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Minnesota Legislature

Office of the Revisor of Statutes

SF 2933

2nd Engrossment - 86th Legislature (2009 - 2010) Posted on 05/12/2010 08:51am

KEY: stricken = removed, old language.
underscored = added, new language.

Current Version - 2nd Engrossment

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A bill for an act
relating to human services; amending continuing care policy and technical
provisions; modifying the nursing facility level of care criteria; modifying
nursing facilities layaway status; permitting certain services by related
individuals; requiring home care services providers to provide recipients with
copies of the home care bill of rights; allowing personal care assistants to
enroll with a different personal care assistance provider agency; allowing lead
agencies to contract for assessments and reassessments; providing an elderly
waiver conversion under the personal care assistance program; requiring the
commissioner of human services to consult with stakeholders; requiring the
commissioner of human services provide recommendations to improve case
management services; clarifying personal care assistance provisions; amending
Minnesota Statutes 2008, sections 144A.071, subdivision 4b; 144A.161,
subdivision 1a; 245A.03, by adding a subdivision; 256B.0911, subdivision
4d; 256B.092, subdivision 4d; 326B.43, subdivision 2; 626.557, subdivision
9a; Minnesota Statutes 2009 Supplement, sections 144.0724, subdivision 11;
245A.03, subdivision 7; 245A.11, subdivision 7b; 256B.0625, subdivision 19c;
256B.0651, by adding a subdivision; 256B.0652, subdivision 6; 256B.0653,
subdivision 3; 256B.0659, subdivisions 1, 3, 4, 10, 11, 13, 14, 18, 19, 20, 21,
24, 27, 30, by adding a subdivision; 256B.0911, subdivisions 1a, 2b, 3a, 3b;
256D.44, subdivision 5; Laws 2009, chapter 79, article 8, section 81; repealing
Minnesota Statutes 2008, section 256B.0919, subdivision 4.

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

ARTICLE 1

CONTINUING CARE POLICY

Section 1.

Minnesota Statutes 2009 Supplement, section 144.0724, subdivision 11,
is amended to read:


Subd. 11.

Nursing facility level of care.

(a) For purposes of medical assistance
payment of long-term care services, a recipient must be determined, using assessments
defined in subdivision 4, to meet one of the following nursing facility level of care criteria:

new text begin (1) the person requires formal clinical monitoring at least once per day;
new text end

deleted text begin (1)deleted text endnew text begin (2)new text end the person needs the assistance of another person or constant supervision to
begin and complete at least four of the following activities of living: bathing, bed mobility,
dressing, eating, grooming, toileting, transferring, and walking;

deleted text begin (2)deleted text endnew text begin (3)new text end the person needs the assistance of another person or constant supervision
to begin and complete toileting, transferring, or positioning and the assistance cannot
be scheduled;

deleted text begin (3)deleted text endnew text begin (4)new text end the person has significant difficulty with memory, using information, daily
decision making, or behavioral needs that require intervention;

deleted text begin (4)deleted text endnew text begin (5)new text end the person has had a qualifying nursing facility stay of at least 90 daysnew text begin;
new text end

new text begin (6) the person meets the nursing facility level of care criteria determined 90 days
after admission or on the first quarterly assessment after admission, whichever is later
new text end; or

deleted text begin (5)deleted text endnew text begin (7)new text end the person is determined to be at risk for nursing facility admission or
readmission through a face-to-face long-term care consultation assessment as specified
in section 256B.0911, subdivision 3a, 3b, or 4d, by a county, tribe, or managed care
organization under contract with the Department of Human Services. The person is
considered at risk under this clause if the person currently lives alone or will live alone
upon discharge and also meets one of the following criteria:

(i) the person has experienced a fall resulting in a fracture;

(ii) the person has been determined to be at risk of maltreatment or neglect,
including self-neglect; or

(iii) the person has a sensory impairment that substantially impacts functional ability
and maintenance of a community residence.

(b) The assessment used to establish medical assistance payment for nursing facility
services must be the most recent assessment performed under subdivision 4, paragraph
(b), that occurred no more than 90 calendar days before the effective date of medical
assistance eligibility for payment of long-term care services. In no case shall medical
assistance payment for long-term care services occur prior to the date of the determination
of nursing facility level of care.

(c) The assessment used to establish medical assistance payment for long-term care
services provided under sections 256B.0915 and 256B.49 and alternative care payment
for services provided under section 256B.0913 must be the most recent face-to-face
assessment performed under section 256B.0911, subdivision 3a, 3b, or 4d, that occurred
no more than 60 calendar days before the effective date of medical assistance eligibility
for payment of long-term care services.

Sec. 2.

Minnesota Statutes 2008, section 144A.071, subdivision 4b, is amended to read:


Subd. 4b.

Licensed beds on layaway status.

A licensed and certified nursing
facility may lay away, upon prior written notice to the commissioner of health, deleted text beginup to 50
percent of its
deleted text end licensed and certified beds. A nursing facility may not discharge a resident
in order to lay away a bed. Notice to the commissioner shall be given 60 days prior
to the effective date of the layaway. Beds on layaway shall have the same status as
voluntarily delicensed and decertified beds and shall not be subject to license fees and
license surcharge fees. In addition, beds on layaway may be removed from layaway at any
time on or after one year after the effective date of layaway in the facility of origin, with a
60-day notice to the commissioner. A nursing facility that removes beds from layaway
may not place beds on layaway status for one year after the effective date of the removal
from layaway. The commissioner may approve the immediate removal of beds from
layaway if necessary to provide access to those nursing home beds to residents relocated
from other nursing homes due to emergency situations or closure. In the event approval
is granted, the one-year restriction on placing beds on layaway after a removal of beds
from layaway shall not apply. Beds may remain on layaway for up to deleted text beginfivedeleted text endnew text begin tennew text end years. The
commissioner may approve placing and removing beds on layaway at any time during
renovation or construction related to a moratorium project approved under this section
or section 144A.073. new text beginNursing facilities are not required to comply with any licensure or
certification requirements for beds on layaway status.
new text end

Sec. 3.

Minnesota Statutes 2008, section 144A.161, subdivision 1a, is amended to read:


Subd. 1a.

Scope.

Where a facility is undertaking closure, curtailment, reduction, or
change in operations, new text beginor where a housing with services unit registered under chapter 144D
is closed because the space that it occupies is being replaced by a nursing facility bed that
is being reactivated from layaway status,
new text endthe facility and the county social services agency
must comply with the requirements of this section.

Sec. 4.

Minnesota Statutes 2009 Supplement, section 245A.03, subdivision 7, is
amended to read:


Subd. 7.

Licensing moratorium.

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

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

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

(3) new foster care licenses determined to be needed by the commissioner under
paragraph (b) for the closure of a nursing facility, ICF/MR, or regional treatment center;

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Sec. 5.

Minnesota Statutes 2008, section 245A.03, is amended by adding a subdivision
to read:


new text begin Subd. 9. new text end

new text begin Permitted services by an individual who is related. new text end

new text begin Notwithstanding
subdivision 2, paragraph (a), clause (1), and subdivision 7, an individual who is related to a
person receiving supported living services may provide licensed services to that person if:
new text end

new text begin (1) the person who receives supported living services received these services in a
residential site on July 1, 2005;
new text end

new text begin (2) the services under clause (1) were provided in a corporate foster care setting for
adults and were funded by the developmental disabilities home and community-based
services waiver defined in section 256B.092;
new text end

new text begin (3) the individual who is related obtains and maintains both a license under
chapter 245B and an adult foster care license under Minnesota Rules, parts 9555.5105
to 9555.6265; and
new text end

new text begin (4) the individual who is related is not the guardian of the person receiving supported
living services.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 6.

Minnesota Statutes 2009 Supplement, section 245A.11, subdivision 7b, is
amended to read:


Subd. 7b.

Adult foster care data privacy and security.

(a) An adult foster
care license holder who creates, collects, records, maintains, stores, or discloses any
individually identifiable recipient data, whether in an electronic or any other format,
must comply with the privacy and security provisions of applicable privacy laws and
regulations, including:

(1) the federal Health Insurance Portability and Accountability Act of 1996
(HIPAA), Public Law 104-1; and the HIPAA Privacy Rule, Code of Federal Regulations,
title 45, part 160, and subparts A and E of part 164; and

(2) the Minnesota Government Data Practices Act as codified in chapter 13.

(b) For purposes of licensure, the license holder shall be monitored for compliance
with the following data privacy and security provisions:

(1) the license holder must control access to data on foster care recipients according
to the definitions of public and private data on individuals under section 13.02;
classification of the data on individuals as private under section 13.46, subdivision 2;
and control over the collection, storage, use, access, protection, and contracting related
to data according to section 13.05, in which the license holder is assigned the duties
of a government entity;

(2) the license holder must provide each foster care recipient with a notice that
meets the requirements under section 13.04, in which the license holder is assigned the
duties of the government entity, and that meets the requirements of Code of Federal
Regulations, title 45, part 164.52. The notice shall describe the purpose for collection of
the data, and to whom and why it may be disclosed pursuant to law. The notice must
inform the recipient that the license holder uses electronic monitoring and, if applicable,
that recording technology is used;

(3) the license holder must not install monitoring cameras in bathrooms;

(4) electronic monitoring cameras must not be concealed from the foster care
recipients; and

(5) electronic video and audio recordings of foster care recipients shall deleted text beginnotdeleted text end be
stored by the license holder for deleted text beginmore thandeleted text end five daysnew text begin unless: (i) a foster care recipient or
legal representative requests that the recording be held longer based on a specific report
of alleged maltreatment; or (ii) the recording captures an incident or event of alleged
maltreatment under section 626.556 or 626.557 or a crime under chapter 609. When
requested by a recipient or when a recording captures an incident or event of alleged
maltreatment or a crime, the license holder must maintain the recording in a secured area
for no longer than 30 days to give the investigating agency an opportunity to make a copy
of the recording. The investigating agency will maintain the electronic video or audio
recordings as required in section 626.557, subdivision 12b
new text end.

(c) The commissioner shall develop, and make available to license holders and
county licensing workers, a checklist of the data privacy provisions to be monitored
for purposes of licensure.

Sec. 7.

Minnesota Statutes 2009 Supplement, section 256B.0625, subdivision 19c,
is amended to read:


Subd. 19c.

Personal care.

Medical assistance covers personal care assistance
services provided by an individual who is qualified to provide the services according to
subdivision 19a and sections 256B.0651 to 256B.0656, provided in accordance with a
plan, and supervised by a qualified professional.

"Qualified professional" means a mental health professional as defined in section 245.462,
subdivision 18
, or 245.4871, subdivision 27; or a registered nurse as defined in sections
148.171 to 148.285, a licensed social worker as defined in deleted text beginsection 148B.21deleted text endnew text begin sections
148D.010 and 148D.055
new text end, or a qualified developmental disabilities specialist under section
245B.07, subdivision 4. The qualified professional shall perform the duties required in
section 256B.0659.

Sec. 8.

Minnesota Statutes 2009 Supplement, section 256B.0651, is amended by
adding a subdivision to read:


new text begin Subd. 17. new text end

new text begin Recipient protection. new text end

new text begin (a) Providers of home care services must provide
each recipient with a copy of the home care bill of rights under section 144A.44 at
least 30 days prior to terminating services to a recipient, if the termination results from
provider sanctions under section 256B.064, such as a payment withhold, a suspension of
participation, or a termination of participation. If a home care provider determines it is
unable to continue providing services to a recipient, the provider must notify the recipient,
the recipient's responsible party, and the commissioner 30 days prior to terminating
services to the recipient because of an action under section 256B.064, and must assist the
commissioner and lead agency in supporting the recipient in transitioning to another
home care provider of the recipient's choice.
new text end

new text begin (b) In the event of a payment withhold from a home care provider, a suspension of
participation, or a termination of participation of a home care provider under section
256B.064, the commissioner may inform the Office of Ombudsman for Long-Term Care
and the lead agencies for all recipients with active service agreements with the provider.
At the commissioner's request, the lead agencies must contact recipients to ensure that the
recipients are continuing to receive needed care, and that the recipients have been given
free choice of provider if they transfer to another home care provider. In addition, the
commissioner or the commissioner's delegate may directly notify recipients who receive
care from the provider that payments have been withheld or that the provider's participation
in medical assistance has been suspended or terminated, if the commissioner determines
that notification is necessary to protect the welfare of the recipients. For purposes of this
subdivision, "lead agencies" means counties, tribes, and managed care organizations.
new text end

Sec. 9.

Minnesota Statutes 2009 Supplement, section 256B.0652, subdivision 6,
is amended to read:


Subd. 6.

Authorization; personal care assistance and qualified professional.

(a) All personal care assistance services, supervision by a qualified professional, and
additional services beyond the limits established in subdivision 11, must be authorized
by the commissioner or the commissioner's designee before services begin except for the
assessments established in subdivision 11 and section 256B.0911. The authorization for
personal care assistance and qualified professional services under section 256B.0659 must
be completed within 30 days after receiving a complete request.

(b) The amount of personal care assistance services authorized must be based
on the recipient's home care rating. The home care rating shall be determined by the
commissioner or the commissioner's designee based on information submitted to the
commissioner identifying the following:

(1) total number of dependencies of activities of daily living as defined in section
256B.0659;

(2) deleted text beginnumberdeleted text endnew text begin presencenew text end of complex health-related needs as defined in section
256B.0659; and

(3) deleted text beginnumberdeleted text endnew text begin presencenew text end of new text beginLevel Inew text end behavior deleted text begindescriptionsdeleted text end as defined in section
256B.0659.

(c) The methodology to determine total time for personal care assistance services for
each home care rating is based on the median paid units per day for each home care rating
from fiscal year 2007 data for the personal care assistance program. Each home care rating
has a base level of hours assigned. Additional time is added through the assessment and
identification of the following:

(1) 30 additional minutes per day for a dependency in each critical activity of daily
living as defined in section 256B.0659;

(2) 30 additional minutes per day for each complex health-related function as
defined in section 256B.0659; and

(3) 30 additional minutes per day for each behavior issue as defined in section
256B.0659new text begin, subdivision 4, paragraph (d)new text end.

(d) A limit of 96 units of qualified professional supervision may be authorized for
each recipient receiving personal care assistance services. A request to the commissioner
to exceed this total in a calendar year must be requested by the personal care provider
agency on a form approved by the commissioner.

Sec. 10.

Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 10,
is amended to read:


Subd. 10.

Responsible party; duties; delegation.

(a) A responsible party shall
enter into a written agreement with a personal care assistance provider agency, on a form
determined by the commissioner, to perform the following duties:

(1) be available while care is provided in a method agreed upon by the individual
or the individual's legal representative and documented in the recipient's personal care
assistance care plan;

(2) monitor personal care assistance services to ensure the recipient's personal care
assistance care plan is being followed; and

(3) review and sign personal care assistance time sheets after services are provided
to provide verification of the personal care assistance services.

Failure to provide the support required by the recipient must result in a referral to the
county common entry point.

(b) Responsible parties who are parents of minors or guardians of minors or
incapacitated persons may delegate the responsibility to another adult who is not the
personal care assistant during a temporary absence of at least 24 hours but not more
than six months. The person delegated as a responsible party must be able to meet the
definition of the responsible party. The responsible party must ensure that the delegate
performs the functions of the responsible party, is identified at the time of the assessment,
and is listed on the personal care assistance care plan. The responsible party must
communicate to the personal care assistance provider agency about the need for a deleted text begindelegatedeleted text endnew text begin
delegated
new text end responsible party, including the name of the delegated responsible partydeleted text begin, dates
the delegated responsible party will be living with the recipient,
deleted text end and contact numbers.

Sec. 11.

Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 11,
is amended to read:


Subd. 11.

Personal care assistant; requirements.

(a) A personal care assistant
must meet the following requirements:

(1) be at least 18 years of age with the exception of persons who are 16 or 17 years
of age with these additional requirements:

(i) supervision by a qualified professional every 60 days; and

(ii) employment by only one personal care assistance provider agency responsible
for compliance with current labor laws;

(2) be employed by a personal care assistance provider agency;

(3) enroll with the department as a personal care assistant after clearing a background
study.new text begin Except as provided in subdivision 11a,new text end before a personal care assistant provides
services, the personal care assistance provider agency must initiate a background study on
the personal care assistant under chapter 245C, and the personal care assistance provider
agency must have received a notice from the commissioner that the personal care assistant
is:

(i) not disqualified under section 245C.14; or

(ii) is disqualified, but the personal care assistant has received a set aside of the
disqualification under section 245C.22;

(4) be able to effectively communicate with the recipient and personal care
assistance provider agency;

(5) be able to provide covered personal care assistance services according to the
recipient's personal care assistance care plan, respond appropriately to recipient needs,
and report changes in the recipient's condition to the supervising qualified professional
or physician;

(6) not be a consumer of personal care assistance services;

(7) maintain daily written records including, but not limited to, time sheets under
subdivision 12;

(8) effective January 1, 2010, complete standardized training as determined by the
commissioner before completing enrollment. Personal care assistant training must include
successful completion of the following training components: basic first aid, vulnerable
adult, child maltreatment, OSHA universal precautions, basic roles and responsibilities of
personal care assistants including information about assistance with lifting and transfers
for recipients, emergency preparedness, orientation to positive behavioral practices, fraud
issues, and completion of time sheets. Upon completion of the training components,
the personal care assistant must demonstrate the competency to provide assistance to
recipients;

(9) complete training and orientation on the needs of the recipient within the first
seven days after the services begin; and

(10) be limited to providing and being paid for up to 310 hours per month of personal
care assistance services regardless of the number of recipients being served or the number
of personal care assistance provider agencies enrolled with.

(b) A legal guardian may be a personal care assistant if the guardian is not being paid
for the guardian services and meets the criteria for personal care assistants in paragraph (a).

(c) Effective January 1, 2010, persons who do not qualify as a personal care assistant
include parents and stepparents of minors, spouses, paid legal guardians, family foster
care providers, except as otherwise allowed in section 256B.0625, subdivision 19a, or
staff of a residential setting.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective retroactively from July 1, 2009.
new text end

Sec. 12.

Minnesota Statutes 2009 Supplement, section 256B.0659, is amended by
adding a subdivision to read:


new text begin Subd. 11a. new text end

new text begin Exception to personal care assistant; requirements. new text end

new text begin The personal care
assistant for a recipient may be allowed to enroll with a different personal care assistant
provider agency upon initiation of a new background study according to chapter 245C, if
all of the following are met:
new text end

new text begin (1) the commissioner determines that a change in enrollment or affiliation of the
personal care assistant is needed in order to ensure continuity of services and protect the
health and safety of the recipient;
new text end

new text begin (2) the chosen agency has been continuously enrolled as a personal care assistance
provider agency for at least two years;
new text end

new text begin (3) the recipient chooses to transfer to the personal care assistance provider agency;
new text end

new text begin (4) the personal care assistant has been continuously enrolled with the former
personal care assistance provider agency since the last background study was completed;
and
new text end

new text begin (5) the personal care assistant continues to meet requirements of subdivision 11,
excluding paragraph (a), clause (3).
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective retroactively from July 1, 2009.
new text end

Sec. 13.

Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 13,
is amended to read:


Subd. 13.

Qualified professional; qualifications.

(a) The qualified professional
must deleted text beginbe employed bydeleted text endnew text begin work fornew text end a personal care assistance provider agency and meet the
definition under section 256B.0625, subdivision 19c. Before a qualified professional
provides services, the personal care assistance provider agency must initiate a background
study on the qualified professional under chapter 245C, and the personal care assistance
provider agency must have received a notice from the commissioner that the qualified
professional:

(1) is not disqualified under section 245C.14; or

(2) is disqualified, but the qualified professional has received a set aside of the
disqualification under section 245C.22.

(b) The qualified professional shall perform the duties of training, supervision, and
evaluation of the personal care assistance staff and evaluation of the effectiveness of
personal care assistance services. The qualified professional shall:

(1) develop and monitor with the recipient a personal care assistance care plan based
on the service plan and individualized needs of the recipient;

(2) develop and monitor with the recipient a monthly plan for the use of personal
care assistance services;

(3) review documentation of personal care assistance services provided;

(4) provide training and ensure competency for the personal care assistant in the
individual needs of the recipient; and

(5) document all training, communication, evaluations, and needed actions to
improve performance of the personal care assistants.

(c) Effective January 1, 2010, the qualified professional shall complete the provider
training with basic information about the personal care assistance program approved
by the commissioner within six months of the date hired by a personal care assistance
provider agency. Qualified professionals who have completed the required deleted text begintrainingsdeleted text endnew text begin
training
new text end as deleted text beginan employee withdeleted text endnew text begin a worker fromnew text end a personal care assistance provider agency do
not need to repeat the required deleted text begintrainingsdeleted text endnew text begin trainingnew text end if they are hired by another agency, if
they have completed the training within the last three years.

Sec. 14.

Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 21,
is amended to read:


Subd. 21.

Requirements for initial enrollment of personal care assistance
provider agencies.

(a) All personal care assistance provider agencies must provide, at the
time of enrollment as a personal care assistance provider agency in a format determined
by the commissioner, information and documentation that includes, but is not limited to,
the following:

(1) the personal care assistance provider agency's current contact information
including address, telephone number, and e-mail address;

(2) proof of surety bond coverage in the amount of $50,000 or ten percent of the
provider's payments from Medicaid in the previous year, whichever is less;

(3) proof of fidelity bond coverage in the amount of $20,000;

(4) proof of workers' compensation insurance coverage;

new text begin (5) proof of liability insurance;
new text end

deleted text begin (5)deleted text endnew text begin (6)new text end a description of the personal care assistance provider agency's organization
identifying the names of all owners, managing employees, staff, board of directors, and
the affiliations of the directors, owners, or staff to other service providers;

deleted text begin (6)deleted text endnew text begin (7)new text end a copy of the personal care assistance provider agency's written policies
and procedures including: hiring of employees; training requirements; service delivery;
and employee and consumer safety including process for notification and resolution
of consumer grievances, identification and prevention of communicable diseases, and
employee misconduct;

deleted text begin (7)deleted text endnew text begin (8)new text end copies of all other forms the personal care assistance provider agency uses in
the course of daily business including, but not limited to:

(i) a copy of the personal care assistance provider agency's time sheet if the time
sheet varies from the standard time sheet for personal care assistance services approved
by the commissioner, and a letter requesting approval of the personal care assistance
provider agency's nonstandard time sheet;

(ii) the personal care assistance provider agency's template for the personal care
assistance care plan; and

(iii) the personal care assistance provider agency's template for the written
agreement in subdivision 20 for recipients using the personal care assistance choice
option, if applicable;

deleted text begin (8)deleted text endnew text begin (9)new text end a list of all deleted text begintrainingsdeleted text endnew text begin trainingnew text end and classes that the personal care assistance
provider agency requires of its staff providing personal care assistance services;

deleted text begin (9)deleted text endnew text begin (10)new text end documentation that the personal care assistance provider agency and staff
have successfully completed all the training required by this section;

deleted text begin (10)deleted text endnew text begin (11)new text end documentation of the agency's marketing practices;

deleted text begin (11)deleted text endnew text begin (12)new text end disclosure of ownership, leasing, or management of all residential
properties that is used or could be used for providing home care services; and

deleted text begin (12)deleted text endnew text begin (13)new text end documentation that the agency will use the following percentages of
revenue generated from the medical assistance rate paid for personal care assistance
services for employee personal care assistant wages and benefits: 72.5 percent of revenue
in the personal care assistance choice option and 72.5 percent of revenue from other
personal care assistance providers.

(b) Personal care assistance provider agencies shall provide the information specified
in paragraph (a) to the commissioner at the time the personal care assistance provider
agency enrolls as a vendor or upon request from the commissioner. The commissioner
shall collect the information specified in paragraph (a) from all personal care assistance
providers beginning July 1, 2009.

(c) All personal care assistance provider agencies shall complete mandatory training
as determined by the commissioner before enrollment as a provider. Personal care
assistance provider agencies are required to send all owners, qualified professionals
employed by the agency, and all other managing employees to the initial and subsequent
deleted text begin trainingsdeleted text endnew text begin trainingnew text end. Personal care assistance provider agency billing staff shall complete
training about personal care assistance program financial management. This training is
effective July 1, 2009. Any personal care assistance provider agency enrolled before that
date shall, if it has not already, complete the provider training within 18 months of July 1,
2009. Any new owners, new qualified professionals, and new managing employees are
required to complete mandatory training as a requisite of hiring.

Sec. 15.

Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 30,
is amended to read:


Subd. 30.

Notice of service changes to recipients.

The commissioner must provide:

(1) by October 31, 2009, information to recipients likely to be affected that (i)
describes the changes to the personal care assistance program that may result in the
loss of access to personal care assistance services, and (ii) includes resources to obtain
further information; and

(2) notice of changes in medical assistance deleted text beginhome caredeleted text endnew text begin personal care assistantnew text end services
to each affected recipient at least 30 days before the effective date of the change.

The notice shall include how to get further information on the changes, how to get help to
obtain other services, a list of community resources, and appeal rights. Notwithstanding
section 256.045, a recipient may request continued services pending appeal within the
time period allowed to request an appeal.

Sec. 16.

Minnesota Statutes 2009 Supplement, section 256B.0911, subdivision 1a,
is amended to read:


Subd. 1a.

Definitions.

For purposes of this section, the following definitions apply:

(a) "Long-term care consultation services" means:

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

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

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

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

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

(6) federally mandated screening to determine the need for a institutional level of
care under section 256B.0911, subdivision 4, paragraph (a);

(7) determination of home and community-based waiver service eligibility including
level of care determination for individuals who need an institutional level of care as
defined under section 144.0724, subdivision 11, or 256B.092, service eligibility including
state plan home care services identified in deleted text beginsectiondeleted text endnew text begin sectionsnew text end 256B.0625, subdivisions 6,
7, and 19, paragraphs (a) and (c),new text begin and 256B.0657,new text end based on assessment and support plan
development with appropriate referralsnew text begin, including the option for consumer-directed
community supports
new text end;

(8) providing recommendations for nursing facility placement when there are no
cost-effective community services available; and

(9) assistance to transition people back to community settings after facility
admission.

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

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

(d) "Lead agencies" means counties or a collaboration of counties, tribes, and health
plans administering long-term care consultation assessment and support planning services.

Sec. 17.

Minnesota Statutes 2009 Supplement, section 256B.0911, subdivision 2b,
is amended to read:


Subd. 2b.

Certified assessors.

(a) Beginning January 1, 2011, each lead agency
shall use certified assessors who have completed training and the certification processes
determined by the commissioner in subdivision 2c. Certified assessors shall demonstrate
best practices in assessment and support planning including person-centered planning
principals and have a common set of skills that must ensure consistency and equitable
access to services statewide. Assessors must be part of a multidisciplinary team of
professionals that includes public health nurses, social workers, and other professionals
as defined in paragraph (b). For persons with complex health care needs, a public health
nurse or registered nurse from a multidisciplinary team must be consulted.new text begin A lead agency
may choose, according to departmental policies, to contract with a qualified, certified
assessor to conduct assessments and reassessments on behalf of the lead agency.
new text end

(b) Certified assessors are persons with a minimum of a bachelor's degree in social
work, nursing with a public health nursing certificate, or other closely related field with at
least one year of home and community-based experience or a two-year registered nursing
degree with at least three years of home and community-based experience that have
received training and certification specific to assessment and consultation for long-term
care services in the state.

Sec. 18.

Minnesota Statutes 2009 Supplement, section 256B.0911, subdivision 3a,
is amended to read:


Subd. 3a.

Assessment and support planning.

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

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

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

(d) The assessment must be conducted in a face-to-face interview with the person
being assessed and the person's legal representative, as required by legally executed
documents, and other individuals as requested by the person, who can provide information
on the needs, strengths, and preferences of the person necessary to develop a support plan
that ensures the person's health and safety, but who is not a provider of service or has any
financial interest in the provision of services.

(e) The person, or the person's legal representative, must be provided with written
recommendations for community-based servicesnew text begin, including consumer-directed options,new text end
or institutional care that include documentation that the most cost-effective alternatives
available were offered to the individual. For purposes of this requirement, "cost-effective
alternatives" means community services and living arrangements that cost the same as or
less than institutional care.

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

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

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

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

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

(3) information about Minnesota health care programs;

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

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

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

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

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

Sec. 19.

Minnesota Statutes 2009 Supplement, section 256B.0911, subdivision 3b,
is amended to read:


Subd. 3b.

Transition assistance.

(a) A long-term care consultation team shall
provide assistance to persons residing in a nursing facility, hospital, regional treatment
center, or intermediate care facility for persons with developmental disabilities who
request or are referred for assistance. Transition assistance must include assessment,
community support plan development, referrals to long-term care options counseling
under section 256B.975, subdivision 10, for community support plan implementation
and to Minnesota health care programs,new text begin including home and community-based waiver
services and consumer-directed options through the waivers,
new text end and referrals to programs
that provide assistance with housing. Transition assistance must also include information
about the Centers for Independent Living and the Senior LinkAge Line, and about other
organizations that can provide assistance with relocation efforts, and information about
contacting these organizations to obtain their assistance and support.

(b) The county shall develop transition processes with institutional social workers
and discharge planners to ensure that:

(1) persons admitted to facilities receive information about transition assistance
that is available;

(2) the assessment is completed for persons within ten working days of the date of
request or recommendation for assessment; and

(3) there is a plan for transition and follow-up for the individual's return to the
community. The plan must require notification of other local agencies when a person
who may require assistance is screened by one county for admission to a facility located
in another county.

(c) If a person who is eligible for a Minnesota health care program is admitted to a
nursing facility, the nursing facility must include a consultation team member or the case
manager in the discharge planning process.

Sec. 20.

Minnesota Statutes 2008, section 256B.0911, subdivision 4d, is amended to
read:


Subd. 4d.

Preadmission screening of individuals under 65 years of age.

(a)
It is the policy of the state of Minnesota to ensure that individuals with disabilities or
chronic illness are served in the most integrated setting appropriate to their needs and have
the necessary information to make informed choices about home and community-based
service options.

(b) Individuals under 65 years of age who are admitted to a nursing facility from a
hospital must be screened prior to admission as outlined in subdivisions 4a through 4c.

(c) Individuals under 65 years of age who are admitted to nursing facilities with
only a telephone screening must receive a face-to-face assessment from the long-term
care consultation team member of the county in which the facility is located or from the
recipient's county case manager within 40 calendar days of admission.

(d) Individuals under 65 years of age who are admitted to a nursing facility
without preadmission screening according to the exemption described in subdivision 4b,
paragraph (a), clause (3), and who remain in the facility longer than 30 days must receive
a face-to-face assessment within 40 days of admission.

(e) At the face-to-face assessment, the long-term care consultation team member or
county case manager must perform the activities required under subdivision 3b.

(f) For individuals under 21 years of age, a screening interview which recommends
nursing facility admission must be face-to-face and approved by the commissioner before
the individual is admitted to the nursing facility.

(g) In the event that an individual under 65 years of age is admitted to a nursing
facility on an emergency basis, the county must be notified of the admission on the
next working day, and a face-to-face assessment as described in paragraph (c) must be
conducted within 40 calendar days of admission.

(h) At the face-to-face assessment, the long-term care consultation team member or
the case manager must present information about home and community-based optionsnew text begin,
including consumer-directed options,
new text end so the individual can make informed choices. If the
individual chooses home and community-based services, the long-term care consultation
team member or case manager must complete a written relocation plan within 20 working
days of the visit. The plan shall describe the services needed to move out of the facility
and a time line for the move which is designed to ensure a smooth transition to the
individual's home and community.

(i) An individual under 65 years of age residing in a nursing facility shall receive a
face-to-face assessment at least every 12 months to review the person's service choices
and available alternatives unless the individual indicates, in writing, that annual visits are
not desired. In this case, the individual must receive a face-to-face assessment at least
once every 36 months for the same purposes.

(j) Notwithstanding the provisions of subdivision 6, the commissioner may pay
county agencies directly for face-to-face assessments for individuals under 65 years of age
who are being considered for placement or residing in a nursing facility.

Sec. 21.

Minnesota Statutes 2009 Supplement, section 256D.44, subdivision 5, is
amended to read:


Subd. 5.

Special needs.

In addition to the state standards of assistance established in
subdivisions 1 to 4, payments are allowed for the following special needs of recipients of
Minnesota supplemental aid who are not residents of a nursing home, a regional treatment
center, or a group residential housing facility.

(a) The county agency shall pay a monthly allowance for medically prescribed
diets if the cost of those additional dietary needs cannot be met through some other
maintenance benefit. The need for special diets or dietary items must be prescribed by
a licensed physician. Costs for special diets shall be determined as percentages of the
allotment for a one-person household under the thrifty food plan as defined by the United
States Department of Agriculture. The types of diets and the percentages of the thrifty
food plan that are covered are as follows:

(1) high protein diet, at least 80 grams daily, 25 percent of thrifty food plan;

(2) controlled protein diet, 40 to 60 grams and requires special products, 100 percent
of thrifty food plan;

(3) controlled protein diet, less than 40 grams and requires special products, 125
percent of thrifty food plan;

(4) low cholesterol diet, 25 percent of thrifty food plan;

(5) high residue diet, 20 percent of thrifty food plan;

(6) pregnancy and lactation diet, 35 percent of thrifty food plan;

(7) gluten-free diet, 25 percent of thrifty food plan;

(8) lactose-free diet, 25 percent of thrifty food plan;

(9) antidumping diet, 15 percent of thrifty food plan;

(10) hypoglycemic diet, 15 percent of thrifty food plan; or

(11) ketogenic diet, 25 percent of thrifty food plan.

(b) Payment for nonrecurring special needs must be allowed for necessary home
repairs or necessary repairs or replacement of household furniture and appliances using
the payment standard of the AFDC program in effect on July 16, 1996, for these expenses,
as long as other funding sources are not available.

(c) A fee for guardian or conservator service is allowed at a reasonable rate
negotiated by the county or approved by the court. This rate shall not exceed five percent
of the assistance unit's gross monthly income up to a maximum of $100 per month. If the
guardian or conservator is a member of the county agency staff, no fee is allowed.

(d) The county agency shall continue to pay a monthly allowance of $68 for
restaurant meals for a person who was receiving a restaurant meal allowance on June 1,
1990, and who eats two or more meals in a restaurant daily. The allowance must continue
until the person has not received Minnesota supplemental aid for one full calendar month
or until the person's living arrangement changes and the person no longer meets the criteria
for the restaurant meal allowance, whichever occurs first.

(e) A fee of ten percent of the recipient's gross income or $25, whichever is less,
is allowed for representative payee services provided by an agency that meets the
requirements under SSI regulations to charge a fee for representative payee services. This
special need is available to all recipients of Minnesota supplemental aid regardless of
their living arrangement.

(f)(1) Notwithstanding the language in this subdivision, an amount equal to the
maximum allotment authorized by the federal Food Stamp Program for a single individual
which is in effect on the first day of July of each year will be added to the standards of
assistance established in subdivisions 1 to 4 for adults under the age of 65 who qualify
as shelter needy and are: (i) relocating from an institution, or an adult mental health
residential treatment program under section 256B.0622; (ii) eligible for the self-directed
supports option as defined under section 256B.0657, subdivision 2; or (iii) home and
community-based waiver recipients living in their own home or rented or leased apartment
which is not owned, operated, or controlled by a provider of service not related by blood
or marriagenew text begin, unless allowed under paragraph (g)new text end.

(2) Notwithstanding subdivision 3, paragraph (c), an individual eligible for the
shelter needy benefit under this paragraph is considered a household of one. An eligible
individual who receives this benefit prior to age 65 may continue to receive the benefit
after the age of 65.

(3) "Shelter needy" means that the assistance unit incurs monthly shelter costs that
exceed 40 percent of the assistance unit's gross income before the application of this
special needs standard. "Gross income" for the purposes of this section is the applicant's or
recipient's income as defined in section 256D.35, subdivision 10, or the standard specified
in subdivision 3, paragraph (a) or (b), whichever is greater. A recipient of a federal or
state housing subsidy, that limits shelter costs to a percentage of gross income, shall not be
considered shelter needy for purposes of this paragraph.

(g) Notwithstanding this subdivision, to access housing and services as provided
in paragraph (f), the recipient may choose housing that may deleted text beginor may notdeleted text end be owned,
operated, or controlled by the recipient's service provider deleted text beginif the housing is located in a
multifamily
deleted text enddeleted text beginbuilding of six or more unitsdeleted text end. new text beginIn a multifamily building of four or more units,new text end
the maximum number of deleted text beginunitsdeleted text endnew text begin apartmentsnew text end that may be used by recipients of this program
shall be 50 percent of the units in a building. deleted text beginThe department deleted text enddeleted text beginshall develop an exception
process to the 50 percent maximum.
deleted text end This paragraph expires on June 30, deleted text begin2011deleted text end new text begin2012new text end.

Sec. 22.

Minnesota Statutes 2008, section 326B.43, subdivision 2, is amended to read:


Subd. 2.

Agreement with municipality.

The commissioner may enter into an
agreement with a municipality, in which the municipality agrees to perform plan and
specification reviews required to be performed by the commissioner under Minnesota
Rules, part 4715.3130, if:

(a) the municipality has adopted:

(1) the plumbing code;

(2) an ordinance that requires plumbing plans and specifications to be submitted to,
reviewed, and approved by the municipality, except as provided in paragraph (n);

(3) an ordinance that authorizes the municipality to perform inspections required by
the plumbing code; and

(4) an ordinance that authorizes the municipality to enforce the plumbing code in its
entirety, except as provided in paragraph (p);

(b) the municipality agrees to review plumbing plans and specifications for all
construction for which the plumbing code requires the review of plumbing plans and
specifications, except as provided in paragraph (n);

(c) the municipality agrees that, when it reviews plumbing plans and specifications
under paragraph (b), the review will:

(1) reflect the degree to which the plans and specifications affect the public health
and conform to the provisions of the plumbing code;

(2) ensure that there is no physical connection between water supply systems that
are safe for domestic use and those that are unsafe for domestic use; and

(3) ensure that there is no apparatus through which unsafe water may be discharged
or drawn into a safe water supply system;

(d) the municipality agrees to perform all inspections required by the plumbing
code in connection with projects for which the municipality reviews plumbing plans and
specifications under paragraph (b);

(e) the commissioner determines that the individuals who will conduct the
inspections and the plumbing plan and specification reviews for the municipality do not
have any conflict of interest in conducting the inspections and the plan and specification
reviews;

(f) individuals who will conduct the plumbing plan and specification reviews for
the municipality are:

(1) licensed master plumbers;

(2) licensed professional engineers; or

(3) individuals who are working under the supervision of a licensed professional
engineer or licensed master plumber and who are licensed master or journeyman plumbers
or hold a postsecondary degree in engineering;

(g) individuals who will conduct the plumbing plan and specification reviews for
the municipality have passed a competency assessment required by the commissioner to
assess the individual's competency at reviewing plumbing plans and specifications;

(h) individuals who will conduct the plumbing inspections for the municipality
are licensed master or journeyman plumbers, or inspectors meeting the competency
requirements established in rules adopted under section 326B.135;

(i) the municipality agrees to enforce in its entirety the plumbing code on all
projects, except as provided in paragraph (p);

(j) the municipality agrees to keep official records of all documents received,
including plans, specifications, surveys, and plot plans, and of all plan reviews, permits
and certificates issued, reports of inspections, and notices issued in connection with
plumbing inspections and the review of plumbing plans and specifications;

(k) the municipality agrees to maintain the records described in paragraph (j) in the
official records of the municipality for the period required for the retention of public
records under section 138.17, and shall make these records readily available for review at
the request of the commissioner;

(l) the municipality and the commissioner agree that if at any time during the
agreement the municipality does not have in effect the plumbing code or any of ordinances
described in paragraph (a), or if the commissioner determines that the municipality is not
properly administering and enforcing the plumbing code or is otherwise not complying
with the agreement:

(1) the commissioner may, effective 14 days after the municipality's receipt of
written notice, terminate the agreement;

(2) the municipality may challenge the termination in a contested case before the
commissioner pursuant to the Administrative Procedure Act; and

(3) while any challenge is pending under clause (2), the commissioner shall perform
plan and specification reviews within the municipality under Minnesota Rules, part
4715.3130;

(m) the municipality and the commissioner agree that the municipality may terminate
the agreement with or without cause on 90 days' written notice to the commissioner;

(n) the municipality and the commissioner agree that the municipality shall forward
to the state for review all plumbing plans and specifications for the following types of
projects within the municipality:

(1) hospitals, nursing homes, supervised living facilitiesnew text begin licensed for eight or
more individuals
new text end, and similar health-care-related facilities regulated by the Minnesota
Department of Health;

(2) buildings owned by the federal or state government; and

(3) projects of a special nature for which department review is requested by either
the municipality or the state;

(o) where the municipality forwards to the state for review plumbing plans and
specifications, as provided in paragraph (n), the municipality shall not collect any fee for
plan review, and the commissioner shall collect all applicable fees for plan review; and

(p) no municipality shall revoke, suspend, or place restrictions on any plumbing
license issued by the state.

Sec. 23.

Minnesota Statutes 2008, section 626.557, subdivision 9a, is amended to read:


Subd. 9a.

Evaluation and referral of reports made to common entry point unit.

The common entry point must screen the reports of alleged or suspected maltreatment for
immediate risk and make all necessary referrals as follows:

(1) if the common entry point determines that there is an immediate need for
adult protective services, the common entry point agency shall immediately notify the
appropriate county agency;

(2) if the report contains suspected criminal activity against a vulnerable adult, the
common entry point shall immediately notify the appropriate law enforcement agency;

(3) deleted text beginif the report references alleged or suspected maltreatment and there is no
immediate need for adult protective services,
deleted text end the common entry point shall deleted text beginnotifydeleted text endnew text begin refer all
reports of alleged or suspected maltreatment to
new text end the appropriate lead agency as soon as
possible, but in any event no longer than two working days;new text begin and
new text end

deleted text begin (4) if the report does not reference alleged or suspected maltreatment, the common
entry point may determine whether the information will be referred; and
deleted text end

deleted text begin (5)deleted text endnew text begin (4)new text end if the report contains information about a suspicious death, the common entry
point shall immediately notify the appropriate law enforcement agencies, the local medical
examiner, and the ombudsman established under section 245.92. Law enforcement
agencies shall coordinate with the local medical examiner and the ombudsman as provided
by law.

Sec. 24.

Laws 2009, chapter 79, article 8, section 81, is amended to read:


Sec. 81. ESTABLISHING A SINGLE SET OF STANDARDS.

(a) The commissioner of human services shall consult with disability service
providers, advocates, counties, and consumer families to develop a single set of standardsnew text begin,
to be referred to as "quality outcome standards,"
new text end governing services for people with
disabilities receiving services under the home and community-based waiver services
program to replace all or portions of existing laws and rules including, but not limited
to, data practices, licensure of facilities and providers, background studies, reporting
of maltreatment of minors, reporting of maltreatment of vulnerable adults, and the
psychotropic medication checklist. The standards must:

(1) enable optimum consumer choice;

(2) be consumer driven;

(3) link services to individual needs and life goals;

(4) be based on quality assurance and individual outcomes;

(5) utilize the people closest to the recipient, who may include family, friends, and
health and service providers, in conjunction with the recipient's risk management plan to
assist the recipient or the recipient's guardian in making decisions that meet the recipient's
needs in a cost-effective manner and assure the recipient's health and safety;

(6) utilize person-centered planning; and

(7) maximize federal financial participation.

(b) The commissioner may consult with existing stakeholder groups convened under
the commissioner's authority, including the home and community-based expert services
panel established by the commissioner in 2008, to meet all or some of the requirements
of this section.

(c) The commissioner shall provide the reports and plans required by this section to
the legislative committees and budget divisions with jurisdiction over health and human
services policy and finance by January 15, 2012.

Sec. 25. new text beginELDERLY WAIVER CONVERSION.
new text end

new text begin Notwithstanding Minnesota Statutes, section 256B.0915, subdivision 3b, a person
age 65 or older with an MT home care rating on January 1, 2010, is eligible for the elderly
waiver program and shall be considered a conversion for purposes of accessing monthly
budget caps equal to no more than the person's monthly spending under the personal care
assistance program on January 1, 2010.
new text end

Sec. 26. new text beginDIRECTION TO COMMISSIONER; CONSULTATION WITH
STAKEHOLDERS.
new text end

new text begin The commissioner shall consult with stakeholders experienced in using and
providing services through the consumer-directed community supports option during
the identification of data to be used in future development of an individualized budget
methodology for the home and community-based waivers for individuals with disabilities
under the new comprehensive assessment.
new text end

Sec. 27. new text beginCASE MANAGEMENT RECOMMENDATIONS.
new text end

new text begin By February 1, 2011, the commissioner of human services shall provide specific
recommendations and language for proposed legislation to:
new text end

new text begin (1) define the administrative and the service functions of case management for
persons with disabilities and make changes to improve the funding for administrative
functions;
new text end

new text begin (2) standardize and simplify processes, standards, and timelines for case
management with the Department of Human Services Disability Services Division,
including eligibility determinations, resource allocation, management of dollars, provision
for assignment of one case manager at a time per person, waiting lists, quality assurance,
host county concurrence requirements, county of financial responsibility provisions, and
waiver compliance; and
new text end

new text begin (3) increase opportunities for consumer choice of case management functions
involving service coordination.
new text end

new text begin In developing these recommendations, the commissioner of human services shall
consider the recommendations of the 2007 Redesigning Case Management Services for
Persons with Disabilities Report and consult with existing stakeholder groups, which
include representatives of counties, disability and senior advocacy groups, service
providers, and representatives of agencies that provide contacted case management.
new text end

new text begin This section is effective the day following final enactment.
new text end

ARTICLE 2

PERSONAL CARE ASSISTANT SERVICES

Section 1.

Minnesota Statutes 2009 Supplement, section 256B.0653, subdivision 3,
is amended to read:


Subd. 3.

Home health aide visits.

(a) Home health aide visits must be provided
by a certified home health aide using a written plan of care that is updated in compliance
with Medicare regulations. A home health aide shall provide hands-on personal care,
perform simple procedures as an extension of therapy or nursing services, and assist in
instrumental activities of daily living as defined in section 256B.0659new text begin, including assuring
that the person gets to medical appointments if identified in the written plan of care
new text end. Home
health aide visits must be provided in the recipient's home.

(b) All home health aide visits must have authorization under section 256B.0652.
The commissioner shall limit home health aide visits to no more than one visit per day
per recipient.

(c) Home health aides must be supervised by a registered nurse or an appropriate
therapist when providing services that are an extension of therapy.

Sec. 2.

Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 1,
is amended to read:


Subdivision 1.

Definitions.

(a) For the purposes of this section, the terms defined in
paragraphs (b) to deleted text begin(p)deleted text endnew text begin (r)new text end have the meanings given unless otherwise provided in text.

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

(c) "Behavior," effective January 1, 2010, means a category to determine the home
care rating and is based on the criteria found in this section. "Level I behavior" means
physical aggression towards self, others, or destruction of property that requires the
immediate response of another person.

(d) "Complex health-related needs," effective January 1, 2010, means a category to
determine the home care rating and is based on the criteria found in this section.

(e) "Critical activities of daily living," effective January 1, 2010, means transferring,
mobility, eating, and toileting.

(f) "Dependency in activities of daily living" means a person requires assistance to
begin and complete one or more of the activities of daily living.

(g) new text begin"Extended personal care assistance service" means personal care assistance
services included in a service plan under one of the home and community-based services
waivers authorized under sections 256B.49, 256B.0915, and 256B.092, subdivision
5, which exceed the amount, duration, and frequency of the state plan personal care
assistance services for participants who:
new text end

new text begin (1) need assistance provided periodically during a week, but less than daily will not
be able to remain in their home without the assistance, and other replacement services
are more expensive or are not available when personal care assistance services are to be
terminated; or
new text end

new text begin (2) need additional personal care assistance services beyond the amount authorized
by the state plan personal care assistance assessment in order to ensure that their safety,
health, and welfare are provided for in their homes.
new text end

new text begin (h) new text end"Health-related procedures and tasks" means procedures and tasks that can
be delegated or assigned by a licensed health care professional under state law to be
performed by a personal care assistant.

deleted text begin (h)deleted text endnew text begin (i)new text end "Instrumental activities of daily living" means activities to include meal
planning and preparation; basic assistance with paying bills; shopping for food, clothing,
and other essential items; performing household tasks integral to the personal care
assistance services; communication by telephone and other media; and traveling, including
to medical appointments and to participate in the community.

deleted text begin (i)deleted text endnew text begin (j)new text end "Managing employee" has the same definition as Code of Federal Regulations,
title 42, section 455.

deleted text begin (j)deleted text endnew text begin (k)new text end "Qualified professional" means a professional providing supervision of
personal care assistance services and staff as defined in section 256B.0625, subdivision
19c
.

deleted text begin (k)deleted text endnew text begin (l)new text end "Personal care assistance provider agency" means a medical assistance
enrolled provider that provides or assists with providing personal care assistance services
and includes a personal care assistance provider organization, personal care assistance
choice agency, class A licensed nursing agency, and Medicare-certified home health
agency.

deleted text begin (l)deleted text endnew text begin (m)new text end "Personal care assistant" or "PCA" means an individual employed by a
personal care assistance agency who provides personal care assistance services.

deleted text begin (m)deleted text endnew text begin (n)new text end "Personal care assistance care plan" means a written description of personal
care assistance services developed by the personal care assistance provider according
to the service plan.

deleted text begin (n)deleted text endnew text begin (o)new text end "Responsible party" means an individual who is capable of providing the
support necessary to assist the recipient to live in the community.

deleted text begin (o)deleted text endnew text begin (p)new text end "Self-administered medication" means medication taken orally, by injection
or insertion, or applied topically without the need for assistance.

deleted text begin (p)deleted text endnew text begin (q)new text end "Service plan" means a written summary of the assessment and description of
the services needed by the recipient.

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

Sec. 3.

Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 3,
is amended to read:


Subd. 3.

Noncovered personal care assistance services.

(a) Personal care
assistance services are not eligible for medical assistance payment under this section
when provided:

(1) by the recipient's spouse, parent of a recipient under the age of 18, paid legal
guardian, licensed foster provider, except as allowed under section 256B.0651, subdivision
10
, or responsible party;

(2) in lieu of other staffing options in a residential or child care setting;

(3) solely as a child care or babysitting service; or

(4) without authorization by the commissioner or the commissioner's designee.

(b) The following personal care services are not eligible for medical assistance
payment under this section when provided in residential settings:

(1) effective January 1, 2010, when the provider of home care services who is not
related by blood, marriage, or adoption owns or otherwise controls the living arrangement,
including licensed or unlicensed services; or

(2) when personal care assistance services are the responsibility of a residential or
program license holder under the terms of a service agreement and administrative rules.

(c) Other specific tasks not covered under paragraph (a) or (b) that are not eligible
for medical assistance reimbursement for personal care assistance services under this
section include:

(1) sterile procedures;

(2) injections of fluids and medications into veins, muscles, or skin;

(3) home maintenance or chore services;

(4) homemaker services not an integral part of assessed personal care assistance
services needed by a recipient;

(5) application of restraints or implementation of procedures under section 245.825;

(6) instrumental activities of daily living for children under the age of 18new text begin, except
when immediate attention is needed for health or hygiene reasons integral to the personal
care services and the need is listed in the service plan by the assessor
new text end; and

(7) assessments for personal care assistance services by personal care assistance
provider agencies or by independently enrolled registered nurses.

Sec. 4.

Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 4,
is amended to read:


Subd. 4.

Assessment for personal care assistance services; limitations.

(a) An
assessment as defined in subdivision 3a must be completed for personal care assistance
services.

(b) The following limitations apply to the assessment:

(1) a person must be assessed as dependent in an activity of daily living based on
the person'snew text begin dailynew text end need new text beginor need on the days during the week the activity is completednew text enddeleted text begin,
on a daily basis,
deleted text end for:

(i) cuing and constant supervision to complete the task; or

(ii) hands-on assistance to complete the task; and

(2) a child may not be found to be dependent in an activity of daily living if because
of the child's age an adult would either perform the activity for the child or assist the child
with the activity. Assistance needed is the assistance appropriate for a typical child of
the same age.

(c) Assessment for complex health-related needs must meet the criteria in this
paragraph. During the assessment process, a recipient qualifies as having complex
health-related needs if the recipient has one or more of the interventions that are ordered by
a physician, specified in a personal care assistance care plan, and found in the following:

(1) tube feedings requiring:

(i) a deleted text begingastro/jejunostomydeleted text endnew text begin gastrojejunostomynew text end tube; or

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

(2) wounds described as:

(i) stage III or stage IV;

(ii) multiple wounds;

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

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

(3) parenteral therapy described as:

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

(ii) total parenteral nutrition (TPN) daily;

(4) respiratory interventions including:

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

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

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

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

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

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

(5) insertion and maintenance of catheter including:

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

(ii) clean self-catheterization more than six times per day; or

(iii) bladder irrigations;

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

(7) neurological intervention including:

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

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

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

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

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

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

(3) verbally aggressive and resistive to care.

Sec. 5.

Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 11,
is amended to read:


Subd. 11.

Personal care assistant; requirements.

(a) A personal care assistant
must meet the following requirements:

(1) be at least 18 years of age with the exception of persons who are 16 or 17 years
of age with these additional requirements:

(i) supervision by a qualified professional every 60 days; and

(ii) employment by only one personal care assistance provider agency responsible
for compliance with current labor laws;

(2) be employed by a personal care assistance provider agency;

(3) enroll with the department as a personal care assistant after clearing a background
study. Before a personal care assistant provides services, the personal care assistance
provider agency must initiate a background study on the personal care assistant under
chapter 245C, and the personal care assistance provider agency must have received a
notice from the commissioner that the personal care assistant is:

(i) not disqualified under section 245C.14; or

(ii) is disqualified, but the personal care assistant has received a set aside of the
disqualification under section 245C.22;

(4) be able to effectively communicate with the recipient and personal care
assistance provider agency;

(5) be able to provide covered personal care assistance services according to the
recipient's personal care assistance care plan, respond appropriately to recipient needs,
and report changes in the recipient's condition to the supervising qualified professional
or physician;

(6) not be a consumer of personal care assistance services;

(7) maintain daily written records including, but not limited to, time sheets under
subdivision 12;

(8) effective January 1, 2010, complete standardized training as determined
by the commissioner before completing enrollment.new text begin The training must be available
in languages other than English and to those who need accommodations due to
disabilities.
new text end Personal care assistant training must include successful completion of the
following training components: basic first aid, vulnerable adult, child maltreatment,
OSHA universal precautions, basic roles and responsibilities of personal care assistants
including information about assistance with lifting and transfers for recipients, emergency
preparedness, orientation to positive behavioral practices, fraud issues, and completion of
time sheets. Upon completion of the training components, the personal care assistant must
demonstrate the competency to provide assistance to recipients;

(9) complete training and orientation on the needs of the recipient within the first
seven days after the services begin; and

(10) be limited to providing and being paid for up to 310 hours per month of personal
care assistance services regardless of the number of recipients being served or the number
of personal care assistance provider agencies enrolled with.new text begin The number of hours worked
per day shall not be disallowed by the department unless in violation of the law.
new text end

(b) A legal guardian may be a personal care assistant if the guardian is not being paid
for the guardian services and meets the criteria for personal care assistants in paragraph (a).

(c) Effective January 1, 2010, persons who do not qualify as a personal care assistant
include parents and stepparents of minors, spouses, paid legal guardians, family foster
care providers, except as otherwise allowed in section 256B.0625, subdivision 19a, or
staff of a residential setting.

Sec. 6.

Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 13,
is amended to read:


Subd. 13.

Qualified professional; qualifications.

(a) The qualified professional
must be employed by a personal care assistance provider agency and meet the definition
under section 256B.0625, subdivision 19c. Before a qualified professional provides
services, the personal care assistance provider agency must initiate a background study on
the qualified professional under chapter 245C, and the personal care assistance provider
agency must have received a notice from the commissioner that the qualified professional:

(1) is not disqualified under section 245C.14; or

(2) is disqualified, but the qualified professional has received a set aside of the
disqualification under section 245C.22.

(b) The qualified professional shall perform the duties of training, supervision, and
evaluation of the personal care assistance staff and evaluation of the effectiveness of
personal care assistance services. The qualified professional shall:

(1) develop and monitor with the recipient a personal care assistance care plan based
on the service plan and individualized needs of the recipient;

(2) develop and monitor with the recipient a monthly plan for the use of personal
care assistance services;

(3) review documentation of personal care assistance services provided;

(4) provide training and ensure competency for the personal care assistant in the
individual needs of the recipient; and

(5) document all training, communication, evaluations, and needed actions to
improve performance of the personal care assistants.

(c) Effective deleted text beginJanuarydeleted text endnew text begin Julynew text end 1, 2010, the qualified professional shall complete the
provider training with basic information about the personal care assistance program
approved by the commissioner within six months of the date hired by a personal care
assistance provider agency. Qualified professionals who have completed the required
trainings as an employee with a personal care assistance provider agency do not need to
repeat the required trainings if they are hired by another agency, if they have completed the
training within the last three years.new text begin The required training shall be available in languages
other than English and to those who need accommodations due to disabilities, online, or
by electronic remote connection, and provide for competency testing to demonstrate an
understanding of the content without attending in-person training. A qualified professional
is allowed to be employed and is not subject to the training requirement until the training is
offered online or through remote electronic connection. A qualified professional employed
by a personal care assistance provider agency certified for participation in Medicare as
a home health agency is exempt from the training required in this subdivision. The
commissioner shall ensure there is a mechanism in place to verify the identity of persons
completing the competency testing electronically.
new text end

Sec. 7.

Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 14,
is amended to read:


Subd. 14.

Qualified professional; duties.

(a) Effective January 1, 2010, all personal
care assistants must be supervised by a qualified professional.

(b) Through direct training, observation, return demonstrations, and consultation
with the staff and the recipient, the qualified professional must ensure and document
that the personal care assistant is:

(1) capable of providing the required personal care assistance services;

(2) knowledgeable about the plan of personal care assistance services before services
are performed; and

(3) able to identify conditions that should be immediately brought to the attention of
the qualified professional.

(c) The qualified professional shall evaluate the personal care assistant within the first
14 days of starting to providenew text begin regularly schedulednew text end services for a recipient except for the
personal care assistance choice option under subdivision 19, paragraph (a), clause (4).new text begin For
the initial evaluation,
new text end the qualified professional shall evaluate the personal care assistance
services for a recipient through direct observation of a personal care assistant's worknew text begin.
Subsequent visits to evaluate the personal care assistance services provided to a recipient
do not require direct observation of each personal care assistant's work and shall occur
new text end:

(1) at least every 90 days thereafter for the first year of a recipient's services; deleted text beginand
deleted text end

(2) every 120 days after the first year of a recipient's service or whenever needed for
response to a recipient's request for increased supervision of the personal care assistance
staffnew text begin; and
new text end

new text begin (3) after the first 180 days of a recipient's service, supervisory visits may alternate
between unscheduled phone or Internet technology and in-person visits, unless the
in-person visits are needed according to the care plan
new text end.

(d) Communication with the recipient is a part of the evaluation process of the
personal care assistance staff.

(e) At each supervisory visit, the qualified professional shall evaluate personal care
assistance services including the following information:

(1) satisfaction level of the recipient with personal care assistance services;

(2) review of the month-to-month plan for use of personal care assistance services;

(3) review of documentation of personal care assistance services provided;

(4) whether the personal care assistance services are meeting the goals of the service
as stated in the personal care assistance care plan and service plan;

(5) a written record of the results of the evaluation and actions taken to correct any
deficiencies in the work of a personal care assistant; and

(6) revision of the personal care assistance care plan as necessary in consultation
with the recipient or responsible party, to meet the needs of the recipient.

(f) The qualified professional shall complete the required documentation in the
agency recipient and employee files and the recipient's home, including the following
documentation:

(1) the personal care assistance care plan based on the service plan and individualized
needs of the recipient;

(2) a month-to-month plan for use of personal care assistance services;

(3) changes in need of the recipient requiring a change to the level of service and the
personal care assistance care plan;

(4) evaluation results of supervision visits and identified issues with personal care
assistance staff with actions taken;

(5) all communication with the recipient and personal care assistance staff; and

(6) hands-on training or individualized training for the care of the recipient.

(g) The documentation in paragraph (f) must be done on agency forms.

(h) The services that are not eligible for payment as qualified professional services
include:

(1) direct professional nursing tasks that could be assessed and authorized as skilled
nursing tasks;

(2) supervision of personal care assistance completed by telephone;

(3) agency administrative activities;

(4) training other than the individualized training required to provide care for a
recipient; and

(5) any other activity that is not described in this section.

Sec. 8.

Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 18,
is amended to read:


Subd. 18.

Personal care assistance choice option; generally.

(a) The
commissioner may allow a recipient of personal care assistance services to use a fiscal
intermediary to assist the recipient in paying and accounting for medically necessary
covered personal care assistance services. Unless otherwise provided in this section, all
other statutory and regulatory provisions relating to personal care assistance services apply
to a recipient using the personal care assistance choice option.

(b) Personal care assistance choice is an option of the personal care assistance
program that allows the recipient who receives personal care assistance services to be
responsible for the hiring, training, scheduling, and firing of personal care assistantsnew text begin
according to the terms of the written agreement with the personal care assistance choice
agency required under subdivision 20, paragraph (a)
new text end. This program offers greater control
and choice for the recipient in who provides the personal care assistance service and when
the service is scheduled. The recipient or the recipient's responsible party must choose a
personal care assistance choice provider agency as a fiscal intermediary. This personal
care assistance choice provider agency manages payroll, invoices the state, is responsible
for all payroll-related taxes and insurance, and is responsible for providing the consumer
training and support in managing the recipient's personal care assistance services.

Sec. 9.

Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 19,
is amended to read:


Subd. 19.

Personal care assistance choice option; qualifications; duties.

(a)
Under personal care assistance choice, the recipient or responsible party shall:

(1) recruit, hire, schedule, and terminate personal care assistants deleted text beginand a qualified
professional
deleted text endnew text begin according to the terms of the written agreement required under subdivision
20, paragraph (a)
new text end;

(2) develop a personal care assistance care plan based on the assessed needs
and addressing the health and safety of the recipient with the assistance of a qualified
professional as needed;

(3) orient and train the personal care assistant with assistance as needed from the
qualified professional;

(4) effective January 1, 2010, supervise and evaluate the personal care assistant with
the qualified professional, who is required to visit the recipient at least every 180 days;

(5) monitor and verify in writing and report to the personal care assistance choice
agency the number of hours worked by the personal care assistant and the qualified
professional;

(6) engage in an annual face-to-face reassessment to determine continuing eligibility
and service authorization; and

(7) use the same personal care assistance choice provider agency if shared personal
assistance care is being used.

(b) The personal care assistance choice provider agency shall:

(1) meet all personal care assistance provider agency standards;

(2) enter into a written agreement with the recipient, responsible party, and personal
care assistants;

(3) not be related as a parent, child, sibling, or spouse to the recipient, qualified
professional, or the personal care assistant; and

(4) ensure arm's-length transactions without undue influence or coercion with the
recipient and personal care assistant.

(c) The duties of the personal care assistance choice provider agency are to:

(1) be the employer of the personal care assistant and the qualified professional for
employment law and related regulations including, but not limited to, purchasing and
maintaining workers' compensation, unemployment insurance, surety and fidelity bonds,
and liability insurance, and submit any or all necessary documentation including, but not
limited to, workers' compensation and unemployment insurance;

(2) bill the medical assistance program for personal care assistance services and
qualified professional services;

(3) request and complete background studies that comply with the requirements for
personal care assistants and qualified professionals;

(4) pay the personal care assistant and qualified professional based on actual hours
of services provided;

(5) withhold and pay all applicable federal and state taxes;

(6) verify and keep records of hours worked by the personal care assistant and
qualified professional;

(7) make the arrangements and pay taxes and other benefits, if any, and comply with
any legal requirements for a Minnesota employer;

(8) enroll in the medical assistance program as a personal care assistance choice
agency; and

(9) enter into a written agreement as specified in subdivision 20 before services
are provided.

Sec. 10.

Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 20,
is amended to read:


Subd. 20.

Personal care assistance choice option; administration.

(a) Before
services commence under the personal care assistance choice option, and annually
thereafter, the personal care assistance choice provider agencydeleted text begin, recipient, or responsible
party, each personal care assistant, and the qualified professional
deleted text endnew text begin and the recipient or
responsible party
new text end shall enter into a written agreement. Thenew text begin annualnew text end agreement mustnew text begin be
provided to the recipient or responsible party, each personal care assistant, and the
qualified professional when completed, and
new text end include at a minimum:

(1) duties of the recipient, qualified professional, personal care assistant, and
personal care assistance choice provider agency;

(2) salary and benefits for the personal care assistant and the qualified professional;

(3) administrative fee of the personal care assistance choice provider agency and
services paid for with that fee, including background study fees;

(4) grievance procedures to respond to complaints;

(5) procedures for hiring and terminating the personal care assistant; and

(6) documentation requirements including, but not limited to, time sheets, activity
records, and the personal care assistance care plan.

(b) Effective January 1, 2010, except for the administrative fee of the personal care
assistance choice provider agency as reported on the written agreement, the remainder
of the rates paid to the personal care assistance choice provider agency must be used to
pay for the salary and benefits for the personal care assistant or the qualified professional.
The provider agency must use a minimum of 72.5 percent of the revenue generated by
the medical assistance rate for personal care assistance services for employee personal
care assistant wages and benefits.

(c) The commissioner shall deny, revoke, or suspend the authorization to use the
personal care assistance choice option if:

(1) it has been determined by the qualified professional or public health nurse that
the use of this option jeopardizes the recipient's health and safety;

(2) the parties have failed to comply with the written agreement specified in this
subdivision;

(3) the use of the option has led to abusive or fraudulent billing for personal care
assistance services; or

(4) the department terminates the personal care assistance choice option.

(d) The recipient or responsible party may appeal the commissioner's decision in
paragraph (c) according to section 256.045. The denial, revocation, or suspension to
use the personal care assistance choice option must not affect the recipient's authorized
level of personal care assistance services.

Sec. 11.

Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 21,
is amended to read:


Subd. 21.

Requirements for initial enrollment of personal care assistance
provider agencies.

(a) All personal care assistance provider agencies must provide, at the
time of enrollment as a personal care assistance provider agency in a format determined
by the commissioner, information and documentation that includes, but is not limited to,
the following:

(1) the personal care assistance provider agency's current contact information
including address, telephone number, and e-mail address;

(2) proof of surety bond coverage in the amount of $50,000 or ten percent of the
provider's payments from Medicaid in the previous year, whichever is less;

(3) proof of fidelity bond coverage in the amount of $20,000;

(4) proof of workers' compensation insurance coverage;

(5) a description of the personal care assistance provider agency's organization
identifying the names of all owners, managing employees, staff, board of directors, and
the affiliations of the directors, owners, or staff to other service providers;

(6) a copy of the personal care assistance provider agency's written policies and
procedures including: hiring of employees; training requirements; service delivery;
and employee and consumer safety including process for notification and resolution
of consumer grievances, identification and prevention of communicable diseases, and
employee misconduct;

(7) copies of all other forms the personal care assistance provider agency uses in
the course of daily business including, but not limited to:

(i) a copy of the personal care assistance provider agency's time sheet if the time
sheet varies from the standard time sheet for personal care assistance services approved
by the commissioner, and a letter requesting approval of the personal care assistance
provider agency's nonstandard time sheet;

(ii) the personal care assistance provider agency's template for the personal care
assistance care plan; and

(iii) the personal care assistance provider agency's template for the written
agreement in subdivision 20 for recipients using the personal care assistance choice
option, if applicable;

(8) a list of all trainings and classes that the personal care assistance provider agency
requires of its staff providing personal care assistance services;

(9) documentation that the personal care assistance provider agency and staff have
successfully completed all the training required by this section;

(10) documentation of the agency's marketing practices;

(11) disclosure of ownership, leasing, or management of all residential properties
that is used or could be used for providing home care services; deleted text beginand
deleted text end

(12) documentation that the agency will use the following percentages of revenue
generated from the medical assistance rate paid for personal care assistance services
for employee personal care assistant wages and benefits: 72.5 percent of revenue in the
personal care assistance choice option and 72.5 percent of revenue from other personal
care assistance providersnew text begin; and
new text end

new text begin (13) effective the day following final enactment, documentation that the agency does
not burden recipients' free exercise of their right to choose service providers by requiring
personal care assistants to sign an agreement not to work with any particular personal
care assistance recipient or for another personal care assistance provider agency after
leaving the agency and that the agency is not taking action on any such agreements or
requirements regardless of the date signed
new text end.

(b) Personal care assistance provider agencies shall provide the information specified
in paragraph (a) to the commissioner at the time the personal care assistance provider
agency enrolls as a vendor or upon request from the commissioner. The commissioner
shall collect the information specified in paragraph (a) from all personal care assistance
providers beginning July 1, 2009.

(c) All personal care assistance provider agencies shallnew text begin require all employees in
management and supervisory positions and owners of the agency who are active in the
day-to-day management and operations of the agency to
new text end complete mandatory training as
determined by the commissioner before enrollmentnew text begin of the agencynew text end as a provider. deleted text beginPersonal
care assistance provider agencies are required to send all owners, qualified professionals
employed by the agency, and all other managing employees to the initial and subsequent
trainings.
deleted text endnew text begin Employees in management and supervisory positions and owners who are
active in the day-to-day operations of an agency who have completed the required training
as an employee with a personal care assistance provider agency do not need to repeat
the required training if they are hired by another agency, if they have completed the
training within the past three years. By September 1, 2010, the required training must be
available in languages other than English and to those who need accommodations due
to disabilities, online, or by electronic remote connection, and provide for competency
testing.
new text end Personal care assistance provider agency billing staff shall complete training
about personal care assistance program financial management. This training is effective
July 1, 2009. Any personal care assistance provider agency enrolled before that date
shall, if it has not already, complete the provider training within 18 months of July 1,
2009. Any new ownersdeleted text begin, new qualified professionals, and new managingdeleted text endnew text begin ornew text end employeesnew text begin in
management and supervisory positions involved in the day-to-day operations
new text end are required
to complete mandatory training as a requisite of deleted text beginhiringdeleted text endnew text begin working for the agency. Personal
care assistance provider agencies certified for participation in Medicare as home health
agencies are exempt from the training required in this subdivision
new text end.

Sec. 12.

Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 24,
is amended to read:


Subd. 24.

Personal care assistance provider agency; general duties.

A personal
care assistance provider agency shall:

(1) enroll as a Medicaid provider meeting all provider standards, including
completion of the required provider training;

(2) comply with general medical assistance coverage requirements;

(3) demonstrate compliance with law and policies of the personal care assistance
program to be determined by the commissioner;

(4) comply with background study requirements;

(5) verify and keep records of hours worked by the personal care assistant and
qualified professional;

(6) deleted text beginmarket agency services only through printed information in brochures and on
Web sites and
deleted text end not engage in any agency-initiated direct contact or marketing in person, by
phone, or other electronic means to potential recipients, guardians, or family members;

(7) pay the personal care assistant and qualified professional based on actual hours
of services provided;

(8) withhold and pay all applicable federal and state taxes;

(9) effective January 1, 2010, document that the agency uses a minimum of 72.5
percent of the revenue generated by the medical assistance rate for personal care assistance
services for employee personal care assistant wages and benefits;

(10) make the arrangements and pay unemployment insurance, taxes, workers'
compensation, liability insurance, and other benefits, if any;

(11) enter into a written agreement under subdivision 20 before services are provided;

(12) report suspected neglect and abuse to the common entry point according to
section 256B.0651;

(13) provide the recipient with a copy of the home care bill of rights at start of
service; and

(14) request reassessments at least 60 days prior to the end of the current
authorization for personal care assistance services, on forms provided by the commissioner.

Sec. 13.

Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 27,
is amended to read:


Subd. 27.

Personal care assistance provider agencydeleted text begin; ventilator trainingdeleted text end.

new text begin(a) new text endThe
personal care assistance provider agency is required to provide training for the personal
care assistant responsible for working with a recipient who is ventilator dependent. All
training must be administered by a respiratory therapist, nurse, or physician. Qualified
professional supervision by a nurse must be completed and documented on file in the
personal care assistant's employment record and the recipient's health record. If offering
personal care services to a ventilator-dependent recipient, the personal care assistance
provider agency shall demonstrate new text beginand document new text endthe ability to:

(1) train the personal care assistant;

(2) supervise the personal care assistant in deleted text beginventilator operation and maintenancedeleted text endnew text begin the
care of a ventilator-dependent recipient
new text end; deleted text beginand
deleted text end

(3) supervise the recipient and responsible party in deleted text beginventilator operation and
maintenance
deleted text endnew text begin the care of a ventilator-dependent recipient; and
new text end

new text begin (4) provide documentation of the training and supervision in clauses (1) to (3)
upon request
new text end.

new text begin (b) A personal care assistant shall not undertake any clinical services, patient
assessment, patient evaluation, or clinical education regarding the ventilator or the patient
on the ventilator. These services may only be provided by health care professionals
licensed or registered in this state.
new text end

new text begin (c) A personal care assistant may only perform tasks associated with ventilator
maintenance that are approved by the Board of Medical Practice in consultation with the
Respiratory Care Practitioner Advisory Council and the Department of Human Services.
new text end

Sec. 14.

Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 30,
is amended to read:


Subd. 30.

Notice of service changes to recipients.

The commissioner must provide:

(1) by October 31, 2009, information to recipients likely to be affected that (i)
describes the changes to the personal care assistance program that may result in the
loss of access to personal care assistance services, and (ii) includes resources to obtain
further information; deleted text beginand
deleted text end

(2) notice of changes in medical assistance home care services to each affected
recipient at least 30 days before the effective date of the change.

The notice shall include how to get further information on the changes, how to get help to
obtain other services, a list of community resources, and appeal rights. Notwithstanding
section 256.045, a recipient may request continued services pending appeal within the
time period allowed to request an appealnew text begin; and
new text end

new text begin (3) a service agreement authorizing personal care assistance hours of service at
the previously authorized level, throughout the appeal process period, when a recipient
requests services pending an appeal
new text end.

Sec. 15.

Minnesota Statutes 2008, section 256B.092, subdivision 4d, is amended to
read:


Subd. 4d.

Medicaid reimbursement; licensed provider; related individuals.

deleted text beginThe
commissioner shall seek a federal amendment to the home and community-based services
waiver for individuals with developmental disabilities, to allow
deleted text end Medicaid reimbursement
for the provision of supported living services to a related individualnew text begin is allowednew text end when the
deleted text begin followingdeleted text end conditions deleted text beginhave been met:deleted text endnew text begin specified in section 245A.03, subdivision 9, are met.new text end

deleted text begin (1) the individual is 18 years of age or older;
deleted text end

deleted text begin (2) the provider is certified initially and annually thereafter, by the county, as
meeting the provider standards established in chapter 245B and the federal waiver plan;
deleted text end

deleted text begin (3) the provider has been certified by the county as meeting the adult foster care
provider standards established in Minnesota Rules, parts 9555.5105 to 9555.6265;
deleted text end

deleted text begin (4) the provider is not the legal guardian or conservator of the related individual; and
deleted text end

deleted text begin (5) the individual's service plan meets the standards of this section and specifies any
special conditions necessary to prevent a conflict of interest for the provider.
deleted text end

Sec. 16. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2008, section 256B.0919, subdivision 4, new text end new text begin is repealed.
new text end