SF 3923

as introduced - 91st Legislature (2019 - 2020) Posted on 03/05/2020 08:30am

A bill for an act
relating to human services; modifying service plan review and evaluation
requirements for waiver service providers; modifying the required elements of
long-term care consultation services; modifying requirements for waiver case
management; directing the commissioner of human services to modify the
MnCHOICES assessment tool; amending Minnesota Statutes 2018, sections
256B.092, subdivision 1a; 256B.49, subdivision 16; Minnesota Statutes 2019
Supplement, sections 245D.071, subdivision 5; 256B.0911, subdivisions 1a, 3a;
256B.092, subdivision 1b; 256B.49, subdivisions 13, 14.

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

Section 1.

Minnesota Statutes 2019 Supplement, section 245D.071, subdivision 5, is
amended to read:

Subd. 5.

Service plan review and evaluation.

(a) The license holder must give the
person or the person's legal representative and case manager an opportunity to participate
in the ongoing review and development of the service plan and the methods used to support
the person and accomplish outcomes identified in subdivisions 3 and 4. At least once per
year, or within 30 days of a written request by the person, the person's legal representative,
or the case manager, the license holder, in coordination with the person's support team or
expanded support team, must meet with the person, the person's legal representative, and
the case manager, and participate in service plan review meetings following stated timelines
established in the person's coordinated service and support plan or coordinated service and
support plan addendum. The purpose of the service plan review is to determine whether
changes are needed to the service plan based on the assessment information, the license
holder's evaluation of progress deleted text begin towards deleted text end new text begin toward new text end accomplishing outcomes, or other information
provided by the support team or expanded support team.

(b) At least once per year, the license holder, in coordination with the person's support
team or expanded support team, must meet with the person, the person's legal representative,
and the case manager to discuss how technology might be used to meet the person's desired
outcomes. The coordinated service and support plan addendum must include a summary of
this discussion. The summary must include a statement regarding any decision made related
to the use of technology and a description of any further research that must be completed
before a decision regarding the use of technology can be made. Nothing in this paragraph
requires the coordinated service and support plan addendum to include the use of technology
for the provision of services.

(c) new text begin At least once per year, the license holder, in coordination with the person's support
team or expanded support team, must meet with a person receiving residential supports and
services, the person's legal representative, and the case manager to discuss options for:
new text end

new text begin (1) transitioning out of a community residential setting, family adult foster care residence,
or supervised living facility and into a community-living setting as defined under section
256B.49, subdivision 23; and
new text end

new text begin (2) transitioning from residential supports and services as described in section 245D.03,
subdivision 1, paragraph (c), clause (3), to integrated community supports as described in
section 245D.03, subdivision 1, paragraph (c), clause (8).
new text end

new text begin (d) The coordinated service and support plan addendum must include a summary of the
discussion required in paragraph (c). The summary must include a statement about any
decision made regarding clauses (1) and (2) and a description of any further research that
must be completed before a decision regarding clauses (1) and (2) can be made.
new text end

new text begin (e) At least once per year, the license holder, in coordination with the person's support
team or expanded support team, must meet with a person receiving day services, the person's
legal representative, and the case manager to discuss options for transitioning to an
employment service described in section 245D.03, subdivision 1, paragraph (c), clauses (5)
to (7).
new text end

new text begin (f) The coordinated service and support plan addendum must include a summary of the
discussion required in paragraph (e). The summary must include a statement about any
decision made concerning transition to an employment service and a description of any
further research that must be completed before a decision regarding transitioning to an
employment service can be made.
new text end

new text begin (g) new text end The license holder must summarize the person's status and progress toward achieving
the identified outcomes and make recommendations and identify the rationale for changing,
continuing, or discontinuing implementation of supports and methods identified in
subdivision 4 in a report available at the time of the progress review meeting. The report
must be sent at least five working days prior to the progress review meeting if requested by
the team in the coordinated service and support plan or coordinated service and support
plan addendum.

deleted text begin (d) deleted text end new text begin (h) new text end The license holder must send the coordinated service and support plan addendum
to the person, the person's legal representative, and the case manager by mail within ten
working days of the progress review meeting. Within ten working days of the mailing of
the coordinated service and support plan addendum, the license holder must obtain dated
signatures from the person or the person's legal representative and the case manager to
document approval of any changes to the coordinated service and support plan addendum.

deleted text begin (e) deleted text end new text begin (i) new text end If, within ten working days of submitting changes to the coordinated service and
support plan and coordinated service and support plan addendum, the person or the person's
legal representative or case manager has not signed and returned to the license holder the
coordinated service and support plan or coordinated service and support plan addendum or
has not proposed written modifications to the license holder's submission, the submission
is deemed approved and the coordinated service and support plan addendum becomes
effective and remains in effect until the legal representative or case manager submits a
written request to revise the coordinated service and support plan addendum.

Sec. 2.

Minnesota Statutes 2019 Supplement, section 256B.0911, subdivision 1a, is
amended to read:

Subd. 1a.

Definitions.

For purposes of this section, the following definitions apply:

(a) Until additional requirements apply under paragraph (b), "long-term care consultation
services" means:

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

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

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

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

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

(6) determination of home and community-based waiver and other service eligibility as
required under chapter 256S and sections 256B.0913, 256B.092, and 256B.49, including
level of care determination for individuals who need an institutional level of care as
determined under subdivision 4e, based on assessment and community support plan
development, appropriate referrals to obtain necessary diagnostic information, and including
an eligibility determination for consumer-directed community supports;

(7) providing recommendations for institutional placement when there are no
cost-effective community services available;

(8) providing access to assistance to transition people back to community settings after
institutional admission; deleted text begin and
deleted text end

(9) providing information about competitive employment, with or without supports, for
school-age youth and working-age adults and referrals to the Disability Linkage Line and
Disability Benefits 101 to ensure that an informed choice about competitive employment
can be made. For the purposes of this subdivision, "competitive employment" means work
in the competitive labor market that is performed on a full-time or part-time basis in an
integrated setting, and for which an individual is compensated at or above the minimum
wage, but not less than the customary wage and level of benefits paid by the employer for
the same or similar work performed by individuals without disabilities deleted text begin . deleted text end new text begin ;
new text end

new text begin (10) providing information about independent living to ensure that a fully informed
choice about independent living can be made; and
new text end

new text begin (11) providing information about self-directed services and supports, including
self-directed funding options, to ensure that a fully informed choice about self-directed
options can be made.
new text end

(b) Upon statewide implementation of lead agency requirements in subdivisions 2b, 2c,
and 3a, "long-term care consultation services" also means:

(1) service eligibility determination for new text begin the following new text end state plan services deleted text begin identified in deleted text end :

(i) new text begin personal care assistance services under new text end section 256B.0625, subdivisions 19a and 19c;

(ii) consumer support grants under section 256.476; or

(iii) new text begin community first services and supports under new text end section 256B.85;

(2) notwithstanding provisions in Minnesota Rules, parts 9525.0004 to 9525.0024,
gaining access to case management services available under sections 256B.0621, subdivision
2, clause (4), 256B.0924, and Minnesota Rules, part 9525.0016;

(3) determination of eligibility for semi-independent living services under section
252.275; and

(4) obtaining necessary diagnostic information to determine eligibility under clauses (2)
and (3).

(c) "Long-term care options counseling" means the services provided by the linkage
lines as mandated by sections 256.01, subdivision 24, and 256.975, subdivision 7, and also
includes telephone assistance and follow up once a long-term care consultation assessment
has been completed.

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

(e) "Lead agencies" means counties administering or tribes and health plans under
contract with the commissioner to administer long-term care consultation assessment and
support planning services.

(f) "Person-centered planning" is a process that includes the active participation of a
person in the planning of the person's services, including in making meaningful and informed
choices about the person's own goals, talents, and objectives, as well as making meaningful
and informed choices about the services the person receives deleted text begin . For the purposes of this section deleted text end ,
new text begin the settings in which the person receives them, and the setting in which the person lives.
new text end

new text begin (g) new text end "Informed choice" means a voluntary choice of services new text begin , settings, and living
arrangement new text end by a person from all available service new text begin and setting new text end options based on accurate
and complete information concerning all available service new text begin and setting new text end options and concerning
the person's own preferences, abilities, goals, and objectives. In order for a person to make
an informed choice, all available options must be developed and presented to the person new text begin in
a way the person can understand new text end to empower the person to make deleted text begin decisions deleted text end new text begin fully informed
choices new text end .

new text begin (h) "Available service and setting options" or "available options," with respect to the
home and community-based waivers under chapter 256S and sections 256B.092 and 256B.49,
means all services and settings defined under the waiver plans.
new text end

new text begin (i) "Independent living" means living in a setting that is not an institution, a community
residential setting, a family adult foster care residence, or a supervised living facility.
new text end

Sec. 3.

Minnesota Statutes 2019 Supplement, section 256B.0911, subdivision 3a, is
amended to read:

Subd. 3a.

Assessment and support planning.

(a) Persons requesting assessment, services
planning, or other assistance intended to support community-based living, including persons
who need assessment in order to determine waiver or alternative care program eligibility,
must be visited by a long-term care consultation team within 20 calendar days after the date
on which an assessment was requested or recommended. Upon statewide implementation
of subdivisions 2b, 2c, and 5, this requirement also applies to an assessment of a person
requesting personal care assistance services. Face-to-face assessments must be conducted
according to paragraphs (b) to (i).

(b) Upon implementation of subdivisions 2b, 2c, and 5, lead agencies shall use certified
assessors to conduct the assessment. For a person with complex health care needs, a public
health or registered nurse from the team must be consulted.

(c) The MnCHOICES assessment provided by the commissioner to lead agencies must
be used to complete a comprehensive, conversation-based, person-centered assessment.
The assessment must include the health, psychological, functional, environmental, and
social needs of the individual necessary to develop a new text begin person-centered new text end community support
plan that meets the individual's needs and preferences.

(d) The assessment must be conducted in a face-to-face conversational interview with
the person being assessed. The person's legal representative must provide input during the
assessment process and may do so remotely if requested. At the request of the person, other
individuals may participate in the assessment to provide information on the needs, strengths,
and preferences of the person necessary to develop a community support plan that ensures
the person's health and safety. Except for legal representatives or family members invited
by the person, persons participating in the assessment may not be a provider of service or
have any financial interest in the provision of services. For persons who are to be assessed
for elderly waiver customized living or adult day services under chapter 256S, with the
permission of the person being assessed or the person's designated or legal representative,
the client's current or proposed provider of services may submit a copy of the provider's
nursing assessment or written report outlining its recommendations regarding the client's
care needs. The person conducting the assessment must notify the provider of the date by
which this information is to be submitted. This information shall be provided to the person
conducting the assessment prior to the assessment. For a person who is to be assessed for
waiver services under section 256B.092 or 256B.49, with the permission of the person being
assessed or the person's designated legal representative, the person's current provider of
services may submit a written report outlining recommendations regarding the person's care
needs the person completed in consultation with someone who is known to the person and
has interaction with the person on a regular basis. The provider must submit the report at
least 60 days before the end of the person's current service agreement. The certified assessor
must consider the content of the submitted report prior to finalizing the person's assessment
or reassessment.

(e) The certified assessor and the individual responsible for developing the coordinated
service and support plan must complete the community support plan and the coordinated
service and support plan no more than 60 calendar days from the assessment visit. The
person or the person's legal representative must be provided with a written community
support plan within the timelines established by the commissioner, regardless of whether
the person is eligible for Minnesota health care programs.

(f) For a person being assessed for elderly waiver services under chapter 256S, a provider
who submitted information under paragraph (d) shall receive the final written community
support plan when available and the Residential Services Workbook.

(g) The written community support plan must include:

(1) a summary of assessed needs as defined in paragraphs (c) and (d);

(2) the individual's options and choices to meet identified needs, including new text begin :
new text end

new text begin (i) new text end all available options for case management services and providers deleted text begin , including deleted text end new text begin ;
new text end

new text begin (ii) all available options for employment services, settings, and providers;
new text end

new text begin (iii) all available options for living arrangements;
new text end

new text begin (iv) all available options for self-directed services and supports, including self-directed
budget options; and
new text end

new text begin (v) new text end service provided in a deleted text begin non-disability-specific deleted text end new text begin nondisability-specific new text end setting;

(3) identification of health and safety risks and how those risks will be addressed,
including personal risk management strategies;

(4) referral information; and

(5) informal caregiver supports, if applicable.

For a person determined eligible for state plan home care under subdivision 1a, paragraph
(b), clause (1), the person or person's representative must also receive a copy of the home
care service plan developed by the certified assessor.

(h) A person may request assistance in identifying community supports without
participating in a complete assessment. Upon a request for assistance identifying community
support, the person must be transferred or referred to long-term care options counseling
services available under sections 256.975, subdivision 7, and 256.01, subdivision 24, for
telephone assistance and follow up.

(i) The person has the right to make the final decision new text begin :
new text end

new text begin (1) new text end between institutional placement and community placement after the recommendations
have been provided, except as provided in section 256.975, subdivision 7a, paragraph (d) deleted text begin . deleted text end new text begin ;
new text end

new text begin (2) between living in a community residential setting as defined in section 245D.02,
subdivision 4a, and available options for living independently after the recommendations
have been provided; and
new text end

new text begin (3) regarding available options for self-directed services and supports, including
self-directed funding options.
new text end

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

(1) written recommendations for community-based services and consumer-directed
options;

(2) documentation that the most cost-effective alternatives available were offered to the
individual. For purposes of this clause, "cost-effective" means community services and
living arrangements that cost the same as or less than institutional care. For an individual
found to meet eligibility criteria for home and community-based service programs under
chapter 256S or section 256B.49, "cost-effectiveness" has the meaning found in the federally
approved waiver plan for each program;

(3) the need for and purpose of preadmission screening conducted by long-term care
options counselors according to section 256.975, subdivisions 7a to 7c, if the person selects
nursing facility placement. If the individual selects nursing facility placement, the lead
agency shall forward information needed to complete the level of care determinations and
screening for developmental disability and mental illness collected during the assessment
to the long-term care options counselor using forms provided by the commissioner;

(4) the role of long-term care consultation assessment and support planning in eligibility
determination for waiver and alternative care programs, and state plan home care, case
management, and other services as defined in subdivision 1a, paragraphs (a), clause (6),
and (b);

(5) information about Minnesota health care programs;

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

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

(8) the certified assessor's decision regarding the person's need for institutional level of
care as determined under criteria established in subdivision 4e and the certified assessor's
decision regarding eligibility for all services and programs as defined in subdivision 1a,
paragraphs (a), clause (6), and (b); deleted text begin and
deleted text end

(9) the person's right to appeal the certified assessor's decision regarding eligibility for
all services and programs as defined in subdivision 1a, paragraphs (a), clauses (6), (7), and
(8), and (b), and incorporating the decision regarding the need for institutional level of care
or the lead agency's final decisions regarding public programs eligibility according to section
256.045, subdivision 3. The certified assessor must verbally communicate this appeal right
to the person and must visually point out where in the document the right to appeal is stated deleted text begin . deleted text end new text begin ;
and
new text end

new text begin (10) documentation that available options for employment services, independent living,
and self-directed services and supports were offered to the individual.
new text end

(k) Face-to-face assessment completed as part of eligibility determination for the
alternative care, elderly waiver, developmental disabilities, community access for disability
inclusion, community alternative care, and brain injury waiver programs under chapter 256S
and sections 256B.0913, 256B.092, and 256B.49 is valid to establish service eligibility for
no more than 60 calendar days after the date of assessment.

(l) The effective eligibility start date for programs in paragraph (k) can never be prior
to the date of assessment. If an assessment was completed more than 60 days before the
effective waiver or alternative care program eligibility start date, assessment and support
plan information must be updated and documented in the department's Medicaid Management
Information System (MMIS). Notwithstanding retroactive medical assistance coverage of
state plan services, the effective date of eligibility for programs included in paragraph (k)
cannot be prior to the date the most recent updated assessment is completed.

(m) If an eligibility update is completed within 90 days of the previous face-to-face
assessment and documented in the department's Medicaid Management Information System
(MMIS), the effective date of eligibility for programs included in paragraph (k) is the date
of the previous face-to-face assessment when all other eligibility requirements are met.

(n) At the time of reassessment, the certified assessor shall assess each person receiving
waiver new text begin residential supports and new text end services currently residing in a community residential setting,
deleted text begin or licensed adult foster care home that is not the primary residence of the license holder, or
in which the license holder is not the primary caregiver, deleted text end new text begin family adult foster care residence,
or supervised living facility new text end to determine if that person would prefer to be served in a
community-living setting as defined in section 256B.49, subdivision 23 new text begin , or to receive
integrated community supports as described in section 245D.03, subdivision 1, paragraph
(c), clause (8) new text end . The certified assessor shall offer the person, through a person-centered
planning process, the option to receive alternative housing and service options.

new text begin (o) At the time of reassessment, the certified assessor shall assess each person receiving
waiver day services to determine if that person would prefer to receive employment services
as described in section 245D.03, subdivision 1, paragraph (c), clauses (5) to (7). The certified
assessor shall offer the person through a person-centered planning process the option to
receive employment services.
new text end

new text begin (p) At the time of reassessment, the certified assessor shall assess each person receiving
nonself-directed waiver services to determine if that person would prefer an available service
and setting option that would permit self-directed services and supports. The certified
assessor shall offer the person through a person-centered planning process the option to
receive self-directed services and supports.
new text end

Sec. 4.

Minnesota Statutes 2018, section 256B.092, subdivision 1a, is amended to read:

Subd. 1a.

Case management services.

(a) Each recipient of a home and community-based
waiver shall be provided case management services by qualified vendors as described in
the federally approved waiver application.

(b) Case management service activities provided to or arranged for a person include:

(1) development of the new text begin person-centered new text end coordinated service and support plan under
subdivision 1b;

(2) informing the individual or the individual's legal guardian or conservator, or parent
if the person is a minor, of service options new text begin , including all service options available under the
waiver plan new text end ;

(3) consulting with relevant medical experts or service providers;

(4) assisting the person in the identification of potential providers, including new text begin :
new text end

new text begin (i) providers of new text end services provided in a deleted text begin non-disability-specific deleted text end new text begin nondisability-specific new text end
setting;

new text begin (ii) employment service providers;
new text end

new text begin (iii) providers of services provided in settings that are not community residential settings;
and
new text end

new text begin (iv) providers of financial management services;
new text end

(5) assisting the person to access services and assisting in appeals under section 256.045;

(6) coordination of services, if coordination is not provided by another service provider;

(7) evaluation and monitoring of the services identified in the coordinated service and
support plan, which must incorporate at least one annual face-to-face visit by the case
manager with each person; and

(8) reviewing coordinated service and support plans and providing the lead agency with
recommendations for service authorization based upon the individual's needs identified in
the coordinated service and support plan.

(c) Case management service activities that are provided to the person with a
developmental disability shall be provided directly by county agencies or under contract.
Case management services must be provided by a public or private agency that is enrolled
as a medical assistance provider determined by the commissioner to meet all of the
requirements in the approved federal waiver plans. Case management services must not be
provided to a recipient by a private agency that has a financial interest in the provision of
any other services included in the recipient's coordinated service and support plan. For
purposes of this section, "private agency" means any agency that is not identified as a lead
agency under section 256B.0911, subdivision 1a, paragraph (e).

(d) Case managers are responsible for service provisions listed in paragraphs (a) and
(b). Case managers shall collaborate with consumers, families, legal representatives, and
relevant medical experts and service providers in the development and annual review of the
new text begin person-centered new text end coordinated service and support plan and habilitation plan.

(e) For persons who need a positive support transition plan as required in chapter 245D,
the case manager shall participate in the development and ongoing evaluation of the plan
with the expanded support team. At least quarterly, the case manager, in consultation with
the expanded support team, shall evaluate the effectiveness of the plan based on progress
evaluation data submitted by the licensed provider to the case manager. The evaluation must
identify whether the plan has been developed and implemented in a manner to achieve the
following within the required timelines:

(1) phasing out the use of prohibited procedures;

(2) acquisition of skills needed to eliminate the prohibited procedures within the plan's
timeline; and

(3) accomplishment of identified outcomes.

If adequate progress is not being made, the case manager shall consult with the person's
expanded support team to identify needed modifications and whether additional professional
support is required to provide consultation.

(f) The Department of Human Services shall offer ongoing education in case management
to case managers. Case managers shall receive no less than ten hours of case management
education and disability-related training each year. new text begin The education and training must include
person-centered planning. For the purposes of this section, "person-centered planning" or
"person-centered" has the meaning given in section 256B.0911, subdivision 1a, paragraph
(f).
new text end

Sec. 5.

Minnesota Statutes 2019 Supplement, section 256B.092, subdivision 1b, is amended
to read:

Subd. 1b.

Coordinated service and support plan.

(a) Each recipient of home and
community-based waivered services shall be provided a copy of the written new text begin person-centered
new text end coordinated service and support plan that:

(1) is developed with and signed by the recipient within the timelines established by the
commissioner and section 256B.0911, subdivision 3a, paragraph (e);

(2) includes the person's need for service, including identification of service needs that
will be or that are met by the person's relatives, friends, and others, as well as community
services used by the general public;

(3) reasonably ensures the health and welfare of the recipient;

(4) identifies the person's preferences for services as stated by the person, the person's
legal guardian or conservator, or the parent if the person is a minor, including the person's
choices made on self-directed options deleted text begin and on deleted text end new text begin , new text end services and supports to achieve employment
goals new text begin , and living arrangements new text end ;

(5) provides for an informed choice, as defined in section 256B.77, subdivision 2,
paragraph (o), of service and support providers, and identifies all available options for case
management services and providers;

(6) identifies long-range and short-range goals for the person;

(7) identifies specific services and the amount and frequency of the services to be provided
to the person based on assessed needs, preferences, and available resources. The
new text begin person-centered new text end coordinated service and support plan shall also specify other services the
person needs that are not available;

(8) identifies the need for an individual program plan to be developed by the provider
according to the respective state and federal licensing and certification standards, and
additional assessments to be completed or arranged by the provider after service initiation;

(9) identifies provider responsibilities to implement and make recommendations for
modification to the coordinated service and support plan;

(10) includes notice of the right to request a conciliation conference or a hearing under
section 256.045;

(11) is agreed upon and signed by the person, the person's legal guardian or conservator,
or the parent if the person is a minor, and the authorized county representative;

(12) is reviewed by a health professional if the person has overriding medical needs that
impact the delivery of services; and

(13) includes the authorized annual and monthly amounts for the services.

(b) In developing the new text begin person-centered new text end coordinated service and support plan, the case
manager is encouraged to include the use of volunteers, religious organizations, social clubs,
and civic and service organizations to support the individual in the community. The lead
agency must be held harmless for damages or injuries sustained through the use of volunteers
and agencies under this paragraph, including workers' compensation liability.

(c) Approved, written, and signed changes to a consumer's services that meet the criteria
in this subdivision shall be an addendum to that consumer's individual service plan.

Sec. 6.

Minnesota Statutes 2019 Supplement, section 256B.49, subdivision 13, is amended
to read:

Subd. 13.

Case management.

(a) Each recipient of a home and community-based waiver
shall be provided case management services by qualified vendors as described in the federally
approved waiver application. The case management service activities provided must include:

(1) finalizing the new text begin person-centered new text end written coordinated service and support plan within
the timelines established by the commissioner and section 256B.0911, subdivision 3a,
paragraph (e);

(2) informing the recipient or the recipient's legal guardian or conservator of service
options new text begin , including all service options available under the waiver plans new text end ;

(3) assisting the recipient in the identification of potential service providers deleted text begin and deleted text end new text begin , including:
new text end

new text begin (i) new text end available options for case management service and providers deleted text begin , including deleted text end new text begin ;
new text end

new text begin (ii) new text end new text begin providers of new text end services provided in a deleted text begin non-disability-specific deleted text end new text begin nondisability-specific new text end
setting;

new text begin (iii) employment service providers;
new text end

new text begin (iv) providers of services provided in settings that are not community residential settings;
and
new text end

new text begin (v) providers of financial management services;
new text end

(4) assisting the recipient to access services and assisting with appeals under section
256.045; and

(5) coordinating, evaluating, and monitoring of the services identified in the service
plan.

(b) The case manager may delegate certain aspects of the case management service
activities to another individual provided there is oversight by the case manager. The case
manager may not delegate those aspects which require professional judgment including:

(1) finalizing the new text begin person-centered new text end coordinated service and support plan;

(2) ongoing assessment and monitoring of the person's needs and adequacy of the
approved new text begin person-centered new text end coordinated service and support plan; and

(3) adjustments to the new text begin person-centered new text end coordinated service and support plan.

(c) Case management services must be provided by a public or private agency that is
enrolled as a medical assistance provider determined by the commissioner to meet all of
the requirements in the approved federal waiver plans. Case management services must not
be provided to a recipient by a private agency that has any financial interest in the provision
of any other services included in the recipient's coordinated service and support plan. For
purposes of this section, "private agency" means any agency that is not identified as a lead
agency under section 256B.0911, subdivision 1a, paragraph (e).

(d) For persons who need a positive support transition plan as required in chapter 245D,
the case manager shall participate in the development and ongoing evaluation of the plan
with the expanded support team. At least quarterly, the case manager, in consultation with
the expanded support team, shall evaluate the effectiveness of the plan based on progress
evaluation data submitted by the licensed provider to the case manager. The evaluation must
identify whether the plan has been developed and implemented in a manner to achieve the
following within the required timelines:

(1) phasing out the use of prohibited procedures;

(2) acquisition of skills needed to eliminate the prohibited procedures within the plan's
timeline; and

(3) accomplishment of identified outcomes.

If adequate progress is not being made, the case manager shall consult with the person's
expanded support team to identify needed modifications and whether additional professional
support is required to provide consultation.

new text begin (e) The Department of Human Services shall offer ongoing education in case management
to case managers. Case managers shall receive no less than ten hours of case management
education and disability-related training each year. The education and training must include
person-centered planning. For the purposes of this section, "person-centered planning" or
"person-centered" has the meaning given in section 256B.0911, subdivision 1a, paragraph
(f).
new text end

Sec. 7.

Minnesota Statutes 2019 Supplement, section 256B.49, subdivision 14, is amended
to read:

Subd. 14.

Assessment and reassessment.

(a) Assessments and reassessments shall be
conducted by certified assessors according to section 256B.0911, subdivision 2b. The
certified assessor, with the permission of the recipient or the recipient's designated legal
representative, may invite other individuals to attend the assessment. With the permission
of the recipient or the recipient's designated legal representative, the recipient's current
provider of services may submit a written report outlining their recommendations regarding
the recipient's care needs prepared by a direct service employee who is familiar with the
person. The provider must submit the report at least 60 days before the end of the person's
current service agreement. The certified assessor must consider the content of the submitted
report prior to finalizing the person's assessment or reassessment.

(b) There must be a determination that the client requires a hospital level of care or a
nursing facility level of care as defined in section 256B.0911, subdivision 4e, at initial and
subsequent assessments to initiate and maintain participation in the waiver program.

(c) Regardless of other assessments identified in section 144.0724, subdivision 4, as
appropriate to determine nursing facility level of care for purposes of medical assistance
payment for nursing facility services, only face-to-face assessments conducted according
to section 256B.0911, subdivisions 3a, 3b, and 4d, that result in a hospital level of care
determination or a nursing facility level of care determination must be accepted for purposes
of initial and ongoing access to waiver services payment.

(d) Recipients who are found eligible for home and community-based services under
this section before their 65th birthday may remain eligible for these services after their 65th
birthday if they continue to meet all other eligibility factors.

new text begin (e) At the time of reassessment, the certified assessor shall assess each person receiving
waiver residential supports and services currently residing in a community residential setting,
family adult foster care residence, or supervised living facility to determine if that person
would prefer to be served in a community-living setting as defined in subdivision 23 or to
receive integrated community supports as described in section 245D.03, subdivision 1,
paragraph (c), clause (8). The certified assessor shall offer the person through a
person-centered planning process the option to receive alternative housing and service
options.
new text end

new text begin (f) At the time of reassessment, the certified assessor shall assess each person receiving
waiver day services to determine if that person would prefer to receive employment services
as described in section 245D.03, subdivision 1, paragraph (c), clauses (5) to (7). The certified
assessor shall offer the person through a person-centered planning process the option to
receive employment services.
new text end

new text begin (g) At the time of reassessment, the certified assessor shall assess each person receiving
nonself-directed waiver services to determine if that person would prefer an available service
and setting option that would permit self-directed services and supports. The certified
assessor shall offer the person through a person-centered planning process the option to
receive self-directed services and supports.
new text end

Sec. 8.

Minnesota Statutes 2018, section 256B.49, subdivision 16, is amended to read:

Subd. 16.

Services and supports.

(a) Services and supports included in the home and
community-based waivers for persons with disabilities shall meet the requirements set out
in United States Code, title 42, section 1396n. The services and supports, which are offered
as alternatives to institutional care, shall promote consumer choice, community inclusion,
self-sufficiency, and self-determination.

(b) Beginning January 1, 2003, the commissioner shall simplify and improve access to
home and community-based waivered services, to the extent possible, through the
establishment of a common service menu that is available to eligible recipients regardless
of age, disability type, or waiver program.

(c) Consumer directed community support services shall be offered as an option to all
persons eligible for services under subdivision 11, by January 1, 2002.

(d) Services and supports shall be arranged and provided consistent with individualized
written plans of care for eligible waiver recipients.

(e) A transitional supports allowance shall be available to all persons under a home and
community-based waiver who are moving from a licensed setting to a deleted text begin community deleted text end new text begin
community-living new text end setting new text begin or who are transitioning from residential supports and services to
integrated community supports new text end . "Transitional supports allowance" means a onetime payment
of up to $3,000, to cover the costs, not covered by other sources, associated with moving
from a licensed setting to a deleted text begin community deleted text end new text begin community-living new text end setting new text begin or a setting in which the
provision of integrated community supports are permitted under the waiver plans new text end . Covered
costs include:

(1) lease or rent deposits;

(2) security deposits;

(3) utilities setup costs, including telephone;

(4) essential furnishings and supplies; and

(5) personal supports and transports needed to locate and transition to community settings.

(f) The state of Minnesota and county agencies that administer home and
community-based waivered services for persons with disabilities, shall not be liable for
damages, injuries, or liabilities sustained through the purchase of supports by the individual,
the individual's family, legal representative, or the authorized representative with funds
received through the consumer-directed community support service under this section.
Liabilities include but are not limited to: workers' compensation liability, the Federal
Insurance Contributions Act (FICA), or the Federal Unemployment Tax Act (FUTA).

Sec. 9. new text begin DIRECTION TO COMMISSIONER OF HUMAN SERVICES;
ASSESSMENTS AND CASE MANAGEMENT.
new text end

new text begin Subdivision 1. new text end

new text begin Update MnCHOICES. new text end

new text begin By January 1, 2021, the commissioner of human
services shall make the MnCHOICES assessment tool consistent with state and federal
statutes and rules, including the requirements of Minnesota Statutes, section 256B.0911,
subdivision 3a, paragraphs (n) to (p).
new text end

new text begin Subd. 2. new text end

new text begin Implement person-centered planning procedures. new text end

new text begin By January 1, 2021, the
commissioner shall implement required procedures that certified assessors and case managers
must follow when conducting person-centered planning. The procedures must ensure that
waiver participants are fully informed of all the service and setting options available under
the waiver plans and that each waiver participant can make a fully informed choice regarding
employment, living arrangement, and self-directed services.
new text end

new text begin Subd. 3. new text end

new text begin Implement informed decision-making process. new text end

new text begin By January 1, 2021, the
commissioner shall develop and implement materials and procedures for certified assessors
and case managers to use during person-centered planning to aide waiver participants in
becoming fully informed of all service and setting options available under the waiver plans.
The procedures developed by the commissioner must include a requirement that each wavier
recipient be educated about all the employment, housing, and self-directed options available
under the waivers before having the recipient's needs and preferences in these areas assessed
and before the recipient's community support plans, coordinated service and support plans,
and coordinated service and support plan addendums are developed.
new text end

new text begin Subd. 4. new text end

new text begin Implement training to improve inter-assessor reliability. new text end

new text begin (a) By January 1,
2021, the commissioner shall develop and implement modifications to the training and
certification process required under Minnesota Statutes, section 256B.0911, subdivision
2c, to improve inter-assessor reliability.
new text end

new text begin (b) By January 1, 2021, the commissioner shall develop and implement a methodology
for measuring inter-assessor reliability and tracking changes over time in the measurements
of inter-assessor reliability.
new text end

new text begin Subd. 5. new text end

new text begin Implement continuous process improvement. new text end

new text begin (a) By January 1, 2021, the
commissioner shall develop and implement a continuous improvement plan for the entire
process of long-term care consultation services, case management for persons receiving
long-term services and supports, and provider-developed service plans for long-term services
and supports. The commissioner shall base the continuous improvement plan on the principles
of Lean Six Sigma or similar continuous improvement methodology.
new text end

new text begin (b) In developing a continuous improvement plan, the commissioner shall pay particular
attention to ensuring that the process of assessment, case management, and service planning
and delivery supports a presumption that people receiving long-term services and supports
will receive those services and supports in the most integrated, independent, and self-directed
manner consistent with the person's expressed preferences and fully informed choices.
new text end