SF 2024

1st Engrossment - 85th Legislature (2007 - 2008) Posted on 12/15/2009 12:00am

A bill for an act
relating to human services; requiring notice for a redetermination of eligibility
for services to disabled children; amending Minnesota Statutes 2006, section
256B.055, subdivision 12.

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

Section 1.

Minnesota Statutes 2006, section 256B.055, subdivision 12, is amended to
read:

Subd. 12.

Disabled children.

(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. new text begin 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. new text end 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 and the home care independent rating document under section 256B.0655,
subdivision 4, clause (3), adjusted to address age-appropriate standards for children age 18
and under, pursuant to section 256B.0655, subdivision 3.

(d) For purposes of this subdivision, "intermediate care facility for persons with
developmental disabilities" or "ICF/MR" 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/MR 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/MR 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/MR, 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/MR;

(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 by the preadmission screening team under section 256B.0911.

(h) Children eligible for medical assistance services under section 256B.055,
subdivision 12, as of June 30, 1995, must be screened according to the criteria in this
subdivision prior to January 1, 1996. Children found to be ineligible may not be removed
from the program until January 1, 1996.