SF 2933

2nd Unofficial Engrossment - 86th Legislature (2009 - 2010) Posted on 12/26/2012 11:17pm

1.1A bill for an act

1.2relating to human services; making changes to continuing care policy and
1.3personal care assistance services;amending Minnesota Statutes 2008, sections
1.443A.318, subdivision 2; 144A.071, subdivision 4b; 144A.161, subdivision
1.51a; 245A.03, by adding a subdivision; 256B.0911, subdivision 4d; 256B.092,
1.6subdivision 4d; 326B.43, subdivision 2; 626.557, subdivision 9a; Minnesota
1.7Statutes 2009 Supplement, sections 144.0724, subdivision 11; 245A.03,
1.8subdivision 7; 245A.11, subdivision 7b; 256B.0625, subdivision 19c; 256B.0651,
1.9by adding a subdivision; 256B.0652, subdivision 6; 256B.0653, subdivision
1.103; 256B.0659, subdivisions 1, 3, 4, 10, 11, 13, 14, 18, 19, 20, 21, 24, 27, 30,
1.11by adding a subdivision; 256B.0911, subdivisions 1a, 2b, 3a, 3b; 256D.44,
1.12subdivision 5; Laws 2009, chapter 79, article 8, section 81; repealing Minnesota
1.13Statutes 2008, section 256B.0919, subdivision 4.
1.14BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.15ARTICLE 1

1.16CONTINUING CARE POLICY

1.17    Section 1. Minnesota Statutes 2008, section 43A.318, subdivision 2, is amended to
1.18read:
1.19    Subd. 2. Program creation; general provisions. (a) The commissioner may
1.20administer a program to make long-term care coverage available to eligible persons. The
1.21commissioner may determine the program's funding arrangements, request bids from
1.22qualified vendors, and negotiate and enter into contracts with qualified vendors. Contracts
1.23are not subject to the requirements of section 16C.16 or 16C.19. Contracts must be for a
1.24uniform term of at least one year, but may be made automatically renewable from term
1.25to term in the absence of notice of termination by either party. The program may not be
1.26self-insured until the commissioner has completed an actuarial study of the program and
2.1reported the results of the study to the legislature and self-insurance has been specifically
2.2authorized by law.
2.3(b) The program may provide coverage for home, community, and institutional
2.4long-term care and any other benefits as determined by the commissioner. Coverage is
2.5optional. The enrolled eligible person must pay the full cost of the coverage.
2.6(c) The commissioner shall promote activities that attempt to raise awareness of
2.7the need for long-term care insurance among residents of the state and encourage the
2.8increased prevalence of long-term care coverage. These activities must include the sharing
2.9of knowledge gained in the development of the program.
2.10(d) The commissioner may employ and contract with persons and other entities to
2.11perform the duties under this section and may determine their duties and compensation
2.12consistent with this chapter.
2.13(e) The benefits provided under this section are not terms and conditions of
2.14employment as defined under section 179A.03, subdivision 19, and are not subject to
2.15collective bargaining.
2.16(f) The commissioner shall establish underwriting criteria for entry of all eligible
2.17persons into the program. Eligible persons who would be immediately eligible for benefits
2.18may not enroll.
2.19(g) Eligible persons who meet underwriting criteria may enroll in the program upon
2.20hiring and at other times established by the commissioner.
2.21(h) An eligible person enrolled in the program may continue to participate in the
2.22program even if an event, such as termination of employment, changes the person's
2.23employment status.
2.24(i) Participating public employee pension plans and public employers may provide
2.25automatic pension or payroll deduction for payment of long-term care insurance premiums
2.26to qualified vendors contracted with under this section.
2.27(j) The premium charged to program enrollees must include an administrative fee to
2.28cover all program expenses incurred in addition to the cost of coverage. All fees collected
2.29are appropriated to the commissioner for the purpose of administrating the program.
2.30(k) Public employees of local units of government including but not limited to
2.31townships, municipalities, cities, and counties may buy into the long-term care insurance
2.32under this section.

2.33    Sec. 2. Minnesota Statutes 2009 Supplement, section 144.0724, subdivision 11,
2.34is amended to read:
3.1    Subd. 11. Nursing facility level of care. (a) For purposes of medical assistance
3.2payment of long-term care services, a recipient must be determined, using assessments
3.3defined in subdivision 4, to meet one of the following nursing facility level of care criteria:
3.4    (1) the person requires formal clinical monitoring at least once per day;
3.5    (1) (2) the person needs the assistance of another person or constant supervision to
3.6begin and complete at least four of the following activities of living: bathing, bed mobility,
3.7dressing, eating, grooming, toileting, transferring, and walking;
3.8    (2) (3) the person needs the assistance of another person or constant supervision
3.9to begin and complete toileting, transferring, or positioning and the assistance cannot
3.10be scheduled;
3.11    (3) (4) the person has significant difficulty with memory, using information, daily
3.12decision making, or behavioral needs that require intervention;
3.13    (4) (5) the person has had a qualifying nursing facility stay of at least 90 days;
3.14    (6) the person meets the nursing facility level of care criteria determined 90 days
3.15after admission or on the first quarterly assessment after admission, whichever is later; or
3.16    (5) (7) the person is determined to be at risk for nursing facility admission or
3.17readmission through a face-to-face long-term care consultation assessment as specified
3.18in section 256B.0911, subdivision 3a, 3b, or 4d, by a county, tribe, or managed care
3.19organization under contract with the Department of Human Services. The person is
3.20considered at risk under this clause if the person currently lives alone or will live alone
3.21upon discharge and also meets one of the following criteria:
3.22    (i) the person has experienced a fall resulting in a fracture;
3.23    (ii) the person has been determined to be at risk of maltreatment or neglect,
3.24including self-neglect; or
3.25    (iii) the person has a sensory impairment that substantially impacts functional ability
3.26and maintenance of a community residence.
3.27    (b) The assessment used to establish medical assistance payment for nursing facility
3.28services must be the most recent assessment performed under subdivision 4, paragraph
3.29(b), that occurred no more than 90 calendar days before the effective date of medical
3.30assistance eligibility for payment of long-term care services. In no case shall medical
3.31assistance payment for long-term care services occur prior to the date of the determination
3.32of nursing facility level of care.
3.33    (c) The assessment used to establish medical assistance payment for long-term care
3.34services provided under sections 256B.0915 and 256B.49 and alternative care payment
3.35for services provided under section 256B.0913 must be the most recent face-to-face
3.36assessment performed under section 256B.0911, subdivision 3a, 3b, or 4d, that occurred
4.1no more than 60 calendar days before the effective date of medical assistance eligibility
4.2for payment of long-term care services.

4.3    Sec. 3. Minnesota Statutes 2008, section 144A.071, subdivision 4b, is amended to read:
4.4    Subd. 4b. Licensed beds on layaway status. A licensed and certified nursing
4.5facility may lay away, upon prior written notice to the commissioner of health, up to 50
4.6percent of its licensed and certified beds. A nursing facility may not discharge a resident
4.7in order to lay away a bed. Notice to the commissioner shall be given 60 days prior
4.8to the effective date of the layaway. Beds on layaway shall have the same status as
4.9voluntarily delicensed and decertified beds and shall not be subject to license fees and
4.10license surcharge fees. In addition, beds on layaway may be removed from layaway at any
4.11time on or after one year after the effective date of layaway in the facility of origin, with a
4.1260-day notice to the commissioner. A nursing facility that removes beds from layaway
4.13may not place beds on layaway status for one year after the effective date of the removal
4.14from layaway. The commissioner may approve the immediate removal of beds from
4.15layaway if necessary to provide access to those nursing home beds to residents relocated
4.16from other nursing homes due to emergency situations or closure. In the event approval
4.17is granted, the one-year restriction on placing beds on layaway after a removal of beds
4.18from layaway shall not apply. Beds may remain on layaway for up to five ten years. The
4.19commissioner may approve placing and removing beds on layaway at any time during
4.20renovation or construction related to a moratorium project approved under this section
4.21or section 144A.073. Nursing facilities are not required to comply with any licensure or
4.22certification requirements for beds on layaway status.

4.23    Sec. 4. Minnesota Statutes 2008, section 144A.161, subdivision 1a, is amended to read:
4.24    Subd. 1a. Scope. Where a facility is undertaking closure, curtailment, reduction, or
4.25change in operations, or where a housing with services unit registered under chapter 144D
4.26is closed because the space that it occupies is being replaced by a nursing facility bed that
4.27is being reactivated from layaway status, the facility and the county social services agency
4.28must comply with the requirements of this section.

4.29    Sec. 5. Minnesota Statutes 2009 Supplement, section 245A.03, subdivision 7, is
4.30amended to read:
4.31    Subd. 7. Licensing moratorium. (a) The commissioner shall not issue an
4.32initial license for child foster care licensed under Minnesota Rules, parts 2960.3000 to
4.332960.3340, or adult foster care licensed under Minnesota Rules, parts 9555.5105 to
5.19555.6265, under this chapter for a physical location that will not be the primary residence
5.2of the license holder for the entire period of licensure. If a license is issued during this
5.3moratorium, and the license holder changes the license holder's primary residence away
5.4from the physical location of the foster care license, the commissioner shall revoke the
5.5license according to section 245A.07. Exceptions to the moratorium include:
5.6(1) foster care settings that are required to be registered under chapter 144D;
5.7(2) foster care licenses replacing foster care licenses in existence on May 15, 2009,
5.8and determined to be needed by the commissioner under paragraph (b);
5.9(3) new foster care licenses determined to be needed by the commissioner under
5.10paragraph (b) for the closure of a nursing facility, ICF/MR, or regional treatment center;
5.11(4) new foster care licenses determined to be needed by the commissioner under
5.12paragraph (b) for persons requiring hospital level care; or
5.13(5) new foster care licenses determined to be needed by the commissioner for the
5.14transition of people from personal care assistance to the home and community-based
5.15services.
5.16(b) The commissioner shall determine the need for newly licensed foster care homes
5.17as defined under this subdivision. As part of the determination, the commissioner shall
5.18consider the availability of foster care capacity in the area in which the licensee seeks to
5.19operate, and the recommendation of the local county board. The determination by the
5.20commissioner must be final. A determination of need is not required for a change in
5.21ownership at the same address.
5.22    (c) Residential settings that would otherwise be subject to the moratorium established
5.23in paragraph (a), that are in the process of receiving an adult or child foster care license as
5.24of July 1, 2009, shall be allowed to continue to complete the process of receiving an adult
5.25or child foster care license. For this paragraph, all of the following conditions must be met
5.26to be considered in the process of receiving an adult or child foster care license:
5.27    (1) participants have made decisions to move into the residential setting, including
5.28documentation in each participant's care plan;
5.29    (2) the provider has purchased housing or has made a financial investment in the
5.30property;
5.31    (3) the lead agency has approved the plans, including costs for the residential setting
5.32for each individual;
5.33    (4) the completion of the licensing process, including all necessary inspections, is
5.34the only remaining component prior to being able to provide services; and
5.35    (5) the needs of the individuals cannot be met within the existing capacity in that
5.36county.
6.1To qualify for the process under this paragraph, the lead agency must submit
6.2documentation to the commissioner by August 1, 2009, that all of the above criteria are
6.3met.
6.4(d) The commissioner shall study the effects of the license moratorium under this
6.5subdivision and shall report back to the legislature by January 15, 2011. This study shall
6.6include, but is not limited to the following:
6.7(1) the overall capacity and utilization of foster care beds where the physical location
6.8is not the primary residence of the license holder prior to and after implementation
6.9of the moratorium;
6.10(2) the overall capacity and utilization of foster care beds where the physical
6.11location is the primary residence of the license holder prior to and after implementation
6.12of the moratorium; and
6.13(3) the number of licensed and occupied ICF/MR beds prior to and after
6.14implementation of the moratorium.

6.15    Sec. 6. Minnesota Statutes 2008, section 245A.03, is amended by adding a subdivision
6.16to read:
6.17    Subd. 9. Permitted services by an individual who is related. Notwithstanding
6.18subdivision 2, paragraph (a), clause (1), and subdivision 7, an individual who is related to a
6.19person receiving supported living services may provide licensed services to that person if:
6.20    (1) the person who receives supported living services received these services in a
6.21residential site on July 1, 2005;
6.22    (2) the services under clause (1) were provided in a corporate foster care setting for
6.23adults and were funded by the developmental disabilities home and community-based
6.24services waiver defined in section 256B.092;
6.25    (3) the individual who is related obtains and maintains both a license under
6.26chapter 245B and an adult foster care license under Minnesota Rules, parts 9555.5105
6.27to 9555.6265; and
6.28    (4) the individual who is related is not the guardian of the person receiving supported
6.29living services.
6.30EFFECTIVE DATE.This section is effective the day following final enactment.

6.31    Sec. 7. Minnesota Statutes 2009 Supplement, section 245A.11, subdivision 7b, is
6.32amended to read:
6.33    Subd. 7b. Adult foster care data privacy and security. (a) An adult foster
6.34care license holder who creates, collects, records, maintains, stores, or discloses any
7.1individually identifiable recipient data, whether in an electronic or any other format,
7.2must comply with the privacy and security provisions of applicable privacy laws and
7.3regulations, including:
7.4(1) the federal Health Insurance Portability and Accountability Act of 1996
7.5(HIPAA), Public Law 104-1; and the HIPAA Privacy Rule, Code of Federal Regulations,
7.6title 45, part 160, and subparts A and E of part 164; and
7.7(2) the Minnesota Government Data Practices Act as codified in chapter 13.
7.8(b) For purposes of licensure, the license holder shall be monitored for compliance
7.9with the following data privacy and security provisions:
7.10(1) the license holder must control access to data on foster care recipients according
7.11to the definitions of public and private data on individuals under section 13.02;
7.12classification of the data on individuals as private under section 13.46, subdivision 2;
7.13and control over the collection, storage, use, access, protection, and contracting related
7.14to data according to section 13.05, in which the license holder is assigned the duties
7.15of a government entity;
7.16(2) the license holder must provide each foster care recipient with a notice that
7.17meets the requirements under section 13.04, in which the license holder is assigned the
7.18duties of the government entity, and that meets the requirements of Code of Federal
7.19Regulations, title 45, part 164.52. The notice shall describe the purpose for collection of
7.20the data, and to whom and why it may be disclosed pursuant to law. The notice must
7.21inform the recipient that the license holder uses electronic monitoring and, if applicable,
7.22that recording technology is used;
7.23(3) the license holder must not install monitoring cameras in bathrooms;
7.24(4) electronic monitoring cameras must not be concealed from the foster care
7.25recipients; and
7.26(5) electronic video and audio recordings of foster care recipients shall not be
7.27stored by the license holder for more than five days unless: (i) a foster care recipient or
7.28legal representative requests that the recording be held longer based on a specific report
7.29of alleged maltreatment; or (ii) the recording captures an incident or event of alleged
7.30maltreatment under section 626.556 or 626.557 or a crime under chapter 609. When
7.31requested by a recipient or when a recording captures an incident or event of alleged
7.32maltreatment or a crime, the license holder must maintain the recording in a secured area
7.33for no longer than 30 days to give the investigating agency an opportunity to make a copy
7.34of the recording. The investigating agency will maintain the electronic video or audio
7.35recordings as required in section 626.557, subdivision 12b.
8.1(c) The commissioner shall develop, and make available to license holders and
8.2county licensing workers, a checklist of the data privacy provisions to be monitored
8.3for purposes of licensure.

8.4    Sec. 8. Minnesota Statutes 2009 Supplement, section 256B.0625, subdivision 19c,
8.5is amended to read:
8.6    Subd. 19c. Personal care. Medical assistance covers personal care assistance
8.7services provided by an individual who is qualified to provide the services according to
8.8subdivision 19a and sections 256B.0651 to 256B.0656, provided in accordance with a
8.9plan, and supervised by a qualified professional.
8.10"Qualified professional" means a mental health professional as defined in section 245.462,
8.11subdivision 18 , or 245.4871, subdivision 27; or a registered nurse as defined in sections
8.12148.171 to 148.285, a licensed social worker as defined in section 148B.21 sections
8.13148D.010 and 148D.055, or a qualified developmental disabilities specialist under section
8.14245B.07, subdivision 4 . The qualified professional shall perform the duties required in
8.15section 256B.0659.

8.16    Sec. 9. Minnesota Statutes 2009 Supplement, section 256B.0651, is amended by
8.17adding a subdivision to read:
8.18    Subd. 17. Recipient protection. (a) Providers of home care services must provide
8.19each recipient with a copy of the home care bill of rights under section 144A.44 at
8.20least 30 days prior to terminating services to a recipient, if the termination results from
8.21provider sanctions under section 256B.064, such as a payment withhold, a suspension of
8.22participation, or a termination of participation. If a home care provider determines it is
8.23unable to continue providing services to a recipient, the provider must notify the recipient,
8.24the recipient's responsible party, and the commissioner 30 days prior to terminating
8.25services to the recipient because of an action under section 256B.064, and must assist the
8.26commissioner and lead agency in supporting the recipient in transitioning to another
8.27home care provider of the recipient's choice.
8.28    (b) In the event of a payment withhold from a home care provider, a suspension of
8.29participation, or a termination of participation of a home care provider under section
8.30256B.064, the commissioner may inform the Office of Ombudsman for Long-Term Care
8.31and the lead agencies for all recipients with active service agreements with the provider.
8.32At the commissioner's request, the lead agencies must contact recipients to ensure that the
8.33recipients are continuing to receive needed care, and that the recipients have been given
8.34free choice of provider if they transfer to another home care provider. In addition, the
9.1commissioner or the commissioner's delegate may directly notify recipients who receive
9.2care from the provider that payments have been withheld or that the provider's participation
9.3in medical assistance has been suspended or terminated, if the commissioner determines
9.4that notification is necessary to protect the welfare of the recipients. For purposes of this
9.5subdivision, "lead agencies" means counties, tribes, and managed care organizations.

9.6    Sec. 10. Minnesota Statutes 2009 Supplement, section 256B.0652, subdivision 6,
9.7is amended to read:
9.8    Subd. 6. Authorization; personal care assistance and qualified professional.
9.9    (a) All personal care assistance services, supervision by a qualified professional, and
9.10additional services beyond the limits established in subdivision 11, must be authorized
9.11by the commissioner or the commissioner's designee before services begin except for the
9.12assessments established in subdivision 11 and section 256B.0911. The authorization for
9.13personal care assistance and qualified professional services under section 256B.0659 must
9.14be completed within 30 days after receiving a complete request.
9.15    (b) The amount of personal care assistance services authorized must be based
9.16on the recipient's home care rating. The home care rating shall be determined by the
9.17commissioner or the commissioner's designee based on information submitted to the
9.18commissioner identifying the following:
9.19    (1) total number of dependencies of activities of daily living as defined in section
9.20256B.0659 ;
9.21    (2) number presence of complex health-related needs as defined in section
9.22256B.0659 ; and
9.23    (3) number presence of Level I behavior descriptions as defined in section
9.24256B.0659 .
9.25    (c) The methodology to determine total time for personal care assistance services for
9.26each home care rating is based on the median paid units per day for each home care rating
9.27from fiscal year 2007 data for the personal care assistance program. Each home care rating
9.28has a base level of hours assigned. Additional time is added through the assessment and
9.29identification of the following:
9.30    (1) 30 additional minutes per day for a dependency in each critical activity of daily
9.31living as defined in section 256B.0659;
9.32    (2) 30 additional minutes per day for each complex health-related function as
9.33defined in section 256B.0659; and
9.34    (3) 30 additional minutes per day for each behavior issue as defined in section
9.35256B.0659, subdivision 4, paragraph (d) .
10.1    (d) A limit of 96 units of qualified professional supervision may be authorized for
10.2each recipient receiving personal care assistance services. A request to the commissioner
10.3to exceed this total in a calendar year must be requested by the personal care provider
10.4agency on a form approved by the commissioner.

10.5    Sec. 11. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 10,
10.6is amended to read:
10.7    Subd. 10. Responsible party; duties; delegation. (a) A responsible party shall
10.8enter into a written agreement with a personal care assistance provider agency, on a form
10.9determined by the commissioner, to perform the following duties:
10.10    (1) be available while care is provided in a method agreed upon by the individual
10.11or the individual's legal representative and documented in the recipient's personal care
10.12assistance care plan;
10.13    (2) monitor personal care assistance services to ensure the recipient's personal care
10.14assistance care plan is being followed; and
10.15    (3) review and sign personal care assistance time sheets after services are provided
10.16to provide verification of the personal care assistance services.
10.17Failure to provide the support required by the recipient must result in a referral to the
10.18county common entry point.
10.19    (b) Responsible parties who are parents of minors or guardians of minors or
10.20incapacitated persons may delegate the responsibility to another adult who is not the
10.21personal care assistant during a temporary absence of at least 24 hours but not more
10.22than six months. The person delegated as a responsible party must be able to meet the
10.23definition of the responsible party. The responsible party must ensure that the delegate
10.24performs the functions of the responsible party, is identified at the time of the assessment,
10.25and is listed on the personal care assistance care plan. The responsible party must
10.26communicate to the personal care assistance provider agency about the need for a delegate
10.27delegated responsible party, including the name of the delegated responsible party, dates
10.28the delegated responsible party will be living with the recipient, and contact numbers.

10.29    Sec. 12. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 11,
10.30is amended to read:
10.31    Subd. 11. Personal care assistant; requirements. (a) A personal care assistant
10.32must meet the following requirements:
10.33    (1) be at least 18 years of age with the exception of persons who are 16 or 17 years
10.34of age with these additional requirements:
11.1    (i) supervision by a qualified professional every 60 days; and
11.2    (ii) employment by only one personal care assistance provider agency responsible
11.3for compliance with current labor laws;
11.4    (2) be employed by a personal care assistance provider agency;
11.5    (3) enroll with the department as a personal care assistant after clearing a background
11.6study. Except as provided in subdivision 11a, before a personal care assistant provides
11.7services, the personal care assistance provider agency must initiate a background study on
11.8the personal care assistant under chapter 245C, and the personal care assistance provider
11.9agency must have received a notice from the commissioner that the personal care assistant
11.10is:
11.11    (i) not disqualified under section 245C.14; or
11.12    (ii) is disqualified, but the personal care assistant has received a set aside of the
11.13disqualification under section 245C.22;
11.14    (4) be able to effectively communicate with the recipient and personal care
11.15assistance provider agency;
11.16    (5) be able to provide covered personal care assistance services according to the
11.17recipient's personal care assistance care plan, respond appropriately to recipient needs,
11.18and report changes in the recipient's condition to the supervising qualified professional
11.19or physician;
11.20    (6) not be a consumer of personal care assistance services;
11.21    (7) maintain daily written records including, but not limited to, time sheets under
11.22subdivision 12;
11.23    (8) effective January 1, 2010, complete standardized training as determined by the
11.24commissioner before completing enrollment. Personal care assistant training must include
11.25successful completion of the following training components: basic first aid, vulnerable
11.26adult, child maltreatment, OSHA universal precautions, basic roles and responsibilities of
11.27personal care assistants including information about assistance with lifting and transfers
11.28for recipients, emergency preparedness, orientation to positive behavioral practices, fraud
11.29issues, and completion of time sheets. Upon completion of the training components,
11.30the personal care assistant must demonstrate the competency to provide assistance to
11.31recipients;
11.32    (9) complete training and orientation on the needs of the recipient within the first
11.33seven days after the services begin; and
11.34    (10) be limited to providing and being paid for up to 310 hours per month of personal
11.35care assistance services regardless of the number of recipients being served or the number
11.36of personal care assistance provider agencies enrolled with.
12.1    (b) A legal guardian may be a personal care assistant if the guardian is not being paid
12.2for the guardian services and meets the criteria for personal care assistants in paragraph (a).
12.3    (c) Effective January 1, 2010, persons who do not qualify as a personal care assistant
12.4include parents and stepparents of minors, spouses, paid legal guardians, family foster
12.5care providers, except as otherwise allowed in section 256B.0625, subdivision 19a, or
12.6staff of a residential setting.
12.7EFFECTIVE DATE.This section is effective retroactively from July 1, 2009.

12.8    Sec. 13. Minnesota Statutes 2009 Supplement, section 256B.0659, is amended by
12.9adding a subdivision to read:
12.10    Subd. 11a. Exception to personal care assistant; requirements. The personal care
12.11assistant for a recipient may be allowed to enroll with a different personal care assistant
12.12provider agency upon initiation of a new background study according to chapter 245C, if
12.13all of the following are met:
12.14    (1) the commissioner determines that a change in enrollment or affiliation of the
12.15personal care assistant is needed in order to ensure continuity of services and protect the
12.16health and safety of the recipient;
12.17    (2) the chosen agency has been continuously enrolled as a personal care assistance
12.18provider agency for at least two years;
12.19    (3) the recipient chooses to transfer to the personal care assistance provider agency;
12.20    (4) the personal care assistant has been continuously enrolled with the former
12.21personal care assistance provider agency since the last background study was completed;
12.22and
12.23    (5) the personal care assistant continues to meet requirements of subdivision 11,
12.24excluding paragraph (a), clause (3).
12.25EFFECTIVE DATE.This section is effective retroactively from July 1, 2009.

12.26    Sec. 14. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 13,
12.27is amended to read:
12.28    Subd. 13. Qualified professional; qualifications. (a) The qualified professional
12.29must be employed by work for a personal care assistance provider agency and meet the
12.30definition under section 256B.0625, subdivision 19c. Before a qualified professional
12.31provides services, the personal care assistance provider agency must initiate a background
12.32study on the qualified professional under chapter 245C, and the personal care assistance
13.1provider agency must have received a notice from the commissioner that the qualified
13.2professional:
13.3    (1) is not disqualified under section 245C.14; or
13.4    (2) is disqualified, but the qualified professional has received a set aside of the
13.5disqualification under section 245C.22.
13.6    (b) The qualified professional shall perform the duties of training, supervision, and
13.7evaluation of the personal care assistance staff and evaluation of the effectiveness of
13.8personal care assistance services. The qualified professional shall:
13.9    (1) develop and monitor with the recipient a personal care assistance care plan based
13.10on the service plan and individualized needs of the recipient;
13.11    (2) develop and monitor with the recipient a monthly plan for the use of personal
13.12care assistance services;
13.13    (3) review documentation of personal care assistance services provided;
13.14    (4) provide training and ensure competency for the personal care assistant in the
13.15individual needs of the recipient; and
13.16    (5) document all training, communication, evaluations, and needed actions to
13.17improve performance of the personal care assistants.
13.18    (c) Effective January 1, 2010, the qualified professional shall complete the provider
13.19training with basic information about the personal care assistance program approved
13.20by the commissioner within six months of the date hired by a personal care assistance
13.21provider agency. Qualified professionals who have completed the required trainings
13.22training as an employee with a worker from a personal care assistance provider agency do
13.23not need to repeat the required trainings training if they are hired by another agency, if
13.24they have completed the training within the last three years.

13.25    Sec. 15. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 21,
13.26is amended to read:
13.27    Subd. 21. Requirements for initial enrollment of personal care assistance
13.28provider agencies. (a) All personal care assistance provider agencies must provide, at the
13.29time of enrollment as a personal care assistance provider agency in a format determined
13.30by the commissioner, information and documentation that includes, but is not limited to,
13.31the following:
13.32    (1) the personal care assistance provider agency's current contact information
13.33including address, telephone number, and e-mail address;
13.34    (2) proof of surety bond coverage in the amount of $50,000 or ten percent of the
13.35provider's payments from Medicaid in the previous year, whichever is less;
14.1    (3) proof of fidelity bond coverage in the amount of $20,000;
14.2    (4) proof of workers' compensation insurance coverage;
14.3    (5) proof of liability insurance;
14.4    (5) (6) a description of the personal care assistance provider agency's organization
14.5identifying the names of all owners, managing employees, staff, board of directors, and
14.6the affiliations of the directors, owners, or staff to other service providers;
14.7    (6) (7) a copy of the personal care assistance provider agency's written policies
14.8and procedures including: hiring of employees; training requirements; service delivery;
14.9and employee and consumer safety including process for notification and resolution
14.10of consumer grievances, identification and prevention of communicable diseases, and
14.11employee misconduct;
14.12    (7) (8) copies of all other forms the personal care assistance provider agency uses in
14.13the course of daily business including, but not limited to:
14.14    (i) a copy of the personal care assistance provider agency's time sheet if the time
14.15sheet varies from the standard time sheet for personal care assistance services approved
14.16by the commissioner, and a letter requesting approval of the personal care assistance
14.17provider agency's nonstandard time sheet;
14.18    (ii) the personal care assistance provider agency's template for the personal care
14.19assistance care plan; and
14.20    (iii) the personal care assistance provider agency's template for the written
14.21agreement in subdivision 20 for recipients using the personal care assistance choice
14.22option, if applicable;
14.23    (8) (9) a list of all trainings training and classes that the personal care assistance
14.24provider agency requires of its staff providing personal care assistance services;
14.25    (9) (10) documentation that the personal care assistance provider agency and staff
14.26have successfully completed all the training required by this section;
14.27    (10) (11) documentation of the agency's marketing practices;
14.28    (11) (12) disclosure of ownership, leasing, or management of all residential
14.29properties that is used or could be used for providing home care services; and
14.30    (12) (13) documentation that the agency will use the following percentages of
14.31revenue generated from the medical assistance rate paid for personal care assistance
14.32services for employee personal care assistant wages and benefits: 72.5 percent of revenue
14.33in the personal care assistance choice option and 72.5 percent of revenue from other
14.34personal care assistance providers.
14.35    (b) Personal care assistance provider agencies shall provide the information specified
14.36in paragraph (a) to the commissioner at the time the personal care assistance provider
15.1agency enrolls as a vendor or upon request from the commissioner. The commissioner
15.2shall collect the information specified in paragraph (a) from all personal care assistance
15.3providers beginning July 1, 2009.
15.4    (c) All personal care assistance provider agencies shall complete mandatory training
15.5as determined by the commissioner before enrollment as a provider. Personal care
15.6assistance provider agencies are required to send all owners, qualified professionals
15.7employed by the agency, and all other managing employees to the initial and subsequent
15.8trainings training. Personal care assistance provider agency billing staff shall complete
15.9training about personal care assistance program financial management. This training is
15.10effective July 1, 2009. Any personal care assistance provider agency enrolled before that
15.11date shall, if it has not already, complete the provider training within 18 months of July 1,
15.122009. Any new owners, new qualified professionals, and new managing employees are
15.13required to complete mandatory training as a requisite of hiring.

15.14    Sec. 16. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 30,
15.15is amended to read:
15.16    Subd. 30. Notice of service changes to recipients. The commissioner must provide:
15.17    (1) by October 31, 2009, information to recipients likely to be affected that (i)
15.18describes the changes to the personal care assistance program that may result in the
15.19loss of access to personal care assistance services, and (ii) includes resources to obtain
15.20further information; and
15.21    (2) notice of changes in medical assistance home care personal care assistant services
15.22to each affected recipient at least 30 days before the effective date of the change.
15.23The notice shall include how to get further information on the changes, how to get help to
15.24obtain other services, a list of community resources, and appeal rights. Notwithstanding
15.25section 256.045, a recipient may request continued services pending appeal within the
15.26time period allowed to request an appeal.

15.27    Sec. 17. Minnesota Statutes 2009 Supplement, section 256B.0911, subdivision 1a,
15.28is amended to read:
15.29    Subd. 1a. Definitions. For purposes of this section, the following definitions apply:
15.30    (a) "Long-term care consultation services" means:
15.31    (1) assistance in identifying services needed to maintain an individual in the most
15.32inclusive environment;
15.33    (2) providing recommendations on cost-effective community services that are
15.34available to the individual;
16.1    (3) development of an individual's person-centered community support plan;
16.2    (4) providing information regarding eligibility for Minnesota health care programs;
16.3    (5) face-to-face long-term care consultation assessments, which may be completed
16.4in a hospital, nursing facility, intermediate care facility for persons with developmental
16.5disabilities (ICF/DDs), regional treatment centers, or the person's current or planned
16.6residence;
16.7    (6) federally mandated screening to determine the need for a institutional level of
16.8care under section 256B.0911, subdivision 4, paragraph (a);
16.9    (7) determination of home and community-based waiver service eligibility including
16.10level of care determination for individuals who need an institutional level of care as
16.11defined under section 144.0724, subdivision 11, or 256B.092, service eligibility including
16.12state plan home care services identified in section sections 256B.0625, subdivisions 6,
16.137, and 19, paragraphs (a) and (c), and 256B.0657, based on assessment and support plan
16.14development with appropriate referrals, including the option for consumer-directed
16.15community supports;
16.16    (8) providing recommendations for nursing facility placement when there are no
16.17cost-effective community services available; and
16.18    (9) assistance to transition people back to community settings after facility
16.19admission.
16.20    (b) "Long-term care options counseling" means the services provided by the linkage
16.21lines as mandated by sections 256.01 and 256.975, subdivision 7, and also includes
16.22telephone assistance and follow up once a long-term care consultation assessment has
16.23been completed.
16.24    (c) "Minnesota health care programs" means the medical assistance program under
16.25chapter 256B and the alternative care program under section 256B.0913.
16.26    (d) "Lead agencies" means counties or a collaboration of counties, tribes, and health
16.27plans administering long-term care consultation assessment and support planning services.

16.28    Sec. 18. Minnesota Statutes 2009 Supplement, section 256B.0911, subdivision 2b,
16.29is amended to read:
16.30    Subd. 2b. Certified assessors. (a) Beginning January 1, 2011, each lead agency
16.31shall use certified assessors who have completed training and the certification processes
16.32determined by the commissioner in subdivision 2c. Certified assessors shall demonstrate
16.33best practices in assessment and support planning including person-centered planning
16.34principals and have a common set of skills that must ensure consistency and equitable
16.35access to services statewide. Assessors must be part of a multidisciplinary team of
17.1professionals that includes public health nurses, social workers, and other professionals
17.2as defined in paragraph (b). For persons with complex health care needs, a public health
17.3nurse or registered nurse from a multidisciplinary team must be consulted. A lead agency
17.4may choose, according to departmental policies, to contract with a qualified, certified
17.5assessor to conduct assessments and reassessments on behalf of the lead agency.
17.6    (b) Certified assessors are persons with a minimum of a bachelor's degree in social
17.7work, nursing with a public health nursing certificate, or other closely related field with at
17.8least one year of home and community-based experience or a two-year registered nursing
17.9degree with at least three years of home and community-based experience that have
17.10received training and certification specific to assessment and consultation for long-term
17.11care services in the state.

17.12    Sec. 19. Minnesota Statutes 2009 Supplement, section 256B.0911, subdivision 3a,
17.13is amended to read:
17.14    Subd. 3a. Assessment and support planning. (a) Persons requesting assessment,
17.15services planning, or other assistance intended to support community-based living,
17.16including persons who need assessment in order to determine waiver or alternative care
17.17program eligibility, must be visited by a long-term care consultation team within 15
17.18calendar days after the date on which an assessment was requested or recommended. After
17.19January 1, 2011, these requirements also apply to personal care assistance services, private
17.20duty nursing, and home health agency services, on timelines established in subdivision 5.
17.21Face-to-face assessments must be conducted according to paragraphs (b) to (i).
17.22    (b) The county may utilize a team of either the social worker or public health nurse,
17.23or both. After January 1, 2011, lead agencies shall use certified assessors to conduct the
17.24assessment in a face-to-face interview. The consultation team members must confer
17.25regarding the most appropriate care for each individual screened or assessed.
17.26    (c) The assessment must be comprehensive and include a person-centered
17.27assessment of the health, psychological, functional, environmental, and social needs of
17.28referred individuals and provide information necessary to develop a support plan that
17.29meets the consumers needs, using an assessment form provided by the commissioner.
17.30    (d) The assessment must be conducted in a face-to-face interview with the person
17.31being assessed and the person's legal representative, as required by legally executed
17.32documents, and other individuals as requested by the person, who can provide information
17.33on the needs, strengths, and preferences of the person necessary to develop a support plan
17.34that ensures the person's health and safety, but who is not a provider of service or has any
17.35financial interest in the provision of services.
18.1    (e) The person, or the person's legal representative, must be provided with written
18.2recommendations for community-based services, including consumer-directed options,
18.3or institutional care that include documentation that the most cost-effective alternatives
18.4available were offered to the individual. For purposes of this requirement, "cost-effective
18.5alternatives" means community services and living arrangements that cost the same as or
18.6less than institutional care.
18.7    (f) If the person chooses to use community-based services, the person or the person's
18.8legal representative must be provided with a written community support plan, regardless
18.9of whether the individual is eligible for Minnesota health care programs. A person may
18.10request assistance in identifying community supports without participating in a complete
18.11assessment. Upon a request for assistance identifying community support, the person must
18.12be transferred or referred to the services available under sections 256.975, subdivision 7,
18.13and 256.01, subdivision 24, for telephone assistance and follow up.
18.14    (g) The person has the right to make the final decision between institutional
18.15placement and community placement after the recommendations have been provided,
18.16except as provided in subdivision 4a, paragraph (c).
18.17    (h) The team must give the person receiving assessment or support planning, or
18.18the person's legal representative, materials, and forms supplied by the commissioner
18.19containing the following information:
18.20    (1) the need for and purpose of preadmission screening if the person selects nursing
18.21facility placement;
18.22    (2) the role of the long-term care consultation assessment and support planning in
18.23waiver and alternative care program eligibility determination;
18.24    (3) information about Minnesota health care programs;
18.25    (4) the person's freedom to accept or reject the recommendations of the team;
18.26    (5) the person's right to confidentiality under the Minnesota Government Data
18.27Practices Act, chapter 13;
18.28    (6) the long-term care consultant's decision regarding the person's need for
18.29institutional level of care as determined under criteria established in section 144.0724,
18.30subdivision 11 , or 256B.092; and
18.31    (7) the person's right to appeal the decision regarding the need for nursing facility
18.32level of care or the county's final decisions regarding public programs eligibility according
18.33to section 256.045, subdivision 3.
18.34    (i) Face-to-face assessment completed as part of eligibility determination for
18.35the alternative care, elderly waiver, community alternatives for disabled individuals,
18.36community alternative care, and traumatic brain injury waiver programs under sections
19.1256B.0915 , 256B.0917, and 256B.49 is valid to establish service eligibility for no more
19.2than 60 calendar days after the date of assessment. The effective eligibility start date
19.3for these programs can never be prior to the date of assessment. If an assessment was
19.4completed more than 60 days before the effective waiver or alternative care program
19.5eligibility start date, assessment and support plan information must be updated in a
19.6face-to-face visit and documented in the department's Medicaid Management Information
19.7System (MMIS). The effective date of program eligibility in this case cannot be prior to
19.8the date the updated assessment is completed.

19.9    Sec. 20. Minnesota Statutes 2009 Supplement, section 256B.0911, subdivision 3b,
19.10is amended to read:
19.11    Subd. 3b. Transition assistance. (a) A long-term care consultation team shall
19.12provide assistance to persons residing in a nursing facility, hospital, regional treatment
19.13center, or intermediate care facility for persons with developmental disabilities who
19.14request or are referred for assistance. Transition assistance must include assessment,
19.15community support plan development, referrals to long-term care options counseling
19.16under section 256B.975, subdivision 10, for community support plan implementation
19.17and to Minnesota health care programs, including home and community-based waiver
19.18services and consumer-directed options through the waivers, and referrals to programs
19.19that provide assistance with housing. Transition assistance must also include information
19.20about the Centers for Independent Living and the Senior LinkAge Line, and about other
19.21organizations that can provide assistance with relocation efforts, and information about
19.22contacting these organizations to obtain their assistance and support.
19.23    (b) The county shall develop transition processes with institutional social workers
19.24and discharge planners to ensure that:
19.25    (1) persons admitted to facilities receive information about transition assistance
19.26that is available;
19.27    (2) the assessment is completed for persons within ten working days of the date of
19.28request or recommendation for assessment; and
19.29    (3) there is a plan for transition and follow-up for the individual's return to the
19.30community. The plan must require notification of other local agencies when a person
19.31who may require assistance is screened by one county for admission to a facility located
19.32in another county.
19.33    (c) If a person who is eligible for a Minnesota health care program is admitted to a
19.34nursing facility, the nursing facility must include a consultation team member or the case
19.35manager in the discharge planning process.

20.1    Sec. 21. Minnesota Statutes 2008, section 256B.0911, subdivision 4d, is amended to
20.2read:
20.3    Subd. 4d. Preadmission screening of individuals under 65 years of age. (a)
20.4It is the policy of the state of Minnesota to ensure that individuals with disabilities or
20.5chronic illness are served in the most integrated setting appropriate to their needs and have
20.6the necessary information to make informed choices about home and community-based
20.7service options.
20.8    (b) Individuals under 65 years of age who are admitted to a nursing facility from a
20.9hospital must be screened prior to admission as outlined in subdivisions 4a through 4c.
20.10    (c) Individuals under 65 years of age who are admitted to nursing facilities with
20.11only a telephone screening must receive a face-to-face assessment from the long-term
20.12care consultation team member of the county in which the facility is located or from the
20.13recipient's county case manager within 40 calendar days of admission.
20.14    (d) Individuals under 65 years of age who are admitted to a nursing facility
20.15without preadmission screening according to the exemption described in subdivision 4b,
20.16paragraph (a), clause (3), and who remain in the facility longer than 30 days must receive
20.17a face-to-face assessment within 40 days of admission.
20.18    (e) At the face-to-face assessment, the long-term care consultation team member or
20.19county case manager must perform the activities required under subdivision 3b.
20.20    (f) For individuals under 21 years of age, a screening interview which recommends
20.21nursing facility admission must be face-to-face and approved by the commissioner before
20.22the individual is admitted to the nursing facility.
20.23    (g) In the event that an individual under 65 years of age is admitted to a nursing
20.24facility on an emergency basis, the county must be notified of the admission on the
20.25next working day, and a face-to-face assessment as described in paragraph (c) must be
20.26conducted within 40 calendar days of admission.
20.27    (h) At the face-to-face assessment, the long-term care consultation team member or
20.28the case manager must present information about home and community-based options,
20.29including consumer-directed options, so the individual can make informed choices. If the
20.30individual chooses home and community-based services, the long-term care consultation
20.31team member or case manager must complete a written relocation plan within 20 working
20.32days of the visit. The plan shall describe the services needed to move out of the facility
20.33and a time line for the move which is designed to ensure a smooth transition to the
20.34individual's home and community.
20.35    (i) An individual under 65 years of age residing in a nursing facility shall receive a
20.36face-to-face assessment at least every 12 months to review the person's service choices
21.1and available alternatives unless the individual indicates, in writing, that annual visits are
21.2not desired. In this case, the individual must receive a face-to-face assessment at least
21.3once every 36 months for the same purposes.
21.4    (j) Notwithstanding the provisions of subdivision 6, the commissioner may pay
21.5county agencies directly for face-to-face assessments for individuals under 65 years of age
21.6who are being considered for placement or residing in a nursing facility.

21.7    Sec. 22. Minnesota Statutes 2009 Supplement, section 256D.44, subdivision 5, is
21.8amended to read:
21.9    Subd. 5. Special needs. In addition to the state standards of assistance established in
21.10subdivisions 1 to 4, payments are allowed for the following special needs of recipients of
21.11Minnesota supplemental aid who are not residents of a nursing home, a regional treatment
21.12center, or a group residential housing facility.
21.13    (a) The county agency shall pay a monthly allowance for medically prescribed
21.14diets if the cost of those additional dietary needs cannot be met through some other
21.15maintenance benefit. The need for special diets or dietary items must be prescribed by
21.16a licensed physician. Costs for special diets shall be determined as percentages of the
21.17allotment for a one-person household under the thrifty food plan as defined by the United
21.18States Department of Agriculture. The types of diets and the percentages of the thrifty
21.19food plan that are covered are as follows:
21.20    (1) high protein diet, at least 80 grams daily, 25 percent of thrifty food plan;
21.21    (2) controlled protein diet, 40 to 60 grams and requires special products, 100 percent
21.22of thrifty food plan;
21.23    (3) controlled protein diet, less than 40 grams and requires special products, 125
21.24percent of thrifty food plan;
21.25    (4) low cholesterol diet, 25 percent of thrifty food plan;
21.26    (5) high residue diet, 20 percent of thrifty food plan;
21.27    (6) pregnancy and lactation diet, 35 percent of thrifty food plan;
21.28    (7) gluten-free diet, 25 percent of thrifty food plan;
21.29    (8) lactose-free diet, 25 percent of thrifty food plan;
21.30    (9) antidumping diet, 15 percent of thrifty food plan;
21.31    (10) hypoglycemic diet, 15 percent of thrifty food plan; or
21.32    (11) ketogenic diet, 25 percent of thrifty food plan.
21.33    (b) Payment for nonrecurring special needs must be allowed for necessary home
21.34repairs or necessary repairs or replacement of household furniture and appliances using
22.1the payment standard of the AFDC program in effect on July 16, 1996, for these expenses,
22.2as long as other funding sources are not available.
22.3    (c) A fee for guardian or conservator service is allowed at a reasonable rate
22.4negotiated by the county or approved by the court. This rate shall not exceed five percent
22.5of the assistance unit's gross monthly income up to a maximum of $100 per month. If the
22.6guardian or conservator is a member of the county agency staff, no fee is allowed.
22.7    (d) The county agency shall continue to pay a monthly allowance of $68 for
22.8restaurant meals for a person who was receiving a restaurant meal allowance on June 1,
22.91990, and who eats two or more meals in a restaurant daily. The allowance must continue
22.10until the person has not received Minnesota supplemental aid for one full calendar month
22.11or until the person's living arrangement changes and the person no longer meets the criteria
22.12for the restaurant meal allowance, whichever occurs first.
22.13    (e) A fee of ten percent of the recipient's gross income or $25, whichever is less,
22.14is allowed for representative payee services provided by an agency that meets the
22.15requirements under SSI regulations to charge a fee for representative payee services. This
22.16special need is available to all recipients of Minnesota supplemental aid regardless of
22.17their living arrangement.
22.18    (f)(1) Notwithstanding the language in this subdivision, an amount equal to the
22.19maximum allotment authorized by the federal Food Stamp Program for a single individual
22.20which is in effect on the first day of July of each year will be added to the standards of
22.21assistance established in subdivisions 1 to 4 for adults under the age of 65 who qualify
22.22as shelter needy and are: (i) relocating from an institution, or an adult mental health
22.23residential treatment program under section 256B.0622; (ii) eligible for the self-directed
22.24supports option as defined under section 256B.0657, subdivision 2; or (iii) home and
22.25community-based waiver recipients living in their own home or rented or leased apartment
22.26which is not owned, operated, or controlled by a provider of service not related by blood
22.27or marriage, unless allowed under paragraph (g).
22.28    (2) Notwithstanding subdivision 3, paragraph (c), an individual eligible for the
22.29shelter needy benefit under this paragraph is considered a household of one. An eligible
22.30individual who receives this benefit prior to age 65 may continue to receive the benefit
22.31after the age of 65.
22.32    (3) "Shelter needy" means that the assistance unit incurs monthly shelter costs that
22.33exceed 40 percent of the assistance unit's gross income before the application of this
22.34special needs standard. "Gross income" for the purposes of this section is the applicant's or
22.35recipient's income as defined in section 256D.35, subdivision 10, or the standard specified
22.36in subdivision 3, paragraph (a) or (b), whichever is greater. A recipient of a federal or
23.1state housing subsidy, that limits shelter costs to a percentage of gross income, shall not be
23.2considered shelter needy for purposes of this paragraph.
23.3(g) Notwithstanding this subdivision, to access housing and services as provided
23.4in paragraph (f), the recipient may choose housing that may or may not be owned,
23.5operated, or controlled by the recipient's service provider if the housing is located in a
23.6multifamily building of six or more units. In a multifamily building of four or more units,
23.7the maximum number of units apartments that may be used by recipients of this program
23.8shall be 50 percent of the units in a building. The department shall develop an exception
23.9process to the 50 percent maximum. This paragraph expires on June 30, 2011 2012.

23.10    Sec. 23. Minnesota Statutes 2008, section 326B.43, subdivision 2, is amended to read:
23.11    Subd. 2. Agreement with municipality. The commissioner may enter into an
23.12agreement with a municipality, in which the municipality agrees to perform plan and
23.13specification reviews required to be performed by the commissioner under Minnesota
23.14Rules, part 4715.3130, if:
23.15    (a) the municipality has adopted:
23.16    (1) the plumbing code;
23.17    (2) an ordinance that requires plumbing plans and specifications to be submitted to,
23.18reviewed, and approved by the municipality, except as provided in paragraph (n);
23.19    (3) an ordinance that authorizes the municipality to perform inspections required by
23.20the plumbing code; and
23.21    (4) an ordinance that authorizes the municipality to enforce the plumbing code in its
23.22entirety, except as provided in paragraph (p);
23.23    (b) the municipality agrees to review plumbing plans and specifications for all
23.24construction for which the plumbing code requires the review of plumbing plans and
23.25specifications, except as provided in paragraph (n);
23.26    (c) the municipality agrees that, when it reviews plumbing plans and specifications
23.27under paragraph (b), the review will:
23.28    (1) reflect the degree to which the plans and specifications affect the public health
23.29and conform to the provisions of the plumbing code;
23.30    (2) ensure that there is no physical connection between water supply systems that
23.31are safe for domestic use and those that are unsafe for domestic use; and
23.32    (3) ensure that there is no apparatus through which unsafe water may be discharged
23.33or drawn into a safe water supply system;
24.1    (d) the municipality agrees to perform all inspections required by the plumbing
24.2code in connection with projects for which the municipality reviews plumbing plans and
24.3specifications under paragraph (b);
24.4    (e) the commissioner determines that the individuals who will conduct the
24.5inspections and the plumbing plan and specification reviews for the municipality do not
24.6have any conflict of interest in conducting the inspections and the plan and specification
24.7reviews;
24.8    (f) individuals who will conduct the plumbing plan and specification reviews for
24.9the municipality are:
24.10    (1) licensed master plumbers;
24.11    (2) licensed professional engineers; or
24.12    (3) individuals who are working under the supervision of a licensed professional
24.13engineer or licensed master plumber and who are licensed master or journeyman plumbers
24.14or hold a postsecondary degree in engineering;
24.15    (g) individuals who will conduct the plumbing plan and specification reviews for
24.16the municipality have passed a competency assessment required by the commissioner to
24.17assess the individual's competency at reviewing plumbing plans and specifications;
24.18    (h) individuals who will conduct the plumbing inspections for the municipality
24.19are licensed master or journeyman plumbers, or inspectors meeting the competency
24.20requirements established in rules adopted under section 326B.135;
24.21    (i) the municipality agrees to enforce in its entirety the plumbing code on all
24.22projects, except as provided in paragraph (p);
24.23    (j) the municipality agrees to keep official records of all documents received,
24.24including plans, specifications, surveys, and plot plans, and of all plan reviews, permits
24.25and certificates issued, reports of inspections, and notices issued in connection with
24.26plumbing inspections and the review of plumbing plans and specifications;
24.27    (k) the municipality agrees to maintain the records described in paragraph (j) in the
24.28official records of the municipality for the period required for the retention of public
24.29records under section 138.17, and shall make these records readily available for review at
24.30the request of the commissioner;
24.31    (l) the municipality and the commissioner agree that if at any time during the
24.32agreement the municipality does not have in effect the plumbing code or any of ordinances
24.33described in paragraph (a), or if the commissioner determines that the municipality is not
24.34properly administering and enforcing the plumbing code or is otherwise not complying
24.35with the agreement:
25.1    (1) the commissioner may, effective 14 days after the municipality's receipt of
25.2written notice, terminate the agreement;
25.3    (2) the municipality may challenge the termination in a contested case before the
25.4commissioner pursuant to the Administrative Procedure Act; and
25.5    (3) while any challenge is pending under clause (2), the commissioner shall perform
25.6plan and specification reviews within the municipality under Minnesota Rules, part
25.74715.3130;
25.8    (m) the municipality and the commissioner agree that the municipality may terminate
25.9the agreement with or without cause on 90 days' written notice to the commissioner;
25.10    (n) the municipality and the commissioner agree that the municipality shall forward
25.11to the state for review all plumbing plans and specifications for the following types of
25.12projects within the municipality:
25.13    (1) hospitals, nursing homes, supervised living facilities licensed for eight or
25.14more individuals, and similar health-care-related facilities regulated by the Minnesota
25.15Department of Health;
25.16    (2) buildings owned by the federal or state government; and
25.17    (3) projects of a special nature for which department review is requested by either
25.18the municipality or the state;
25.19    (o) where the municipality forwards to the state for review plumbing plans and
25.20specifications, as provided in paragraph (n), the municipality shall not collect any fee for
25.21plan review, and the commissioner shall collect all applicable fees for plan review; and
25.22    (p) no municipality shall revoke, suspend, or place restrictions on any plumbing
25.23license issued by the state.

25.24    Sec. 24. Minnesota Statutes 2008, section 626.557, subdivision 9a, is amended to read:
25.25    Subd. 9a. Evaluation and referral of reports made to common entry point unit.
25.26    The common entry point must screen the reports of alleged or suspected maltreatment for
25.27immediate risk and make all necessary referrals as follows:
25.28    (1) if the common entry point determines that there is an immediate need for
25.29adult protective services, the common entry point agency shall immediately notify the
25.30appropriate county agency;
25.31    (2) if the report contains suspected criminal activity against a vulnerable adult, the
25.32common entry point shall immediately notify the appropriate law enforcement agency;
25.33    (3) if the report references alleged or suspected maltreatment and there is no
25.34immediate need for adult protective services, the common entry point shall notify refer all
26.1reports of alleged or suspected maltreatment to the appropriate lead agency as soon as
26.2possible, but in any event no longer than two working days; and
26.3    (4) if the report does not reference alleged or suspected maltreatment, the common
26.4entry point may determine whether the information will be referred; and
26.5    (5) (4) if the report contains information about a suspicious death, the common entry
26.6point shall immediately notify the appropriate law enforcement agencies, the local medical
26.7examiner, and the ombudsman established under section 245.92. Law enforcement
26.8agencies shall coordinate with the local medical examiner and the ombudsman as provided
26.9by law.

26.10    Sec. 25. Laws 2009, chapter 79, article 8, section 81, is amended to read:
26.11    Sec. 81. ESTABLISHING A SINGLE SET OF STANDARDS.
26.12(a) The commissioner of human services shall consult with disability service
26.13providers, advocates, counties, and consumer families to develop a single set of standards,
26.14to be referred to as "quality outcome standards," governing services for people with
26.15disabilities receiving services under the home and community-based waiver services
26.16program to replace all or portions of existing laws and rules including, but not limited
26.17to, data practices, licensure of facilities and providers, background studies, reporting
26.18of maltreatment of minors, reporting of maltreatment of vulnerable adults, and the
26.19psychotropic medication checklist. The standards must:
26.20(1) enable optimum consumer choice;
26.21(2) be consumer driven;
26.22(3) link services to individual needs and life goals;
26.23(4) be based on quality assurance and individual outcomes;
26.24(5) utilize the people closest to the recipient, who may include family, friends, and
26.25health and service providers, in conjunction with the recipient's risk management plan to
26.26assist the recipient or the recipient's guardian in making decisions that meet the recipient's
26.27needs in a cost-effective manner and assure the recipient's health and safety;
26.28(6) utilize person-centered planning; and
26.29(7) maximize federal financial participation.
26.30(b) The commissioner may consult with existing stakeholder groups convened under
26.31the commissioner's authority, including the home and community-based expert services
26.32panel established by the commissioner in 2008, to meet all or some of the requirements
26.33of this section.
27.1(c) The commissioner shall provide the reports and plans required by this section to
27.2the legislative committees and budget divisions with jurisdiction over health and human
27.3services policy and finance by January 15, 2012.

27.4    Sec. 26. ELDERLY WAIVER CONVERSION.
27.5    Notwithstanding Minnesota Statutes, section 256B.0915, subdivision 3b, a person
27.6age 65 or older with an MT home care rating on January 1, 2010, is eligible for the elderly
27.7waiver program and shall be considered a conversion for purposes of accessing monthly
27.8budget caps equal to no more than the person's monthly spending under the personal care
27.9assistance program on January 1, 2010.

27.10    Sec. 27. DIRECTION TO COMMISSIONER; CONSULTATION WITH
27.11STAKEHOLDERS.
27.12    The commissioner shall consult with stakeholders experienced in using and
27.13providing services through the consumer-directed community supports option during
27.14the identification of data to be used in future development of an individualized budget
27.15methodology for the home and community-based waivers for individuals with disabilities
27.16under the new comprehensive assessment.

27.17    Sec. 28. CASE MANAGEMENT REFORM.
27.18(a) By February 1, 2011, the commissioner of human services shall provide specific
27.19recommendations and language for proposed legislation to:
27.20(1) define the administrative and the service functions of case management and make
27.21changes to improve the funding for administrative functions;
27.22(2) standardize and simplify processes, standards, and timelines for administrative
27.23functions of case management within the Department of Human Services, Disability
27.24Services Division, including eligibility determinations, resource allocation, management
27.25of dollars, provision for assignment of one case manager at a time per person, waiting lists,
27.26quality assurance, host county concurrence requirements, county of financial responsibility
27.27provisions, and waiver compliance; and
27.28(3) increase opportunities for consumer choice of case management functions
27.29involving service coordination.
27.30(b) In developing these recommendations, the commissioner shall consider the
27.31recommendations of the 2007 Redesigning Case Management Services for Persons
27.32with Disabilities report and consult with existing stakeholder groups, which include
28.1representatives of counties, disability and senior advocacy groups, service providers, and
28.2representatives of agencies which provide contracted case management.
28.3EFFECTIVE DATE.This section is effective the day following final enactment.

28.4ARTICLE 2

28.5PERSONAL CARE ASSISTANT SERVICES

28.6    Section 1. Minnesota Statutes 2009 Supplement, section 256B.0653, subdivision 3,
28.7is amended to read:
28.8    Subd. 3. Home health aide visits. (a) Home health aide visits must be provided
28.9by a certified home health aide using a written plan of care that is updated in compliance
28.10with Medicare regulations. A home health aide shall provide hands-on personal care,
28.11perform simple procedures as an extension of therapy or nursing services, and assist in
28.12instrumental activities of daily living as defined in section 256B.0659, including assuring
28.13that the person gets to medical appointments if identified in the written plan of care. Home
28.14health aide visits must be provided in the recipient's home.
28.15    (b) All home health aide visits must have authorization under section 256B.0652.
28.16The commissioner shall limit home health aide visits to no more than one visit per day
28.17per recipient.
28.18    (c) Home health aides must be supervised by a registered nurse or an appropriate
28.19therapist when providing services that are an extension of therapy.

28.20    Sec. 2. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 1,
28.21is amended to read:
28.22    Subdivision 1. Definitions. (a) For the purposes of this section, the terms defined in
28.23paragraphs (b) to (p) (r) have the meanings given unless otherwise provided in text.
28.24    (b) "Activities of daily living" means grooming, dressing, bathing, transferring,
28.25mobility, positioning, eating, and toileting.
28.26    (c) "Behavior," effective January 1, 2010, means a category to determine the home
28.27care rating and is based on the criteria found in this section. "Level I behavior" means
28.28physical aggression towards self, others, or destruction of property that requires the
28.29immediate response of another person.
28.30    (d) "Complex health-related needs," effective January 1, 2010, means a category to
28.31determine the home care rating and is based on the criteria found in this section.
28.32    (e) "Critical activities of daily living," effective January 1, 2010, means transferring,
28.33mobility, eating, and toileting.
29.1    (f) "Dependency in activities of daily living" means a person requires assistance to
29.2begin and complete one or more of the activities of daily living.
29.3    (g) "Extended personal care assistance service" means personal care assistance
29.4services included in a service plan under one of the home and community-based services
29.5waivers authorized under sections 256B.49, 256B.0915, and 256B.092, subdivision
29.65, which exceed the amount, duration, and frequency of the state plan personal care
29.7assistance services for participants who:
29.8    (1) need assistance provided periodically during a week, but less than daily will not
29.9be able to remain in their home without the assistance, and other replacement services
29.10are more expensive or are not available when personal care assistance services are to be
29.11terminated; or
29.12    (2) need additional personal care assistance services beyond the amount authorized
29.13by the state plan personal care assistance assessment in order to ensure that their safety,
29.14health, and welfare are provided for in their homes.
29.15    (h) "Health-related procedures and tasks" means procedures and tasks that can
29.16be delegated or assigned by a licensed health care professional under state law to be
29.17performed by a personal care assistant.
29.18    (h) (i) "Instrumental activities of daily living" means activities to include meal
29.19planning and preparation; basic assistance with paying bills; shopping for food, clothing,
29.20and other essential items; performing household tasks integral to the personal care
29.21assistance services; communication by telephone and other media; and traveling, including
29.22to medical appointments and to participate in the community.
29.23    (i) (j) "Managing employee" has the same definition as Code of Federal Regulations,
29.24title 42, section 455.
29.25    (j) (k) "Qualified professional" means a professional providing supervision of
29.26personal care assistance services and staff as defined in section 256B.0625, subdivision
29.2719c .
29.28    (k) (l) "Personal care assistance provider agency" means a medical assistance
29.29enrolled provider that provides or assists with providing personal care assistance services
29.30and includes a personal care assistance provider organization, personal care assistance
29.31choice agency, class A licensed nursing agency, and Medicare-certified home health
29.32agency.
29.33    (l) (m) "Personal care assistant" or "PCA" means an individual employed by a
29.34personal care assistance agency who provides personal care assistance services.
30.1    (m) (n) "Personal care assistance care plan" means a written description of personal
30.2care assistance services developed by the personal care assistance provider according
30.3to the service plan.
30.4    (n) (o) "Responsible party" means an individual who is capable of providing the
30.5support necessary to assist the recipient to live in the community.
30.6    (o) (p) "Self-administered medication" means medication taken orally, by injection
30.7or insertion, or applied topically without the need for assistance.
30.8    (p) (q) "Service plan" means a written summary of the assessment and description of
30.9the services needed by the recipient.
30.10    (r) "Wages and benefits" means wages and salaries, the employer's share of FICA
30.11taxes, Medicare taxes, state and federal unemployment taxes, workers' compensation,
30.12mileage reimbursement, health and dental insurance, life insurance, disability insurance,
30.13long-term care insurance, uniform allowance, and contributions to employee retirement
30.14accounts.

30.15    Sec. 3. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 3,
30.16is amended to read:
30.17    Subd. 3. Noncovered personal care assistance services. (a) Personal care
30.18assistance services are not eligible for medical assistance payment under this section
30.19when provided:
30.20    (1) by the recipient's spouse, parent of a recipient under the age of 18, paid legal
30.21guardian, licensed foster provider, except as allowed under section 256B.0651, subdivision
30.2210 , or responsible party;
30.23    (2) in lieu of other staffing options in a residential or child care setting;
30.24    (3) solely as a child care or babysitting service; or
30.25    (4) without authorization by the commissioner or the commissioner's designee.
30.26    (b) The following personal care services are not eligible for medical assistance
30.27payment under this section when provided in residential settings:
30.28    (1) effective January 1, 2010, when the provider of home care services who is not
30.29related by blood, marriage, or adoption owns or otherwise controls the living arrangement,
30.30including licensed or unlicensed services; or
30.31    (2) when personal care assistance services are the responsibility of a residential or
30.32program license holder under the terms of a service agreement and administrative rules.
30.33    (c) Other specific tasks not covered under paragraph (a) or (b) that are not eligible
30.34for medical assistance reimbursement for personal care assistance services under this
30.35section include:
31.1    (1) sterile procedures;
31.2    (2) injections of fluids and medications into veins, muscles, or skin;
31.3    (3) home maintenance or chore services;
31.4    (4) homemaker services not an integral part of assessed personal care assistance
31.5services needed by a recipient;
31.6    (5) application of restraints or implementation of procedures under section 245.825;
31.7    (6) instrumental activities of daily living for children under the age of 18, except
31.8when immediate attention is needed for health or hygiene reasons integral to the personal
31.9care services and the need is listed in the service plan by the assessor; and
31.10    (7) assessments for personal care assistance services by personal care assistance
31.11provider agencies or by independently enrolled registered nurses.

31.12    Sec. 4. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 4,
31.13is amended to read:
31.14    Subd. 4. Assessment for personal care assistance services; limitations. (a) An
31.15assessment as defined in subdivision 3a must be completed for personal care assistance
31.16services.
31.17    (b) The following limitations apply to the assessment:
31.18    (1) a person must be assessed as dependent in an activity of daily living based on
31.19the person's daily need or need on the days during the week the activity is completed,
31.20on a daily basis, for:
31.21    (i) cuing and constant supervision to complete the task; or
31.22    (ii) hands-on assistance to complete the task; and
31.23    (2) a child may not be found to be dependent in an activity of daily living if because
31.24of the child's age an adult would either perform the activity for the child or assist the child
31.25with the activity. Assistance needed is the assistance appropriate for a typical child of
31.26the same age.
31.27    (c) Assessment for complex health-related needs must meet the criteria in this
31.28paragraph. During the assessment process, a recipient qualifies as having complex
31.29health-related needs if the recipient has one or more of the interventions that are ordered by
31.30a physician, specified in a personal care assistance care plan, and found in the following:
31.31    (1) tube feedings requiring:
31.32    (i) a gastro/jejunostomy gastrojejunostomy tube; or
31.33    (ii) continuous tube feeding lasting longer than 12 hours per day;
31.34    (2) wounds described as:
31.35    (i) stage III or stage IV;
32.1    (ii) multiple wounds;
32.2    (iii) requiring sterile or clean dressing changes or a wound vac; or
32.3    (iv) open lesions such as burns, fistulas, tube sites, or ostomy sites that require
32.4specialized care;
32.5    (3) parenteral therapy described as:
32.6    (i) IV therapy more than two times per week lasting longer than four hours for
32.7each treatment; or
32.8    (ii) total parenteral nutrition (TPN) daily;
32.9    (4) respiratory interventions including:
32.10    (i) oxygen required more than eight hours per day;
32.11    (ii) respiratory vest more than one time per day;
32.12    (iii) bronchial drainage treatments more than two times per day;
32.13    (iv) sterile or clean suctioning more than six times per day;
32.14    (v) dependence on another to apply respiratory ventilation augmentation devices
32.15such as BiPAP and CPAP; and
32.16    (vi) ventilator dependence under section 256B.0652;
32.17    (5) insertion and maintenance of catheter including:
32.18    (i) sterile catheter changes more than one time per month;
32.19    (ii) clean self-catheterization more than six times per day; or
32.20    (iii) bladder irrigations;
32.21    (6) bowel program more than two times per week requiring more than 30 minutes to
32.22perform each time;
32.23    (7) neurological intervention including:
32.24    (i) seizures more than two times per week and requiring significant physical
32.25assistance to maintain safety; or
32.26    (ii) swallowing disorders diagnosed by a physician and requiring specialized
32.27assistance from another on a daily basis; and
32.28    (8) other congenital or acquired diseases creating a need for significantly increased
32.29direct hands-on assistance and interventions in six to eight activities of daily living.
32.30    (d) An assessment of behaviors must meet the criteria in this paragraph. A recipient
32.31qualifies as having a need for assistance due to behaviors if the recipient's behavior requires
32.32assistance at least four times per week and shows one or more of the following behaviors:
32.33    (1) physical aggression towards self or others, or destruction of property that requires
32.34the immediate response of another person;
32.35    (2) increased vulnerability due to cognitive deficits or socially inappropriate
32.36behavior; or
33.1    (3) verbally aggressive and resistive to care.

33.2    Sec. 5. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 11,
33.3is amended to read:
33.4    Subd. 11. Personal care assistant; requirements. (a) A personal care assistant
33.5must meet the following requirements:
33.6    (1) be at least 18 years of age with the exception of persons who are 16 or 17 years
33.7of age with these additional requirements:
33.8    (i) supervision by a qualified professional every 60 days; and
33.9    (ii) employment by only one personal care assistance provider agency responsible
33.10for compliance with current labor laws;
33.11    (2) be employed by a personal care assistance provider agency;
33.12    (3) enroll with the department as a personal care assistant after clearing a background
33.13study. Before a personal care assistant provides services, the personal care assistance
33.14provider agency must initiate a background study on the personal care assistant under
33.15chapter 245C, and the personal care assistance provider agency must have received a
33.16notice from the commissioner that the personal care assistant is:
33.17    (i) not disqualified under section 245C.14; or
33.18    (ii) is disqualified, but the personal care assistant has received a set aside of the
33.19disqualification under section 245C.22;
33.20    (4) be able to effectively communicate with the recipient and personal care
33.21assistance provider agency;
33.22    (5) be able to provide covered personal care assistance services according to the
33.23recipient's personal care assistance care plan, respond appropriately to recipient needs,
33.24and report changes in the recipient's condition to the supervising qualified professional
33.25or physician;
33.26    (6) not be a consumer of personal care assistance services;
33.27    (7) maintain daily written records including, but not limited to, time sheets under
33.28subdivision 12;
33.29    (8) effective January 1, 2010, complete standardized training as determined
33.30by the commissioner before completing enrollment. The training must be available
33.31in languages other than English and to those who need accommodations due to
33.32disabilities. Personal care assistant training must include successful completion of the
33.33following training components: basic first aid, vulnerable adult, child maltreatment,
33.34OSHA universal precautions, basic roles and responsibilities of personal care assistants
33.35including information about assistance with lifting and transfers for recipients, emergency
34.1preparedness, orientation to positive behavioral practices, fraud issues, and completion of
34.2time sheets. Upon completion of the training components, the personal care assistant must
34.3demonstrate the competency to provide assistance to recipients;
34.4    (9) complete training and orientation on the needs of the recipient within the first
34.5seven days after the services begin; and
34.6    (10) be limited to providing and being paid for up to 310 hours per month of personal
34.7care assistance services regardless of the number of recipients being served or the number
34.8of personal care assistance provider agencies enrolled with. The number of hours worked
34.9per day shall not be disallowed by the department unless in violation of the law.
34.10    (b) A legal guardian may be a personal care assistant if the guardian is not being paid
34.11for the guardian services and meets the criteria for personal care assistants in paragraph (a).
34.12    (c) Effective January 1, 2010, persons who do not qualify as a personal care assistant
34.13include parents and stepparents of minors, spouses, paid legal guardians, family foster
34.14care providers, except as otherwise allowed in section 256B.0625, subdivision 19a, or
34.15staff of a residential setting.

34.16    Sec. 6. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 13,
34.17is amended to read:
34.18    Subd. 13. Qualified professional; qualifications. (a) The qualified professional
34.19must be employed by a personal care assistance provider agency and meet the definition
34.20under section 256B.0625, subdivision 19c. Before a qualified professional provides
34.21services, the personal care assistance provider agency must initiate a background study on
34.22the qualified professional under chapter 245C, and the personal care assistance provider
34.23agency must have received a notice from the commissioner that the qualified professional:
34.24    (1) is not disqualified under section 245C.14; or
34.25    (2) is disqualified, but the qualified professional has received a set aside of the
34.26disqualification under section 245C.22.
34.27    (b) The qualified professional shall perform the duties of training, supervision, and
34.28evaluation of the personal care assistance staff and evaluation of the effectiveness of
34.29personal care assistance services. The qualified professional shall:
34.30    (1) develop and monitor with the recipient a personal care assistance care plan based
34.31on the service plan and individualized needs of the recipient;
34.32    (2) develop and monitor with the recipient a monthly plan for the use of personal
34.33care assistance services;
34.34    (3) review documentation of personal care assistance services provided;
35.1    (4) provide training and ensure competency for the personal care assistant in the
35.2individual needs of the recipient; and
35.3    (5) document all training, communication, evaluations, and needed actions to
35.4improve performance of the personal care assistants.
35.5    (c) Effective January July 1, 2010, the qualified professional shall complete the
35.6provider training with basic information about the personal care assistance program
35.7approved by the commissioner within six months of the date hired by a personal care
35.8assistance provider agency. Qualified professionals who have completed the required
35.9trainings as an employee with a personal care assistance provider agency do not need to
35.10repeat the required trainings if they are hired by another agency, if they have completed the
35.11training within the last three years. The required training shall be available in languages
35.12other than English and to those who need accommodations due to disabilities, online, or
35.13by electronic remote connection, and provide for competency testing to demonstrate an
35.14understanding of the content without attending in-person training. A qualified professional
35.15is allowed to be employed and is not subject to the training requirement until the training is
35.16offered online or through remote electronic connection. A qualified professional employed
35.17by a personal care assistance provider agency certified for participation in Medicare as
35.18a home health agency is exempt from the training required in this subdivision. The
35.19commissioner shall ensure there is a mechanism in place to verify the identity of persons
35.20completing the competency testing electronically.

35.21    Sec. 7. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 14,
35.22is amended to read:
35.23    Subd. 14. Qualified professional; duties. (a) Effective January 1, 2010, all personal
35.24care assistants must be supervised by a qualified professional.
35.25    (b) Through direct training, observation, return demonstrations, and consultation
35.26with the staff and the recipient, the qualified professional must ensure and document
35.27that the personal care assistant is:
35.28    (1) capable of providing the required personal care assistance services;
35.29    (2) knowledgeable about the plan of personal care assistance services before services
35.30are performed; and
35.31    (3) able to identify conditions that should be immediately brought to the attention of
35.32the qualified professional.
35.33    (c) The qualified professional shall evaluate the personal care assistant within the first
35.3414 days of starting to provide regularly scheduled services for a recipient except for the
35.35personal care assistance choice option under subdivision 19, paragraph (a), clause (4). For
36.1the initial evaluation, the qualified professional shall evaluate the personal care assistance
36.2services for a recipient through direct observation of a personal care assistant's work.
36.3Subsequent visits to evaluate the personal care assistance services provided to a recipient
36.4do not require direct observation of each personal care assistant's work and shall occur:
36.5    (1) at least every 90 days thereafter for the first year of a recipient's services; and
36.6    (2) every 120 days after the first year of a recipient's service or whenever needed for
36.7response to a recipient's request for increased supervision of the personal care assistance
36.8staff; and
36.9    (3) after the first 180 days of a recipient's service, supervisory visits may alternate
36.10between unscheduled phone or Internet technology and in-person visits, unless the
36.11in-person visits are needed according to the care plan.
36.12    (d) Communication with the recipient is a part of the evaluation process of the
36.13personal care assistance staff.
36.14    (e) At each supervisory visit, the qualified professional shall evaluate personal care
36.15assistance services including the following information:
36.16    (1) satisfaction level of the recipient with personal care assistance services;
36.17    (2) review of the month-to-month plan for use of personal care assistance services;
36.18    (3) review of documentation of personal care assistance services provided;
36.19    (4) whether the personal care assistance services are meeting the goals of the service
36.20as stated in the personal care assistance care plan and service plan;
36.21    (5) a written record of the results of the evaluation and actions taken to correct any
36.22deficiencies in the work of a personal care assistant; and
36.23    (6) revision of the personal care assistance care plan as necessary in consultation
36.24with the recipient or responsible party, to meet the needs of the recipient.
36.25    (f) The qualified professional shall complete the required documentation in the
36.26agency recipient and employee files and the recipient's home, including the following
36.27documentation:
36.28    (1) the personal care assistance care plan based on the service plan and individualized
36.29needs of the recipient;
36.30    (2) a month-to-month plan for use of personal care assistance services;
36.31    (3) changes in need of the recipient requiring a change to the level of service and the
36.32personal care assistance care plan;
36.33    (4) evaluation results of supervision visits and identified issues with personal care
36.34assistance staff with actions taken;
36.35    (5) all communication with the recipient and personal care assistance staff; and
36.36    (6) hands-on training or individualized training for the care of the recipient.
37.1    (g) The documentation in paragraph (f) must be done on agency forms.
37.2    (h) The services that are not eligible for payment as qualified professional services
37.3include:
37.4    (1) direct professional nursing tasks that could be assessed and authorized as skilled
37.5nursing tasks;
37.6    (2) supervision of personal care assistance completed by telephone;
37.7    (3) agency administrative activities;
37.8    (4) training other than the individualized training required to provide care for a
37.9recipient; and
37.10    (5) any other activity that is not described in this section.

37.11    Sec. 8. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 18,
37.12is amended to read:
37.13    Subd. 18. Personal care assistance choice option; generally. (a) The
37.14commissioner may allow a recipient of personal care assistance services to use a fiscal
37.15intermediary to assist the recipient in paying and accounting for medically necessary
37.16covered personal care assistance services. Unless otherwise provided in this section, all
37.17other statutory and regulatory provisions relating to personal care assistance services apply
37.18to a recipient using the personal care assistance choice option.
37.19    (b) Personal care assistance choice is an option of the personal care assistance
37.20program that allows the recipient who receives personal care assistance services to be
37.21responsible for the hiring, training, scheduling, and firing of personal care assistants
37.22according to the terms of the written agreement with the personal care assistance choice
37.23agency required under subdivision 20, paragraph (a). This program offers greater control
37.24and choice for the recipient in who provides the personal care assistance service and when
37.25the service is scheduled. The recipient or the recipient's responsible party must choose a
37.26personal care assistance choice provider agency as a fiscal intermediary. This personal
37.27care assistance choice provider agency manages payroll, invoices the state, is responsible
37.28for all payroll-related taxes and insurance, and is responsible for providing the consumer
37.29training and support in managing the recipient's personal care assistance services.

37.30    Sec. 9. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 19,
37.31is amended to read:
37.32    Subd. 19. Personal care assistance choice option; qualifications; duties. (a)
37.33Under personal care assistance choice, the recipient or responsible party shall:
38.1    (1) recruit, hire, schedule, and terminate personal care assistants and a qualified
38.2professional according to the terms of the written agreement required under subdivision
38.320, paragraph (a);
38.4    (2) develop a personal care assistance care plan based on the assessed needs
38.5and addressing the health and safety of the recipient with the assistance of a qualified
38.6professional as needed;
38.7    (3) orient and train the personal care assistant with assistance as needed from the
38.8qualified professional;
38.9    (4) effective January 1, 2010, supervise and evaluate the personal care assistant with
38.10the qualified professional, who is required to visit the recipient at least every 180 days;
38.11    (5) monitor and verify in writing and report to the personal care assistance choice
38.12agency the number of hours worked by the personal care assistant and the qualified
38.13professional;
38.14    (6) engage in an annual face-to-face reassessment to determine continuing eligibility
38.15and service authorization; and
38.16    (7) use the same personal care assistance choice provider agency if shared personal
38.17assistance care is being used.
38.18    (b) The personal care assistance choice provider agency shall:
38.19    (1) meet all personal care assistance provider agency standards;
38.20    (2) enter into a written agreement with the recipient, responsible party, and personal
38.21care assistants;
38.22    (3) not be related as a parent, child, sibling, or spouse to the recipient, qualified
38.23professional, or the personal care assistant; and
38.24    (4) ensure arm's-length transactions without undue influence or coercion with the
38.25recipient and personal care assistant.
38.26    (c) The duties of the personal care assistance choice provider agency are to:
38.27    (1) be the employer of the personal care assistant and the qualified professional for
38.28employment law and related regulations including, but not limited to, purchasing and
38.29maintaining workers' compensation, unemployment insurance, surety and fidelity bonds,
38.30and liability insurance, and submit any or all necessary documentation including, but not
38.31limited to, workers' compensation and unemployment insurance;
38.32    (2) bill the medical assistance program for personal care assistance services and
38.33qualified professional services;
38.34    (3) request and complete background studies that comply with the requirements for
38.35personal care assistants and qualified professionals;
39.1    (4) pay the personal care assistant and qualified professional based on actual hours
39.2of services provided;
39.3    (5) withhold and pay all applicable federal and state taxes;
39.4    (6) verify and keep records of hours worked by the personal care assistant and
39.5qualified professional;
39.6    (7) make the arrangements and pay taxes and other benefits, if any, and comply with
39.7any legal requirements for a Minnesota employer;
39.8    (8) enroll in the medical assistance program as a personal care assistance choice
39.9agency; and
39.10    (9) enter into a written agreement as specified in subdivision 20 before services
39.11are provided.

39.12    Sec. 10. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 20,
39.13is amended to read:
39.14    Subd. 20. Personal care assistance choice option; administration. (a) Before
39.15services commence under the personal care assistance choice option, and annually
39.16thereafter, the personal care assistance choice provider agency, recipient, or responsible
39.17party, each personal care assistant, and the qualified professional and the recipient or
39.18responsible party shall enter into a written agreement. The annual agreement must be
39.19provided to the recipient or responsible party, each personal care assistant, and the
39.20qualified professional when completed, and include at a minimum:
39.21    (1) duties of the recipient, qualified professional, personal care assistant, and
39.22personal care assistance choice provider agency;
39.23    (2) salary and benefits for the personal care assistant and the qualified professional;
39.24    (3) administrative fee of the personal care assistance choice provider agency and
39.25services paid for with that fee, including background study fees;
39.26    (4) grievance procedures to respond to complaints;
39.27    (5) procedures for hiring and terminating the personal care assistant; and
39.28    (6) documentation requirements including, but not limited to, time sheets, activity
39.29records, and the personal care assistance care plan.
39.30    (b) Effective January 1, 2010, except for the administrative fee of the personal care
39.31assistance choice provider agency as reported on the written agreement, the remainder
39.32of the rates paid to the personal care assistance choice provider agency must be used to
39.33pay for the salary and benefits for the personal care assistant or the qualified professional.
39.34The provider agency must use a minimum of 72.5 percent of the revenue generated by
40.1the medical assistance rate for personal care assistance services for employee personal
40.2care assistant wages and benefits.
40.3    (c) The commissioner shall deny, revoke, or suspend the authorization to use the
40.4personal care assistance choice option if:
40.5    (1) it has been determined by the qualified professional or public health nurse that
40.6the use of this option jeopardizes the recipient's health and safety;
40.7    (2) the parties have failed to comply with the written agreement specified in this
40.8subdivision;
40.9    (3) the use of the option has led to abusive or fraudulent billing for personal care
40.10assistance services; or
40.11    (4) the department terminates the personal care assistance choice option.
40.12    (d) The recipient or responsible party may appeal the commissioner's decision in
40.13paragraph (c) according to section 256.045. The denial, revocation, or suspension to
40.14use the personal care assistance choice option must not affect the recipient's authorized
40.15level of personal care assistance services.

40.16    Sec. 11. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 21,
40.17is amended to read:
40.18    Subd. 21. Requirements for initial enrollment of personal care assistance
40.19provider agencies. (a) All personal care assistance provider agencies must provide, at the
40.20time of enrollment as a personal care assistance provider agency in a format determined
40.21by the commissioner, information and documentation that includes, but is not limited to,
40.22the following:
40.23    (1) the personal care assistance provider agency's current contact information
40.24including address, telephone number, and e-mail address;
40.25    (2) proof of surety bond coverage in the amount of $50,000 or ten percent of the
40.26provider's payments from Medicaid in the previous year, whichever is less;
40.27    (3) proof of fidelity bond coverage in the amount of $20,000;
40.28    (4) proof of workers' compensation insurance coverage;
40.29    (5) a description of the personal care assistance provider agency's organization
40.30identifying the names of all owners, managing employees, staff, board of directors, and
40.31the affiliations of the directors, owners, or staff to other service providers;
40.32    (6) a copy of the personal care assistance provider agency's written policies and
40.33procedures including: hiring of employees; training requirements; service delivery;
40.34and employee and consumer safety including process for notification and resolution
41.1of consumer grievances, identification and prevention of communicable diseases, and
41.2employee misconduct;
41.3    (7) copies of all other forms the personal care assistance provider agency uses in
41.4the course of daily business including, but not limited to:
41.5    (i) a copy of the personal care assistance provider agency's time sheet if the time
41.6sheet varies from the standard time sheet for personal care assistance services approved
41.7by the commissioner, and a letter requesting approval of the personal care assistance
41.8provider agency's nonstandard time sheet;
41.9    (ii) the personal care assistance provider agency's template for the personal care
41.10assistance care plan; and
41.11    (iii) the personal care assistance provider agency's template for the written
41.12agreement in subdivision 20 for recipients using the personal care assistance choice
41.13option, if applicable;
41.14    (8) a list of all trainings and classes that the personal care assistance provider agency
41.15requires of its staff providing personal care assistance services;
41.16    (9) documentation that the personal care assistance provider agency and staff have
41.17successfully completed all the training required by this section;
41.18    (10) documentation of the agency's marketing practices;
41.19    (11) disclosure of ownership, leasing, or management of all residential properties
41.20that is used or could be used for providing home care services; and
41.21    (12) documentation that the agency will use the following percentages of revenue
41.22generated from the medical assistance rate paid for personal care assistance services
41.23for employee personal care assistant wages and benefits: 72.5 percent of revenue in the
41.24personal care assistance choice option and 72.5 percent of revenue from other personal
41.25care assistance providers; and
41.26    (13) effective the day following final enactment, documentation that the agency does
41.27not burden recipients' free exercise of their right to choose service providers by requiring
41.28personal care assistants to sign an agreement not to work with any particular personal
41.29care assistance recipient or for another personal care assistance provider agency after
41.30leaving the agency and that the agency is not taking action on any such agreements or
41.31requirements regardless of the date signed.
41.32    (b) Personal care assistance provider agencies shall provide the information specified
41.33in paragraph (a) to the commissioner at the time the personal care assistance provider
41.34agency enrolls as a vendor or upon request from the commissioner. The commissioner
41.35shall collect the information specified in paragraph (a) from all personal care assistance
41.36providers beginning July 1, 2009.
42.1    (c) All personal care assistance provider agencies shall require all employees in
42.2management and supervisory positions and owners of the agency who are active in the
42.3day-to-day management and operations of the agency to complete mandatory training as
42.4determined by the commissioner before enrollment of the agency as a provider. Personal
42.5care assistance provider agencies are required to send all owners, qualified professionals
42.6employed by the agency, and all other managing employees to the initial and subsequent
42.7trainings. Employees in management and supervisory positions and owners who are
42.8active in the day-to-day operations of an agency who have completed the required training
42.9as an employee with a personal care assistance provider agency do not need to repeat
42.10the required training if they are hired by another agency, if they have completed the
42.11training within the past three years. By September 1, 2010, the required training must be
42.12available in languages other than English and to those who need accommodations due
42.13to disabilities, online, or by electronic remote connection, and provide for competency
42.14testing. Personal care assistance provider agency billing staff shall complete training
42.15about personal care assistance program financial management. This training is effective
42.16July 1, 2009. Any personal care assistance provider agency enrolled before that date
42.17shall, if it has not already, complete the provider training within 18 months of July 1,
42.182009. Any new owners, new qualified professionals, and new managing or employees in
42.19management and supervisory positions involved in the day-to-day operations are required
42.20to complete mandatory training as a requisite of hiring working for the agency. Personal
42.21care assistance provider agencies certified for participation in Medicare as home health
42.22agencies are exempt from the training required in this subdivision.

42.23    Sec. 12. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 24,
42.24is amended to read:
42.25    Subd. 24. Personal care assistance provider agency; general duties. A personal
42.26care assistance provider agency shall:
42.27    (1) enroll as a Medicaid provider meeting all provider standards, including
42.28completion of the required provider training;
42.29    (2) comply with general medical assistance coverage requirements;
42.30    (3) demonstrate compliance with law and policies of the personal care assistance
42.31program to be determined by the commissioner;
42.32    (4) comply with background study requirements;
42.33    (5) verify and keep records of hours worked by the personal care assistant and
42.34qualified professional;
43.1    (6) market agency services only through printed information in brochures and on
43.2Web sites and not engage in any agency-initiated direct contact or marketing in person, by
43.3phone, or other electronic means to potential recipients, guardians, or family members;
43.4    (7) pay the personal care assistant and qualified professional based on actual hours
43.5of services provided;
43.6    (8) withhold and pay all applicable federal and state taxes;
43.7    (9) effective January 1, 2010, document that the agency uses a minimum of 72.5
43.8percent of the revenue generated by the medical assistance rate for personal care assistance
43.9services for employee personal care assistant wages and benefits;
43.10    (10) make the arrangements and pay unemployment insurance, taxes, workers'
43.11compensation, liability insurance, and other benefits, if any;
43.12    (11) enter into a written agreement under subdivision 20 before services are provided;
43.13    (12) report suspected neglect and abuse to the common entry point according to
43.14section 256B.0651;
43.15    (13) provide the recipient with a copy of the home care bill of rights at start of
43.16service; and
43.17    (14) request reassessments at least 60 days prior to the end of the current
43.18authorization for personal care assistance services, on forms provided by the commissioner.

43.19    Sec. 13. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 27,
43.20is amended to read:
43.21    Subd. 27. Personal care assistance provider agency; ventilator training. (a) The
43.22personal care assistance provider agency is required to provide training for the personal
43.23care assistant responsible for working with a recipient who is ventilator dependent. All
43.24training must be administered by a respiratory therapist, nurse, or physician. Qualified
43.25professional supervision by a nurse must be completed and documented on file in the
43.26personal care assistant's employment record and the recipient's health record. If offering
43.27personal care services to a ventilator-dependent recipient, the personal care assistance
43.28provider agency shall demonstrate and document the ability to:
43.29    (1) train the personal care assistant;
43.30    (2) supervise the personal care assistant in ventilator operation and maintenance the
43.31care of a ventilator-dependent recipient; and
43.32    (3) supervise the recipient and responsible party in ventilator operation and
43.33maintenance the care of a ventilator-dependent recipient; and
43.34    (4) provide documentation of the training and supervision in clauses (1) to (3)
43.35upon request.
44.1    (b) A personal care assistant shall not undertake any clinical services, patient
44.2assessment, patient evaluation, or clinical education regarding the ventilator or the patient
44.3on the ventilator. These services may only be provided by health care professionals
44.4licensed or registered in this state.
44.5    (c) A personal care assistant may only perform tasks associated with ventilator
44.6maintenance that are approved by the Board of Medical Practice in consultation with the
44.7Respiratory Care Practitioner Advisory Council and the Department of Human Services.

44.8    Sec. 14. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 30,
44.9is amended to read:
44.10    Subd. 30. Notice of service changes to recipients. The commissioner must provide:
44.11    (1) by October 31, 2009, information to recipients likely to be affected that (i)
44.12describes the changes to the personal care assistance program that may result in the
44.13loss of access to personal care assistance services, and (ii) includes resources to obtain
44.14further information; and
44.15    (2) notice of changes in medical assistance home care services to each affected
44.16recipient at least 30 days before the effective date of the change.
44.17The notice shall include how to get further information on the changes, how to get help to
44.18obtain other services, a list of community resources, and appeal rights. Notwithstanding
44.19section 256.045, a recipient may request continued services pending appeal within the
44.20time period allowed to request an appeal; and
44.21    (3) a service agreement authorizing personal care assistance hours of service at
44.22the previously authorized level, throughout the appeal process period, when a recipient
44.23requests services pending an appeal.

44.24    Sec. 15. Minnesota Statutes 2008, section 256B.092, subdivision 4d, is amended to
44.25read:
44.26    Subd. 4d. Medicaid reimbursement; licensed provider; related individuals. The
44.27commissioner shall seek a federal amendment to the home and community-based services
44.28waiver for individuals with developmental disabilities, to allow Medicaid reimbursement
44.29for the provision of supported living services to a related individual is allowed when the
44.30following conditions have been met: specified in section 245A.03, subdivision 9, are met.
44.31    (1) the individual is 18 years of age or older;
44.32    (2) the provider is certified initially and annually thereafter, by the county, as
44.33meeting the provider standards established in chapter 245B and the federal waiver plan;
45.1    (3) the provider has been certified by the county as meeting the adult foster care
45.2provider standards established in Minnesota Rules, parts 9555.5105 to 9555.6265;
45.3    (4) the provider is not the legal guardian or conservator of the related individual; and
45.4    (5) the individual's service plan meets the standards of this section and specifies any
45.5special conditions necessary to prevent a conflict of interest for the provider.

45.6    Sec. 16. REPEALER.
45.7Minnesota Statutes 2008, section 256B.0919, subdivision 4, is repealed.