SF 3277

as introduced - 92nd Legislature (2021 - 2022) Posted on 02/22/2022 08:24am

A bill for an act
relating to human services; modifying home care services by adding care
coordination and care evaluation; establishing home and community-based services
homemaker rates; amending Minnesota Statutes 2020, sections 256B.0651,
subdivisions 1, 2; 256B.0652, subdivision 11; 256B.0653, subdivisions 2, 6;
256S.18, subdivision 1; Minnesota Statutes 2021 Supplement, section 256B.85,
subdivision 8; proposing coding for new law in Minnesota Statutes, chapter 256B.

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

Section 1.

Minnesota Statutes 2020, section 256B.0651, subdivision 1, is amended to read:

Subdivision 1.

Definitions.

(a) For the purposes of sections 256B.0651 to 256B.0654
and 256B.0659, the terms in paragraphs (b) to deleted text begin (g) deleted text end new text begin (i) new text end have the meanings given.

(b) "Activities of daily living" has the meaning given in section 256B.0659, subdivision
1, paragraph (b).

(c) "Assessment" means a review and evaluation of a recipient's need for home care
services conducted in person.

new text begin (d) "Care coordination" means a service performed by a licensed professional employed
by a home health agency to coordinate both skilled and unskilled home care services, except
personal care assistance, for a recipient.
new text end

new text begin (e) "Care evaluation" means a start-of-care visit, a resumption-of-care visit, or a
recertification visit that is a face-to-face assessment of a person by a licensed professional
employed by a home health agency to develop, update, or review the service plan for both
skilled and unskilled home care services, except personal care assistance.
new text end

deleted text begin (d) deleted text end new text begin (f) new text end "Home care services" means medical assistance covered services that are home
health agency services, including skilled nurse visits; home health aide visits; physical
therapy, occupational therapy, respiratory therapy, and language-speech pathology therapy;
home care nursing; and personal care assistance.

deleted text begin (e) deleted text end new text begin (g) new text end "Home residence," effective January 1, 2010, means a residence owned or rented
by the recipient either alone, with roommates of the recipient's choosing, or with an unpaid
responsible party or legal representative; or a family foster home where the license holder
lives with the recipient and is not paid to provide home care services for the recipient except
as allowed under sections 256B.0652, subdivision 10, and 256B.0654, subdivision 4.

deleted text begin (f) deleted text end new text begin (h) new text end "Medically necessary" has the meaning given in Minnesota Rules, parts 9505.0170
to 9505.0475.

deleted text begin (g) deleted text end new text begin (i) new text end "Ventilator-dependent" means an individual who receives mechanical ventilation
for life support at least six hours per day and is expected to be or has been dependent on a
ventilator for at least 30 consecutive days.

Sec. 2.

Minnesota Statutes 2020, section 256B.0651, subdivision 2, is amended to read:

Subd. 2.

Services covered.

Home care services covered under this section and sections
256B.0652 to 256B.0654 and 256B.0659 include:

new text begin (1) care coordination services under subdivision 1, paragraph (d);
new text end

new text begin (2) care evaluation services under subdivision 1, paragraph (e);
new text end

deleted text begin (1) deleted text end new text begin (3) new text end nursing services under sections 256B.0625, subdivision 6a, and 256B.0653;

deleted text begin (2) deleted text end new text begin (4) new text end home care nursing services under sections 256B.0625, subdivision 7, and
256B.0654;

deleted text begin (3) deleted text end new text begin (5) new text end home health services under sections 256B.0625, subdivision 6a, and 256B.0653;

deleted text begin (4) deleted text end new text begin (6) new text end personal care assistance services under sections 256B.0625, subdivision 19a, and
256B.0659;

deleted text begin (5) deleted text end new text begin (7) new text end supervision of personal care assistance services provided by a qualified
professional under sections 256B.0625, subdivision 19a, and 256B.0659;

deleted text begin (6) deleted text end new text begin (8) new text end face-to-face assessments by county public health nurses for services under sections
256B.0625, subdivision 19a, and 256B.0659; and

deleted text begin (7) deleted text end new text begin (9) new text end service updates and review of temporary increases for personal care assistance
services by the county public health nurse for services under sections 256B.0625, subdivision
19a, and 256B.0659.

Sec. 3.

Minnesota Statutes 2020, section 256B.0652, subdivision 11, is amended to read:

Subd. 11.

Limits on services without authorization.

A recipient may receive the
following home care services during a calendar year:

(1) up to two face-to-face assessments to determine a recipient's need for personal care
assistance services;

(2) one service update done to determine a recipient's need for personal care assistance
services; deleted text begin and
deleted text end

(3) up to nine face-to-face new text begin visits that may include both new text end skilled nurse visits deleted text begin . deleted text end new text begin and care
evaluations; and
new text end

new text begin (4) up to four 15-minute units of care coordination per episode of care to coordinate
home health services for a recipient.
new text end

Sec. 4.

Minnesota Statutes 2020, section 256B.0653, subdivision 2, is amended to read:

Subd. 2.

Definitions.

For the purposes of this section, the following terms have the
meanings given.

(a) "Assessment" means an evaluation of the recipient's medical need for home health
agency services by a registered nurse or appropriate therapist that is conducted within 30
days of a request.

(b) "Home care therapies" means occupational, physical, and respiratory therapy and
speech-language pathology services provided in the home by a Medicare certified home
health agency.

(c) "Home health agency services" means services delivered by a home health agency
to a recipient with medical needs due to illness, disability, or physical conditions in settings
permitted under section 256B.0625, subdivision 6a new text begin ; care coordination as defined in section
256B.0651, subdivision 1, paragraph (d); and care evaluation as defined in section
256B.0651, subdivision 1, paragraph (e) new text end .

(d) "Home health aide" means an employee of a home health agency who completes
medically oriented tasks written in the plan of care for a recipient.

(e) "Home health agency" means a home care provider agency that is Medicare-certified.

(f) "Occupational therapy services" mean the services defined in Minnesota Rules, part
9505.0390.

(g) "Physical therapy services" mean the services defined in Minnesota Rules, part
9505.0390.

(h) "Respiratory therapy services" mean the services defined in chapter 147C.

(i) "Speech-language pathology services" mean the services defined in Minnesota Rules,
part 9505.0390.

(j) "Skilled nurse visit" means a professional nursing visit to complete nursing tasks
required due to a recipient's medical condition that can only be safely provided by a
professional nurse to restore and maintain optimal health.

(k) "Store-and-forward technology" means telehomecare services that do not occur in
real time via synchronous transmissions such as diabetic and vital sign monitoring.

(l) "Telehomecare" means the use of telecommunications technology via live, two-way
interactive audiovisual technology which may be augmented by store-and-forward
technology.

(m) "Telehomecare skilled nurse visit" means a visit by a professional nurse to deliver
a skilled nurse visit to a recipient located at a site other than the site where the nurse is
located and is used in combination with face-to-face skilled nurse visits to adequately meet
the recipient's needs.

Sec. 5.

Minnesota Statutes 2020, section 256B.0653, subdivision 6, is amended to read:

Subd. 6.

Noncovered home health agency services.

The following are not eligible for
payment under medical assistance as a home health agency service:

(1) telehomecare skilled nurses services that is communication between the home care
nurse and recipient that consists solely of a telephone conversation, facsimile, electronic
mail, or a consultation between two health care practitioners;

(2) the following skilled nurse visits:

(i) for the purpose of monitoring medication compliance with an established medication
program for a recipient;

(ii) administering or assisting with medication administration, including injections,
prefilling syringes for injections, or oral medication setup of an adult recipient, when, as
determined and documented by the registered nurse, the need can be met by an available
pharmacy or the recipient or a family member is physically and mentally able to
self-administer or prefill a medication;

(iii) services done for the sole purpose of supervision of the home health aide or personal
care assistant;

(iv) services done for the sole purpose to train other home health agency workers;

(v) services done for the sole purpose of blood samples or lab draw when the recipient
is able to access these services outside the home; and

(vi) Medicare evaluation or administrative nursing visits required by Medicare new text begin , with the
exception of care evaluation as defined in section 256B.0651, subdivision 1, paragraph (e) new text end ;

(3) home health aide visits when the following activities are the sole purpose for the
visit: companionship, socialization, household tasks, transportation, and education;

(4) home care therapies provided in other settings such as a clinic or as an inpatient or
when the recipient can access therapy outside of the recipient's residence; and

(5) home health agency services without qualifying documentation of a face-to-face
encounter as specified in subdivision 7.

Sec. 6.

new text begin [256B.4909] HOME AND COMMUNITY-BASED SERVICES;
HOMEMAKER RATES.
new text end

new text begin Subdivision 1. new text end

new text begin Application. new text end

new text begin (a) Notwithstanding any law to the contrary, the payment
methodologies for homemaker services defined in this section apply to those homemaker
services offered under:
new text end

new text begin (1) home and community-based services waivers under sections 256B.092 and 256B.49;
new text end

new text begin (2) alternative care under section 256B.0913;
new text end

new text begin (3) essential community supports under section 256B.0922; and
new text end

new text begin (4) elderly waiver, elderly waiver customized living, and elderly waiver foster care under
chapter 256S.
new text end

new text begin (b) This section does not change existing waiver policies and procedures.
new text end

new text begin Subd. 2. new text end

new text begin Definition. new text end

new text begin For purposes of this section, "homemaker services" means
homemaker services and assistance with personal care, homemaker services and cleaning,
and homemaker services and home management under chapter 256S and similar services
offered under home and community-based services waivers under sections 256B.092 and
256B.49, alternative care under section 256B.0913, and essential community supports under
section 256B.0922.
new text end

new text begin Subd. 3. new text end

new text begin Rate methodology. new text end

new text begin (a) Beginning January 1, 2023, the rate methodology for
each homemaker service must be determined under sections 256S.211, subdivision 1, and
256S.212 to 256S.215, as adjusted by paragraph (b).
new text end

new text begin (b) As applicable to this section, the commissioner shall update for each homemaker
service the base wage index in section 256S.212, publish these updated values, and load
them into the appropriate rate system as follows:
new text end

new text begin (1) on November 1, 2024, based on the most recently available wage data by standard
occupational classification (SOC) from the Bureau of Labor Statistics; and
new text end

new text begin (2) on July 1, 2026, and every two years thereafter, based on the most recently available
wage data by SOC from the Bureau of Labor Statistics.
new text end

Sec. 7.

Minnesota Statutes 2021 Supplement, section 256B.85, subdivision 8, is amended
to read:

Subd. 8.

Determination of CFSS service authorization amount.

(a) All community
first services and supports must be authorized by the commissioner or the commissioner's
designee before services begin. The authorization for CFSS must be completed as soon as
possible following an assessment but no later than 40 calendar days from the date of the
assessment.

(b) The amount of CFSS authorized must be based on the participant's home care rating
described in paragraphs (d) and (e) and any additional service units for which the participant
qualifies as described in paragraph (f).

(c) The home care rating shall be determined by the commissioner or the commissioner's
designee based on information submitted to the commissioner identifying the following for
a participant:

(1) the total number of dependencies of activities of daily living;

(2) the presence of complex health-related needs; and

(3) the presence of Level I behavior.

(d) The methodology to determine the total service units for CFSS for each home care
rating is based on the median paid units per day for each home care rating from fiscal year
2007 data for the PCA program.

(e) Each home care rating is designated by the letters P through Z and EN and has the
following base number of service units assigned:

(1) P home care rating requires Level I behavior or one to three dependencies in ADLs
and qualifies the person for five service units;

(2) Q home care rating requires Level I behavior and one to three dependencies in ADLs
and qualifies the person for six service units;

(3) R home care rating requires a complex health-related need and one to three
dependencies in ADLs and qualifies the person for seven service units;

(4) S home care rating requires four to six dependencies in ADLs and qualifies the person
for ten service units;

(5) T home care rating requires four to six dependencies in ADLs and Level I behavior
and qualifies the person for 11 service units;

(6) U home care rating requires four to six dependencies in ADLs and a complex
health-related need and qualifies the person for 14 service units;

(7) V home care rating requires seven to eight dependencies in ADLs and qualifies the
person for 17 service units;

(8) W home care rating requires seven to eight dependencies in ADLs and Level I
behavior and qualifies the person for 20 service units;

(9) Z home care rating requires seven to eight dependencies in ADLs and a complex
health-related need and qualifies the person for 30 service units; and

(10) EN home care rating includes ventilator dependency as defined in section 256B.0651,
subdivision 1, paragraph deleted text begin (g) deleted text end new text begin (i) new text end . A person who meets the definition of ventilator-dependent
and the EN home care rating and utilize a combination of CFSS and home care nursing
services is limited to a total of 96 service units per day for those services in combination.
Additional units may be authorized when a person's assessment indicates a need for two
staff to perform activities. Additional time is limited to 16 service units per day.

(f) Additional service units are provided through the assessment and identification of
the following:

(1) 30 additional minutes per day for a dependency in each critical activity of daily
living;

(2) 30 additional minutes per day for each complex health-related need; and

(3) 30 additional minutes per day for each behavior under this clause that requires
assistance at least four times per week:

(i) level I behavior that requires the immediate response of another person;

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

(iii) increased need for assistance for participants who are verbally aggressive or resistive
to care so that the time needed to perform activities of daily living is increased.

(g) The service budget for budget model participants shall be based on:

(1) assessed units as determined by the home care rating; and

(2) an adjustment needed for administrative expenses.

Sec. 8.

Minnesota Statutes 2020, section 256S.18, subdivision 1, is amended to read:

Subdivision 1.

Case mix classifications.

(a) The elderly waiver case mix classifications
A to K shall be the resident classes A to K established under Minnesota Rules, parts
9549.0058 and 9549.0059.

(b) A participant assigned to elderly waiver case mix classification A must be reassigned
to elderly waiver case mix classification L if an assessment or reassessment performed
under section 256B.0911 determines that the participant has:

(1) no dependencies in activities of daily living; or

(2) up to two dependencies in bathing, dressing, grooming, walking, or eating when the
dependency score in eating is three or greater.

(c) A participant must be assigned to elderly waiver case mix classification V if the
participant meets the definition of ventilator-dependent in section 256B.0651, subdivision
1, paragraph deleted text begin (g) deleted text end new text begin (i) new text end .