SF 2934

as introduced - 86th Legislature (2009 - 2010) Posted on 03/01/2010 12:59pm

A bill for an act
relating to human services; modifying personal care assistant services; amending
Minnesota Statutes 2009 Supplement, sections 256B.0625, subdivision 6a;
256B.0653, subdivision 3; 256B.0659, subdivisions 1, 3, 4, 11, 13, 14, 18, 19,
20, 21, 27, 29, 30.

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

Section 1.

Minnesota Statutes 2009 Supplement, section 256B.0625, subdivision 6a,
is amended to read:

Subd. 6a.

Home health services.

Home health services are those services specified
in Minnesota Rules, part 9505.0295 and sections 256B.0651 and 256B.0653. Medical
assistance covers home health services deleted text begin at a recipient's home residence deleted text end new text begin for a recipient
who lives at the recipient's home new text end . Medical assistance does not cover home health
services for residents of a hospital, nursing facility, or intermediate care facility, unless
the commissioner of human services has authorized skilled nurse visits for less than
90 days for a resident at an intermediate care facility for persons with developmental
disabilities, to prevent an admission to a hospital or nursing facility or unless a resident
who is otherwise eligible is on leave from the facility and the facility either pays for the
home health services or forgoes the facility per diem for the leave days that home health
services are used. Home health services must be provided by a Medicare certified home
health agency. All nursing and home health aide services must be provided according to
sections 256B.0651 to 256B.0653.

Sec. 2.

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.0659. Home health aide
visits deleted text begin must be deleted text end new text begin are new text end provided deleted text begin in the recipient's deleted text end new text begin to a recipient living at the recipient's new text end 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. 3.

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 end new text begin (s) 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.049, 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 such assistance, and other replacement
services are more expensive or are not available when personal care assistance services
are to be terminated;
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 assure that their safety,
health, and welfare are provided for in their homes; or
new text end

new text begin (3) need a personal care assistance staff to exceed the 310-hour monthly work limit
because of the need for intermittent care over a 24-hour period up to an amount designated
in the individual service plan, as long as there is a dependable staffing backup plan as
part of the individual service plan.
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 end new 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 end new 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 end new 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 end new 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 end new 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 end new 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.

new text begin (o) "Personal care support service" means a service that meets the requirements of
this section but is available only to participants in a home and community-based services
waiver who no longer qualify for personal care assistance services because they do not
meet the requirements of subdivision 4, paragraph (b), but do need prompting and cuing
in order to accomplish activities of daily living necessary to maintain their health and
welfare and remain safely in their home or apartment and any recommended replacement
services will either cost more than personal care assistance services or are not available
when the personal care assistance services are to be terminated.
new text end

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

new text begin (s) "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, contributions to employee retirement
accounts, and other payments made by the employer for the benefit of its employees.
new text end

Sec. 4.

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 18 new text begin , unless
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. 5.

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's new text begin ongoing new text end need deleted text begin , on a daily basis, deleted text end for:

(i) cuing and constant supervision to complete the task; deleted text begin or
deleted text end

(ii) hands-on assistance to complete the task; deleted text begin and deleted text end new text begin or
new text end

new text begin (iii) prompting and cuing essential to ensure accomplishment of the task; and
new text end

(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 gastro/jejunostomy 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. 6.

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 deleted text begin ; deleted text end new text begin .
new text end

new text begin For individuals who are not disqualified or who have received a set-aside, the
commissioner shall issue a unique medical provider identification number within five
working days of the personal care assistance agency's request. After five days, the personal
care assistant may begin to provide personal care assistance services, and the agency
may bill using the agency's unique medical provider identification number. The claims
submitted under the agency's number that include more than 24 hours of personal care
assistance services per day shall not be rejected if more than one personal care assistant is
using the agency billing number under this subdivision, until the commissioner issues the
individual personal care assistant a unique medical provider identification number;
new text end

(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. new text begin The number of hours
worked per day shall be set by the personal care assistance agency and not 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. 7.

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 begin January deleted text end new text begin July new 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 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.
new text end

Sec. 8.

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 provide new text begin regularly scheduled new 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
this 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 work new 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 begin and
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
staff deleted text begin . deleted text end new 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. 9.

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 assistants new 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. 10.

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 begin and a qualified
professional deleted text end new 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. 11.

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 agency deleted text begin , recipient, or responsible
party, each personal care assistant, and the qualified professional deleted text end new text begin and the recipient or
responsible party new text end shall enter into a written agreement. The new text begin annual new text end agreement must new 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. 12.

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 begin and
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 providers new text begin ; and
new text end

new text begin (13) documentation that the agency does not require personal care assistants to sign
an employment contract agreeing not to work for another personal care assistance agency
in the future when no longer an employee of that agency 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 shall new 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 enrollment new text begin of the agency new text end as a provider. deleted text begin 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
trainings. deleted text end new 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
online or by electronic remote connection, and provide for competency testing, including
the opportunity to pass the test without attending the in-person training. Upon completion
of the training, the person subject to the training must demonstrate competency in the
subjects trained. 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 deleted text begin owners, new qualified professionals, and new managing deleted text end
employees new text begin in management and supervisory positions, including owners involved in the
day-to-day operations, new text end are required to complete mandatory training as a requisite of
deleted text begin hiring deleted text end new 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. 13.

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

Subd. 27.

Personal care assistance provider agency; ventilator training.

The
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 the ability to:

(1) train the personal care assistant;

(2) supervise the personal care assistant in ventilator operation and maintenance; and

(3) supervise the recipient and responsible party in ventilator operation and
maintenance.

new text begin Personal care assistance provider agencies certified for participation in Medicare as
home health agencies are exempt from providing the training required in this subdivision.
new text end

Sec. 14.

Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 29,
is amended to read:

Subd. 29.

Transitional assistance.

new text begin Transitional assistance includes:
new text end

new text begin (1) assistance and services provided through new text end the commissioner, counties, health
plans, tribes, and personal care assistance providers deleted text begin shall work together to provide
transitional assistance deleted text end for recipients and families to come into compliance with the new
requirements of this section that may require a change in living arrangement no later
than August 10, 2010 new text begin ; and
new text end

new text begin (2) continued personal care assistance services at the previously assessed level for
those who are referred to other services to be provided in their home for which they
qualify but cannot receive because the type of service is unavailable to come into their
home, not offered in their county, or would cost more on an annual basis than the personal
care assistance services being reduced or terminated new text end .

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; deleted text begin and
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 appeal new 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 when a recipient requests services pending an appeal new text end .

Sec. 16. new text begin PERSONAL CARE SUPPORT SERVICES FOR THOSE ON HOME
AND COMMUNITY-BASED SERVICES WAIVERS PROGRAMS.
new text end

new text begin The commissioner shall add personal care support to each home and
community-based services waiver for persons who no longer qualify for state plan
personal care assistance services because they need prompting and cuing to accomplish
activities of daily living, and the tasks are necessary to provide for the person's health,
safety, and welfare in order to remain in their home. Personal care support services must
meet the requirements of Minnesota Statutes, section 256B.0659, except that the amount,
duration, and frequency of the service can exceed the limits established for personal
care assistance 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