting;

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

(4) referral information; and

(5) informal caregiver supports, if applicable.

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

(h) A person may request assistance in identifying community supports without
participating in a complete assessment. Upon a request for assistance identifying community
support, the person must be transferred or referred to long-term care options counseling
services available under sections 256.975, subdivision 7, and 256.01, subdivision 24, for
telephone assistance and follow up.

(i) The person has the right to make the final decision between institutional placement
and community placement after the recommendations have been provided, except as provided
in section 256.975, subdivision 7a, paragraph (d).

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

(1) written recommendations for community-based services and consumer-directed
options;

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

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

(4) the role of long-term care consultation assessment and support planning in eligibility
determination for waiver and alternative care programs, and state plan home care, case
management, and other services as defined in subdivision 1a, paragraphs (a), clause (6),
and (b);

(5) information about Minnesota health care programs;

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

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

(8) the certified assessor's decision regarding the person's need for institutional level of
care as determined under criteria established in subdivision 4e and the certified assessor's
decision regarding eligibility for all services and programs as defined in subdivision 1a,
paragraphs (a), clause (6), and (b); and

(9) the person's right to appeal the certified assessor's decision regarding eligibility for
all services and programs as defined in subdivision 1a, paragraphs (a), clauses (6), (7), and
(8), and (b), and incorporating the decision regarding the need for institutional level of care
or the lead agency's final decisions regarding public programs eligibility according to section
256.045, subdivision 3.

(k) Face-to-face assessment completed as part of eligibility determination for the
alternative care, elderly waiver, new text begin developmental disabilities, new text end community access for disability
inclusion, community alternative care, and brain injury waiver programs under sections
256B.0913, 256B.0915, and 256B.49 is valid to establish service eligibility for no more
than 60 calendar days after the date of assessment.

(l) The effective eligibility start date for programs in paragraph (k) 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 and documented in the department's Medicaid Management
Information System (MMIS). Notwithstanding retroactive medical assistance coverage of
state plan services, the effective date of eligibility for programs included in paragraph (k)
cannot be prior to the date the most recent updated assessment is completed.

(m) If an eligibility update is completed within 90 days of the previous face-to-face
assessment and documented in the department's Medicaid Management Information System
(MMIS), the effective date of eligibility for programs included in paragraph (k) is the date
of the previous face-to-face assessment when all other eligibility requirements are met.

(n) At the time of reassessment, the certified assessor shall assess each person receiving
waiver services currently residing in a community residential setting, or licensed adult foster
care home that is not the primary residence of the license holder, or in which the license
holder is not the primary caregiver, to determine if that person would prefer to be served in
a community-living setting as defined in section 256B.49, subdivision 23. The certified
assessor shall offer the person, through a person-centered planning process, the option to
receive alternative housing and service options.

Sec. 3.

Minnesota Statutes 2017 Supplement, section 256B.0911, subdivision 3f, is amended
to read:

Subd. 3f.

Long-term care reassessments and community support plan updates.

Reassessments must be tailored using the professional judgment of the assessor to the
person's known needs, strengths, preferences, and circumstances. Reassessments provide
information to support the person's informed choice and opportunities to express choice
regarding activities that contribute to quality of life, as well as information and opportunity
to identify goals related to desired employment, community activities, and preferred living
environment. Reassessments allow for a review of the current new text begin coordinated service and
new text end support plan's effectiveness, monitoring of services, and the development of an updated
person-centered community support plan. Reassessments verify continued eligibility or
offer alternatives as warranted and provide an opportunity for quality assurance of service
delivery. Face-to-face deleted text begin assessments deleted text end new text begin reassessments new text end must be conducted annually or as required
by federal and state laws and rules. new text begin For reassessments, the certified assessor and the individual
responsible for developing the coordinated service and support plan must ensure the
continuity of care for the person receiving services and complete the updated community
support plan and the updated coordinated service and support plan within the timelines
established by the commissioner.
new text end

Sec. 4.

Minnesota Statutes 2016, section 256B.0915, subdivision 6, is amended to read:

Subd. 6.

Implementation of coordinated service and support plan.

(a) Each elderly
waiver client shall be provided a copy of a written coordinated service and support plan
deleted text begin which deleted text end new text begin that new text end :

(1) is developed new text begin with new text end and signed by the recipient within deleted text begin ten working days after the case
manager receives the assessment information and written community support plan as
described in section 256B.0911, subdivision 3a, from the certified assessor deleted text end new text begin the timelines
established by the commissioner. The timeline for completing the community support plan
under section 256B.0911, subdivision 3a, and the coordinated service and support plan must
not exceed 56 calendar days from the assessment visit new text end ;

(2) includes the person's need for service and identification of service needs that will be
or that are met by the person's relatives, friends, and others, as well as community services
used by the general public;

(3) reasonably ensures the health and welfare of the recipient;

(4) identifies the person's preferences for services as stated by the person or the person's
legal guardian or conservator;

(5) reflects the person's informed choice between institutional and community-based
services, as well as choice of services, supports, and providers, including available case
manager providers;

(6) identifies long-range and short-range goals for the person;

(7) identifies specific services and the amount, frequency, duration, and cost of the
services to be provided to the person based on assessed needs, preferences, and available
resources;

(8) includes information about the right to appeal decisions under section 256.045; and

(9) includes the authorized annual and estimated monthly amounts for the services.

(b) In developing the coordinated service and support plan, the case manager should
also include the use of volunteers, religious organizations, social clubs, and civic and service
organizations to support the individual in the community. The lead agency must be held
harmless for damages or injuries sustained through the use of volunteers and agencies under
this paragraph, including workers' compensation liability.

Sec. 5.

Minnesota Statutes 2016, section 256B.092, subdivision 1b, is amended to read:

Subd. 1b.

Coordinated service and support plan.

(a) Each recipient of home and
community-based waivered services shall be provided a copy of the written coordinated
service and support plan deleted text begin which deleted text end new text begin that new text end :

(1) is developed new text begin with new text end and signed by the recipient within deleted text begin ten working days after the case
manager receives the assessment information and written community support plan as
described in section 256B.0911, subdivision 3a, from the certified assessor deleted text end new text begin the timelines
established by the commissioner. The timeline for completing the community support plan
under section 256B.0911, subdivision 3a, and the coordinated service and support plan must
not exceed 56 calendar days from the assessment visit new text end ;

(2) includes the person's need for service, including identification of service needs that
will be or that are met by the person's relatives, friends, and others, as well as community
services used by the general public;

(3) reasonably ensures the health and welfare of the recipient;

(4) identifies the person's preferences for services as stated by the person, the person's
legal guardian or conservator, or the parent if the person is a minor, including the person's
choices made on self-directed options and on services and supports to achieve employment
goals;

(5) provides for an informed choice, as defined in section 256B.77, subdivision 2,
paragraph (o), of service and support providers, and identifies all available options for case
management services and providers;

(6) identifies long-range and short-range goals for the person;

(7) identifies specific services and the amount and frequency of the services to be provided
to the person based on assessed needs, preferences, and available resources. The coordinated
service and support plan shall also specify other services the person needs that are not
available;

(8) identifies the need for an individual program plan to be developed by the provider
according to the respective state and federal licensing and certification standards, and
additional assessments to be completed or arranged by the provider after service initiation;

(9) identifies provider responsibilities to implement and make recommendations for
modification to the coordinated service and support plan;

(10) includes notice of the right to request a conciliation conference or a hearing under
section 256.045;

(11) is agreed upon and signed by the person, the person's legal guardian or conservator,
or the parent if the person is a minor, and the authorized county representative;

(12) is reviewed by a health professional if the person has overriding medical needs that
impact the delivery of services; and

(13) includes the authorized annual and monthly amounts for the services.

(b) In developing the coordinated service and support plan, the case manager is
encouraged to include the use of volunteers, religious organizations, social clubs, and civic
and service organizations to support the individual in the community. The lead agency must
be held harmless for damages or injuries sustained through the use of volunteers and agencies
under this paragraph, including workers' compensation liability.

(c) Approved, written, and signed changes to a consumer's services that meet the criteria
in this subdivision shall be an addendum to that consumer's individual service plan.

Sec. 6.

Minnesota Statutes 2017 Supplement, 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 must include:

(1) finalizing the written coordinated service and support plan within deleted text begin ten working days
after the case manager receives the plan from the certified assessor deleted text end new text begin the timelines established
by the commissioner. The timeline for completing the community support plan under section
256B.0911, subdivision 3a, and the coordinated service and support plan must not exceed
56 calendar days from the assessment visit new text end ;

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

(3) assisting the recipient in the identification of potential service providers and available
options for case management service and providers, including services provided in a
non-disability-specific setting;

(4) assisting the recipient to access services and assisting with appeals under section
256.045; and

(5) coordinating, evaluating, and monitoring of the services identified in the service
plan.

(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:

(1) finalizing the coordinated service and support plan;

(2) ongoing assessment and monitoring of the person's needs and adequacy of the
approved coordinated service and support plan; and

(3) adjustments to the coordinated service and support plan.

(c) Case management services must be provided by a public or private agency that is
enrolled as a medical assistance provider determined by the commissioner to meet all of
the requirements in the approved federal waiver plans. Case management services must not
be provided to a recipient by a private agency that has any financial interest in the provision
of any other services included in the recipient's coordinated service and support plan. For
purposes of this section, "private agency" means any agency that is not identified as a lead
agency under section 256B.0911, subdivision 1a, paragraph (e).

(d) For persons who need a positive support transition plan as required in chapter 245D,
the case manager shall participate in the development and ongoing evaluation of the plan
with the expanded support team. At least quarterly, the case manager, in consultation with
the expanded support team, shall evaluate the effectiveness of the plan based on progress
evaluation data submitted by the licensed provider to the case manager. The evaluation must
identify whether the plan has been developed and implemented in a manner to achieve the
following within the required timelines:

(1) phasing out the use of prohibited procedures;

(2) acquisition of skills needed to eliminate the prohibited procedures within the plan's
timeline; and

(3) accomplishment of identified outcomes.

If adequate progress is not being made, the case manager shall consult with the person's
expanded support team to identify needed modifications and whether additional professional
support is required to provide consultation.