SF 2933

1st Unofficial Engrossment - 86th Legislature (2009 - 2010) Posted on 12/26/2012 11:17pm

1.1A bill for an act

1.2relating to human services; making changes to continuing care policy and
1.3personal care assistance services;amending Minnesota Statutes 2008, sections
1.4144A.071, subdivision 4b; 144A.161, subdivision 1a; 245A.03, by adding a
1.5subdivision; 256B.0911, subdivision 4d; 256B.092, subdivision 4d; 626.557,
1.6subdivision 9a; Minnesota Statutes 2009 Supplement, sections 144.0724,
1.7subdivision 11; 256B.0625, subdivision 19c; 256B.0651, by adding a
1.8subdivision; 256B.0652, subdivision 6; 256B.0653, subdivision 3; 256B.0659,
1.9subdivisions 1, 3, 4, 10, 11, 13, 14, 18, 19, 20, 21, 24, 27, 30, by adding a
1.10subdivision; 256B.0911, subdivisions 1a, 2b, 3a, 3b; repealing Minnesota
1.11Statutes 2008, section 256B.0919, subdivision 4.
1.12BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.13ARTICLE 1

1.14CONTINUING CARE POLICY

1.15    Section 1. Minnesota Statutes 2009 Supplement, section 144.0724, subdivision 11,
1.16is amended to read:
1.17    Subd. 11. Nursing facility level of care. (a) For purposes of medical assistance
1.18payment of long-term care services, a recipient must be determined, using assessments
1.19defined in subdivision 4, to meet one of the following nursing facility level of care criteria:
1.20    (1) the person requires formal clinical monitoring at least once per day;
1.21    (1) (2) the person needs the assistance of another person or constant supervision to
1.22begin and complete at least four of the following activities of living: bathing, bed mobility,
1.23dressing, eating, grooming, toileting, transferring, and walking;
1.24    (2) (3) the person needs the assistance of another person or constant supervision
1.25to begin and complete toileting, transferring, or positioning and the assistance cannot
1.26be scheduled;
2.1    (3) (4) the person has significant difficulty with memory, using information, daily
2.2decision making, or behavioral needs that require intervention;
2.3    (4) (5) the person has had a qualifying nursing facility stay of at least 90 days;
2.4    (6) the person meets the nursing facility level of care criteria determined 90 days
2.5after admission or on the first quarterly assessment after admission, whichever is later; or
2.6    (5) (7) the person is determined to be at risk for nursing facility admission or
2.7readmission through a face-to-face long-term care consultation assessment as specified
2.8in section 256B.0911, subdivision 3a, 3b, or 4d, by a county, tribe, or managed care
2.9organization under contract with the Department of Human Services. The person is
2.10considered at risk under this clause if the person currently lives alone or will live alone
2.11upon discharge and also meets one of the following criteria:
2.12    (i) the person has experienced a fall resulting in a fracture;
2.13    (ii) the person has been determined to be at risk of maltreatment or neglect,
2.14including self-neglect; or
2.15    (iii) the person has a sensory impairment that substantially impacts functional ability
2.16and maintenance of a community residence.
2.17    (b) The assessment used to establish medical assistance payment for nursing facility
2.18services must be the most recent assessment performed under subdivision 4, paragraph
2.19(b), that occurred no more than 90 calendar days before the effective date of medical
2.20assistance eligibility for payment of long-term care services. In no case shall medical
2.21assistance payment for long-term care services occur prior to the date of the determination
2.22of nursing facility level of care.
2.23    (c) The assessment used to establish medical assistance payment for long-term care
2.24services provided under sections 256B.0915 and 256B.49 and alternative care payment
2.25for services provided under section 256B.0913 must be the most recent face-to-face
2.26assessment performed under section 256B.0911, subdivision 3a, 3b, or 4d, that occurred
2.27no more than 60 calendar days before the effective date of medical assistance eligibility
2.28for payment of long-term care services.

2.29    Sec. 2. Minnesota Statutes 2008, section 144A.071, subdivision 4b, is amended to read:
2.30    Subd. 4b. Licensed beds on layaway status. A licensed and certified nursing
2.31facility may lay away, upon prior written notice to the commissioner of health, up to 50
2.32percent of its licensed and certified beds. A nursing facility may not discharge a resident
2.33in order to lay away a bed. Notice to the commissioner shall be given 60 days prior
2.34to the effective date of the layaway. Beds on layaway shall have the same status as
2.35voluntarily delicensed and decertified beds and shall not be subject to license fees and
3.1license surcharge fees. In addition, beds on layaway may be removed from layaway at any
3.2time on or after one year after the effective date of layaway in the facility of origin, with a
3.360-day notice to the commissioner. A nursing facility that removes beds from layaway
3.4may not place beds on layaway status for one year after the effective date of the removal
3.5from layaway. The commissioner may approve the immediate removal of beds from
3.6layaway if necessary to provide access to those nursing home beds to residents relocated
3.7from other nursing homes due to emergency situations or closure. In the event approval
3.8is granted, the one-year restriction on placing beds on layaway after a removal of beds
3.9from layaway shall not apply. Beds may remain on layaway for up to five ten years. The
3.10commissioner may approve placing and removing beds on layaway at any time during
3.11renovation or construction related to a moratorium project approved under this section
3.12or section 144A.073. Nursing facilities are not required to comply with any licensure or
3.13certification requirements for beds on layaway status.

3.14    Sec. 3. Minnesota Statutes 2008, section 144A.161, subdivision 1a, is amended to read:
3.15    Subd. 1a. Scope. Where a facility is undertaking closure, curtailment, reduction, or
3.16change in operations, or where a housing with services unit registered under chapter 144D
3.17is closed because the space that it occupies is being replaced by a nursing facility bed that
3.18is being reactivated from layaway status, the facility and the county social services agency
3.19must comply with the requirements of this section.

3.20    Sec. 4. Minnesota Statutes 2008, section 245A.03, is amended by adding a subdivision
3.21to read:
3.22    Subd. 9. Permitted services by an individual who is related. Notwithstanding
3.23subdivision 2, paragraph (a), clause (1), and subdivision 7, an individual who is related to a
3.24person receiving supported living services may provide licensed services to that person if:
3.25    (1) the person who receives supported living services received these services in a
3.26residential site on July 1, 2005;
3.27    (2) the services under clause (1) were provided in a corporate foster care setting for
3.28adults and were funded by the developmental disabilities home and community-based
3.29services waiver defined in section 256B.092;
3.30    (3) the individual who is related obtains and maintains both a license under
3.31chapter 245B and an adult foster care license under Minnesota Rules, parts 9555.5105
3.32to 9555.6265; and
3.33    (4) the individual who is related is not the guardian of the person receiving supported
3.34living services.
4.1EFFECTIVE DATE.This section is effective the day following final enactment.

4.2    Sec. 5. Minnesota Statutes 2009 Supplement, section 256B.0625, subdivision 19c,
4.3is amended to read:
4.4    Subd. 19c. Personal care. Medical assistance covers personal care assistance
4.5services provided by an individual who is qualified to provide the services according to
4.6subdivision 19a and sections 256B.0651 to 256B.0656, provided in accordance with a
4.7plan, and supervised by a qualified professional.
4.8"Qualified professional" means a mental health professional as defined in section 245.462,
4.9subdivision 18 , or 245.4871, subdivision 27; or a registered nurse as defined in sections
4.10148.171 to 148.285, a licensed social worker as defined in section 148B.21 sections
4.11148D.010 and 148D.055, or a qualified developmental disabilities specialist under section
4.12245B.07, subdivision 4 . The qualified professional shall perform the duties required in
4.13section 256B.0659.

4.14    Sec. 6. Minnesota Statutes 2009 Supplement, section 256B.0651, is amended by
4.15adding a subdivision to read:
4.16    Subd. 17. Recipient protection. (a) Providers of home care services must provide
4.17each recipient with a copy of the home care bill of rights under section 144A.44 at
4.18least 30 days prior to terminating services to a recipient, if the termination results from
4.19provider sanctions under section 256B.064, such as a payment withhold, a suspension of
4.20participation, or a termination of participation. If a home care provider determines it is
4.21unable to continue providing services to a recipient, the provider must notify the recipient,
4.22the recipient's responsible party, and the commissioner 30 days prior to terminating
4.23services to the recipient because of an action under section 256B.064, and must assist the
4.24commissioner and lead agency in supporting the recipient in transitioning to another
4.25home care provider of the recipient's choice.
4.26    (b) In the event of a payment withhold from a home care provider, a suspension of
4.27participation, or a termination of participation of a home care provider under section
4.28256B.064, the commissioner may inform the Office of Ombudsman for Long-Term Care
4.29and the lead agencies for all recipients with active service agreements with the provider.
4.30At the commissioner's request, the lead agencies must contact recipients to ensure that the
4.31recipients are continuing to receive needed care, and that the recipients have been given
4.32free choice of provider if they transfer to another home care provider. In addition, the
4.33commissioner or the commissioner's delegate may directly notify recipients who receive
4.34care from the provider that payments have been withheld or that the provider's participation
5.1in medical assistance has been suspended or terminated, if the commissioner determines
5.2that notification is necessary to protect the welfare of the recipients. For purposes of this
5.3subdivision, "lead agencies" means counties, tribes, and managed care organizations.

5.4    Sec. 7. Minnesota Statutes 2009 Supplement, section 256B.0652, subdivision 6,
5.5is amended to read:
5.6    Subd. 6. Authorization; personal care assistance and qualified professional.
5.7    (a) All personal care assistance services, supervision by a qualified professional, and
5.8additional services beyond the limits established in subdivision 11, must be authorized
5.9by the commissioner or the commissioner's designee before services begin except for the
5.10assessments established in subdivision 11 and section 256B.0911. The authorization for
5.11personal care assistance and qualified professional services under section 256B.0659 must
5.12be completed within 30 days after receiving a complete request.
5.13    (b) The amount of personal care assistance services authorized must be based
5.14on the recipient's home care rating. The home care rating shall be determined by the
5.15commissioner or the commissioner's designee based on information submitted to the
5.16commissioner identifying the following:
5.17    (1) total number of dependencies of activities of daily living as defined in section
5.18256B.0659 ;
5.19    (2) number presence of complex health-related needs as defined in section
5.20256B.0659 ; and
5.21    (3) number presence of Level I behavior descriptions as defined in section
5.22256B.0659 .
5.23    (c) The methodology to determine total time for personal care assistance services for
5.24each home care rating is based on the median paid units per day for each home care rating
5.25from fiscal year 2007 data for the personal care assistance program. Each home care rating
5.26has a base level of hours assigned. Additional time is added through the assessment and
5.27identification of the following:
5.28    (1) 30 additional minutes per day for a dependency in each critical activity of daily
5.29living as defined in section 256B.0659;
5.30    (2) 30 additional minutes per day for each complex health-related function as
5.31defined in section 256B.0659; and
5.32    (3) 30 additional minutes per day for each behavior issue as defined in section
5.33256B.0659, subdivision 4, paragraph (d) .
5.34    (d) A limit of 96 units of qualified professional supervision may be authorized for
5.35each recipient receiving personal care assistance services. A request to the commissioner
6.1to exceed this total in a calendar year must be requested by the personal care provider
6.2agency on a form approved by the commissioner.

6.3    Sec. 8. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 10,
6.4is amended to read:
6.5    Subd. 10. Responsible party; duties; delegation. (a) A responsible party shall
6.6enter into a written agreement with a personal care assistance provider agency, on a form
6.7determined by the commissioner, to perform the following duties:
6.8    (1) be available while care is provided in a method agreed upon by the individual
6.9or the individual's legal representative and documented in the recipient's personal care
6.10assistance care plan;
6.11    (2) monitor personal care assistance services to ensure the recipient's personal care
6.12assistance care plan is being followed; and
6.13    (3) review and sign personal care assistance time sheets after services are provided
6.14to provide verification of the personal care assistance services.
6.15Failure to provide the support required by the recipient must result in a referral to the
6.16county common entry point.
6.17    (b) Responsible parties who are parents of minors or guardians of minors or
6.18incapacitated persons may delegate the responsibility to another adult who is not the
6.19personal care assistant during a temporary absence of at least 24 hours but not more
6.20than six months. The person delegated as a responsible party must be able to meet the
6.21definition of the responsible party. The responsible party must ensure that the delegate
6.22performs the functions of the responsible party, is identified at the time of the assessment,
6.23and is listed on the personal care assistance care plan. The responsible party must
6.24communicate to the personal care assistance provider agency about the need for a delegate
6.25delegated responsible party, including the name of the delegated responsible party, dates
6.26the delegated responsible party will be living with the recipient, and contact numbers.

6.27    Sec. 9. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 11,
6.28is amended to read:
6.29    Subd. 11. Personal care assistant; requirements. (a) A personal care assistant
6.30must meet the following requirements:
6.31    (1) be at least 18 years of age with the exception of persons who are 16 or 17 years
6.32of age with these additional requirements:
6.33    (i) supervision by a qualified professional every 60 days; and
7.1    (ii) employment by only one personal care assistance provider agency responsible
7.2for compliance with current labor laws;
7.3    (2) be employed by a personal care assistance provider agency;
7.4    (3) enroll with the department as a personal care assistant after clearing a background
7.5study. Except as provided in subdivision 11a, before a personal care assistant provides
7.6services, the personal care assistance provider agency must initiate a background study on
7.7the personal care assistant under chapter 245C, and the personal care assistance provider
7.8agency must have received a notice from the commissioner that the personal care assistant
7.9is:
7.10    (i) not disqualified under section 245C.14; or
7.11    (ii) is disqualified, but the personal care assistant has received a set aside of the
7.12disqualification under section 245C.22;
7.13    (4) be able to effectively communicate with the recipient and personal care
7.14assistance provider agency;
7.15    (5) be able to provide covered personal care assistance services according to the
7.16recipient's personal care assistance care plan, respond appropriately to recipient needs,
7.17and report changes in the recipient's condition to the supervising qualified professional
7.18or physician;
7.19    (6) not be a consumer of personal care assistance services;
7.20    (7) maintain daily written records including, but not limited to, time sheets under
7.21subdivision 12;
7.22    (8) effective January 1, 2010, complete standardized training as determined by the
7.23commissioner before completing enrollment. Personal care assistant training must include
7.24successful completion of the following training components: basic first aid, vulnerable
7.25adult, child maltreatment, OSHA universal precautions, basic roles and responsibilities of
7.26personal care assistants including information about assistance with lifting and transfers
7.27for recipients, emergency preparedness, orientation to positive behavioral practices, fraud
7.28issues, and completion of time sheets. Upon completion of the training components,
7.29the personal care assistant must demonstrate the competency to provide assistance to
7.30recipients;
7.31    (9) complete training and orientation on the needs of the recipient within the first
7.32seven days after the services begin; and
7.33    (10) be limited to providing and being paid for up to 310 hours per month of personal
7.34care assistance services regardless of the number of recipients being served or the number
7.35of personal care assistance provider agencies enrolled with.
8.1    (b) A legal guardian may be a personal care assistant if the guardian is not being paid
8.2for the guardian services and meets the criteria for personal care assistants in paragraph (a).
8.3    (c) Effective January 1, 2010, persons who do not qualify as a personal care assistant
8.4include parents and stepparents of minors, spouses, paid legal guardians, family foster
8.5care providers, except as otherwise allowed in section 256B.0625, subdivision 19a, or
8.6staff of a residential setting.
8.7EFFECTIVE DATE.This section is effective retroactively from July 1, 2009.

8.8    Sec. 10. Minnesota Statutes 2009 Supplement, section 256B.0659, is amended by
8.9adding a subdivision to read:
8.10    Subd. 11a. Exception to personal care assistant; requirements. The personal care
8.11assistant for a recipient may be allowed to enroll with a different personal care assistant
8.12provider agency upon initiation of a new background study according to chapter 245C, if
8.13all of the following are met:
8.14    (1) the commissioner determines that a change in enrollment or affiliation of the
8.15personal care assistant is needed in order to ensure continuity of services and protect the
8.16health and safety of the recipient;
8.17    (2) the chosen agency has been continuously enrolled as a personal care assistance
8.18provider agency for at least two years;
8.19    (3) the recipient chooses to transfer to the personal care assistance provider agency;
8.20    (4) the personal care assistant has been continuously enrolled with the former
8.21personal care assistance provider agency since the last background study was completed;
8.22and
8.23    (5) the personal care assistant continues to meet requirements of subdivision 11,
8.24excluding paragraph (a), clause (3).
8.25EFFECTIVE DATE.This section is effective retroactively from July 1, 2009.

8.26    Sec. 11. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 13,
8.27is amended to read:
8.28    Subd. 13. Qualified professional; qualifications. (a) The qualified professional
8.29must be employed by work for a personal care assistance provider agency and meet the
8.30definition under section 256B.0625, subdivision 19c. Before a qualified professional
8.31provides services, the personal care assistance provider agency must initiate a background
8.32study on the qualified professional under chapter 245C, and the personal care assistance
9.1provider agency must have received a notice from the commissioner that the qualified
9.2professional:
9.3    (1) is not disqualified under section 245C.14; or
9.4    (2) is disqualified, but the qualified professional has received a set aside of the
9.5disqualification under section 245C.22.
9.6    (b) The qualified professional shall perform the duties of training, supervision, and
9.7evaluation of the personal care assistance staff and evaluation of the effectiveness of
9.8personal care assistance services. The qualified professional shall:
9.9    (1) develop and monitor with the recipient a personal care assistance care plan based
9.10on the service plan and individualized needs of the recipient;
9.11    (2) develop and monitor with the recipient a monthly plan for the use of personal
9.12care assistance services;
9.13    (3) review documentation of personal care assistance services provided;
9.14    (4) provide training and ensure competency for the personal care assistant in the
9.15individual needs of the recipient; and
9.16    (5) document all training, communication, evaluations, and needed actions to
9.17improve performance of the personal care assistants.
9.18    (c) Effective January 1, 2010, the qualified professional shall complete the provider
9.19training with basic information about the personal care assistance program approved
9.20by the commissioner within six months of the date hired by a personal care assistance
9.21provider agency. Qualified professionals who have completed the required trainings
9.22training as an employee with a worker from a personal care assistance provider agency do
9.23not need to repeat the required trainings training if they are hired by another agency, if
9.24they have completed the training within the last three years.

9.25    Sec. 12. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 21,
9.26is amended to read:
9.27    Subd. 21. Requirements for initial enrollment of personal care assistance
9.28provider agencies. (a) All personal care assistance provider agencies must provide, at the
9.29time of enrollment as a personal care assistance provider agency in a format determined
9.30by the commissioner, information and documentation that includes, but is not limited to,
9.31the following:
9.32    (1) the personal care assistance provider agency's current contact information
9.33including address, telephone number, and e-mail address;
9.34    (2) proof of surety bond coverage in the amount of $50,000 or ten percent of the
9.35provider's payments from Medicaid in the previous year, whichever is less;
10.1    (3) proof of fidelity bond coverage in the amount of $20,000;
10.2    (4) proof of workers' compensation insurance coverage;
10.3    (5) proof of liability insurance;
10.4    (5) (6) a description of the personal care assistance provider agency's organization
10.5identifying the names of all owners, managing employees, staff, board of directors, and
10.6the affiliations of the directors, owners, or staff to other service providers;
10.7    (6) (7) a copy of the personal care assistance provider agency's written policies
10.8and procedures including: hiring of employees; training requirements; service delivery;
10.9and employee and consumer safety including process for notification and resolution
10.10of consumer grievances, identification and prevention of communicable diseases, and
10.11employee misconduct;
10.12    (7) (8) copies of all other forms the personal care assistance provider agency uses in
10.13the course of daily business including, but not limited to:
10.14    (i) a copy of the personal care assistance provider agency's time sheet if the time
10.15sheet varies from the standard time sheet for personal care assistance services approved
10.16by the commissioner, and a letter requesting approval of the personal care assistance
10.17provider agency's nonstandard time sheet;
10.18    (ii) the personal care assistance provider agency's template for the personal care
10.19assistance care plan; and
10.20    (iii) the personal care assistance provider agency's template for the written
10.21agreement in subdivision 20 for recipients using the personal care assistance choice
10.22option, if applicable;
10.23    (8) (9) a list of all trainings training and classes that the personal care assistance
10.24provider agency requires of its staff providing personal care assistance services;
10.25    (9) (10) documentation that the personal care assistance provider agency and staff
10.26have successfully completed all the training required by this section;
10.27    (10) (11) documentation of the agency's marketing practices;
10.28    (11) (12) disclosure of ownership, leasing, or management of all residential
10.29properties that is used or could be used for providing home care services; and
10.30    (12) (13) documentation that the agency will use the following percentages of
10.31revenue generated from the medical assistance rate paid for personal care assistance
10.32services for employee personal care assistant wages and benefits: 72.5 percent of revenue
10.33in the personal care assistance choice option and 72.5 percent of revenue from other
10.34personal care assistance providers.
10.35    (b) Personal care assistance provider agencies shall provide the information specified
10.36in paragraph (a) to the commissioner at the time the personal care assistance provider
11.1agency enrolls as a vendor or upon request from the commissioner. The commissioner
11.2shall collect the information specified in paragraph (a) from all personal care assistance
11.3providers beginning July 1, 2009.
11.4    (c) All personal care assistance provider agencies shall complete mandatory training
11.5as determined by the commissioner before enrollment as a provider. Personal care
11.6assistance provider agencies are required to send all owners, qualified professionals
11.7employed by the agency, and all other managing employees to the initial and subsequent
11.8trainings training. Personal care assistance provider agency billing staff shall complete
11.9training about personal care assistance program financial management. This training is
11.10effective July 1, 2009. Any personal care assistance provider agency enrolled before that
11.11date shall, if it has not already, complete the provider training within 18 months of July 1,
11.122009. Any new owners, new qualified professionals, and new managing employees are
11.13required to complete mandatory training as a requisite of hiring.

11.14    Sec. 13. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 30,
11.15is amended to read:
11.16    Subd. 30. Notice of service changes to recipients. The commissioner must provide:
11.17    (1) by October 31, 2009, information to recipients likely to be affected that (i)
11.18describes the changes to the personal care assistance program that may result in the
11.19loss of access to personal care assistance services, and (ii) includes resources to obtain
11.20further information; and
11.21    (2) notice of changes in medical assistance home care personal care assistant services
11.22to each affected recipient at least 30 days before the effective date of the change.
11.23The notice shall include how to get further information on the changes, how to get help to
11.24obtain other services, a list of community resources, and appeal rights. Notwithstanding
11.25section 256.045, a recipient may request continued services pending appeal within the
11.26time period allowed to request an appeal.

11.27    Sec. 14. Minnesota Statutes 2009 Supplement, section 256B.0911, subdivision 1a,
11.28is amended to read:
11.29    Subd. 1a. Definitions. For purposes of this section, the following definitions apply:
11.30    (a) "Long-term care consultation services" means:
11.31    (1) assistance in identifying services needed to maintain an individual in the most
11.32inclusive environment;
11.33    (2) providing recommendations on cost-effective community services that are
11.34available to the individual;
12.1    (3) development of an individual's person-centered community support plan;
12.2    (4) providing information regarding eligibility for Minnesota health care programs;
12.3    (5) face-to-face long-term care consultation assessments, which may be completed
12.4in a hospital, nursing facility, intermediate care facility for persons with developmental
12.5disabilities (ICF/DDs), regional treatment centers, or the person's current or planned
12.6residence;
12.7    (6) federally mandated screening to determine the need for a institutional level of
12.8care under section 256B.0911, subdivision 4, paragraph (a);
12.9    (7) determination of home and community-based waiver service eligibility including
12.10level of care determination for individuals who need an institutional level of care as
12.11defined under section 144.0724, subdivision 11, or 256B.092, service eligibility including
12.12state plan home care services identified in section sections 256B.0625, subdivisions 6,
12.137, and 19, paragraphs (a) and (c), and 256B.0657, based on assessment and support plan
12.14development with appropriate referrals, including the option for consumer-directed
12.15community supports;
12.16    (8) providing recommendations for nursing facility placement when there are no
12.17cost-effective community services available; and
12.18    (9) assistance to transition people back to community settings after facility
12.19admission.
12.20    (b) "Long-term care options counseling" means the services provided by the linkage
12.21lines as mandated by sections 256.01 and 256.975, subdivision 7, and also includes
12.22telephone assistance and follow up once a long-term care consultation assessment has
12.23been completed.
12.24    (c) "Minnesota health care programs" means the medical assistance program under
12.25chapter 256B and the alternative care program under section 256B.0913.
12.26    (d) "Lead agencies" means counties or a collaboration of counties, tribes, and health
12.27plans administering long-term care consultation assessment and support planning services.

12.28    Sec. 15. Minnesota Statutes 2009 Supplement, section 256B.0911, subdivision 2b,
12.29is amended to read:
12.30    Subd. 2b. Certified assessors. (a) Beginning January 1, 2011, each lead agency
12.31shall use certified assessors who have completed training and the certification processes
12.32determined by the commissioner in subdivision 2c. Certified assessors shall demonstrate
12.33best practices in assessment and support planning including person-centered planning
12.34principals and have a common set of skills that must ensure consistency and equitable
12.35access to services statewide. Assessors must be part of a multidisciplinary team of
13.1professionals that includes public health nurses, social workers, and other professionals
13.2as defined in paragraph (b). For persons with complex health care needs, a public health
13.3nurse or registered nurse from a multidisciplinary team must be consulted. A lead agency
13.4may choose, according to departmental policies, to contract with a qualified, certified
13.5assessor to conduct assessments and reassessments on behalf of the lead agency.
13.6    (b) Certified assessors are persons with a minimum of a bachelor's degree in social
13.7work, nursing with a public health nursing certificate, or other closely related field with at
13.8least one year of home and community-based experience or a two-year registered nursing
13.9degree with at least three years of home and community-based experience that have
13.10received training and certification specific to assessment and consultation for long-term
13.11care services in the state.

13.12    Sec. 16. Minnesota Statutes 2009 Supplement, section 256B.0911, subdivision 3a,
13.13is amended to read:
13.14    Subd. 3a. Assessment and support planning. (a) Persons requesting assessment,
13.15services planning, or other assistance intended to support community-based living,
13.16including persons who need assessment in order to determine waiver or alternative care
13.17program eligibility, must be visited by a long-term care consultation team within 15
13.18calendar days after the date on which an assessment was requested or recommended. After
13.19January 1, 2011, these requirements also apply to personal care assistance services, private
13.20duty nursing, and home health agency services, on timelines established in subdivision 5.
13.21Face-to-face assessments must be conducted according to paragraphs (b) to (i).
13.22    (b) The county may utilize a team of either the social worker or public health nurse,
13.23or both. After January 1, 2011, lead agencies shall use certified assessors to conduct the
13.24assessment in a face-to-face interview. The consultation team members must confer
13.25regarding the most appropriate care for each individual screened or assessed.
13.26    (c) The assessment must be comprehensive and include a person-centered
13.27assessment of the health, psychological, functional, environmental, and social needs of
13.28referred individuals and provide information necessary to develop a support plan that
13.29meets the consumers needs, using an assessment form provided by the commissioner.
13.30    (d) The assessment must be conducted in a face-to-face interview with the person
13.31being assessed and the person's legal representative, as required by legally executed
13.32documents, and other individuals as requested by the person, who can provide information
13.33on the needs, strengths, and preferences of the person necessary to develop a support plan
13.34that ensures the person's health and safety, but who is not a provider of service or has any
13.35financial interest in the provision of services.
14.1    (e) The person, or the person's legal representative, must be provided with written
14.2recommendations for community-based services, including consumer-directed options,
14.3or institutional care that include documentation that the most cost-effective alternatives
14.4available were offered to the individual. For purposes of this requirement, "cost-effective
14.5alternatives" means community services and living arrangements that cost the same as or
14.6less than institutional care.
14.7    (f) If the person chooses to use community-based services, the person or the person's
14.8legal representative must be provided with a written community support plan, regardless
14.9of whether the individual is eligible for Minnesota health care programs. A person may
14.10request assistance in identifying community supports without participating in a complete
14.11assessment. Upon a request for assistance identifying community support, the person must
14.12be transferred or referred to the services available under sections 256.975, subdivision 7,
14.13and 256.01, subdivision 24, for telephone assistance and follow up.
14.14    (g) The person has the right to make the final decision between institutional
14.15placement and community placement after the recommendations have been provided,
14.16except as provided in subdivision 4a, paragraph (c).
14.17    (h) The team must give the person receiving assessment or support planning, or
14.18the person's legal representative, materials, and forms supplied by the commissioner
14.19containing the following information:
14.20    (1) the need for and purpose of preadmission screening if the person selects nursing
14.21facility placement;
14.22    (2) the role of the long-term care consultation assessment and support planning in
14.23waiver and alternative care program eligibility determination;
14.24    (3) information about Minnesota health care programs;
14.25    (4) the person's freedom to accept or reject the recommendations of the team;
14.26    (5) the person's right to confidentiality under the Minnesota Government Data
14.27Practices Act, chapter 13;
14.28    (6) the long-term care consultant's decision regarding the person's need for
14.29institutional level of care as determined under criteria established in section 144.0724,
14.30subdivision 11 , or 256B.092; and
14.31    (7) the person's right to appeal the decision regarding the need for nursing facility
14.32level of care or the county's final decisions regarding public programs eligibility according
14.33to section 256.045, subdivision 3.
14.34    (i) Face-to-face assessment completed as part of eligibility determination for
14.35the alternative care, elderly waiver, community alternatives for disabled individuals,
14.36community alternative care, and traumatic brain injury waiver programs under sections
15.1256B.0915 , 256B.0917, and 256B.49 is valid to establish service eligibility for no more
15.2than 60 calendar days after the date of assessment. The effective eligibility start date
15.3for these programs can never be prior to the date of assessment. If an assessment was
15.4completed more than 60 days before the effective waiver or alternative care program
15.5eligibility start date, assessment and support plan information must be updated in a
15.6face-to-face visit and documented in the department's Medicaid Management Information
15.7System (MMIS). The effective date of program eligibility in this case cannot be prior to
15.8the date the updated assessment is completed.

15.9    Sec. 17. Minnesota Statutes 2009 Supplement, section 256B.0911, subdivision 3b,
15.10is amended to read:
15.11    Subd. 3b. Transition assistance. (a) A long-term care consultation team shall
15.12provide assistance to persons residing in a nursing facility, hospital, regional treatment
15.13center, or intermediate care facility for persons with developmental disabilities who
15.14request or are referred for assistance. Transition assistance must include assessment,
15.15community support plan development, referrals to long-term care options counseling
15.16under section 256B.975, subdivision 10, for community support plan implementation
15.17and to Minnesota health care programs, including home and community-based waiver
15.18services and consumer-directed options through the waivers, and referrals to programs
15.19that provide assistance with housing. Transition assistance must also include information
15.20about the Centers for Independent Living and the Senior LinkAge Line, and about other
15.21organizations that can provide assistance with relocation efforts, and information about
15.22contacting these organizations to obtain their assistance and support.
15.23    (b) The county shall develop transition processes with institutional social workers
15.24and discharge planners to ensure that:
15.25    (1) persons admitted to facilities receive information about transition assistance
15.26that is available;
15.27    (2) the assessment is completed for persons within ten working days of the date of
15.28request or recommendation for assessment; and
15.29    (3) there is a plan for transition and follow-up for the individual's return to the
15.30community. The plan must require notification of other local agencies when a person
15.31who may require assistance is screened by one county for admission to a facility located
15.32in another county.
15.33    (c) If a person who is eligible for a Minnesota health care program is admitted to a
15.34nursing facility, the nursing facility must include a consultation team member or the case
15.35manager in the discharge planning process.

16.1    Sec. 18. Minnesota Statutes 2008, section 256B.0911, subdivision 4d, is amended to
16.2read:
16.3    Subd. 4d. Preadmission screening of individuals under 65 years of age. (a)
16.4It is the policy of the state of Minnesota to ensure that individuals with disabilities or
16.5chronic illness are served in the most integrated setting appropriate to their needs and have
16.6the necessary information to make informed choices about home and community-based
16.7service options.
16.8    (b) Individuals under 65 years of age who are admitted to a nursing facility from a
16.9hospital must be screened prior to admission as outlined in subdivisions 4a through 4c.
16.10    (c) Individuals under 65 years of age who are admitted to nursing facilities with
16.11only a telephone screening must receive a face-to-face assessment from the long-term
16.12care consultation team member of the county in which the facility is located or from the
16.13recipient's county case manager within 40 calendar days of admission.
16.14    (d) Individuals under 65 years of age who are admitted to a nursing facility
16.15without preadmission screening according to the exemption described in subdivision 4b,
16.16paragraph (a), clause (3), and who remain in the facility longer than 30 days must receive
16.17a face-to-face assessment within 40 days of admission.
16.18    (e) At the face-to-face assessment, the long-term care consultation team member or
16.19county case manager must perform the activities required under subdivision 3b.
16.20    (f) For individuals under 21 years of age, a screening interview which recommends
16.21nursing facility admission must be face-to-face and approved by the commissioner before
16.22the individual is admitted to the nursing facility.
16.23    (g) In the event that an individual under 65 years of age is admitted to a nursing
16.24facility on an emergency basis, the county must be notified of the admission on the
16.25next working day, and a face-to-face assessment as described in paragraph (c) must be
16.26conducted within 40 calendar days of admission.
16.27    (h) At the face-to-face assessment, the long-term care consultation team member or
16.28the case manager must present information about home and community-based options,
16.29including consumer-directed options, so the individual can make informed choices. If the
16.30individual chooses home and community-based services, the long-term care consultation
16.31team member or case manager must complete a written relocation plan within 20 working
16.32days of the visit. The plan shall describe the services needed to move out of the facility
16.33and a time line for the move which is designed to ensure a smooth transition to the
16.34individual's home and community.
16.35    (i) An individual under 65 years of age residing in a nursing facility shall receive a
16.36face-to-face assessment at least every 12 months to review the person's service choices
17.1and available alternatives unless the individual indicates, in writing, that annual visits are
17.2not desired. In this case, the individual must receive a face-to-face assessment at least
17.3once every 36 months for the same purposes.
17.4    (j) Notwithstanding the provisions of subdivision 6, the commissioner may pay
17.5county agencies directly for face-to-face assessments for individuals under 65 years of age
17.6who are being considered for placement or residing in a nursing facility.

17.7    Sec. 19. Minnesota Statutes 2008, section 626.557, subdivision 9a, is amended to read:
17.8    Subd. 9a. Evaluation and referral of reports made to common entry point unit.
17.9    The common entry point must screen the reports of alleged or suspected maltreatment for
17.10immediate risk and make all necessary referrals as follows:
17.11    (1) if the common entry point determines that there is an immediate need for
17.12adult protective services, the common entry point agency shall immediately notify the
17.13appropriate county agency;
17.14    (2) if the report contains suspected criminal activity against a vulnerable adult, the
17.15common entry point shall immediately notify the appropriate law enforcement agency;
17.16    (3) if the report references alleged or suspected maltreatment and there is no
17.17immediate need for adult protective services, the common entry point shall notify refer all
17.18reports of alleged or suspected maltreatment to the appropriate lead agency as soon as
17.19possible, but in any event no longer than two working days; and
17.20    (4) if the report does not reference alleged or suspected maltreatment, the common
17.21entry point may determine whether the information will be referred; and
17.22    (5) (4) if the report contains information about a suspicious death, the common entry
17.23point shall immediately notify the appropriate law enforcement agencies, the local medical
17.24examiner, and the ombudsman established under section 245.92. Law enforcement
17.25agencies shall coordinate with the local medical examiner and the ombudsman as provided
17.26by law.

17.27    Sec. 20. ELDERLY WAIVER CONVERSION.
17.28    Notwithstanding Minnesota Statutes, section 256B.0915, subdivision 3b, a person
17.29age 65 or older with an MT home care rating on January 1, 2010, is eligible for the elderly
17.30waiver program and shall be considered a conversion for purposes of accessing monthly
17.31budget caps equal to no more than the person's monthly spending under the personal care
17.32assistance program on January 1, 2010.

18.1    Sec. 21. DIRECTION TO COMMISSIONER; CONSULTATION WITH
18.2STAKEHOLDERS.
18.3    The commissioner shall consult with stakeholders experienced in using and
18.4providing services through the consumer-directed community supports option during
18.5the identification of data to be used in future development of an individualized budget
18.6methodology for the home and community-based waivers for individuals with disabilities
18.7under the new comprehensive assessment.

18.8ARTICLE 2

18.9PERSONAL CARE ASSISTANT SERVICES

18.10    Section 1. Minnesota Statutes 2009 Supplement, section 256B.0653, subdivision 3,
18.11is amended to read:
18.12    Subd. 3. Home health aide visits. (a) Home health aide visits must be provided
18.13by a certified home health aide using a written plan of care that is updated in compliance
18.14with Medicare regulations. A home health aide shall provide hands-on personal care,
18.15perform simple procedures as an extension of therapy or nursing services, and assist in
18.16instrumental activities of daily living as defined in section 256B.0659, including assuring
18.17that the person gets to medical appointments if identified in the written plan of care. Home
18.18health aide visits must be provided in the recipient's home.
18.19    (b) All home health aide visits must have authorization under section 256B.0652.
18.20The commissioner shall limit home health aide visits to no more than one visit per day
18.21per recipient.
18.22    (c) Home health aides must be supervised by a registered nurse or an appropriate
18.23therapist when providing services that are an extension of therapy.

18.24    Sec. 2. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 1,
18.25is amended to read:
18.26    Subdivision 1. Definitions. (a) For the purposes of this section, the terms defined in
18.27paragraphs (b) to (p) (r) have the meanings given unless otherwise provided in text.
18.28    (b) "Activities of daily living" means grooming, dressing, bathing, transferring,
18.29mobility, positioning, eating, and toileting.
18.30    (c) "Behavior," effective January 1, 2010, means a category to determine the home
18.31care rating and is based on the criteria found in this section. "Level I behavior" means
18.32physical aggression towards self, others, or destruction of property that requires the
18.33immediate response of another person.
19.1    (d) "Complex health-related needs," effective January 1, 2010, means a category to
19.2determine the home care rating and is based on the criteria found in this section.
19.3    (e) "Critical activities of daily living," effective January 1, 2010, means transferring,
19.4mobility, eating, and toileting.
19.5    (f) "Dependency in activities of daily living" means a person requires assistance to
19.6begin and complete one or more of the activities of daily living.
19.7    (g) "Extended personal care assistance service" means personal care assistance
19.8services included in a service plan under one of the home and community-based services
19.9waivers authorized under sections 256B.49, 256B.0915, and 256B.092, subdivision
19.105, which exceed the amount, duration, and frequency of the state plan personal care
19.11assistance services for participants who:
19.12    (1) need assistance provided periodically during a week, but less than daily will not
19.13be able to remain in their home without the assistance, and other replacement services
19.14are more expensive or are not available when personal care assistance services are to be
19.15terminated; or
19.16    (2) need additional personal care assistance services beyond the amount authorized
19.17by the state plan personal care assistance assessment in order to ensure that their safety,
19.18health, and welfare are provided for in their homes.
19.19    (h) "Health-related procedures and tasks" means procedures and tasks that can
19.20be delegated or assigned by a licensed health care professional under state law to be
19.21performed by a personal care assistant.
19.22    (h) (i) "Instrumental activities of daily living" means activities to include meal
19.23planning and preparation; basic assistance with paying bills; shopping for food, clothing,
19.24and other essential items; performing household tasks integral to the personal care
19.25assistance services; communication by telephone and other media; and traveling, including
19.26to medical appointments and to participate in the community.
19.27    (i) (j) "Managing employee" has the same definition as Code of Federal Regulations,
19.28title 42, section 455.
19.29    (j) (k) "Qualified professional" means a professional providing supervision of
19.30personal care assistance services and staff as defined in section 256B.0625, subdivision
19.3119c .
19.32    (k) (l) "Personal care assistance provider agency" means a medical assistance
19.33enrolled provider that provides or assists with providing personal care assistance services
19.34and includes a personal care assistance provider organization, personal care assistance
19.35choice agency, class A licensed nursing agency, and Medicare-certified home health
19.36agency.
20.1    (l) (m) "Personal care assistant" or "PCA" means an individual employed by a
20.2personal care assistance agency who provides personal care assistance services.
20.3    (m) (n) "Personal care assistance care plan" means a written description of personal
20.4care assistance services developed by the personal care assistance provider according
20.5to the service plan.
20.6    (n) (o) "Responsible party" means an individual who is capable of providing the
20.7support necessary to assist the recipient to live in the community.
20.8    (o) (p) "Self-administered medication" means medication taken orally, by injection
20.9or insertion, or applied topically without the need for assistance.
20.10    (p) (q) "Service plan" means a written summary of the assessment and description of
20.11the services needed by the recipient.
20.12    (r) "Wages and benefits" means wages and salaries, the employer's share of FICA
20.13taxes, Medicare taxes, state and federal unemployment taxes, workers' compensation,
20.14mileage reimbursement, health and dental insurance, life insurance, disability insurance,
20.15long-term care insurance, uniform allowance, and contributions to employee retirement
20.16accounts.

20.17    Sec. 3. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 3,
20.18is amended to read:
20.19    Subd. 3. Noncovered personal care assistance services. (a) Personal care
20.20assistance services are not eligible for medical assistance payment under this section
20.21when provided:
20.22    (1) by the recipient's spouse, parent of a recipient under the age of 18, paid legal
20.23guardian, licensed foster provider, except as allowed under section 256B.0651, subdivision
20.2410 , or responsible party;
20.25    (2) in lieu of other staffing options in a residential or child care setting;
20.26    (3) solely as a child care or babysitting service; or
20.27    (4) without authorization by the commissioner or the commissioner's designee.
20.28    (b) The following personal care services are not eligible for medical assistance
20.29payment under this section when provided in residential settings:
20.30    (1) effective January 1, 2010, when the provider of home care services who is not
20.31related by blood, marriage, or adoption owns or otherwise controls the living arrangement,
20.32including licensed or unlicensed services; or
20.33    (2) when personal care assistance services are the responsibility of a residential or
20.34program license holder under the terms of a service agreement and administrative rules.
21.1    (c) Other specific tasks not covered under paragraph (a) or (b) that are not eligible
21.2for medical assistance reimbursement for personal care assistance services under this
21.3section include:
21.4    (1) sterile procedures;
21.5    (2) injections of fluids and medications into veins, muscles, or skin;
21.6    (3) home maintenance or chore services;
21.7    (4) homemaker services not an integral part of assessed personal care assistance
21.8services needed by a recipient;
21.9    (5) application of restraints or implementation of procedures under section 245.825;
21.10    (6) instrumental activities of daily living for children under the age of 18, except
21.11when immediate attention is needed for health or hygiene reasons integral to the personal
21.12care services and the need is listed in the service plan by the assessor; and
21.13    (7) assessments for personal care assistance services by personal care assistance
21.14provider agencies or by independently enrolled registered nurses.

21.15    Sec. 4. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 4,
21.16is amended to read:
21.17    Subd. 4. Assessment for personal care assistance services; limitations. (a) An
21.18assessment as defined in subdivision 3a must be completed for personal care assistance
21.19services.
21.20    (b) The following limitations apply to the assessment:
21.21    (1) a person must be assessed as dependent in an activity of daily living based on
21.22the person's daily need or need on the days during the week the activity is completed,
21.23on a daily basis, for:
21.24    (i) cuing and constant supervision to complete the task; or
21.25    (ii) hands-on assistance to complete the task; and
21.26    (2) a child may not be found to be dependent in an activity of daily living if because
21.27of the child's age an adult would either perform the activity for the child or assist the child
21.28with the activity. Assistance needed is the assistance appropriate for a typical child of
21.29the same age.
21.30    (c) Assessment for complex health-related needs must meet the criteria in this
21.31paragraph. During the assessment process, a recipient qualifies as having complex
21.32health-related needs if the recipient has one or more of the interventions that are ordered by
21.33a physician, specified in a personal care assistance care plan, and found in the following:
21.34    (1) tube feedings requiring:
21.35    (i) a gastro/jejunostomy gastrojejunostomy tube; or
22.1    (ii) continuous tube feeding lasting longer than 12 hours per day;
22.2    (2) wounds described as:
22.3    (i) stage III or stage IV;
22.4    (ii) multiple wounds;
22.5    (iii) requiring sterile or clean dressing changes or a wound vac; or
22.6    (iv) open lesions such as burns, fistulas, tube sites, or ostomy sites that require
22.7specialized care;
22.8    (3) parenteral therapy described as:
22.9    (i) IV therapy more than two times per week lasting longer than four hours for
22.10each treatment; or
22.11    (ii) total parenteral nutrition (TPN) daily;
22.12    (4) respiratory interventions including:
22.13    (i) oxygen required more than eight hours per day;
22.14    (ii) respiratory vest more than one time per day;
22.15    (iii) bronchial drainage treatments more than two times per day;
22.16    (iv) sterile or clean suctioning more than six times per day;
22.17    (v) dependence on another to apply respiratory ventilation augmentation devices
22.18such as BiPAP and CPAP; and
22.19    (vi) ventilator dependence under section 256B.0652;
22.20    (5) insertion and maintenance of catheter including:
22.21    (i) sterile catheter changes more than one time per month;
22.22    (ii) clean self-catheterization more than six times per day; or
22.23    (iii) bladder irrigations;
22.24    (6) bowel program more than two times per week requiring more than 30 minutes to
22.25perform each time;
22.26    (7) neurological intervention including:
22.27    (i) seizures more than two times per week and requiring significant physical
22.28assistance to maintain safety; or
22.29    (ii) swallowing disorders diagnosed by a physician and requiring specialized
22.30assistance from another on a daily basis; and
22.31    (8) other congenital or acquired diseases creating a need for significantly increased
22.32direct hands-on assistance and interventions in six to eight activities of daily living.
22.33    (d) An assessment of behaviors must meet the criteria in this paragraph. A recipient
22.34qualifies as having a need for assistance due to behaviors if the recipient's behavior requires
22.35assistance at least four times per week and shows one or more of the following behaviors:
23.1    (1) physical aggression towards self or others, or destruction of property that requires
23.2the immediate response of another person;
23.3    (2) increased vulnerability due to cognitive deficits or socially inappropriate
23.4behavior; or
23.5    (3) verbally aggressive and resistive to care.

23.6    Sec. 5. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 11,
23.7is amended to read:
23.8    Subd. 11. Personal care assistant; requirements. (a) A personal care assistant
23.9must meet the following requirements:
23.10    (1) be at least 18 years of age with the exception of persons who are 16 or 17 years
23.11of age with these additional requirements:
23.12    (i) supervision by a qualified professional every 60 days; and
23.13    (ii) employment by only one personal care assistance provider agency responsible
23.14for compliance with current labor laws;
23.15    (2) be employed by a personal care assistance provider agency;
23.16    (3) enroll with the department as a personal care assistant after clearing a background
23.17study. Before a personal care assistant provides services, the personal care assistance
23.18provider agency must initiate a background study on the personal care assistant under
23.19chapter 245C, and the personal care assistance provider agency must have received a
23.20notice from the commissioner that the personal care assistant is:
23.21    (i) not disqualified under section 245C.14; or
23.22    (ii) is disqualified, but the personal care assistant has received a set aside of the
23.23disqualification under section 245C.22;
23.24    (4) be able to effectively communicate with the recipient and personal care
23.25assistance provider agency;
23.26    (5) be able to provide covered personal care assistance services according to the
23.27recipient's personal care assistance care plan, respond appropriately to recipient needs,
23.28and report changes in the recipient's condition to the supervising qualified professional
23.29or physician;
23.30    (6) not be a consumer of personal care assistance services;
23.31    (7) maintain daily written records including, but not limited to, time sheets under
23.32subdivision 12;
23.33    (8) effective January 1, 2010, complete standardized training as determined
23.34by the commissioner before completing enrollment. The training must be available
23.35in languages other than English and to those who need accommodations due to
24.1disabilities. Personal care assistant training must include successful completion of the
24.2following training components: basic first aid, vulnerable adult, child maltreatment,
24.3OSHA universal precautions, basic roles and responsibilities of personal care assistants
24.4including information about assistance with lifting and transfers for recipients, emergency
24.5preparedness, orientation to positive behavioral practices, fraud issues, and completion of
24.6time sheets. Upon completion of the training components, the personal care assistant must
24.7demonstrate the competency to provide assistance to recipients;
24.8    (9) complete training and orientation on the needs of the recipient within the first
24.9seven days after the services begin; and
24.10    (10) be limited to providing and being paid for up to 310 hours per month of personal
24.11care assistance services regardless of the number of recipients being served or the number
24.12of personal care assistance provider agencies enrolled with. The number of hours worked
24.13per day shall not be disallowed by the department unless in violation of the law.
24.14    (b) A legal guardian may be a personal care assistant if the guardian is not being paid
24.15for the guardian services and meets the criteria for personal care assistants in paragraph (a).
24.16    (c) Effective January 1, 2010, persons who do not qualify as a personal care assistant
24.17include parents and stepparents of minors, spouses, paid legal guardians, family foster
24.18care providers, except as otherwise allowed in section 256B.0625, subdivision 19a, or
24.19staff of a residential setting.

24.20    Sec. 6. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 13,
24.21is amended to read:
24.22    Subd. 13. Qualified professional; qualifications. (a) The qualified professional
24.23must be employed by a personal care assistance provider agency and meet the definition
24.24under section 256B.0625, subdivision 19c. Before a qualified professional provides
24.25services, the personal care assistance provider agency must initiate a background study on
24.26the qualified professional under chapter 245C, and the personal care assistance provider
24.27agency must have received a notice from the commissioner that the qualified professional:
24.28    (1) is not disqualified under section 245C.14; or
24.29    (2) is disqualified, but the qualified professional has received a set aside of the
24.30disqualification under section 245C.22.
24.31    (b) The qualified professional shall perform the duties of training, supervision, and
24.32evaluation of the personal care assistance staff and evaluation of the effectiveness of
24.33personal care assistance services. The qualified professional shall:
24.34    (1) develop and monitor with the recipient a personal care assistance care plan based
24.35on the service plan and individualized needs of the recipient;
25.1    (2) develop and monitor with the recipient a monthly plan for the use of personal
25.2care assistance services;
25.3    (3) review documentation of personal care assistance services provided;
25.4    (4) provide training and ensure competency for the personal care assistant in the
25.5individual needs of the recipient; and
25.6    (5) document all training, communication, evaluations, and needed actions to
25.7improve performance of the personal care assistants.
25.8    (c) Effective January July 1, 2010, the qualified professional shall complete the
25.9provider training with basic information about the personal care assistance program
25.10approved by the commissioner within six months of the date hired by a personal care
25.11assistance provider agency. Qualified professionals who have completed the required
25.12trainings as an employee with a personal care assistance provider agency do not need to
25.13repeat the required trainings if they are hired by another agency, if they have completed the
25.14training within the last three years. The required training shall be available in languages
25.15other than English and to those who need accommodations due to disabilities, online, or
25.16by electronic remote connection, and provide for competency testing to demonstrate an
25.17understanding of the content without attending in-person training. A qualified professional
25.18is allowed to be employed and is not subject to the training requirement until the training is
25.19offered online or through remote electronic connection. A qualified professional employed
25.20by a personal care assistance provider agency certified for participation in Medicare as
25.21a home health agency is exempt from the training required in this subdivision. The
25.22commissioner shall ensure there is a mechanism in place to verify the identity of persons
25.23completing the competency testing electronically.

25.24    Sec. 7. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 14,
25.25is amended to read:
25.26    Subd. 14. Qualified professional; duties. (a) Effective January 1, 2010, all personal
25.27care assistants must be supervised by a qualified professional.
25.28    (b) Through direct training, observation, return demonstrations, and consultation
25.29with the staff and the recipient, the qualified professional must ensure and document
25.30that the personal care assistant is:
25.31    (1) capable of providing the required personal care assistance services;
25.32    (2) knowledgeable about the plan of personal care assistance services before services
25.33are performed; and
25.34    (3) able to identify conditions that should be immediately brought to the attention of
25.35the qualified professional.
26.1    (c) The qualified professional shall evaluate the personal care assistant within the first
26.214 days of starting to provide regularly scheduled services for a recipient except for the
26.3personal care assistance choice option under subdivision 19, paragraph (a), clause (4). For
26.4the initial evaluation, the qualified professional shall evaluate the personal care assistance
26.5services for a recipient through direct observation of a personal care assistant's work.
26.6Subsequent visits to evaluate the personal care assistance services provided to a recipient
26.7do not require direct observation of each personal care assistant's work and shall occur:
26.8    (1) at least every 90 days thereafter for the first year of a recipient's services; and
26.9    (2) every 120 days after the first year of a recipient's service or whenever needed for
26.10response to a recipient's request for increased supervision of the personal care assistance
26.11staff; and
26.12    (3) after the first 180 days of a recipient's service, supervisory visits may alternate
26.13between unscheduled phone or Internet technology and in-person visits, unless the
26.14in-person visits are needed according to the care plan.
26.15    (d) Communication with the recipient is a part of the evaluation process of the
26.16personal care assistance staff.
26.17    (e) At each supervisory visit, the qualified professional shall evaluate personal care
26.18assistance services including the following information:
26.19    (1) satisfaction level of the recipient with personal care assistance services;
26.20    (2) review of the month-to-month plan for use of personal care assistance services;
26.21    (3) review of documentation of personal care assistance services provided;
26.22    (4) whether the personal care assistance services are meeting the goals of the service
26.23as stated in the personal care assistance care plan and service plan;
26.24    (5) a written record of the results of the evaluation and actions taken to correct any
26.25deficiencies in the work of a personal care assistant; and
26.26    (6) revision of the personal care assistance care plan as necessary in consultation
26.27with the recipient or responsible party, to meet the needs of the recipient.
26.28    (f) The qualified professional shall complete the required documentation in the
26.29agency recipient and employee files and the recipient's home, including the following
26.30documentation:
26.31    (1) the personal care assistance care plan based on the service plan and individualized
26.32needs of the recipient;
26.33    (2) a month-to-month plan for use of personal care assistance services;
26.34    (3) changes in need of the recipient requiring a change to the level of service and the
26.35personal care assistance care plan;
27.1    (4) evaluation results of supervision visits and identified issues with personal care
27.2assistance staff with actions taken;
27.3    (5) all communication with the recipient and personal care assistance staff; and
27.4    (6) hands-on training or individualized training for the care of the recipient.
27.5    (g) The documentation in paragraph (f) must be done on agency forms.
27.6    (h) The services that are not eligible for payment as qualified professional services
27.7include:
27.8    (1) direct professional nursing tasks that could be assessed and authorized as skilled
27.9nursing tasks;
27.10    (2) supervision of personal care assistance completed by telephone;
27.11    (3) agency administrative activities;
27.12    (4) training other than the individualized training required to provide care for a
27.13recipient; and
27.14    (5) any other activity that is not described in this section.

27.15    Sec. 8. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 18,
27.16is amended to read:
27.17    Subd. 18. Personal care assistance choice option; generally. (a) The
27.18commissioner may allow a recipient of personal care assistance services to use a fiscal
27.19intermediary to assist the recipient in paying and accounting for medically necessary
27.20covered personal care assistance services. Unless otherwise provided in this section, all
27.21other statutory and regulatory provisions relating to personal care assistance services apply
27.22to a recipient using the personal care assistance choice option.
27.23    (b) Personal care assistance choice is an option of the personal care assistance
27.24program that allows the recipient who receives personal care assistance services to be
27.25responsible for the hiring, training, scheduling, and firing of personal care assistants
27.26according to the terms of the written agreement with the personal care assistance choice
27.27agency required under subdivision 20, paragraph (a). This program offers greater control
27.28and choice for the recipient in who provides the personal care assistance service and when
27.29the service is scheduled. The recipient or the recipient's responsible party must choose a
27.30personal care assistance choice provider agency as a fiscal intermediary. This personal
27.31care assistance choice provider agency manages payroll, invoices the state, is responsible
27.32for all payroll-related taxes and insurance, and is responsible for providing the consumer
27.33training and support in managing the recipient's personal care assistance services.

28.1    Sec. 9. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 19,
28.2is amended to read:
28.3    Subd. 19. Personal care assistance choice option; qualifications; duties. (a)
28.4Under personal care assistance choice, the recipient or responsible party shall:
28.5    (1) recruit, hire, schedule, and terminate personal care assistants and a qualified
28.6professional according to the terms of the written agreement required under subdivision
28.720, paragraph (a);
28.8    (2) develop a personal care assistance care plan based on the assessed needs
28.9and addressing the health and safety of the recipient with the assistance of a qualified
28.10professional as needed;
28.11    (3) orient and train the personal care assistant with assistance as needed from the
28.12qualified professional;
28.13    (4) effective January 1, 2010, supervise and evaluate the personal care assistant with
28.14the qualified professional, who is required to visit the recipient at least every 180 days;
28.15    (5) monitor and verify in writing and report to the personal care assistance choice
28.16agency the number of hours worked by the personal care assistant and the qualified
28.17professional;
28.18    (6) engage in an annual face-to-face reassessment to determine continuing eligibility
28.19and service authorization; and
28.20    (7) use the same personal care assistance choice provider agency if shared personal
28.21assistance care is being used.
28.22    (b) The personal care assistance choice provider agency shall:
28.23    (1) meet all personal care assistance provider agency standards;
28.24    (2) enter into a written agreement with the recipient, responsible party, and personal
28.25care assistants;
28.26    (3) not be related as a parent, child, sibling, or spouse to the recipient, qualified
28.27professional, or the personal care assistant; and
28.28    (4) ensure arm's-length transactions without undue influence or coercion with the
28.29recipient and personal care assistant.
28.30    (c) The duties of the personal care assistance choice provider agency are to:
28.31    (1) be the employer of the personal care assistant and the qualified professional for
28.32employment law and related regulations including, but not limited to, purchasing and
28.33maintaining workers' compensation, unemployment insurance, surety and fidelity bonds,
28.34and liability insurance, and submit any or all necessary documentation including, but not
28.35limited to, workers' compensation and unemployment insurance;
29.1    (2) bill the medical assistance program for personal care assistance services and
29.2qualified professional services;
29.3    (3) request and complete background studies that comply with the requirements for
29.4personal care assistants and qualified professionals;
29.5    (4) pay the personal care assistant and qualified professional based on actual hours
29.6of services provided;
29.7    (5) withhold and pay all applicable federal and state taxes;
29.8    (6) verify and keep records of hours worked by the personal care assistant and
29.9qualified professional;
29.10    (7) make the arrangements and pay taxes and other benefits, if any, and comply with
29.11any legal requirements for a Minnesota employer;
29.12    (8) enroll in the medical assistance program as a personal care assistance choice
29.13agency; and
29.14    (9) enter into a written agreement as specified in subdivision 20 before services
29.15are provided.

29.16    Sec. 10. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 20,
29.17is amended to read:
29.18    Subd. 20. Personal care assistance choice option; administration. (a) Before
29.19services commence under the personal care assistance choice option, and annually
29.20thereafter, the personal care assistance choice provider agency, recipient, or responsible
29.21party, each personal care assistant, and the qualified professional and the recipient or
29.22responsible party shall enter into a written agreement. The annual agreement must be
29.23provided to the recipient or responsible party, each personal care assistant, and the
29.24qualified professional when completed, and include at a minimum:
29.25    (1) duties of the recipient, qualified professional, personal care assistant, and
29.26personal care assistance choice provider agency;
29.27    (2) salary and benefits for the personal care assistant and the qualified professional;
29.28    (3) administrative fee of the personal care assistance choice provider agency and
29.29services paid for with that fee, including background study fees;
29.30    (4) grievance procedures to respond to complaints;
29.31    (5) procedures for hiring and terminating the personal care assistant; and
29.32    (6) documentation requirements including, but not limited to, time sheets, activity
29.33records, and the personal care assistance care plan.
29.34    (b) Effective January 1, 2010, except for the administrative fee of the personal care
29.35assistance choice provider agency as reported on the written agreement, the remainder
30.1of the rates paid to the personal care assistance choice provider agency must be used to
30.2pay for the salary and benefits for the personal care assistant or the qualified professional.
30.3The provider agency must use a minimum of 72.5 percent of the revenue generated by
30.4the medical assistance rate for personal care assistance services for employee personal
30.5care assistant wages and benefits.
30.6    (c) The commissioner shall deny, revoke, or suspend the authorization to use the
30.7personal care assistance choice option if:
30.8    (1) it has been determined by the qualified professional or public health nurse that
30.9the use of this option jeopardizes the recipient's health and safety;
30.10    (2) the parties have failed to comply with the written agreement specified in this
30.11subdivision;
30.12    (3) the use of the option has led to abusive or fraudulent billing for personal care
30.13assistance services; or
30.14    (4) the department terminates the personal care assistance choice option.
30.15    (d) The recipient or responsible party may appeal the commissioner's decision in
30.16paragraph (c) according to section 256.045. The denial, revocation, or suspension to
30.17use the personal care assistance choice option must not affect the recipient's authorized
30.18level of personal care assistance services.

30.19    Sec. 11. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 21,
30.20is amended to read:
30.21    Subd. 21. Requirements for initial enrollment of personal care assistance
30.22provider agencies. (a) All personal care assistance provider agencies must provide, at the
30.23time of enrollment as a personal care assistance provider agency in a format determined
30.24by the commissioner, information and documentation that includes, but is not limited to,
30.25the following:
30.26    (1) the personal care assistance provider agency's current contact information
30.27including address, telephone number, and e-mail address;
30.28    (2) proof of surety bond coverage in the amount of $50,000 or ten percent of the
30.29provider's payments from Medicaid in the previous year, whichever is less;
30.30    (3) proof of fidelity bond coverage in the amount of $20,000;
30.31    (4) proof of workers' compensation insurance coverage;
30.32    (5) a description of the personal care assistance provider agency's organization
30.33identifying the names of all owners, managing employees, staff, board of directors, and
30.34the affiliations of the directors, owners, or staff to other service providers;
31.1    (6) a copy of the personal care assistance provider agency's written policies and
31.2procedures including: hiring of employees; training requirements; service delivery;
31.3and employee and consumer safety including process for notification and resolution
31.4of consumer grievances, identification and prevention of communicable diseases, and
31.5employee misconduct;
31.6    (7) copies of all other forms the personal care assistance provider agency uses in
31.7the course of daily business including, but not limited to:
31.8    (i) a copy of the personal care assistance provider agency's time sheet if the time
31.9sheet varies from the standard time sheet for personal care assistance services approved
31.10by the commissioner, and a letter requesting approval of the personal care assistance
31.11provider agency's nonstandard time sheet;
31.12    (ii) the personal care assistance provider agency's template for the personal care
31.13assistance care plan; and
31.14    (iii) the personal care assistance provider agency's template for the written
31.15agreement in subdivision 20 for recipients using the personal care assistance choice
31.16option, if applicable;
31.17    (8) a list of all trainings and classes that the personal care assistance provider agency
31.18requires of its staff providing personal care assistance services;
31.19    (9) documentation that the personal care assistance provider agency and staff have
31.20successfully completed all the training required by this section;
31.21    (10) documentation of the agency's marketing practices;
31.22    (11) disclosure of ownership, leasing, or management of all residential properties
31.23that is used or could be used for providing home care services; and
31.24    (12) documentation that the agency will use the following percentages of revenue
31.25generated from the medical assistance rate paid for personal care assistance services
31.26for employee personal care assistant wages and benefits: 72.5 percent of revenue in the
31.27personal care assistance choice option and 72.5 percent of revenue from other personal
31.28care assistance providers; and
31.29    (13) effective the day following final enactment, documentation that the agency does
31.30not burden recipients' free exercise of their right to choose service providers by requiring
31.31personal care assistants to sign an agreement not to work with any particular personal
31.32care assistance recipient or for another personal care assistance provider agency after
31.33leaving the agency and that the agency is not taking action on any such agreements or
31.34requirements regardless of the date signed.
31.35    (b) Personal care assistance provider agencies shall provide the information specified
31.36in paragraph (a) to the commissioner at the time the personal care assistance provider
32.1agency enrolls as a vendor or upon request from the commissioner. The commissioner
32.2shall collect the information specified in paragraph (a) from all personal care assistance
32.3providers beginning July 1, 2009.
32.4    (c) All personal care assistance provider agencies shall require all employees in
32.5management and supervisory positions and owners of the agency who are active in the
32.6day-to-day management and operations of the agency to complete mandatory training as
32.7determined by the commissioner before enrollment of the agency as a provider. Personal
32.8care assistance provider agencies are required to send all owners, qualified professionals
32.9employed by the agency, and all other managing employees to the initial and subsequent
32.10trainings. Employees in management and supervisory positions and owners who are
32.11active in the day-to-day operations of an agency who have completed the required training
32.12as an employee with a personal care assistance provider agency do not need to repeat
32.13the required training if they are hired by another agency, if they have completed the
32.14training within the past three years. By September 1, 2010, the required training must be
32.15available in languages other than English and to those who need accommodations due
32.16to disabilities, online, or by electronic remote connection, and provide for competency
32.17testing. Personal care assistance provider agency billing staff shall complete training
32.18about personal care assistance program financial management. This training is effective
32.19July 1, 2009. Any personal care assistance provider agency enrolled before that date
32.20shall, if it has not already, complete the provider training within 18 months of July 1,
32.212009. Any new owners, new qualified professionals, and new managing or employees in
32.22management and supervisory positions involved in the day-to-day operations are required
32.23to complete mandatory training as a requisite of hiring working for the agency. Personal
32.24care assistance provider agencies certified for participation in Medicare as home health
32.25agencies are exempt from the training required in this subdivision.

32.26    Sec. 12. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 24,
32.27is amended to read:
32.28    Subd. 24. Personal care assistance provider agency; general duties. A personal
32.29care assistance provider agency shall:
32.30    (1) enroll as a Medicaid provider meeting all provider standards, including
32.31completion of the required provider training;
32.32    (2) comply with general medical assistance coverage requirements;
32.33    (3) demonstrate compliance with law and policies of the personal care assistance
32.34program to be determined by the commissioner;
32.35    (4) comply with background study requirements;
33.1    (5) verify and keep records of hours worked by the personal care assistant and
33.2qualified professional;
33.3    (6) market agency services only through printed information in brochures and on
33.4Web sites and not engage in any agency-initiated direct contact or marketing in person, by
33.5phone, or other electronic means to potential recipients, guardians, or family members;
33.6    (7) pay the personal care assistant and qualified professional based on actual hours
33.7of services provided;
33.8    (8) withhold and pay all applicable federal and state taxes;
33.9    (9) effective January 1, 2010, document that the agency uses a minimum of 72.5
33.10percent of the revenue generated by the medical assistance rate for personal care assistance
33.11services for employee personal care assistant wages and benefits;
33.12    (10) make the arrangements and pay unemployment insurance, taxes, workers'
33.13compensation, liability insurance, and other benefits, if any;
33.14    (11) enter into a written agreement under subdivision 20 before services are provided;
33.15    (12) report suspected neglect and abuse to the common entry point according to
33.16section 256B.0651;
33.17    (13) provide the recipient with a copy of the home care bill of rights at start of
33.18service; and
33.19    (14) request reassessments at least 60 days prior to the end of the current
33.20authorization for personal care assistance services, on forms provided by the commissioner.

33.21    Sec. 13. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 27,
33.22is amended to read:
33.23    Subd. 27. Personal care assistance provider agency; ventilator training. (a) The
33.24personal care assistance provider agency is required to provide training for the personal
33.25care assistant responsible for working with a recipient who is ventilator dependent. All
33.26training must be administered by a respiratory therapist, nurse, or physician. Qualified
33.27professional supervision by a nurse must be completed and documented on file in the
33.28personal care assistant's employment record and the recipient's health record. If offering
33.29personal care services to a ventilator-dependent recipient, the personal care assistance
33.30provider agency shall demonstrate and document the ability to:
33.31    (1) train the personal care assistant;
33.32    (2) supervise the personal care assistant in ventilator operation and maintenance the
33.33care of a ventilator-dependent recipient; and
33.34    (3) supervise the recipient and responsible party in ventilator operation and
33.35maintenance the care of a ventilator-dependent recipient; and
34.1    (4) provide documentation of the training and supervision in clauses (1) to (3)
34.2upon request.
34.3    (b) A personal care assistant shall not undertake any clinical services, patient
34.4assessment, patient evaluation, or clinical education regarding the ventilator or the patient
34.5on the ventilator. These services may only be provided by health care professionals
34.6licensed or registered in this state.
34.7    (c) A personal care assistant may only perform tasks associated with ventilator
34.8maintenance that are approved by the Board of Medical Practice in consultation with the
34.9Respiratory Care Practitioner Advisory Council and the Department of Human Services.

34.10    Sec. 14. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 30,
34.11is amended to read:
34.12    Subd. 30. Notice of service changes to recipients. The commissioner must provide:
34.13    (1) by October 31, 2009, information to recipients likely to be affected that (i)
34.14describes the changes to the personal care assistance program that may result in the
34.15loss of access to personal care assistance services, and (ii) includes resources to obtain
34.16further information; and
34.17    (2) notice of changes in medical assistance home care services to each affected
34.18recipient at least 30 days before the effective date of the change.
34.19The notice shall include how to get further information on the changes, how to get help to
34.20obtain other services, a list of community resources, and appeal rights. Notwithstanding
34.21section 256.045, a recipient may request continued services pending appeal within the
34.22time period allowed to request an appeal; and
34.23    (3) a service agreement authorizing personal care assistance hours of service at
34.24the previously authorized level, throughout the appeal process period, when a recipient
34.25requests services pending an appeal.

34.26    Sec. 15. Minnesota Statutes 2008, section 256B.092, subdivision 4d, is amended to
34.27read:
34.28    Subd. 4d. Medicaid reimbursement; licensed provider; related individuals. The
34.29commissioner shall seek a federal amendment to the home and community-based services
34.30waiver for individuals with developmental disabilities, to allow Medicaid reimbursement
34.31for the provision of supported living services to a related individual is allowed when the
34.32following conditions have been met: specified in section 245A.03, subdivision 9, are met.
34.33    (1) the individual is 18 years of age or older;
35.1    (2) the provider is certified initially and annually thereafter, by the county, as
35.2meeting the provider standards established in chapter 245B and the federal waiver plan;
35.3    (3) the provider has been certified by the county as meeting the adult foster care
35.4provider standards established in Minnesota Rules, parts 9555.5105 to 9555.6265;
35.5    (4) the provider is not the legal guardian or conservator of the related individual; and
35.6    (5) the individual's service plan meets the standards of this section and specifies any
35.7special conditions necessary to prevent a conflict of interest for the provider.

35.8    Sec. 16. REPEALER.
35.9Minnesota Statutes 2008, section 256B.0919, subdivision 4, is repealed.