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SF 4200

as introduced - 91st Legislature (2019 - 2020) Posted on 03/10/2020 09:10am

KEY: stricken = removed, old language.
underscored = added, new language.
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A bill for an act
relating to human services; modifying long-term care consultation services;
modifying long-term care options counseling; modifying reimbursement for
long-term care consultation services; amending Minnesota Statutes 2018, sections
144.586, by adding a subdivision; 144D.04, subdivision 2; 144G.03, subdivision
4; 256.01, subdivision 24; 256.975, subdivisions 7, 7c, 7d, by adding subdivisions;
256B.055, subdivision 12; 256B.0575, subdivision 2; 256B.0911, subdivisions 1,
2b, 2c, 3, 3b, 4d, 6, by adding a subdivision; Minnesota Statutes 2019 Supplement,
sections 144G.50, subdivision 2; 144G.70, subdivision 2; 256B.0911, subdivisions
1a, 3a, 3f, 5; repealing Minnesota Statutes 2018, section 256B.0911, subdivisions
3c, 3d, 3e.

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

Section 1.

Minnesota Statutes 2018, section 144.586, is amended by adding a subdivision
to read:


new text begin Subd. 4. new text end

new text begin Referrals for long-term care options counseling. new text end

new text begin Hospitals shall refer all
individuals identified as at-risk individuals under section 256.975, subdivision 7, paragraph
(b), clause (12), to the Senior LinkAge Line for long-term care options counseling prior to
discharge from an inpatient hospital stay. Hospitals shall make these referrals using referral
protocols and processes developed under section 256.975, subdivision 7. The purpose of
the counseling is to support persons with current or anticipated long-term care needs in
making informed choices among options that include the most cost-effective and least
restrictive setting.
new text end

Sec. 2.

Minnesota Statutes 2018, section 144D.04, subdivision 2, is amended to read:


Subd. 2.

Contents of contract.

A housing with services contract, which need not be
entitled as such to comply with this section, shall include at least the following elements in
itself or through supporting documents or attachments:

(1) the name, street address, and mailing address of the establishment;

(2) the name and mailing address of the owner or owners of the establishment and, if
the owner or owners is not a natural person, identification of the type of business entity of
the owner or owners;

(3) the name and mailing address of the managing agent, through management agreement
or lease agreement, of the establishment, if different from the owner or owners;

(4) the name and address of at least one natural person who is authorized to accept service
of process on behalf of the owner or owners and managing agent;

(5) a statement describing the registration and licensure status of the establishment and
any provider providing health-related or supportive services under an arrangement with the
establishment;

(6) the term of the contract;

(7) a description of the services to be provided to the resident in the base rate to be paid
by the resident, including a delineation of the portion of the base rate that constitutes rent
and a delineation of charges for each service included in the base rate;

(8) a description of any additional services, including home care services, available for
an additional fee from the establishment directly or through arrangements with the
establishment, and a schedule of fees charged for these services;

(9) a conspicuous notice informing the tenant of the policy concerning the conditions
under which and the process through which the contract may be modified, amended, or
terminated, including whether a move to a different room or sharing a room would be
required in the event that the tenant can no longer pay the current rent;

(10) a description of the establishment's complaint resolution process available to residents
including the toll-free complaint line for the Office of Ombudsman for Long-Term Care;

(11) the resident's designated representative, if any;

(12) the establishment's referral procedures if the contract is terminated;

(13) requirements of residency used by the establishment to determine who may reside
or continue to reside in the housing with services establishment;

(14) billing and payment procedures and requirements;

(15) a statement regarding the ability of a resident to receive services from service
providers with whom the establishment does not have an arrangement;

(16) a statement regarding the availability of public funds for payment for residence or
services in the establishment; and

(17) a statement regarding the availability of and contact information for long-term care
deleted text begin consultation services under section 256B.0911 in the county in which the establishment is
located
deleted text endnew text begin options counseling under sections 256.01, subdivision 24, and 256.975, subdivisions
7 to 7f
new text end.

Sec. 3.

Minnesota Statutes 2018, section 144G.03, subdivision 4, is amended to read:


Subd. 4.

Nursing assessment.

(a) A housing with services establishment offering or
providing assisted living shall:

(1) offer to have the arranged home care provider conduct a nursing assessment by a
registered nurse of the physical and cognitive needs of the prospective resident and propose
a service plan prior to the date on which a prospective resident executes a contract with a
housing with services establishment or the date on which a prospective resident moves in,
whichever is earlier; and

(2) inform the prospective resident of the availability of and contact information for
long-term care deleted text beginconsultation services under section 256B.0911deleted text endnew text begin options counseling under
sections 256.01, subdivision 24, and 256.975, subdivisions 7 to 7f
new text end, prior to the date on which
a prospective resident executes a contract with a housing with services establishment or the
date on which a prospective resident moves in, whichever is earlier.

(b) An arranged home care provider is not obligated to conduct a nursing assessment
by a registered nurse when requested by a prospective resident if either the geographic
distance between the prospective resident and the provider, or urgent or unexpected
circumstances, do not permit the assessment to be conducted prior to the date on which the
prospective resident executes a contract or moves in, whichever is earlier. When such
circumstances occur, the arranged home care provider shall offer to conduct a telephone
conference whenever reasonably possible.

(c) The arranged home care provider shall comply with applicable home care licensure
requirements in chapter 144A and sections 148.171 to 148.285, with respect to the provision
of a nursing assessment prior to the delivery of nursing services and the execution of a home
care service plan or service agreement.

Sec. 4.

Minnesota Statutes 2019 Supplement, section 144G.50, subdivision 2, is amended
to read:


Subd. 2.

Contract information.

(a) The contract must include in a conspicuous place
and manner on the contract the legal name and the license number of the facility.

(b) The contract must include the name, telephone number, and physical mailing address,
which may not be a public or private post office box, of:

(1) the facility and contracted service provider when applicable;

(2) the licensee of the facility;

(3) the managing agent of the facility, if applicable; and

(4) the authorized agent for the facility.

(c) The contract must include:

(1) a disclosure of the category of assisted living facility license held by the facility and,
if the facility is not an assisted living facility with dementia care, a disclosure that it does
not hold an assisted living facility with dementia care license;

(2) a description of all the terms and conditions of the contract, including a description
of and any limitations to the housing or assisted living services to be provided for the
contracted amount;

(3) a delineation of the cost and nature of any other services to be provided for an
additional fee;

(4) a delineation and description of any additional fees the resident may be required to
pay if the resident's condition changes during the term of the contract;

(5) a delineation of the grounds under which the resident may be discharged, evicted,
or transferred or have services terminated;

(6) billing and payment procedures and requirements; and

(7) disclosure of the facility's ability to provide specialized diets.

(d) The contract must include a description of the facility's complaint resolution process
available to residents, including the name and contact information of the person representing
the facility who is designated to handle and resolve complaints.

(e) The contract must include a clear and conspicuous notice of:

(1) the right under section 144G.54 to appeal the termination of an assisted living contract;

(2) the facility's policy regarding transfer of residents within the facility, under what
circumstances a transfer may occur, and the circumstances under which resident consent is
required for a transfer;

(3) contact information for the Office of Ombudsman for Long-Term Care, the
Ombudsman for Mental Health and Developmental Disabilities, and the Office of Health
Facility Complaints;

(4) the resident's right to obtain services from an unaffiliated service provider;

(5) a description of the facility's policies related to medical assistance waivers under
chapter 256S and section 256B.49 and the housing support program under chapter 256I,
including:

(i) whether the facility is enrolled with the commissioner of human services to provide
customized living services under medical assistance waivers;

(ii) whether the facility has an agreement to provide housing support under section
256I.04, subdivision 2, paragraph (b);

(iii) whether there is a limit on the number of people residing at the facility who can
receive customized living services or participate in the housing support program at any
point in time. If so, the limit must be provided;

(iv) whether the facility requires a resident to pay privately for a period of time prior to
accepting payment under medical assistance waivers or the housing support program, and
if so, the length of time that private payment is required;

(v) a statement that medical assistance waivers provide payment for services, but do not
cover the cost of rent;

(vi) a statement that residents may be eligible for assistance with rent through the housing
support program; and

(vii) a description of the rent requirements for people who are eligible for medical
assistance waivers but who are not eligible for assistance through the housing support
program;

(6) the contact information to obtain long-term care deleted text beginconsulting services under section
256B.0911
deleted text endnew text begin options counseling under sections 256.01, subdivision 24, and 256.975,
subdivisions 7 to 7f
new text end; and

(7) the toll-free phone number for the Minnesota Adult Abuse Reporting Center.

(f) The contract must include a description of the facility's complaint resolution process
available to residents, including the name and contact information of the person representing
the facility who is designated to handle and resolve complaints.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2021.
new text end

Sec. 5.

Minnesota Statutes 2019 Supplement, section 144G.70, subdivision 2, is amended
to read:


Subd. 2.

Initial reviews, assessments, and monitoring.

(a) Residents who are not
receiving any services shall not be required to undergo an initial nursing assessment.

(b) An assisted living facility shall conduct a nursing assessment by a registered nurse
of the physical and cognitive needs of the prospective resident and propose a temporary
service plan prior to the date on which a prospective resident executes a contract with a
facility or the date on which a prospective resident moves in, whichever is earlier. If
necessitated by either the geographic distance between the prospective resident and the
facility, or urgent or unexpected circumstances, the assessment may be conducted using
telecommunication methods based on practice standards that meet the resident's needs and
reflect person-centered planning and care delivery.

(c) Resident reassessment and monitoring must be conducted no more than 14 calendar
days after initiation of services. Ongoing resident reassessment and monitoring must be
conducted as needed based on changes in the needs of the resident and cannot exceed 90
calendar days from the last date of the assessment.

(d) For residents only receiving assisted living services specified in section 144G.08,
subdivision 9, clauses (1) to (5), the facility shall complete an individualized initial review
of the resident's needs and preferences. The initial review must be completed within 30
calendar days of the start of services. Resident monitoring and review must be conducted
as needed based on changes in the needs of the resident and cannot exceed 90 calendar days
from the date of the last review.

(e) A facility must inform the prospective resident of the availability of and contact
information for long-term care deleted text beginconsultation services under section 256B.0911deleted text endnew text begin options
counseling under sections 256.01, subdivision 24, and 256.975, subdivisions 7 to 7f
new text end, prior
to the date on which a prospective resident executes a contract with a facility or the date on
which a prospective resident moves in, whichever is earlier.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2021.
new text end

Sec. 6.

Minnesota Statutes 2018, section 256.01, subdivision 24, is amended to read:


Subd. 24.

Disability Linkage Line.

The commissioner shall establish the Disability
Linkage Line, which shall serve people with disabilities as the designated Aging and
Disability Resource Center under United States Code, title 42, section 3001, the Older
Americans Act Amendments of 2006, in partnership with the Senior LinkAge Line deleted text beginand
shall
deleted text endnew text begin under section 256.975, subdivision 7;new text end serve as Minnesota's neutral access point for
statewide disability information and assistancenew text begin;new text end and deleted text beginmustdeleted text end be available during business hours
through a statewide toll-free number and the Internet. The Disability Linkage Linenew text begin, in
partnership with the Senior LinkAge Line,
new text end shall:

(1) deliver information and assistance based on national and state standards;

(2) provide information about state and federal eligibility requirements, benefits, and
service options;

(3) provide deleted text beginbenefits anddeleted text end new text beginlong-term care new text endoptions counselingnew text begin under section 256.975,
subdivisions 7 to 7f
new text end;

(4) make referrals to appropriate support entities;

(5) educate people on their options so they can make well-informed choices and link
them to quality profiles;

(6) help support the timely resolution of service access and benefit issues;

(7) inform people of their long-term community services and supports;

(8) provide necessary resources and supports that can lead to employment and increased
economic stability of people with disabilities; and

(9) serve as the technical assistance and help center for the web-based tool, Minnesota's
Disability Benefits 101.org.

Sec. 7.

Minnesota Statutes 2018, section 256.975, subdivision 7, is amended to read:


Subd. 7.

Consumer information and assistance and long-term care options
counseling; Senior LinkAge Line.

(a) The Minnesota Board on Aging shall operate a
statewide service to aid older Minnesotans and their families in making informed choices
about long-term care options and health care benefits. Language services to persons with
limited English language skills may be made available. The service, known as Senior
LinkAge Line, shall serve older adults as the designated Aging and Disability Resource
Center under United States Code, title 42, section 3001, the Older Americans Act
Amendments of 2006 in partnership with the Disability Linkage Line under section 256.01,
subdivision 24
, and must be available during business hours through a statewide toll-free
number and the Internet. The Minnesota Board on Aging shall consult with, and when
appropriate work through, the area agencies on aging counties, and other entities that serve
aging and disabled populations of all ages, to provide and maintain the telephone
infrastructure and related support for the Aging and Disability Resource Center partners
which agree by memorandum to access the infrastructure, including the designated providers
of the Senior LinkAge Line and the Disability Linkage Line.

(b) The servicenew text begin, in partnership with the Disability Linkage Line,new text end must provide long-term
care options counseling by assisting older adults, new text beginpeople with disabilities, new text endcaregivers, and
providers in accessing information and options counseling about choices in long-term care
services that are purchased through private providers or available through public options.
The service must:

(1) develop and provide for regular updating of a comprehensive database that includes
detailed listings in both consumer- and provider-oriented formats that can provide search
results down to the neighborhood level;

(2) make the database accessible on the Internet and through other telecommunication
and media-related tools;

(3) link callers to interactive long-term care screening tools and make these tools available
through the Internet by integrating the tools with the database;

(4) develop community education materials with a focus on planning for long-term care
and evaluating independent living, housing, new text beginemployment, new text endand service options;

(5) conduct an outreach campaign to assist older adultsnew text begin, people with disabilities,new text end and
their caregivers in finding information on the Internet and through other means of
communication;

(6) implement a messaging system for overflow callers and respond to these callers by
the next business day;

(7) link callers with county human services and other providers to receive more in-depth
assistance and deleted text beginconsultation related to long-term care optionsdeleted text endnew text begin long-term care consultation
services
new text end;

(8) link callers with quality profiles for nursing facilities and other home and
community-based services providers developed by the commissioners of health and human
services;

(9) develop an outreach plan to deleted text beginseniorsdeleted text endnew text begin older adults, people with disabilities,new text end and their
caregivers with a particular focus on establishing a clear presence in places that deleted text beginseniorsdeleted text end
new text begin older adults and people with disabilities new text endrecognize and:

(i) place a significant emphasis on improved outreach and service to deleted text beginseniorsdeleted text endnew text begin older adults,
people with disabilities,
new text end and their caregivers by establishing annual plans by neighborhood,
city, and county, as necessary, to address the unique needs of geographic areas in the state
where there are dense populations of deleted text beginseniorsdeleted text endnew text begin older adults or people with disabilitiesnew text end;

(ii) establish an efficient workforce management approach and assign community living
specialist staff and volunteers to geographic areas as well as aging and disability resource
center sites so that deleted text beginseniorsdeleted text endnew text begin older adults, people with disabilities,new text end and their caregivers and
professionals recognize the Senior LinkAge Line as the place to call for aging services and
informationnew text begin and the Disability Linkage Line as the place to call for disabilities services and
information
new text end;

(iii) recognize the size and complexity of the metropolitan area service system by working
with metropolitan counties to establish a clear partnership with them, including seeking
county advice on the establishment of local aging and disabilities resource center sites; and

(iv) maintain dashboards with metrics that demonstrate how the service is expanding
and extending or enhancing its outreach efforts in dispersed or hard to reach locations in
varied population centers;

(10) incorporate information about the availability of housing options, as well as
registered housing with services and consumer rights within the MinnesotaHelp.info network
long-term care database to facilitate consumer comparison of services and costs among
housing with services establishments and with other in-home services and to support financial
self-sufficiency as long as possible. Housing with services establishments and their arranged
home care providers shall provide information that will facilitate price comparisons, including
delineation of charges for rent and for services available. The commissioners of health and
human services shall align the data elements required by section 144G.06, the Uniform
Consumer Information Guide, and this section to provide consumers standardized information
and ease of comparison of long-term care options. The commissioner of human services
shall provide the data to the Minnesota Board on Aging for inclusion in the
MinnesotaHelp.info network long-term care database;

(11) provide long-term care options counseling. Long-term care options counselors shall:

(i) for individuals not eligible for case management under a public program or public
funding source, provide interactive decision support under which consumers, family
members, or other helpers are supported in their deliberations to determine appropriate
long-term care choices in the context of the consumer's needs, preferences, values, and
individual circumstances, including implementing a community support plan;

(ii) provide web-based educational information and collateral written materials to
familiarize consumers, family members, or other helpers with the long-term care basics,
issues to be considered, and the range of options available in the community;

(iii) provide long-term care futures planning, which means providing assistance to
individuals who anticipate having long-term care needs to develop a plan for the more
distant future; and

(iv) provide expertise in benefits and financing options for long-term care, including
Medicare, long-term care insurance, tax or employer-based incentives, reverse mortgages,
private pay options, and ways to access low or no-cost services or benefits through
volunteer-based or charitable programs;

(12) using risk management and support planning protocols, provide long-term care
options counseling under clause (13) to current residents of nursing homes deemed
appropriate for discharge by the commissioner who meet a profile that demonstrates that
the consumer is either at risk of readmission to a nursing home or hospital, or would benefit
from long-term care options counseling to age in place. The Senior LinkAge Line shall
identify and contact residents or patients deemed appropriate by developing targeting criteria
and creating a profile in consultation with the commissioner. The commissioner shall provide
designated Senior LinkAge Line contact centers with a list of current or former nursing
home residents or people discharged from a hospital or for whom Medicare home care has
ended, that meet the criteria as being appropriate for long-term care options counseling
through a referral via a secure web portal. Senior LinkAge Line shall provide these residents,
if they indicate a preference to receive long-term care options counseling, with initial
assessment and, if appropriate, a referral to:

(i) long-term care consultation services under section 256B.0911;

(ii) designated care coordinators of contracted entities under section 256B.035 for persons
who are enrolled in a managed care plan; or

(iii) the long-term care consultation team for those who are eligible for relocation service
coordination due to high-risk factors or psychological or physical disability; and

(13) develop referral protocols and processes that will assist certified health care homes,
Medicare home care, and hospitals to identify at-risk older adults and determine when to
refer these individuals to the Senior LinkAge Line for long-term care options counseling
under this section. The commissioner is directed to work with the commissioner of health
to develop protocols that would comply with the health care home designation criteria and
protocols available at the time of hospital discharge or the end of Medicare home care. The
commissioner shall keep a record of the number of people who choose long-term care
options counseling as a result of this section.

(c) Nursing homes shall provide contact information to the Senior LinkAge Line for
residents identified in paragraph (b), clause (12), to provide long-term care options counseling
pursuant to paragraph (b), clause (11). The contact information for residents shall include
all information reasonably necessary to contact residents, including first and last names,
permanent and temporary addresses, telephone numbers, and e-mail addresses.

(d) The Senior LinkAge Line shall determine when it is appropriate to refer a consumer
who receives long-term care options counseling under paragraph (b), clause (12) or (13),
and who uses an unpaid caregiver to the self-directed caregiver service under subdivision
12.

Sec. 8.

Minnesota Statutes 2018, section 256.975, subdivision 7c, is amended to read:


Subd. 7c.

new text beginPreadmission new text endscreening requirements.

(a) A person may be screened for
nursing facility admission by telephone or in a face-to-face screening interviewnew text begin except as
provided in paragraph (b)
new text end. The Senior LinkAge Line shall identify each individual's needs
using the following categories:

(1) the person needs no face-to-face long-term care consultation assessment completed
under section 256B.0911, subdivision 3a, 3b, or 4d, by a county, tribe, or managed care
organization under contract with the Department of Human Services to determine the need
for nursing facility level of care based on information obtained from other health care
professionals;

(2) the person needs an immediate face-to-face long-term care consultation assessment
completed under section 256B.0911, subdivision 3a, 3b, or 4d, by a county, tribe, or managed
care organization under contract with the Department of Human Services to determine the
need for nursing facility level of care and complete activities required under subdivision
7a; or

(3) the person may be exempt from screening requirements as outlined in subdivision
7b, but will need transitional assistance after admission or in-person follow-along after a
return home.

(b) deleted text beginIndividuals under 65 years of age who are admitted to nursing facilities with only a
telephone screening must receive a face-to-face assessment from the long-term care
consultation team member of the county in which the facility is located or from the recipient's
county case manager within 40 calendar days of admission as described in section 256B.0911,
subdivision 4d
, paragraph (c).
deleted text endnew text begin For individuals under 21 years of age, a preadmission screening
interview which recommends nursing facility admission must be face-to-face and approved
by the commissioner before the individual is admitted to the nursing facility.
new text end

(c) Persons admitted on a nonemergency basis to a Medicaid-certified nursing facility
must be screened prior to admission.

(d) Screenings provided by the Senior LinkAge Line must include processes to identify
persons who may require transition assistance described in subdivision 7, paragraph (b),
clause (12), and section 256B.0911, subdivision 3b.

Sec. 9.

Minnesota Statutes 2018, section 256.975, subdivision 7d, is amended to read:


Subd. 7d.

Payment for preadmission screening.

new text begin(a) new text endFunding for preadmission screening
shall be provided to the Minnesota Board on Aging by the Department of Human Services
to cover screener salaries and expenses to provide the services described in subdivisions 7a
to 7c. The Minnesota Board on Aging shall employ, or contract with other agencies to
employ, within the limits of available funding, sufficient personnel to provide preadmission
screening and level of care determination services and shall seek to maximize federal funding
for the service as provided under section 256.01, subdivision 2, paragraph (aa).

new text begin (b) Funding for preadmission screening follow-up shall be provided to the Disability
Linkage Line for the population under age 60 by the Department of Human Services to
cover options counseling salaries and expenses to provide the services described in
subdivisions 7a to 7c. The Disability Linkage Line shall employ, or contract with other
agencies to employ, within the limits of available funding, sufficient personnel to provide
preadmission screening follow-up services and shall seek to maximize federal funding for
the service as provided under section 256.01, subdivision 2, paragraph (aa).
new text end

Sec. 10.

Minnesota Statutes 2018, section 256.975, is amended by adding a subdivision
to read:


new text begin Subd. 7e. new text end

new text begin Options counseling for housing with services. new text end

new text begin (a) The purpose of long-term
care options counseling for registered housing with services is to support persons with
current or anticipated long-term care needs in making informed choices among options that
include the most cost-effective and least restrictive settings. Prospective residents maintain
the right to choose housing with services or assisted living if that option is their preference.
new text end

new text begin (b) Registered housing with services establishments shall inform each prospective resident
or the prospective resident's designated or legal representative of the availability of long-term
care options counseling and the need to receive and verify the counseling prior to signing
a lease or contract. Long-term care options counseling for registered housing with services
is provided as determined by the commissioner of human services. The service is delivered
under a partnership between the Senior LinkAge Line, the Disability Linkage Line, and the
Area Agencies on Aging, and is a point of entry to telephone-based long-term care options
counseling provided by the Senior LinkAge Line. The point of entry service must be provided
within five working days of the request of the prospective resident as follows:
new text end

new text begin (1) the options counseling shall be conducted with the prospective resident, or in the
alternative, the resident's designated or legal representative, if:
new text end

new text begin (i) the resident verbally requests; or
new text end

new text begin (ii) the registered housing with services provider has documentation of the designated
or legal representative's authority to enter into a lease or contract on behalf of the prospective
resident and accepts the documentation in good faith;
new text end

new text begin (2) the options counseling shall be performed in a manner that provides objective and
complete information;
new text end

new text begin (3) the options counseling must include a review of the prospective resident's reasons
for considering housing with services, the prospective resident's personal goals, a discussion
of the prospective resident's immediate and projected long-term care needs, and alternative
community services or housing with services settings that may meet the prospective resident's
needs;
new text end

new text begin (4) the prospective resident, if eligible for long-term care consultation services under
section 256B.0911, must be informed of the availability of a face-to-face visit at no charge
to the prospective resident to assist the prospective resident in assessment and planning to
meet the prospective resident's long-term care needs; and
new text end

new text begin (5) verification of options counseling shall be generated and provided to the prospective
resident by the Senior LinkAge Line upon completion of the telephone-based counseling.
new text end

new text begin (c) Housing with services establishments registered under chapter 144D shall:
new text end

new text begin (1) inform each prospective resident or the prospective resident's designated or legal
representative of the availability of and contact information for options counseling under
this subdivision;
new text end

new text begin (2) receive a copy of the verification of options counseling prior to executing a lease or
service contract with the prospective resident, and prior to executing a service contract with
individuals who have previously entered into lease-only arrangements; and
new text end

new text begin (3) retain a copy of the verification of options counseling as part of the resident's file.
new text end

new text begin (d) Emergency admissions to registered housing with services establishments prior to
options counseling under paragraph (b) are permitted according to policies established by
the commissioner.
new text end

Sec. 11.

Minnesota Statutes 2018, section 256.975, is amended by adding a subdivision
to read:


new text begin Subd. 7f. new text end

new text begin Options counseling for housing with services exemptions. new text end

new text begin Individuals shall
be exempt from the requirements outlined in subdivision 7e in the following circumstances:
new text end

new text begin (1) the individual is seeking a lease-only arrangement in a subsidized housing setting;
new text end

new text begin (2) the individual has previously received a long-term care consultation assessment
under section 256B.0911. In this instance, the assessor who completes the long-term care
consultation assessment will issue a verification code and provide it to the individual;
new text end

new text begin (3) the individual is receiving or is being evaluated for hospice services from a hospice
provider licensed under sections 144A.75 to 144A.755; or
new text end

new text begin (4) the individual has used financial planning services and created a long-term care plan
as defined by the commissioner in the 12 months prior to signing a lease or contract with a
registered housing with services establishment.
new text end

Sec. 12.

Minnesota Statutes 2018, section 256B.055, subdivision 12, is amended to read:


Subd. 12.

Children with disabilities.

(a) A person is eligible for medical assistance if
the person is under age 19 and qualifies as a disabled individual under United States Code,
title 42, section 1382c(a), and would be eligible for medical assistance under the state plan
if residing in a medical institution, and the child requires a level of care provided in a hospital,
nursing facility, or intermediate care facility for persons with developmental disabilities,
for whom home care is appropriate, provided that the cost to medical assistance under this
section is not more than the amount that medical assistance would pay for if the child resides
in an institution. After the child is determined to be eligible under this section, the
commissioner shall review the child's disability under United States Code, title 42, section
1382c(a) and level of care defined under this section no more often than annually and may
elect, based on the recommendation of health care professionals under contract with the
state medical review team, to extend the review of disability and level of care up to a
maximum of four years. The commissioner's decision on the frequency of continuing review
of disability and level of care is not subject to administrative appeal under section 256.045.
The county agency shall send a notice of disability review to the enrollee six months prior
to the date the recertification of disability is due. Nothing in this subdivision shall be
construed as affecting other redeterminations of medical assistance eligibility under this
chapter and annual cost-effective reviews under this section.

(b) For purposes of this subdivision, "hospital" means an institution as defined in section
144.696, subdivision 3, 144.55, subdivision 3, or Minnesota Rules, part 4640.3600, and
licensed pursuant to sections 144.50 to 144.58. For purposes of this subdivision, a child
requires a level of care provided in a hospital if the child is determined by the commissioner
to need an extensive array of health services, including mental health services, for an
undetermined period of time, whose health condition requires frequent monitoring and
treatment by a health care professional or by a person supervised by a health care
professional, who would reside in a hospital or require frequent hospitalization if these
services were not provided, and the daily care needs are more complex than a nursing facility
level of care.

A child with serious emotional disturbance requires a level of care provided in a hospital
if the commissioner determines that the individual requires 24-hour supervision because
the person exhibits recurrent or frequent suicidal or homicidal ideation or behavior, recurrent
or frequent psychosomatic disorders or somatopsychic disorders that may become life
threatening, recurrent or frequent severe socially unacceptable behavior associated with
psychiatric disorder, ongoing and chronic psychosis or severe, ongoing and chronic
developmental problems requiring continuous skilled observation, or severe disabling
symptoms for which office-centered outpatient treatment is not adequate, and which overall
severely impact the individual's ability to function.

(c) For purposes of this subdivision, "nursing facility" means a facility which provides
nursing care as defined in section 144A.01, subdivision 5, licensed pursuant to sections
144A.02 to 144A.10, which is appropriate if a person is in active restorative treatment; is
in need of special treatments provided or supervised by a licensed nurse; or has unpredictable
episodes of active disease processes requiring immediate judgment by a licensed nurse. For
purposes of this subdivision, a child requires the level of care provided in a nursing facility
if the child is determined by the commissioner to meet the requirements of the preadmission
screening assessment document under section 256B.0911, adjusted to address age-appropriate
standards for children age 18 and under.

(d) For purposes of this subdivision, "intermediate care facility for persons with
developmental disabilities" or "ICF/DD" means a program licensed to provide services to
persons with developmental disabilities under section 252.28, and chapter 245A, and a
physical plant licensed as a supervised living facility under chapter 144, which together are
certified by the Minnesota Department of Health as meeting the standards in Code of Federal
Regulations, title 42, part 483, for an intermediate care facility which provides services for
persons with developmental disabilities who require 24-hour supervision and active treatment
for medical, behavioral, or habilitation needs. For purposes of this subdivision, a child
requires a level of care provided in an ICF/DD if the commissioner finds that the child has
a developmental disability in accordance with section 256B.092, is in need of a 24-hour
plan of care and active treatment similar to persons with developmental disabilities, and
there is a reasonable indication that the child will need ICF/DD services.

(e) For purposes of this subdivision, a person requires the level of care provided in a
nursing facility if the person requires 24-hour monitoring or supervision and a plan of mental
health treatment because of specific symptoms or functional impairments associated with
a serious mental illness or disorder diagnosis, which meet severity criteria for mental health
established by the commissioner and published in March 1997 as the Minnesota Mental
Health Level of Care for Children and Adolescents with Severe Emotional Disorders.

(f) The determination of the level of care needed by the child shall be made by the
commissioner based on information supplied to the commissioner by the parent or guardian,
the child's physician or physicians, and other professionals as requested by the commissioner.
The commissioner shall establish a screening team to conduct the level of care determinations
according to this subdivision.

(g) If a child meets the conditions in paragraph (b), (c), (d), or (e), the commissioner
must assess the case to determine whether:

(1) the child qualifies as a disabled individual under United States Code, title 42, section
1382c(a), and would be eligible for medical assistance if residing in a medical institution;
and

(2) the cost of medical assistance services for the child, if eligible under this subdivision,
would not be more than the cost to medical assistance if the child resides in a medical
institution to be determined as follows:

(i) for a child who requires a level of care provided in an ICF/DD, the cost of care for
the child in an institution shall be determined using the average payment rate established
for the regional treatment centers that are certified as ICF's/DD;

(ii) for a child who requires a level of care provided in an inpatient hospital setting
according to paragraph (b), cost-effectiveness shall be determined according to Minnesota
Rules, part 9505.3520, items F and G; and

(iii) for a child who requires a level of care provided in a nursing facility according to
paragraph (c) or (e), cost-effectiveness shall be determined according to Minnesota Rules,
part 9505.3040, except that the nursing facility average rate shall be adjusted to reflect rates
which would be paid for children under age 16. The commissioner may authorize an amount
up to the amount medical assistance would pay for a child referred to the commissioner deleted text beginbydeleted text endnew text begin
following
new text end the preadmission screening deleted text beginteamdeleted text endnew text begin requirednew text end under section deleted text begin256B.0911deleted text endnew text begin 256.975,
subdivision 7c, paragraph (b)
new text end.

Sec. 13.

Minnesota Statutes 2018, section 256B.0575, subdivision 2, is amended to read:


Subd. 2.

Reasonable expenses.

For the purposes of subdivision 1, paragraph (a), clause
(9), reasonable expenses are limited to expenses that have not been previously used as a
deduction from income and were not:

(1) for long-term care expenses incurred during a period of ineligibility as defined in
section 256B.0595, subdivision 2;

(2) incurred more than three months before the month of application associated with the
current period of eligibility;

(3) for expenses incurred by a recipient that are duplicative of services that are covered
under chapter 256B; or

(4) nursing facility expenses incurred without a timely deleted text beginassessmentdeleted text endnew text begin nursing facility
preadmission screening
new text end as required under section deleted text begin256B.0911deleted text endnew text begin 256.975, subdivisions 7a to
7c
new text end.

Sec. 14.

Minnesota Statutes 2018, section 256B.0911, subdivision 1, is amended to read:


Subdivision 1.

Purpose and goal.

(a) The purpose of long-term care consultation services
is to assist persons with long-term or chronic care needs in making care decisions and
selecting support and service options that meet their needs and reflect their preferences.
The availability of, and access to, information and other types of assistance, including
new text begin long-term care consultation new text endassessment and new text begincommunity new text endsupport planning, is also intended
to prevent or delay institutional placements and to provide access to transition assistance
after deleted text beginadmissiondeleted text endnew text begin placementnew text end. Further, the goal of deleted text beginthesedeleted text endnew text begin long-term care consultationnew text end services
is to contain costs associated with unnecessary institutional admissions. deleted text beginLong-term
consultation services must be available to any person regardless of public program eligibility.
deleted text end

new text begin (b) new text endThe commissioner of human services shall seek to maximize use of available federal
and state funds deleted text beginand establish the broadest program possible within the funding availabledeleted text end.

deleted text begin (b) Thesedeleted text endnew text begin (c) Long-term care consultationnew text end services must be coordinated with long-term
care options counseling provided under deleted text beginsubdivision 4d,deleted text end section 256.975, subdivisions 7 to
deleted text begin 7cdeleted text endnew text begin 7fnew text end, and section 256.01, subdivision 24.

new text begin (d) new text endThe lead agency providing long-term care consultation services shall encourage the
use of volunteers from families, religious organizations, social clubs, and similar civic and
service organizations to provide community-based services.

Sec. 15.

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 new text beginlong-term care consultation new text endassessment and
community support plan development, deleted text beginappropriate referrals to obtain necessary diagnostic
information, and
deleted text end 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; and

(9) providing information about competitive employmentdeleted text begin,deleted text end with or without supportsdeleted text begin,deleted text end 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.

(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 state plan services identified in:

(i) section 256B.0625, subdivisions 19a and 19c;

(ii) consumer support grants under section 256.476; or

(iii) section 256B.85;

(2) notwithstanding provisions in Minnesota Rules, parts 9525.0004 to 9525.0024,
gaining access tonew text begin:
new text end

new text begin (i) relocation-targeted new text endcase management services available under deleted text beginsectionsdeleted text endnew text begin sectionnew text end
256B.0621, subdivision 2, clause (4)deleted text begin,deleted text endnew text begin;
new text end

new text begin (ii) case management services targeted to vulnerable adults or developmental disabilities
under section
new text end 256B.0924deleted text begin,deleted text endnew text begin;new text end and

new text begin (iii) case management services targeted to people with developmental disabilities under
new text end 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
new text begin community new text endsupport planning deleted text beginservicesdeleted text end.

(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. For the purposes of this section,
"informed choice" means a voluntary choice of services by a person from all available
service options based on accurate and complete information concerning all available service
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 to empower the person to make decisions.

Sec. 16.

Minnesota Statutes 2018, section 256B.0911, is amended by adding a subdivision
to read:


new text begin Subd. 1b. new text end

new text begin Eligibility. new text end

new text begin (a) To be eligible for long-term care consultation services, a person
must be:
new text end

new text begin (1) enrolled in medical assistance;
new text end

new text begin (2) determined financially eligible for the alternative care program;
new text end

new text begin (3) determined to have a developmental disability or related condition as defined in
Minnesota Rules, part 9525.0016, subpart 2, items A to E; or
new text end

new text begin (4) referred to a lead agency under section 256.975, subdivision 7c, paragraph (a), clause
(2), following a nursing facility preadmission screening.
new text end

new text begin (b) To be eligible for long-term care consultation services, a person enrolled in medical
assistance must also have utilized state plan services for at least six months and be either:
new text end

new text begin (1) age 65 or older;
new text end

new text begin (2) blind; or
new text end

new text begin (3) determined to have a disability by the commissioner's state medical review team as
identified in section 256B.055, subdivision 7, or by the Social Security Administration.
new text end

Sec. 17.

Minnesota Statutes 2018, section 256B.0911, subdivision 2b, is amended to read:


Subd. 2b.

MnCHOICES certified assessors.

(a) Each lead agency shall use certified
assessors who have completed MnCHOICES training and the certification processes
determined by the commissioner in subdivision 2c. Certified assessors shall demonstrate
best practices in assessment and support planning including person-centered planning
principles and have a common set of skills that must ensure consistency and equitable access
to services statewide. A lead agency may choose, according to departmental policies, to
contract with a qualified, certified assessor to conduct assessments and reassessments on
behalf of the lead agency. Certified assessors must use person-centered planning principles
to conduct an interview that identifies what is important to the person, the person's needs
for supports, health and safety concerns, and the person's abilities, interests, and goals.

Certified assessors are responsible for:

(1) ensuring persons are offered objective, unbiased access to resources;

(2) ensuring persons have the needed information to support informed choice, including
where and how they choose to live and the opportunity to pursue desired employment;

(3) determining level of care and eligibility for long-term services and supports;

(4) using the information gathered from the interview to develop a person-centered
community support plan that reflects identified needs and support options within the context
of values, interests, and goals important to the person; and

(5) providing the person with a community support plan that summarizes the person's
assessment findings, support options, and agreed-upon next steps.

(b) MnCHOICES certified assessors deleted text beginare persons with a minimum of adeleted text endnew text begin must possess anew text end
bachelor's degree in social work, nursing with a public health nursing certificate, or other
closely related field deleted text beginwithdeleted text endnew text begin and havenew text end at least one year of home and community-based
experience, or new text beginbe new text enda registered nurse with at least two years of home and community-based
experience deleted text beginwho hasdeleted text endnew text begin. A certified assessor must also havenew text end received training and certification
deleted text begin specific to assessment and consultation for long-term care services in the statedeleted text endnew text begin under
subdivision 2c
new text end.

Sec. 18.

Minnesota Statutes 2018, section 256B.0911, subdivision 2c, is amended to read:


Subd. 2c.

Assessor training and certification.

The commissioner shall develop and
implement a curriculum and an assessor certification process. All existing lead agency staff
designated to provide the services defined in subdivision 1a must be certified deleted text beginwithin timelines
specified by the commissioner, but no sooner than six months after statewide availability
of the training and certification process
deleted text end. The commissioner must establish the timelines for
training and certification in a manner that allows lead agencies to most efficiently adopt the
automated process established in subdivision 5. Each lead agency deleted text beginis required todeleted text endnew text begin mustnew text end ensure
that deleted text beginthey havedeleted text endnew text begin it hasnew text end sufficient numbers of certified assessors to provide long-term
consultation assessment and support planning within the timelines and parameters of the
service. Certified assessors deleted text beginare required todeleted text endnew text begin mustnew text end be recertified every three years.

Sec. 19.

Minnesota Statutes 2018, section 256B.0911, subdivision 3, is amended to read:


Subd. 3.

Long-term care consultation team.

(a) A long-term care consultation team
shall be established by the county board of commissioners. Two or more counties may
collaborate to establish a joint local consultation team or teams.

(b) Each lead agency shall establish and maintain a team of certified assessors qualified
under subdivision 2b, paragraph (b). Each team member is responsible for providing
consultation with other team members upon request. The team is responsible for providing
long-term care consultation services to all new text begineligible new text endpersons located in the county who request
the servicesdeleted text begin, regardless of eligibility for Minnesota health care programsdeleted text end. The team of
certified assessors must include, at a minimum:

(1) a social worker; and

(2) a public health nurse or registered nurse.

(c) The commissioner shall allow arrangements and make recommendations that
encourage counties and tribes to collaborate to establish joint local long-term care
consultation teams to ensure that long-term care consultations are done within the timelines
and parameters of the service. This includes integrated service models as required in
subdivision 1, paragraph (b).

(d) Tribes and health plans under contract with the commissioner must provide long-term
care consultation services as specified in the contract.

(e) The lead agency must provide the commissioner with an administrative contact for
communication purposes.

Sec. 20.

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


Subd. 3a.

Assessment and support planning.

(a) new text beginEligible new text endpersons 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 new text begintool new text endprovided 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 community support plan that meets
the individual's needs and preferences.

(d) The assessment must be conducted new text beginby a certified assessor new text endin 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 all available
options for case management services and providers, including service provided in a
non-disability-specific 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) deleted text beginA person may request assistance in identifying community supports without
participating in a complete assessment.
deleted text end Upon a request for assistance identifying community
support, deleted text beginthedeleted text endnew text begin anew text end person new text beginwho is not eligible for long-term care consultation services new text endmust 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 between institutional placement
and community placement after the recommendations have been provided, except as provided
in section 256.975, subdivision 7a, paragraph (d).

(j) The lead agency must give the person receiving assessment deleted text beginor support planning,deleted text end 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); and

(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
deleted text begin or the lead agency's final decisions regarding public programs eligibilitydeleted text end 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.

(k) Face-to-face assessment completed as part of new text beginservice new text endeligibility 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 services currently residing in a community residential setting, 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, to determine if that person would prefer to be served in
a community-living setting as defined in section 256B.49, subdivision 23. The certified
assessor shall offer the person, through a person-centered planning process, the option to
receive alternative housing and service options.

Sec. 21.

Minnesota Statutes 2018, section 256B.0911, subdivision 3b, is amended to read:


Subd. 3b.

Transition assistance.

(a) new text beginNotwithstanding subdivision 1b, new text endlead agency
certified assessors shall provide assistance to new text beginall new text endpersons residing in a nursing facility,
hospital, regional treatment center, or intermediate care facility for persons with
developmental disabilities who request or are referred for assistance. Transition assistance
must include assessment, community support plan development, referrals to long-term care
options counseling under section 256.975, subdivision 7, for community support plan
implementation and to Minnesota health care programs, including home and
community-based waiver services and consumer-directed options through the waivers, and
referrals to programs that provide assistance with housing. Transition assistance must also
include information about the Centers for Independent Living, Disability Linkage Line, and
about other organizations that can provide assistance with relocation efforts, and information
about contacting these organizations to obtain their assistance and support.

(b) The lead agency shall ensure that:

(1) referrals for in-person assessments are taken from long-term care options counselors
as provided for in section 256.975, subdivision 7, paragraph (b), clause (11);

(2) persons assessed in institutions receive information about transition assistance that
is available;

(3) the assessment is completed for persons within 20 calendar days of the date of request
or recommendation for assessment;

(4) there is a plan for transition and follow-up for the individual's return to the community,
including notification of other local agencies when a person may require assistance from
agencies located in another county; and

(5) deleted text beginrelocation targeteddeleted text endnew text begin relocation-targetednew text end case management as defined in section
256B.0621, subdivision 2, clause (4), is authorized for an eligible medical assistance
recipient.

Sec. 22.

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


Subd. 3f.

Long-term care reassessments and community support plan updates.

(a)
Prior to a face-to-face reassessment, the certified assessor must review the person's most
recent assessment. Reassessments must be tailored using the professional judgment of the
assessor to the person's known needs, strengths, preferences, and circumstances.
Reassessments provide information to support the person's informed choice and opportunities
to express choice regarding activities that contribute to quality of life, as well as information
and opportunity to identify goals related to desired employment, community activities, and
preferred living environment. Reassessments require a review of the most recent assessment,
review of the current coordinated service and support plan's effectiveness, monitoring of
services, and the development of an updated person-centered community support plan.
Reassessments new text beginmust new text endverify continued new text beginservice new text endeligibility deleted text beginordeleted text endnew text begin,new text end offer alternatives as warrantednew text begin,new text end
and provide an opportunity for quality assurance of service delivery. Face-to-face
reassessments must be conducted annually or as required by federal and state laws and rules.
For reassessments, the certified assessor and the individual responsible for developing the
coordinated service and support plan must ensure the continuity of care for the person
receiving services and complete the updated community support plan and the updated
coordinated service and support plan no more than 60 days from the reassessment visit.

(b) The commissioner shall develop mechanisms for providers and case managers to
share information with the assessor to facilitate a reassessment and support planning process
tailored to the person's current needs and preferences.

new text begin (c) An individual or an individual's legal representative may indicate, in writing, at the
conclusion of an annual reassessment that a complete annual long-term care consultation
reassessment is not desired for up to two years. Before granting an individual's request to
decline one or two complete annual reassessments, the certified assessor must provide the
individual sufficient information to make a fully informed choice to decline complete annual
reassessments. An eligible individual may request a reassessment at any time. In lieu of an
annual complete long-term care consultation assessment for individuals who decline the
assessment, certified assessors shall annually perform only those activities required by
federal law to maintain the individual's service eligibility.
new text end

Sec. 23.

Minnesota Statutes 2018, section 256B.0911, subdivision 4d, is amended to read:


Subd. 4d.

deleted text beginPreadmission screening ofdeleted text endnew text begin Consultation services fornew text end individuals under 65
years of agenew text begin admitted to a nursing facilitynew text end.

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

deleted text begin (b) Individuals under 65 years of age who are admitted to a Medicaid-certified nursing
facility must be screened prior to admission according to the requirements outlined in section
256.975, subdivisions 7a to 7c. This shall be provided by the Senior LinkAge Line as
required under section 256.975, subdivision 7.
deleted text end

deleted text begin (c)deleted text end new text begin(b) Notwithstanding subdivision 1b, all new text endindividuals under 65 years of age who are
admitted to nursing facilities with only a telephone screeningnew text begin under section 256.975,
subdivisions 7a to 7c,
new text end must receive a face-to-face assessment from the long-term care
consultation team member of the county in which the facility is located or from the recipient's
county case manager within the timeline established by the commissioner, based on review
of data.

deleted text begin (d)deleted text endnew text begin (c)new text end At the face-to-face assessment, the long-term care consultation team member or
county case manager must perform the activities required under subdivision 3b.

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

deleted text begin (f)deleted text endnew text begin (d)new text end In the event that an individual under 65 years of age is admitted to a nursing
facility on an emergency basis, deleted text beginthe Senior LinkAge Line must be notified of the admission
on the next working day, and
deleted text end a face-to-face assessment as described in paragraph deleted text begin(c)deleted text endnew text begin (b)new text end
must be conducted within the timeline established by the commissioner, based on review
of data.

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

deleted text begin (h) Andeleted text end new text begin(f) Notwithstanding subdivision 1b, an new text endindividual under 65 years of age residing
in a nursing facility deleted text beginshalldeleted text endnew text begin mustnew text end receive a face-to-face assessment at least every 12 months
to review the person's service choices and available alternatives unless the individual
indicates, in writing, that annual visits are not desired. In this case, the individual must
receive a face-to-face assessment at least once every 36 months for the same purposes.

deleted text begin (i)deleted text endnew text begin (g)new text end Notwithstanding the provisions of subdivision 6, the commissioner may pay
county agencies directly for face-to-face assessments new text beginunder this subdivision new text endfor individuals
under 65 years of age who are being considered for placement or residing in a nursing
facility.

deleted text begin (j) Funding for preadmission screening follow-up shall be provided to the Disability
Linkage Line for the under-60 population by the Department of Human Services to cover
options counseling salaries and expenses to provide the services described in subdivisions
7a to 7c. The Disability Linkage Line shall employ, or contract with other agencies to
employ, within the limits of available funding, sufficient personnel to provide preadmission
screening follow-up services and shall seek to maximize federal funding for the service as
provided under section 256.01, subdivision 2, paragraph (aa).
deleted text end

Sec. 24.

Minnesota Statutes 2019 Supplement, section 256B.0911, subdivision 5, is
amended to read:


Subd. 5.

Administrative activity.

(a) The commissioner shall streamline the processes,
including timelines for when assessments need to be completed, required to provide the
services in this section and shall implement integrated solutions to automate the business
processes to the extent necessary for community support plan approval, reimbursement,
program planning, evaluation, and policy development.

(b) The commissioner of human services shall work with lead agencies responsible for
conducting long-term new text begincare new text endconsultation services to modify the MnCHOICES application
and assessment policies to create efficiencies while ensuring federal compliance with medical
assistance and long-term services and supports eligibility criteria.

(c) The commissioner shall work with lead agencies responsible for conducting long-term
new text begin care new text endconsultation services to develop a set of measurable benchmarks sufficient to
demonstrate quarterly improvement in the average time per assessment and other mutually
agreed upon measures of increasing efficiency. The commissioner shall collect data on these
benchmarks and provide to the lead agencies and the chairs and ranking minority members
of the legislative committees with jurisdiction over human services an annual trend analysis
of the data in order to demonstrate the commissioner's compliance with the requirements
of this subdivision.

Sec. 25.

Minnesota Statutes 2018, section 256B.0911, subdivision 6, is amended to read:


Subd. 6.

Payment for long-term care consultation services.

deleted text begin (a) Until September 30,
2013, payment for long-term care consultation face-to-face assessment shall be made as
described in this subdivision.
deleted text end

deleted text begin (b) The total payment for each county must be paid monthly by Certified nursing facilities
in the county. The monthly amount to be paid by each nursing facility for each fiscal year
must be determined by dividing the county's annual allocation for long-term care consultation
services by 12 to determine the monthly payment and allocating the monthly payment to
each nursing facility based on the number of licensed beds in the nursing facility. Payments
to counties in which there is no certified nursing facility must be made by increasing the
payment rate of the two facilities located nearest to the county seat.
deleted text end

deleted text begin (c) The commissioner shall include the total annual payment determined under paragraph
(b) for each nursing facility reimbursed under section 256B.431 or 256B.434 or chapter
256R.
deleted text end

deleted text begin (d) In the event of the layaway, delicensure and decertification, or removal from layaway
of 25 percent or more of the beds in a facility, the commissioner may adjust the per diem
payment amount in paragraph (c) and may adjust the monthly payment amount in paragraph
(b). The effective date of an adjustment made under this paragraph shall be on or after the
first day of the month following the effective date of the layaway, delicensure and
decertification, or removal from layaway.
deleted text end

deleted text begin (e)deleted text endnew text begin (a)new text end Payments for long-term care consultation services are available to deleted text beginthe county ordeleted text end
counties new text beginand tribal nations that are lead agencies new text endto cover staff salaries and expenses to
provide the services described in subdivision 1a. The county new text beginor tribal nation new text endshall employ,
or contract with other agencies to employ, within the limits of available funding, sufficient
personnel to provide long-term care consultation services while meeting the state's long-term
care outcomes and objectives as defined in subdivision 1. The county new text beginor tribal nation new text endshall
be accountable for meeting local objectives as approved by the commissioner in the biennial
home and community-based services quality assurance plan on a form provided by the
commissioner.

deleted text begin (f) Notwithstanding section 256B.0641, overpayments attributable to payment of the
screening costs under the medical assistance program may not be recovered from a facility.
deleted text end

deleted text begin (g) The commissioner of human services shall amend the Minnesota medical assistance
plan to include reimbursement for the local consultation teams.
deleted text end

deleted text begin (h) Until the alternative payment methodology in paragraph (i) is implemented, the
county may bill, as case management services, assessments, support planning, and
follow-along provided to persons determined to be eligible for case management under
Minnesota health care programs.
deleted text end

new text begin (b) new text endNo individual or family member shall be charged for an initial assessment or initial
support plan development provided under subdivision 3a or 3b.

deleted text begin (i) The commissioner shall develop an alternative payment methodology, effective on
October 1, 2013, for long-term care consultation services that includes the funding available
under this subdivision, and for assessments authorized under sections 256B.092 and
256B.0659. In developing the new payment methodology, the commissioner shall consider
the maximization of other funding sources, including federal administrative reimbursement
through federal financial participation funding, for all long-term care
deleted text end deleted text begin consultation activity.
The alternative payment methodology shall include the use of the appropriate time studies
and the state financing of nonfederal share as part of the state's medical assistance program.
Between July 1, 2017, and June 30, 2019, the state shall pay 84.3 percent of the nonfederal
share as reimbursement to the counties. Beginning July 1, 2019, the state shall pay 81.9
percent of the nonfederal share as reimbursement to the counties.
deleted text end

new text begin (c) Beginning July 1, 2020, each year the commissioner shall reimburse each county
and tribal nation for long-term care consultation services in an amount equal to the county's
prorated share of the total 2020 appropriation for long-term care consultation services minus
... percent. Each county or tribal nation reimbursed under this section must submit to the
commissioner by September 1 an annual report documenting how the county or tribal nation
spent its reimbursement during the prior state fiscal year.
new text end

Sec. 26. new text beginREPEALER.
new text end

new text begin Minnesota Statutes 2018, section 256B.0911, subdivisions 3c, 3d, and 3e, new text end new text begin are repealed.
new text end

APPENDIX

Repealed Minnesota Statutes: 20-7945

256B.0911 LONG-TERM CARE CONSULTATION SERVICES.

Subd. 3c.

Consultation for housing with services.

(a) The purpose of long-term care consultation for registered housing with services is to support persons with current or anticipated long-term care needs in making informed choices among options that include the most cost-effective and least restrictive settings. Prospective residents maintain the right to choose housing with services or assisted living if that option is their preference.

(b) Registered housing with services establishments shall inform each prospective resident or the prospective resident's designated or legal representative of the availability of long-term care consultation and the need to receive and verify the consultation prior to signing a lease or contract. Long-term care consultation for registered housing with services is provided as determined by the commissioner of human services. The service is delivered under a partnership between lead agencies as defined in subdivision 1a, paragraph (d), and the Area Agencies on Aging, and is a point of entry to a combination of telephone-based long-term care options counseling provided by Senior LinkAge Line and in-person long-term care consultation provided by lead agencies. The point of entry service must be provided within five working days of the request of the prospective resident as follows:

(1) the consultation shall be conducted with the prospective resident, or in the alternative, the resident's designated or legal representative, if:

(i) the resident verbally requests; or

(ii) the registered housing with services provider has documentation of the designated or legal representative's authority to enter into a lease or contract on behalf of the prospective resident and accepts the documentation in good faith;

(2) the consultation shall be performed in a manner that provides objective and complete information;

(3) the consultation must include a review of the prospective resident's reasons for considering housing with services, the prospective resident's personal goals, a discussion of the prospective resident's immediate and projected long-term care needs, and alternative community services or housing with services settings that may meet the prospective resident's needs;

(4) the prospective resident shall be informed of the availability of a face-to-face visit at no charge to the prospective resident to assist the prospective resident in assessment and planning to meet the prospective resident's long-term care needs; and

(5) verification of counseling shall be generated and provided to the prospective resident by Senior LinkAge Line upon completion of the telephone-based counseling.

(c) Housing with services establishments registered under chapter 144D shall:

(1) inform each prospective resident or the prospective resident's designated or legal representative of the availability of and contact information for consultation services under this subdivision;

(2) receive a copy of the verification of counseling prior to executing a lease or service contract with the prospective resident, and prior to executing a service contract with individuals who have previously entered into lease-only arrangements; and

(3) retain a copy of the verification of counseling as part of the resident's file.

(d) Emergency admissions to registered housing with services establishments prior to consultation under paragraph (b) are permitted according to policies established by the commissioner.

Subd. 3d.

Exemptions.

Individuals shall be exempt from the requirements outlined in subdivision 3c in the following circumstances:

(1) the individual is seeking a lease-only arrangement in a subsidized housing setting;

(2) the individual has previously received a long-term care consultation assessment under this section. In this instance, the assessor who completes the long-term care consultation will issue a verification code and provide it to the individual;

(3) the individual is receiving or is being evaluated for hospice services from a hospice provider licensed under sections 144A.75 to 144A.755; or

(4) the individual has used financial planning services and created a long-term care plan as defined by the commissioner in the 12 months prior to signing a lease or contract with a registered housing with services establishment.

Subd. 3e.

Consultation at hospital discharge.

(a) Hospitals shall refer all individuals described in paragraph (b) prior to discharge from an inpatient hospital stay to the Senior LinkAge Line for long-term care options counseling. Hospitals shall make these referrals using referral protocols and processes developed under section 256.975, subdivision 7. The purpose of the counseling is to support persons with current or anticipated long-term care needs in making informed choices among options that include the most cost-effective and least restrictive setting.

(b) The individuals who shall be referred under paragraph (a) include older adults who are at risk of nursing home placement. Protocols for identifying at-risk individuals shall be developed under section 256.975, subdivision 7, paragraph (b), clause (12).

(c) Counseling provided under this subdivision shall meet the requirements for the consultation required under subdivision 3c.