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SF 800

4th Engrossment - 90th Legislature (2017 - 2018) Posted on 05/16/2017 09:11am

KEY: stricken = removed, old language. underscored = added, new language.

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Current Version - 4th Engrossment

A bill for an act
relating to state government; establishing the health and human services budget;
modifying provisions governing community supports, housing, continuing care,
health care, health insurance, direct care and treatment, children and families,
chemical and mental health services, Department of Human Services operations,
Health Department, health licensing boards, and opiate abuse prevention; making
technical changes; modifying terminology and definitions; establishing licensing
fix-it tickets; establishing federally facilitated marketplace; requiring legislative
approval for certain federal waivers and approval; repealing MNsure; requiring
reports; modifying fees; making forecast adjustments; appropriating money;
amending Minnesota Statutes 2016, sections 3.972, by adding subdivisions; 13.32,
by adding a subdivision; 13.46, subdivisions 1, 2; 13.69, subdivision 1; 13.84,
subdivision 5; 62A.04, subdivision 1; 62A.21, subdivision 2a; 62A.3075; 62D.105;
62E.04, subdivision 11; 62E.05, subdivision 1; 62E.06, by adding a subdivision;
62K.15; 103I.101, subdivisions 2, 5; 103I.111, subdivisions 6, 7, 8; 103I.205;
103I.301; 103I.501; 103I.505; 103I.515; 103I.535, subdivisions 3, 6, by adding a
subdivision; 103I.541; 103I.545, subdivisions 1, 2; 103I.711, subdivision 1;
103I.715, subdivision 2; 119B.13, subdivision 1; 144.0722, subdivision 1; 144.0724,
subdivisions 1, 2, 4, 6, 9; 144.122; 144.1501, subdivision 2; 144.1506; 144.551,
subdivision 1; 144.562, subdivision 2; 144.99, subdivision 1; 144A.071,
subdivisions 3, 4a, 4c, 4d; 144A.073, subdivision 3c; 144A.10, subdivision 4;
144A.15, subdivision 2; 144A.154; 144A.161, subdivision 10; 144A.1888;
144A.351, subdivision 1; 144A.472, subdivision 7; 144A.474, subdivision 11;
144A.4799, subdivision 3; 144A.611, subdivision 1; 144A.70, subdivision 6, by
adding a subdivision; 144A.74; 144D.04, subdivision 2, by adding a subdivision;
144D.06; 145.4131, subdivision 1; 145.4716, subdivision 2; 145.928, subdivision
13; 145.986, subdivision 1a; 147.01, subdivision 7; 147.02, subdivision 1; 147.03,
subdivision 1; 147B.08, by adding a subdivision; 147C.40, by adding a subdivision;
148.5194, subdivision 7; 148.6402, subdivision 4; 148.6405; 148.6408, subdivision
2; 148.6410, subdivision 2; 148.6412, subdivision 2; 148.6415; 148.6418,
subdivisions 1, 2, 4, 5; 148.6420, subdivisions 1, 3, 5; 148.6423; 148.6425,
subdivisions 2, 3; 148.6428; 148.6443, subdivisions 5, 6, 7, 8; 148.6445,
subdivisions 1, 10; 148.6448; 148.881; 148.89; 148.90, subdivisions 1, 2; 148.905,
subdivision 1; 148.907, subdivisions 1, 2; 148.9105, subdivisions 1, 4, 5; 148.916,
subdivisions 1, 1a; 148.925; 148.96, subdivision 3; 148B.53, subdivision 1;
150A.06, subdivisions 3, 8; 150A.10, subdivision 4; 151.212, subdivision 2; 152.11,
by adding a subdivision; 152.25, subdivision 1, by adding subdivisions; 152.33,
by adding a subdivision; 157.16, subdivision 1; 214.01, subdivision 2; 245.4889,
subdivision 1; 245.814, subdivisions 2, 3; 245.91, subdivisions 4, 6; 245.94,
subdivision 1; 245.97, subdivision 6; 245A.02, subdivisions 2b, 5a, by adding
subdivisions; 245A.03, subdivisions 2, 7; 245A.04, subdivisions 4, 14; 245A.06,
subdivisions 2, 8, by adding a subdivision; 245A.07, subdivision 3; 245A.11, by
adding subdivisions; 245A.191; 245A.50, subdivision 5; 245D.03, subdivision 1;
245D.04, subdivision 3; 245D.071, subdivision 3; 245D.11, subdivision 4; 245D.24,
subdivision 3; 246.18, subdivision 4, by adding a subdivision; 252.27, subdivision
2a; 252.41, subdivision 3; 253B.10, subdivision 1; 253B.22, subdivision 1;
254A.01; 254A.02, subdivisions 2, 3, 5, 6, 8, 10, by adding subdivisions; 254A.03;
254A.035, subdivision 1; 254A.04; 254A.08; 254A.09; 254A.19, subdivision 3;
254B.01, subdivision 3, by adding a subdivision; 254B.03, subdivision 2; 254B.04,
subdivisions 1, 2b; 254B.05, subdivisions 1, 1a, 5; 254B.051; 254B.07; 254B.08;
254B.09; 254B.12, subdivision 2, by adding a subdivision; 254B.13, subdivision
2a; 256.045, subdivision 3; 256.9657, subdivision 1; 256.9686, subdivision 8;
256.969, subdivisions 1, 2b, 3a, 8, 8c, 9, 12; 256.975, subdivision 7, by adding a
subdivision; 256B.04, subdivision 12; 256B.056, subdivision 5c; 256B.0621,
subdivision 10; 256B.0625, subdivisions 3b, 6a, 7, 13, 13e, 17, 17b, 18h, 20, 30,
31, 45a, 64, by adding subdivisions; 256B.0653, subdivisions 2, 3, 4, 5, 6, by
adding a subdivision; 256B.0659, subdivisions 1, 2, 11, 21, by adding a subdivision;
256B.072; 256B.0755, subdivisions 1, 3, 4, by adding a subdivision; 256B.0911,
subdivisions 1a, 2b, 3a, 4d, 5, by adding a subdivision; 256B.0915, subdivisions
1, 3a, 3e, 3h, 5, by adding subdivisions; 256B.092, subdivision 4; 256B.0921;
256B.0922, subdivision 1; 256B.0924, by adding a subdivision; 256B.0943,
subdivision 13; 256B.0945, subdivisions 2, 4; 256B.196, subdivisions 2, 3, 4;
256B.35, subdivision 4; 256B.431, subdivisions 10, 16, 30; 256B.434, subdivisions
4, 4f; 256B.49, subdivisions 11, 15; 256B.4913, subdivision 4a, by adding a
subdivision; 256B.4914, subdivisions 2, 3, 5, 6, 7, 8, 9, 10, 16; 256B.493,
subdivisions 1, 2, by adding a subdivision; 256B.50, subdivisions 1, 1b; 256B.5012,
by adding subdivisions; 256B.69, subdivisions 5a, 9e, by adding a subdivision;
256B.75; 256B.763; 256B.766; 256C.23, subdivision 2, by adding subdivisions;
256C.233, subdivisions 1, 2; 256C.24, subdivisions 1, 2; 256C.261; 256D.44,
subdivisions 4, 5; 256E.30, subdivision 2; 256I.03, subdivision 8; 256I.04,
subdivisions 1, 2d, 2g, 3; 256I.05, subdivisions 1a, 1c, 1e, 1j, 1m, by adding
subdivisions; 256I.06, subdivisions 2, 8; 256J.24, subdivision 5; 256J.45,
subdivision 2; 256P.06, subdivision 2; 256R.02, subdivisions 4, 17, 18, 19, 22,
42, 52, by adding subdivisions; 256R.06, subdivision 5; 256R.07, by adding a
subdivision; 256R.10, by adding a subdivision; 256R.37; 256R.40, subdivisions
1, 5; 256R.41; 256R.47; 256R.49, subdivision 1; 256R.53, subdivision 2; 260C.451,
subdivision 6; 317A.811, subdivision 1, by adding a subdivision; 327.15,
subdivision 3; 609.5315, subdivision 5c; 626.556, subdivisions 2, 3, 3c, 10d; Laws
2009, chapter 101, article 1, section 12; Laws 2012, chapter 247, article 6, section
2, subdivision 2; Laws 2013, chapter 108, article 15, section 2, subdivision 2; Laws
2015, chapter 71, article 14, section 3, subdivision 2, as amended; Laws 2017,
chapter 2, article 1, sections 5; 7; proposing coding for new law in Minnesota
Statutes, chapters 62J; 119B; 144; 145; 147A; 148; 245; 245A; 256; 256B; 256I;
256N; 256R; 317A; proposing coding for new law as Minnesota Statutes, chapters
144H; 245G; repealing Minnesota Statutes 2016, sections 13.468; 62V.01; 62V.02;
62V.03; 62V.04; 62V.05; 62V.051; 62V.055; 62V.06; 62V.07; 62V.08; 62V.09;
62V.10; 62V.11; 144.4961; 144A.351, subdivision 2; 147.0375, subdivision 7;
147A.21; 147B.08, subdivisions 1, 2, 3; 147C.40, subdivisions 1, 2, 3, 4; 148.6402,
subdivision 2; 148.6450; 148.906; 148.907, subdivision 5; 148.908; 148.909,
subdivision 7; 148.96, subdivisions 4, 5; 179A.50; 179A.51; 179A.52; 179A.53;
245A.1915; 245A.192; 254A.02, subdivision 4; 256B.4914, subdivision 16;
256B.64; 256B.7631; 256C.23, subdivision 3; 256C.233, subdivision 4; 256C.25,
subdivisions 1, 2; 256J.626, subdivision 5; Laws 2012, chapter 247, article 4,
section 47, as amended; Laws 2014, chapter 312, article 23, section 9, subdivision
5; Laws 2015, chapter 71, article 7, section 54; Minnesota Rules, parts 5600.2500;
9530.6405, subparts 1, 1a, 2, 3, 4, 5, 6, 7, 7a, 8, 9, 10, 11, 12, 13, 14, 14a, 15, 15a,
16, 17, 17a, 17b, 17c, 18, 20, 21; 9530.6410; 9530.6415; 9530.6420; 9530.6422;
9530.6425; 9530.6430; 9530.6435; 9530.6440; 9530.6445; 9530.6450; 9530.6455;
9530.6460; 9530.6465; 9530.6470; 9530.6475; 9530.6480; 9530.6485; 9530.6490;
9530.6495; 9530.6500; 9530.6505.

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

ARTICLE 1

COMMUNITY SUPPORTS

Section 1.

Minnesota Statutes 2016, section 144A.351, subdivision 1, is amended to read:


Subdivision 1.

Report requirements.

The commissioners of health and human services,
with the cooperation of counties and in consultation with stakeholders, including persons
who need or are using long-term care services and supports, lead agencies, regional entities,
senior, disability, and mental health organization representatives, service providers, and
community members shall prepare a report to the legislature by August 15, 2013, and
biennially thereafter, regarding the status of the full range of long-term care services and
supports for the elderly and children and adults with disabilities and mental illnesses in
Minnesota. Any amounts appropriated for this report are available in either year of the
biennium.
The report shall address:

(1) demographics and need for long-term care services and supports in Minnesota;

(2) summary of county and regional reports on long-term care gaps, surpluses, imbalances,
and corrective action plans;

(3) status of long-term care services and related mental health services, housing options,
and supports by county and region including:

(i) changes in availability of the range of long-term care services and housing options;

(ii) access problems, including access to the least restrictive and most integrated services
and settings, regarding long-term care services; and

(iii) comparative measures of long-term care services availability, including serving
people in their home areas near family, and changes over time; and

(4) recommendations regarding goals for the future of long-term care services and
supports, policy and fiscal changes, and resource development and transition needs.

Sec. 2.

Minnesota Statutes 2016, section 245D.03, subdivision 1, is amended to read:


Subdivision 1.

Applicability.

(a) The commissioner shall regulate the provision of home
and community-based services to persons with disabilities and persons age 65 and older
pursuant to this chapter. The licensing standards in this chapter govern the provision of
basic support services and intensive support services.

(b) Basic support services provide the level of assistance, supervision, and care that is
necessary to ensure the health and welfare of the person and do not include services that
are specifically directed toward the training, treatment, habilitation, or rehabilitation of the
person. Basic support services include:

(1) in-home and out-of-home respite care services as defined in section 245A.02,
subdivision 15, and under the brain injury, community alternative care, community access
for disability inclusion, developmental disability, and elderly waiver plans, excluding
out-of-home respite care provided to children in a family child foster care home licensed
under Minnesota Rules, parts 2960.3000 to 2960.3100, when the child foster care license
holder complies with the requirements under section 245D.06, subdivisions 5, 6, 7, and 8,
or successor provisions; and section 245D.061 or successor provisions, which must be
stipulated in the statement of intended use required under Minnesota Rules, part 2960.3000,
subpart 4;

(2) adult companion services as defined under the brain injury, community access for
disability inclusion, and elderly waiver plans, excluding adult companion services provided
under the Corporation for National and Community Services Senior Companion Program
established under the Domestic Volunteer Service Act of 1973, Public Law 98-288;

(3) personal support as defined under the developmental disability waiver plan;

(4) 24-hour emergency assistance, personal emergency response as defined under the
community access for disability inclusion and developmental disability waiver plans;

(5) night supervision services as defined under the brain injury waiver plan; and

(6) homemaker services as defined under the community access for disability inclusion,
brain injury, community alternative care, developmental disability, and elderly waiver plans,
excluding providers licensed by the Department of Health under chapter 144A and those
providers providing cleaning services only; and

(7) individual community living support under section 256B.0915, subdivision 3j.

(c) Intensive support services provide assistance, supervision, and care that is necessary
to ensure the health and welfare of the person and services specifically directed toward the
training, habilitation, or rehabilitation of the person. Intensive support services include:

(1) intervention services, including:

(i) behavioral support services as defined under the brain injury and community access
for disability inclusion waiver plans;

(ii) in-home or out-of-home crisis respite services as defined under the developmental
disability waiver plan; and

(iii) specialist services as defined under the current developmental disability waiver
plan;

(2) in-home support services, including:

(i) in-home family support and supported living services as defined under the
developmental disability waiver plan;

(ii) independent living services training as defined under the brain injury and community
access for disability inclusion waiver plans; and

(iii) semi-independent living services; and

(iv) individualized home supports services as defined under the brain injury, community
alternative care, and community access for disability inclusion waiver plans;

(3) residential supports and services, including:

(i) supported living services as defined under the developmental disability waiver plan
provided in a family or corporate child foster care residence, a family adult foster care
residence, a community residential setting, or a supervised living facility;

(ii) foster care services as defined in the brain injury, community alternative care, and
community access for disability inclusion waiver plans provided in a family or corporate
child foster care residence, a family adult foster care residence, or a community residential
setting; and

(iii) residential services provided to more than four persons with developmental
disabilities in a supervised living facility, including ICFs/DD;

(4) day services, including:

(i) structured day services as defined under the brain injury waiver plan;

(ii) day training and habilitation services under sections 252.41 to 252.46, and as defined
under the developmental disability waiver plan; and

(iii) prevocational services as defined under the brain injury and community access for
disability inclusion waiver plans; and

(5) supported employment as defined under the brain injury, developmental disability,
and community access for disability inclusion waiver plans
employment exploration services
as defined under the brain injury, community alternative care, community access for disability
inclusion, and developmental disability waiver plans;

(6) employment development services as defined under the brain injury, community
alternative care, community access for disability inclusion, and developmental disability
waiver plans; and

(7) employment support services as defined under the brain injury, community alternative
care, community access for disability inclusion, and developmental disability waiver plans
.

EFFECTIVE DATE.

(a) The amendment to paragraphs (b) and (c), clause (2), is
effective the day following final enactment.

(b) The amendments to paragraph (c), clauses (5) to (7), are effective upon federal
approval. The commissioner of human services shall notify the revisor of statutes when
federal approval is obtained.

Sec. 3.

Minnesota Statutes 2016, section 252.41, subdivision 3, is amended to read:


Subd. 3.

Day training and habilitation services for adults with developmental
disabilities.

(a) "Day training and habilitation services for adults with developmental
disabilities" means services that:

(1) include supervision, training, assistance, and supported employment, center-based
work-related activities, or other community-integrated activities designed and implemented
in accordance with the individual service and individual habilitation plans required under
Minnesota Rules, parts 9525.0004 to 9525.0036, to help an adult reach and maintain the
highest possible level of independence, productivity, and integration into the community;
and

(2) are provided by a vendor licensed under sections 245A.01 to 245A.16 and 252.28,
subdivision 2
, to provide day training and habilitation services.

(b) Day training and habilitation services reimbursable under this section do not include
special education and related services as defined in the Education of the Individuals with
Disabilities Act, United States Code, title 20, chapter 33, section 1401, clauses (6) and (17),
or vocational services funded under section 110 of the Rehabilitation Act of 1973, United
States Code, title 29, section 720, as amended.

(c) Day training and habilitation services do not include employment exploration,
employment development, or employment support services as defined in the home and
community-based services waivers for people with disabilities authorized under sections
256B.092 and 256B.49.

EFFECTIVE DATE.

This section is effective upon federal approval. The commissioner
of human services shall notify the revisor of statutes when federal approval is obtained.

Sec. 4.

[256.477] SELF-ADVOCACY GRANTS.

(a) The commissioner shall make available a grant for the purposes of establishing and
maintaining a statewide self-advocacy network for persons with intellectual and
developmental disabilities. The self-advocacy network shall:

(1) ensure that persons with intellectual and developmental disabilities are informed of
their rights in employment, housing, transportation, voting, government policy, and other
issues pertinent to the intellectual and developmental disability community;

(2) provide public education and awareness of the civil and human rights issues persons
with intellectual and developmental disabilities face;

(3) provide funds, technical assistance, and other resources for self-advocacy groups
across the state; and

(4) organize systems of communications to facilitate an exchange of information between
self-advocacy groups.

(b) An organization receiving a grant under paragraph (a) must be an organization
governed by people with intellectual and developmental disabilities that administers a
statewide network of disability groups in order to maintain and promote self-advocacy
services and supports for persons with intellectual and developmental disabilities throughout
the state.

Sec. 5.

Minnesota Statutes 2016, section 256B.0625, subdivision 6a, is amended to read:


Subd. 6a.

Home health services.

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

Sec. 6.

Minnesota Statutes 2016, section 256B.0625, subdivision 31, is amended to read:


Subd. 31.

Medical supplies and equipment.

(a) Medical assistance covers medical
supplies and equipment. Separate payment outside of the facility's payment rate shall be
made for wheelchairs and wheelchair accessories for recipients who are residents of
intermediate care facilities for the developmentally disabled. Reimbursement for wheelchairs
and wheelchair accessories for ICF/DD recipients shall be subject to the same conditions
and limitations as coverage for recipients who do not reside in institutions. A wheelchair
purchased outside of the facility's payment rate is the property of the recipient.

(b) Vendors of durable medical equipment, prosthetics, orthotics, or medical supplies
must enroll as a Medicare provider.

(c) When necessary to ensure access to durable medical equipment, prosthetics, orthotics,
or medical supplies, the commissioner may exempt a vendor from the Medicare enrollment
requirement if:

(1) the vendor supplies only one type of durable medical equipment, prosthetic, orthotic,
or medical supply;

(2) the vendor serves ten or fewer medical assistance recipients per year;

(3) the commissioner finds that other vendors are not available to provide same or similar
durable medical equipment, prosthetics, orthotics, or medical supplies; and

(4) the vendor complies with all screening requirements in this chapter and Code of
Federal Regulations, title 42, part 455. The commissioner may also exempt a vendor from
the Medicare enrollment requirement if the vendor is accredited by a Centers for Medicare
and Medicaid Services approved national accreditation organization as complying with the
Medicare program's supplier and quality standards and the vendor serves primarily pediatric
patients.

(d) Durable medical equipment means a device or equipment that:

(1) can withstand repeated use;

(2) is generally not useful in the absence of an illness, injury, or disability; and

(3) is provided to correct or accommodate a physiological disorder or physical condition
or is generally used primarily for a medical purpose.

(e) Electronic tablets may be considered durable medical equipment if the electronic
tablet will be used as an augmentative and alternative communication system as defined
under subdivision 31a, paragraph (a). To be covered by medical assistance, the device must
be locked in order to prevent use not related to communication.

(f) Notwithstanding the requirement in paragraph (e) that an electronic tablet must be
locked to prevent use not as an augmentative communication device, a recipient of waiver
services may use an electronic tablet for a use not related to communication when the
recipient has been authorized under the waiver to receive one or more additional applications
that can be loaded onto the electronic tablet, such that allowing the additional use prevents
the purchase of a separate electronic tablet with waiver funds.

(g) An order or prescription for medical supplies, equipment, or appliances must meet
the requirements in Code of Federal Regulations, title 42, part 470.

Sec. 7.

Minnesota Statutes 2016, section 256B.0653, subdivision 2, is amended to read:


Subd. 2.

Definitions.

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

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

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

(c) "Home health agency services" means services delivered in the recipient's home
residence, except as specified in section 256B.0625,
by a home health agency to a recipient
with medical needs due to illness, disability, or physical conditions in settings permitted
under section 256B.0625, subdivision 6a
.

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

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

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

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

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

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

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

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

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

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

Sec. 8.

Minnesota Statutes 2016, section 256B.0653, subdivision 3, is amended to read:


Subd. 3.

Home health aide visits.

(a) Home health aide visits must be provided by a
certified home health aide using a written plan of care that is updated in compliance with
Medicare regulations. A home health aide shall provide hands-on personal care, perform
simple procedures as an extension of therapy or nursing services, and assist in instrumental
activities of daily living as defined in section 256B.0659, including assuring that the person
gets to medical appointments if identified in the written plan of care. Home health aide
visits must may be provided in the recipient's home or in the community where normal life
activities take the recipient
.

(b) All home health aide visits must have authorization under section 256B.0652. The
commissioner shall limit home health aide visits to no more than one visit per day per
recipient.

(c) Home health aides must be supervised by a registered nurse or an appropriate therapist
when providing services that are an extension of therapy.

Sec. 9.

Minnesota Statutes 2016, section 256B.0653, subdivision 4, is amended to read:


Subd. 4.

Skilled nurse visit services.

(a) Skilled nurse visit services must be provided
by a registered nurse or a licensed practical nurse under the supervision of a registered nurse,
according to the written plan of care and accepted standards of medical and nursing practice
according to chapter 148. Skilled nurse visit services must be ordered by a physician and
documented in a plan of care that is reviewed and approved by the ordering physician at
least once every 60 days. All skilled nurse visits must be medically necessary and provided
in the recipient's home residence or in the community where normal life activities take the
recipient,
except as allowed under section 256B.0625, subdivision 6a.

(b) Skilled nurse visits include face-to-face and telehomecare visits with a limit of up
to two visits per day per recipient. All visits must be based on assessed needs.

(c) Telehomecare skilled nurse visits are allowed when the recipient's health status can
be accurately measured and assessed without a need for a face-to-face, hands-on encounter.
All telehomecare skilled nurse visits must have authorization and are paid at the same
allowable rates as face-to-face skilled nurse visits.

(d) The provision of telehomecare must be made via live, two-way interactive audiovisual
technology and may be augmented by utilizing store-and-forward technologies. Individually
identifiable patient data obtained through real-time or store-and-forward technology must
be maintained as health records according to sections 144.291 to 144.298. If the video is
used for research, training, or other purposes unrelated to the care of the patient, the identity
of the patient must be concealed.

(e) Authorization for skilled nurse visits must be completed under section 256B.0652.
A total of nine face-to-face skilled nurse visits per calendar year do not require authorization.
All telehomecare skilled nurse visits require authorization.

Sec. 10.

Minnesota Statutes 2016, section 256B.0653, subdivision 5, is amended to read:


Subd. 5.

Home care therapies.

(a) Home care therapies include the following: physical
therapy, occupational therapy, respiratory therapy, and speech and language pathology
therapy services.

(b) Home care therapies must be:

(1) provided in the recipient's residence or in the community where normal life activities
take the recipient
after it has been determined the recipient is unable to access outpatient
therapy;

(2) prescribed, ordered, or referred by a physician and documented in a plan of care and
reviewed, according to Minnesota Rules, part 9505.0390;

(3) assessed by an appropriate therapist; and

(4) provided by a Medicare-certified home health agency enrolled as a Medicaid provider
agency.

(c) Restorative and specialized maintenance therapies must be provided according to
Minnesota Rules, part 9505.0390. Physical and occupational therapy assistants may be used
as allowed under Minnesota Rules, part 9505.0390, subpart 1, item B.

(d) For both physical and occupational therapies, the therapist and the therapist's assistant
may not both bill for services provided to a recipient on the same day.

Sec. 11.

Minnesota Statutes 2016, section 256B.0653, subdivision 6, is amended to read:


Subd. 6.

Noncovered home health agency services.

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

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

(2) the following skilled nurse visits:

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

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

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

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

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

(vi) Medicare evaluation or administrative nursing visits required by Medicare;

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

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

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

Sec. 12.

Minnesota Statutes 2016, section 256B.0653, is amended by adding a subdivision
to read:


Subd. 7.

Face-to-face encounter.

(a) A face-to-face encounter by a qualifying provider
must be completed for all home health services regardless of the need for prior authorization,
except when providing a onetime perinatal visit by skilled nursing. The face-to-face encounter
may occur through telemedicine as defined in section 256B.0625, subdivision 3b. The
encounter must be related to the primary reason the recipient requires home health services
and must occur within the 90 days before or the 30 days after the start of services. The
face-to-face encounter may be conducted by one of the following practitioners, licensed in
Minnesota:

(1) a physician;

(2) a nurse practitioner or clinical nurse specialist;

(3) a certified nurse midwife; or

(4) a physician assistant.

(b) The allowed nonphysician practitioner, as described in this subdivision, performing
the face-to-face encounter must communicate the clinical findings of that face-to-face
encounter to the ordering physician. Those clinical findings must be incorporated into a
written or electronic document included in the recipient's medical record. To assure clinical
correlation between the face-to-face encounter and the associated home health services, the
physician responsible for ordering the services must:

(1) document that the face-to-face encounter, which is related to the primary reason the
recipient requires home health services, occurred within the required time period; and

(2) indicate the practitioner who conducted the encounter and the date of the encounter.

(c) For home health services requiring authorization, including prior authorization, home
health agencies must retain the qualifying documentation of a face-to-face encounter as part
of the recipient health service record, and submit the qualifying documentation to the
commissioner or the commissioner's designee upon request.

Sec. 13.

Minnesota Statutes 2016, section 256B.0659, subdivision 1, is amended to read:


Subdivision 1.

Definitions.

(a) For the purposes of this section, the terms defined in
paragraphs (b) to (r) (s) have the meanings given unless otherwise provided in text.

(b) "Activities of daily living" means grooming, dressing, bathing, transferring, mobility,
positioning, eating, and toileting.

(c) "Behavior," effective January 1, 2010, means a category to determine the home care
rating and is based on the criteria found in this section. "Level I behavior" means physical
aggression towards self, others, or destruction of property that requires the immediate
response of another person.

(d) "Complex health-related needs," effective January 1, 2010, means a category to
determine the home care rating and is based on the criteria found in this section.

(e) "Complex personal care assistance services" means personal care assistance services:

(1) for a person who qualifies for ten hours or more of personal care assistance services
per day; and

(2) provided by a personal care assistant who is qualified to provide complex personal
assistance services under subdivision 11, paragraph (d).

(e) (f) "Critical activities of daily living," effective January 1, 2010, means transferring,
mobility, eating, and toileting.

(f) (g) "Dependency in activities of daily living" means a person requires assistance to
begin and complete one or more of the activities of daily living.

(g) (h) "Extended personal care assistance service" means personal care assistance
services included in a service plan under one of the home and community-based services
waivers authorized under sections 256B.0915, 256B.092, subdivision 5, and 256B.49, which
exceed the amount, duration, and frequency of the state plan personal care assistance services
for participants who:

(1) need assistance provided periodically during a week, but less than daily will not be
able to remain in their homes without the assistance, and other replacement services are
more expensive or are not available when personal care assistance services are to be reduced;
or

(2) need additional personal care assistance services beyond the amount authorized by
the state plan personal care assistance assessment in order to ensure that their safety, health,
and welfare are provided for in their homes.

(h) (i) "Health-related procedures and tasks" means procedures and tasks that can be
delegated or assigned by a licensed health care professional under state law to be performed
by a personal care assistant.

(i) (j) "Instrumental activities of daily living" means activities to include meal planning
and preparation; basic assistance with paying bills; shopping for food, clothing, and other
essential items; performing household tasks integral to the personal care assistance services;
communication by telephone and other media; and traveling, including to medical
appointments and to participate in the community.

(j) (k) "Managing employee" has the same definition as Code of Federal Regulations,
title 42, section 455.

(k) (l) "Qualified professional" means a professional providing supervision of personal
care assistance services and staff as defined in section 256B.0625, subdivision 19c.

(l) (m) "Personal care assistance provider agency" means a medical assistance enrolled
provider that provides or assists with providing personal care assistance services and includes
a personal care assistance provider organization, personal care assistance choice agency,
class A licensed nursing agency, and Medicare-certified home health agency.

(m) (n) "Personal care assistant" or "PCA" means an individual employed by a personal
care assistance agency who provides personal care assistance services.

(n) (o) "Personal care assistance care plan" means a written description of personal care
assistance services developed by the personal care assistance provider according to the
service plan.

(o) (p) "Responsible party" means an individual who is capable of providing the support
necessary to assist the recipient to live in the community.

(p) (q) "Self-administered medication" means medication taken orally, by injection,
nebulizer, or insertion, or applied topically without the need for assistance.

(q) (r) "Service plan" means a written summary of the assessment and description of the
services needed by the recipient.

(r) (s) "Wages and benefits" means wages and salaries, the employer's share of FICA
taxes, Medicare taxes, state and federal unemployment taxes, workers' compensation, mileage
reimbursement, health and dental insurance, life insurance, disability insurance, long-term
care insurance, uniform allowance, and contributions to employee retirement accounts.

EFFECTIVE DATE.

This section is effective July 1, 2018.

Sec. 14.

Minnesota Statutes 2016, section 256B.0659, subdivision 2, is amended to read:


Subd. 2.

Personal care assistance services; covered services.

(a) The personal care
assistance services eligible for payment include services and supports furnished to an
individual, as needed, to assist in:

(1) activities of daily living;

(2) health-related procedures and tasks;

(3) observation and redirection of behaviors; and

(4) instrumental activities of daily living.

(b) Activities of daily living include the following covered services:

(1) dressing, including assistance with choosing, application, and changing of clothing
and application of special appliances, wraps, or clothing;

(2) grooming, including assistance with basic hair care, oral care, shaving, applying
cosmetics and deodorant, and care of eyeglasses and hearing aids. Nail care is included,
except for recipients who are diabetic or have poor circulation;

(3) bathing, including assistance with basic personal hygiene and skin care;

(4) eating, including assistance with hand washing and application of orthotics required
for eating, transfers, and feeding;

(5) transfers, including assistance with transferring the recipient from one seating or
reclining area to another;

(6) mobility, including assistance with ambulation, including use of a wheelchair.
Mobility does not include providing transportation for a recipient;

(7) positioning, including assistance with positioning or turning a recipient for necessary
care and comfort; and

(8) toileting, including assistance with helping recipient with bowel or bladder elimination
and care including transfers, mobility, positioning, feminine hygiene, use of toileting
equipment or supplies, cleansing the perineal area, inspection of the skin, and adjusting
clothing.

(c) Health-related procedures and tasks include the following covered services:

(1) range of motion and passive exercise to maintain a recipient's strength and muscle
functioning;

(2) assistance with self-administered medication as defined by this section, including
reminders to take medication, bringing medication to the recipient, and assistance with
opening medication under the direction of the recipient or responsible party, including
medications given through a nebulizer;

(3) interventions for seizure disorders, including monitoring and observation; and

(4) other activities considered within the scope of the personal care service and meeting
the definition of health-related procedures and tasks under this section.

(d) A personal care assistant may provide health-related procedures and tasks associated
with the complex health-related needs of a recipient if the procedures and tasks meet the
definition of health-related procedures and tasks under this section and the personal care
assistant is trained by a qualified professional and demonstrates competency to safely
complete the procedures and tasks. Delegation of health-related procedures and tasks and
all training must be documented in the personal care assistance care plan and the recipient's
and personal care assistant's files. A personal care assistant must not determine the medication
dose or time for medication.

(e) Effective January 1, 2010, for a personal care assistant to provide the health-related
procedures and tasks of tracheostomy suctioning and services to recipients on ventilator
support there must be:

(1) delegation and training by a registered nurse, certified or licensed respiratory therapist,
or a physician;

(2) utilization of clean rather than sterile procedure;

(3) specialized training about the health-related procedures and tasks and equipment,
including ventilator operation and maintenance;

(4) individualized training regarding the needs of the recipient; and

(5) supervision by a qualified professional who is a registered nurse.

(f) Effective January 1, 2010, a personal care assistant may observe and redirect the
recipient for episodes where there is a need for redirection due to behaviors. Training of
the personal care assistant must occur based on the needs of the recipient, the personal care
assistance care plan, and any other support services provided.

(g) Instrumental activities of daily living under subdivision 1, paragraph (i) (j).

EFFECTIVE DATE.

This section is effective July 1, 2018.

Sec. 15.

Minnesota Statutes 2016, section 256B.0659, subdivision 11, is amended to read:


Subd. 11.

Personal care assistant; requirements.

(a) A personal care assistant must
meet the following requirements:

(1) be at least 18 years of age with the exception of persons who are 16 or 17 years of
age with these additional requirements:

(i) supervision by a qualified professional every 60 days; and

(ii) employment by only one personal care assistance provider agency responsible for
compliance with current labor laws;

(2) be employed by a personal care assistance provider agency;

(3) enroll with the department as a personal care assistant after clearing a background
study. Except as provided in subdivision 11a, before a personal care assistant provides
services, the personal care assistance provider agency must initiate a background study on
the personal care assistant under chapter 245C, and the personal care assistance provider
agency must have received a notice from the commissioner that the personal care assistant
is:

(i) not disqualified under section 245C.14; or

(ii) is disqualified, but the personal care assistant has received a set aside of the
disqualification under section 245C.22;

(4) be able to effectively communicate with the recipient and personal care assistance
provider agency;

(5) be able to provide covered personal care assistance services according to the recipient's
personal care assistance care plan, respond appropriately to recipient needs, and report
changes in the recipient's condition to the supervising qualified professional or physician;

(6) not be a consumer of personal care assistance services;

(7) maintain daily written records including, but not limited to, time sheets under
subdivision 12;

(8) effective January 1, 2010, complete standardized training as determined by the
commissioner before completing enrollment. The training must be available in languages
other than English and to those who need accommodations due to disabilities. Personal care
assistant training must include successful completion of the following training components:
basic first aid, vulnerable adult, child maltreatment, OSHA universal precautions, basic
roles and responsibilities of personal care assistants including information about assistance
with lifting and transfers for recipients, emergency preparedness, orientation to positive
behavioral practices, fraud issues, and completion of time sheets. Upon completion of the
training components, the personal care assistant must demonstrate the competency to provide
assistance to recipients;

(9) complete training and orientation on the needs of the recipient; and

(10) be limited to providing and being paid for up to 275 hours per month of personal
care assistance services regardless of the number of recipients being served or the number
of personal care assistance provider agencies enrolled with. The number of hours worked
per day shall not be disallowed by the department unless in violation of the law.

(b) A legal guardian may be a personal care assistant if the guardian is not being paid
for the guardian services and meets the criteria for personal care assistants in paragraph (a).

(c) Persons who do not qualify as a personal care assistant include parents, stepparents,
and legal guardians of minors; spouses; paid legal guardians of adults; family foster care
providers, except as otherwise allowed in section 256B.0625, subdivision 19a; and staff of
a residential setting.

(d) A personal care assistant is qualified to provide complex personal care assistance
services as defined in subdivision 1, paragraph (e), if the personal care assistant:

(1) provides services according to the care plan in subdivision 7 to an individual described
in subdivision 1, paragraph (e), clause (1); and

(2) satisfies the current requirements of Medicare for training and competency or
competency evaluation of home health aides or nursing assistants, as provided by Code of
Federal Regulations, title 42, section 483.151 or 484.36, or alternative, comparable,
state-approved training and competency requirements.

EFFECTIVE DATE.

This section is effective July 1, 2018.

Sec. 16.

Minnesota Statutes 2016, section 256B.0659, is amended by adding a subdivision
to read:


Subd. 17a.

Rate for complex personal care assistance services.

The rate paid to a
provider for complex personal care assistance services shall be 110 percent of the rate paid
for personal care assistance services.

EFFECTIVE DATE.

This section is effective July 1, 2018.

Sec. 17.

Minnesota Statutes 2016, section 256B.0659, subdivision 21, is amended to read:


Subd. 21.

Requirements for provider enrollment of personal care assistance provider
agencies.

(a) All personal care assistance provider agencies must provide, at the time of
enrollment, reenrollment, and revalidation as a personal care assistance provider agency in
a format determined by the commissioner, information and documentation that includes,
but is not limited to, the following:

(1) the personal care assistance provider agency's current contact information including
address, telephone number, and e-mail address;

(2) proof of surety bond coverage. Upon new enrollment, or if the provider's Medicaid
revenue in the previous calendar year is up to and including $300,000, the provider agency
must purchase a surety bond of $50,000. If the Medicaid revenue in the previous year is
over $300,000, the provider agency must purchase a surety bond of $100,000. The surety
bond must be in a form approved by the commissioner, must be renewed annually, and must
allow for recovery of costs and fees in pursuing a claim on the bond;

(3) proof of fidelity bond coverage in the amount of $20,000;

(4) proof of workers' compensation insurance coverage;

(5) proof of liability insurance;

(6) a description of the personal care assistance provider agency's organization identifying
the names of all owners, managing employees, staff, board of directors, and the affiliations
of the directors, owners, or staff to other service providers;

(7) a copy of the personal care assistance provider agency's written policies and
procedures including: hiring of employees; training requirements; service delivery; and
employee and consumer safety including process for notification and resolution of consumer
grievances, identification and prevention of communicable diseases, and employee
misconduct;

(8) copies of all other forms the personal care assistance provider agency uses in the
course of daily business including, but not limited to:

(i) a copy of the personal care assistance provider agency's time sheet if the time sheet
varies from the standard time sheet for personal care assistance services approved by the
commissioner, and a letter requesting approval of the personal care assistance provider
agency's nonstandard time sheet;

(ii) the personal care assistance provider agency's template for the personal care assistance
care plan; and

(iii) the personal care assistance provider agency's template for the written agreement
in subdivision 20 for recipients using the personal care assistance choice option, if applicable;

(9) a list of all training and classes that the personal care assistance provider agency
requires of its staff providing personal care assistance services;

(10) documentation that the personal care assistance provider agency and staff have
successfully completed all the training required by this section, including the requirements
under subdivision 11, paragraph (d), if complex personal care assistance services are provided
and submitted for payment
;

(11) documentation of the agency's marketing practices;

(12) disclosure of ownership, leasing, or management of all residential properties that
is used or could be used for providing home care services;

(13) documentation that the agency will use the following percentages of revenue
generated from the medical assistance rate paid for personal care assistance services for
employee personal care assistant wages and benefits: 72.5 percent of revenue in the personal
care assistance choice option and 72.5 percent of revenue from other personal care assistance
providers. The revenue generated by the qualified professional and the reasonable costs
associated with the qualified professional shall not be used in making this calculation; and

(14) effective May 15, 2010, documentation that the agency does not burden recipients'
free exercise of their right to choose service providers by requiring personal care assistants
to sign an agreement not to work with any particular personal care assistance recipient or
for another personal care assistance provider agency after leaving the agency and that the
agency is not taking action on any such agreements or requirements regardless of the date
signed.

(b) Personal care assistance provider agencies shall provide the information specified
in paragraph (a) to the commissioner at the time the personal care assistance provider agency
enrolls as a vendor or upon request from the commissioner. The commissioner shall collect
the information specified in paragraph (a) from all personal care assistance providers
beginning July 1, 2009.

(c) All personal care assistance provider agencies shall require all employees in
management and supervisory positions and owners of the agency who are active in the
day-to-day management and operations of the agency to complete mandatory training as
determined by the commissioner before enrollment of the agency as a provider. Employees
in management and supervisory positions and owners who are active in the day-to-day
operations of an agency who have completed the required training as an employee with a
personal care assistance provider agency do not need to repeat the required training if they
are hired by another agency, if they have completed the training within the past three years.
By September 1, 2010, the required training must be available with meaningful access
according to title VI of the Civil Rights Act and federal regulations adopted under that law
or any guidance from the United States Health and Human Services Department. The
required training must be available online or by electronic remote connection. The required
training must provide for competency testing. Personal care assistance provider agency
billing staff shall complete training about personal care assistance program financial
management. This training is effective July 1, 2009. Any personal care assistance provider
agency enrolled before that date shall, if it has not already, complete the provider training
within 18 months of July 1, 2009. Any new owners or employees in management and
supervisory positions involved in the day-to-day operations are required to complete
mandatory training as a requisite of working for the agency. Personal care assistance provider
agencies certified for participation in Medicare as home health agencies are exempt from
the training required in this subdivision. When available, Medicare-certified home health
agency owners, supervisors, or managers must successfully complete the competency test.

Sec. 18.

Minnesota Statutes 2016, 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 sections 256B.0913, 256B.0915, and 256B.49, including level of care
determination for individuals who need an institutional level of care as determined under
subdivision 4e, based on assessment and community support plan development, appropriate
referrals to obtain necessary diagnostic information, and including an eligibility determination
for consumer-directed community supports;

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

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

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

(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 home care services identified in:

(i) section 256B.0625, subdivisions 7, 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,
determination of eligibility for case management services available under sections 256B.0621,
subdivision 2
, paragraph (4), and 256B.0924 and Minnesota Rules, part 9525.0016;

(3) determination of institutional level of care, home and community-based service
waiver, and other service eligibility as required under section 256B.092, determination of
eligibility for family support grants under section 252.32, semi-independent living services
under section 252.275, and day training and habilitation services under section 256B.092;
and

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

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

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

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

(f) "Person-centered planning" is a process that includes the active participation of a
person in the planning of the person's services, including in making meaningful and informed
choices about the person's own goals, talents, and objectives, as well as making meaningful
and informed choices about the services the person receives. 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. 19.

Minnesota Statutes 2016, 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
principals 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 are persons with a minimum of a bachelor's degree
in social work, nursing with a public health nursing certificate, or other closely related field
with at least one year of home and community-based experience, or a registered nurse with
at least two years of home and community-based experience who has received training and
certification specific to assessment and consultation for long-term care services in the state.

Sec. 20.

Minnesota Statutes 2016, section 256B.0911, is amended by adding a subdivision
to read:


Subd. 3f.

Long-term care reassessments and community support plan updates.

Face-to-face reassessments must be conducted annually or as required by federal and state
laws and rules. Reassessments build upon all previous assessments conducted and include
a review of needs and services to identify any changes. 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 allow for a review of the current support plan's effectiveness, monitoring of
services, and the development of an updated person-centered community support plan.
Reassessments verify continued eligibility or offer alternatives as warranted and provide
an opportunity for quality assurance of service delivery.

Sec. 21.

Minnesota Statutes 2016, section 256B.0911, subdivision 4d, is amended to read:


Subd. 4d.

Preadmission screening of individuals under 65 years of age.

(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.

(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.

(c) Individuals 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 the timeline established by the
commissioner, based on review of data
.

(d) 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.

(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.

(f) In the event that an individual under 65 years of age is admitted to a nursing facility
on an emergency basis, the Senior LinkAge Line must be notified of the admission on the
next working day, and a face-to-face assessment as described in paragraph (c) must be
conducted within 40 calendar days of admission the timeline established by the commissioner,
based on review of data
.

(g) At the 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.

(h) An individual under 65 years of age residing in a nursing facility shall 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.

(i) Notwithstanding the provisions of subdivision 6, the commissioner may pay county
agencies directly for face-to-face assessments for individuals under 65 years of age who
are being considered for placement or residing in a nursing facility.

(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 (dd).

Sec. 22.

Minnesota Statutes 2016, 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 consultation 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.

Sec. 23.

Minnesota Statutes 2016, section 256B.0921, is amended to read:


256B.0921 HOME AND COMMUNITY-BASED SERVICES INCENTIVE POOL.

The commissioner of human services shall develop an initiative to provide incentives
for innovation in: (1) achieving integrated competitive employment,; (2) achieving integrated
competitive employment for youth under age 25 upon their graduation from school; (3)

living in the most integrated setting,; and (4) other outcomes determined by the commissioner.
The commissioner shall seek requests for proposals and shall contract with one or more
entities to provide incentive payments for meeting identified outcomes. The initial requests
for proposals must be issued by October 1, 2016.

Sec. 24.

Minnesota Statutes 2016, section 256B.4913, subdivision 4a, is amended to read:


Subd. 4a.

Rate stabilization adjustment.

(a) For purposes of this subdivision,
"implementation period" means the period beginning January 1, 2014, and ending on the
last day of the month in which the rate management system is populated with the data
necessary to calculate rates for substantially all individuals receiving home and
community-based waiver services under sections 256B.092 and 256B.49. "Banding period"
means the time period beginning on January 1, 2014, and ending upon the expiration of the
12-month period defined in paragraph (c), clause (5).

(b) For purposes of this subdivision, the historical rate for all service recipients means
the individual reimbursement rate for a recipient in effect on December 1, 2013, except
that:

(1) for a day service recipient who was not authorized to receive these waiver services
prior to January 1, 2014; added a new service or services on or after January 1, 2014; or
changed providers on or after January 1, 2014, the historical rate must be the weighted
average
authorized rate for the provider number in the county of service, effective December
1, 2013; or

(2) for a unit-based service with programming or a unit-based service without
programming recipient who was not authorized to receive these waiver services prior to
January 1, 2014; added a new service or services on or after January 1, 2014; or changed
providers on or after January 1, 2014, the historical rate must be the weighted average
authorized rate for each provider number in the county of service, effective December 1,
2013; or

(3) for residential service recipients who change providers on or after January 1, 2014,
the historical rate must be set by each lead agency within their county aggregate budget
using their respective methodology for residential services effective December 1, 2013, for
determining the provider rate for a similarly situated recipient being served by that provider.

(c) The commissioner shall adjust individual reimbursement rates determined under this
section so that the unit rate is no higher or lower than:

(1) 0.5 percent from the historical rate for the implementation period;

(2) 0.5 percent from the rate in effect in clause (1), for the 12-month period immediately
following the time period of clause (1);

(3) 0.5 percent from the rate in effect in clause (2), for the 12-month period immediately
following the time period of clause (2);

(4) 1.0 percent from the rate in effect in clause (3), for the 12-month period immediately
following the time period of clause (3);

(5) 1.0 percent from the rate in effect in clause (4), for the 12-month period immediately
following the time period of clause (4); and

(6) no adjustment to the rate in effect in clause (5) for the 12-month period immediately
following the time period of clause (5). During this banding rate period, the commissioner
shall not enforce any rate decrease or increase that would otherwise result from the end of
the banding period. The commissioner shall, upon enactment, seek federal approval for the
addition of this banding period; and

(7) one percent from the rate in effect in clause (6) for the 12-month period immediately
following the time period of clause (6)
.

(d) The commissioner shall review all changes to rates that were in effect on December
1, 2013, to verify that the rates in effect produce the equivalent level of spending and service
unit utilization on an annual basis as those in effect on October 31, 2013.

(e) By December 31, 2014, the commissioner shall complete the review in paragraph
(d), adjust rates to provide equivalent annual spending, and make appropriate adjustments.

(f) During the banding period, the Medicaid Management Information System (MMIS)
service agreement rate must be adjusted to account for change in an individual's need. The
commissioner shall adjust the Medicaid Management Information System (MMIS) service
agreement rate by:

(1) calculating a service rate under section 256B.4914, subdivision 6, 7, 8, or 9, for the
individual with variables reflecting the level of service in effect on December 1, 2013;

(2) calculating a service rate under section 256B.4914, subdivision 6, 7, 8, or 9, for the
individual with variables reflecting the updated level of service at the time of application;
and

(3) adding to or subtracting from the Medicaid Management Information System (MMIS)
service agreement rate, the difference between the values in clauses (1) and (2).

(g) This subdivision must not apply to rates for recipients served by providers new to a
given county after January 1, 2014. Providers of personal supports services who also acted
as fiscal support entities must be treated as new providers as of January 1, 2014.

EFFECTIVE DATE.

(a) The amendment to paragraph (b) is effective the day following
final enactment.

(b) The amendment to paragraph (c) is effective upon federal approval. The commissioner
of human services shall notify the revisor of statutes when federal approval is obtained.

Sec. 25.

Minnesota Statutes 2016, section 256B.4913, is amended by adding a subdivision
to read:


Subd. 7.

New services.

(a) A service added to section 256B.4914 after January 1, 2014,
is not subject to rate stabilization adjustment in this section.

(b) Employment support services authorized after January 1, 2018, under the new
employment support services definition according to the home and community-based services
waivers for people with disabilities under sections 256B.092 and 256B.49 are not subject
to rate stabilization adjustment in this section.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 26.

Minnesota Statutes 2016, section 256B.4914, subdivision 2, is amended to read:


Subd. 2.

Definitions.

(a) For purposes of this section, the following terms have the
meanings given them, unless the context clearly indicates otherwise.

(b) "Commissioner" means the commissioner of human services.

(c) "Component value" means underlying factors that are part of the cost of providing
services that are built into the waiver rates methodology to calculate service rates.

(d) "Customized living tool" means a methodology for setting service rates that delineates
and documents the amount of each component service included in a recipient's customized
living service plan.

(e) "Disability waiver rates system" means a statewide system that establishes rates that
are based on uniform processes and captures the individualized nature of waiver services
and recipient needs.

(f) "Individual staffing" means the time spent as a one-to-one interaction specific to an
individual recipient by staff to provide direct support and assistance with activities of daily
living, instrumental activities of daily living, and training to participants, and is based on
the requirements in each individual's coordinated service and support plan under section
245D.02, subdivision 4b; any coordinated service and support plan addendum under section
245D.02, subdivision 4c; and an assessment tool. Provider observation of an individual's
needs must also be considered.

(g) "Lead agency" means a county, partnership of counties, or tribal agency charged
with administering waivered services under sections 256B.092 and 256B.49.

(h) "Median" means the amount that divides distribution into two equal groups, one-half
above the median and one-half below the median.

(i) "Payment or rate" means reimbursement to an eligible provider for services provided
to a qualified individual based on an approved service authorization.

(j) "Rates management system" means a Web-based software application that uses a
framework and component values, as determined by the commissioner, to establish service
rates.

(k) "Recipient" means a person receiving home and community-based services funded
under any of the disability waivers.

(l) "Shared staffing" means time spent by employees, not defined under paragraph (f),
providing or available to provide more than one individual with direct support and assistance
with activities of daily living as defined under section 256B.0659, subdivision 1, paragraph
(b); instrumental activities of daily living as defined under section 256B.0659, subdivision
1, paragraph (i); ancillary activities needed to support individual services; and training to
participants, and is based on the requirements in each individual's coordinated service and
support plan under section 245D.02, subdivision 4b; any coordinated service and support
plan addendum under section 245D.02, subdivision 4c; an assessment tool; and provider
observation of an individual's service need. Total shared staffing hours are divided
proportionally by the number of individuals who receive the shared service provisions.

(m) "Staffing ratio" means the number of recipients a service provider employee supports
during a unit of service based on a uniform assessment tool, provider observation, case
history, and the recipient's services of choice, and not based on the staffing ratios under
section 245D.31.

(n) "Unit of service" means the following:

(1) for residential support services under subdivision 6, a unit of service is a day. Any
portion of any calendar day, within allowable Medicaid rules, where an individual spends
time in a residential setting is billable as a day;

(2) for day services under subdivision 7:

(i) for day training and habilitation services, a unit of service is either:

(A) a day unit of service is defined as six or more hours of time spent providing direct
services and transportation; or

(B) a partial day unit of service is defined as fewer than six hours of time spent providing
direct services and transportation; and

(C) for new day service recipients after January 1, 2014, 15 minute units of service must
be used for fewer than six hours of time spent providing direct services and transportation;

(ii) for adult day and structured day services, a unit of service is a day or 15 minutes. A
day unit of service is six or more hours of time spent providing direct services;

(iii) for prevocational services, a unit of service is a day or an hour. A day unit of service
is six or more hours of time spent providing direct service;

(3) for unit-based services with programming under subdivision 8:

(i) for supported living services, a unit of service is a day or 15 minutes. When a day
rate is authorized, any portion of a calendar day where an individual receives services is
billable as a day; and

(ii) for all other services, a unit of service is 15 minutes; and

(4) for unit-based services without programming under subdivision 9:

(i) for respite services, a unit of service is a day or 15 minutes. When a day rate is
authorized, any portion of a calendar day when an individual receives services is billable
as a day; and

(ii) for all other services, a unit of service is 15 minutes.

EFFECTIVE DATE.

This section is effective upon federal approval. The commissioner
of human services shall notify the revisor of statutes when federal approval is obtained.

Sec. 27.

Minnesota Statutes 2016, section 256B.4914, subdivision 3, is amended to read:


Subd. 3.

Applicable services.

Applicable services are those authorized under the state's
home and community-based services waivers under sections 256B.092 and 256B.49,
including the following, as defined in the federally approved home and community-based
services plan:

(1) 24-hour customized living;

(2) adult day care;

(3) adult day care bath;

(4) behavioral programming;

(5) companion services;

(6) customized living;

(7) day training and habilitation;

(8) housing access coordination;

(9) independent living skills;

(10) in-home family support;

(11) night supervision;

(12) personal support;

(13) prevocational services;

(14) residential care services;

(15) residential support services;

(16) respite services;

(17) structured day services;

(18) supported employment services;

(19) (18) supported living services;

(20) (19) transportation services; and

(20) individualized home supports;

(21) independent living skills specialist services;

(22) employment exploration services;

(23) employment development services;

(24) employment support services; and

(21) (25) other services as approved by the federal government in the state home and
community-based services plan.

EFFECTIVE DATE.

(a) Clause (20) is effective the day following final enactment.

(b) Clauses (21) to (24) are effective upon federal approval. The commissioner of human
services shall notify the revisor of statutes when federal approval is obtained.

Sec. 28.

Minnesota Statutes 2016, section 256B.4914, subdivision 5, is amended to read:


Subd. 5.

Base wage index and standard component values.

(a) The base wage index
is established to determine staffing costs associated with providing services to individuals
receiving home and community-based services. For purposes of developing and calculating
the proposed base wage, Minnesota-specific wages taken from job descriptions and standard
occupational classification (SOC) codes from the Bureau of Labor Statistics as defined in
the most recent edition of the Occupational Handbook must be used. The base wage index
must be calculated as follows:

(1) for residential direct care staff, the sum of:

(i) 15 percent of the subtotal of 50 percent of the median wage for personal and home
health aide (SOC code 39-9021); 30 percent of the median wage for nursing aide assistant
(SOC code 31-1012 31-1014); and 20 percent of the median wage for social and human
services aide (SOC code 21-1093); and

(ii) 85 percent of the subtotal of 20 percent of the median wage for home health aide
(SOC code 31-1011); 20 percent of the median wage for personal and home health aide
(SOC code 39-9021); 20 percent of the median wage for nursing aide assistant (SOC code
31-1012 31-1014); 20 percent of the median wage for psychiatric technician (SOC code
29-2053); and 20 percent of the median wage for social and human services aide (SOC code
21-1093);

(2) for day services, 20 percent of the median wage for nursing aide assistant (SOC code
31-1012 31-1014); 20 percent of the median wage for psychiatric technician (SOC code
29-2053); and 60 percent of the median wage for social and human services aide (SOC code
21-1093);

(3) for residential asleep-overnight staff, the wage will be $7.66 per hour is the minimum
wage in Minnesota for large employers
, except in a family foster care setting, the wage is
$2.80 per hour 36 percent of the minimum wage in Minnesota for large employers;

(4) for behavior program analyst staff, 100 percent of the median wage for mental health
counselors (SOC code 21-1014);

(5) for behavior program professional staff, 100 percent of the median wage for clinical
counseling and school psychologist (SOC code 19-3031);

(6) for behavior program specialist staff, 100 percent of the median wage for psychiatric
technicians (SOC code 29-2053);

(7) for supportive living services staff, 20 percent of the median wage for nursing aide
assistant
(SOC code 31-1012 31-1014); 20 percent of the median wage for psychiatric
technician (SOC code 29-2053); and 60 percent of the median wage for social and human
services aide (SOC code 21-1093);

(8) for housing access coordination staff, 50 100 percent of the median wage for
community and social services specialist (SOC code 21-1099); and 50 percent of the median
wage for social and human services aide (SOC code 21-1093);

(9) for in-home family support staff, 20 percent of the median wage for nursing aide
(SOC code 31-1012); 30 percent of the median wage for community social service specialist
(SOC code 21-1099); 40 percent of the median wage for social and human services aide
(SOC code 21-1093); and ten percent of the median wage for psychiatric technician (SOC
code 29-2053);

(10) for individualized home supports services staff, 40 percent of the median wage for
community social service specialist (SOC code 21-1099); 50 percent of the median wage
for social and human services aide (SOC code 21-1093); and ten percent of the median
wage for psychiatric technician (SOC code 29-2053);

(11) for independent living skills staff, 40 percent of the median wage for community
social service specialist (SOC code 21-1099); 50 percent of the median wage for social and
human services aide (SOC code 21-1093); and ten percent of the median wage for psychiatric
technician (SOC code 29-2053);

(12) for independent living skills specialist staff, 100 percent of mental health and
substance abuse social worker (SOC code 21-1023);

(11) (13) for supported employment support services staff, 20 50 percent of the median
wage for nursing aide rehabilitation counselor (SOC code 31-1012 21-1015); 20 percent of
the median wage for psychiatric technician (SOC code 29-2053);
and 60 50 percent of the
median wage for community and social and human services aide specialist (SOC code
21-1093 21-1099);

(14) for employment exploration services staff, 50 percent of the median wage for
rehabilitation counselor (SOC code 21-1015); and 50 percent of the median wage for
community and social services specialist (SOC code 21-1099);

(15) for employment development services staff, 50 percent of the median wage for
education, guidance, school, and vocational counselors (SOC code 21-1012); and 50 percent
of the median wage for community and social services specialist (SOC code 21-1099);

(12) (16) for adult companion staff, 50 percent of the median wage for personal and
home care aide (SOC code 39-9021); and 50 percent of the median wage for nursing aides,
orderlies, and attendants
assistant (SOC code 31-1012 31-1014);

(13) (17) for night supervision staff, 20 percent of the median wage for home health
aide (SOC code 31-1011); 20 percent of the median wage for personal and home health
aide (SOC code 39-9021); 20 percent of the median wage for nursing aide assistant (SOC
code 31-1012 31-1014); 20 percent of the median wage for psychiatric technician (SOC
code 29-2053); and 20 percent of the median wage for social and human services aide (SOC
code 21-1093);

(14) (18) for respite staff, 50 percent of the median wage for personal and home care
aide (SOC code 39-9021); and 50 percent of the median wage for nursing aides, orderlies,
and attendants
assistant (SOC code 31-1012 31-1014);

(15) (19) for personal support staff, 50 percent of the median wage for personal and
home care aide (SOC code 39-9021); and 50 percent of the median wage for nursing aides,
orderlies, and attendants
assistant (SOC code 31-1012 31-1014);

(16) (20) for supervisory staff, the basic wage is $17.43 per hour, 100 percent of the
median wage for community and social services specialist (SOC code 21-1099),
with the
exception of the supervisor of behavior professional, behavior analyst, and behavior
specialists, which must be $30.75 per hour is 100 percent of the median wage for clinical
counseling and school psychologist (SOC code 19-3031)
;

(17) (21) for registered nurse staff, the basic wage is $30.82 per hour, 100 percent of
the median wage for registered nurses (SOC code 29-1141)
; and

(18) (22) for licensed practical nurse staff, the basic wage is $18.64 per hour 100 percent
of the median wage for licensed practical nurses (SOC code 29-2061)
.

(b) Component values for residential support services are:

(1) supervisory span of control ratio: 11 percent;

(2) employee vacation, sick, and training allowance ratio: 8.71 percent;

(3) employee-related cost ratio: 23.6 percent;

(4) general administrative support ratio: 13.25 percent;

(5) program-related expense ratio: 1.3 percent; and

(6) absence and utilization factor ratio: 3.9 percent.

(c) Component values for family foster care are:

(1) supervisory span of control ratio: 11 percent;

(2) employee vacation, sick, and training allowance ratio: 8.71 percent;

(3) employee-related cost ratio: 23.6 percent;

(4) general administrative support ratio: 3.3 percent;

(5) program-related expense ratio: 1.3 percent; and

(6) absence factor: 1.7 percent.

(d) Component values for day services for all services are:

(1) supervisory span of control ratio: 11 percent;

(2) employee vacation, sick, and training allowance ratio: 8.71 percent;

(3) employee-related cost ratio: 23.6 percent;

(4) program plan support ratio: 5.6 percent;

(5) client programming and support ratio: ten percent;

(6) general administrative support ratio: 13.25 percent;

(7) program-related expense ratio: 1.8 percent; and

(8) absence and utilization factor ratio: 3.9 9.4 percent.

(e) Component values for unit-based services with programming are:

(1) supervisory span of control ratio: 11 percent;

(2) employee vacation, sick, and training allowance ratio: 8.71 percent;

(3) employee-related cost ratio: 23.6 percent;

(4) program plan supports ratio: 3.1 15.5 percent;

(5) client programming and supports ratio: 8.6 4.7 percent;

(6) general administrative support ratio: 13.25 percent;

(7) program-related expense ratio: 6.1 percent; and

(8) absence and utilization factor ratio: 3.9 percent.

(f) Component values for unit-based services without programming except respite are:

(1) supervisory span of control ratio: 11 percent;

(2) employee vacation, sick, and training allowance ratio: 8.71 percent;

(3) employee-related cost ratio: 23.6 percent;

(4) program plan support ratio: 3.1 7.0 percent;

(5) client programming and support ratio: 8.6 2.3 percent;

(6) general administrative support ratio: 13.25 percent;

(7) program-related expense ratio: 6.1 2.9 percent; and

(8) absence and utilization factor ratio: 3.9 percent.

(g) Component values for unit-based services without programming for respite are:

(1) supervisory span of control ratio: 11 percent;

(2) employee vacation, sick, and training allowance ratio: 8.71 percent;

(3) employee-related cost ratio: 23.6 percent;

(4) general administrative support ratio: 13.25 percent;

(5) program-related expense ratio: 6.1 2.9 percent; and

(6) absence and utilization factor ratio: 3.9 percent.

(h) On July 1, 2017, the commissioner shall update the base wage index in paragraph
(a) based on the wage data by standard occupational code (SOC) from the Bureau of Labor
Statistics available on December 31, 2016. The commissioner shall publish these updated
values and load them into the rate management system. This adjustment occurs every five
years. For adjustments in 2021 and beyond, the commissioner shall use the data available
on December 31 of the calendar year five years prior.
On January 1, 2022, and every two
years thereafter, the commissioner shall update the base wage index in paragraph (a) based
on the most recently available wage data by SOC from the Bureau of Labor Statistics. The
commissioner shall publish these updated values and load them into the rate management
system.

(i) On July 1, 2017, the commissioner shall update the framework components in
paragraphs (b) to (g) paragraph (d), clause (5); paragraph (e), clause (5); and paragraph (f),
clause (5)
; subdivision 6, clauses (8) and (9); and subdivision 7, clauses (10), (16), and (17),
for changes in the Consumer Price Index. The commissioner will adjust these values higher
or lower by the percentage change in the Consumer Price Index-All Items, United States
city average (CPI-U) from January 1, 2014, to January 1, 2017. The commissioner shall
publish these updated values and load them into the rate management system. This adjustment
occurs every five years. For adjustments in 2021 and beyond, the commissioner shall use
the data available on January 1 of the calendar year four years prior and January 1 of the
current calendar year.
On January 1, 2022, and every two years thereafter, the commissioner
shall update the framework components in paragraph (d), clause (5); paragraph (e), clause
(5); and paragraph (f), clause (5); subdivision 6, clauses (8) and (9); and subdivision 7,
clauses (10), (16), and (17), for changes in the Consumer Price Index. The commissioner
shall adjust these values higher or lower by the percentage change in the CPI-U from the
date of the previous update to the date of the data most recently available prior to the
scheduled update. The commissioner shall publish these updated values and load them into
the rate management system.

(j) In this subdivision, if Bureau of Labor Statistics occupational codes or Consumer
Price Index items are unavailable in the future, the commissioner shall recommend to the
legislature codes or items to update and replace missing component values.

(k) The commissioner must ensure that wage values and component values in subdivisions
5 to 9 reflect the cost to provide the service. As determined by the commissioner, in
consultation with stakeholders identified in section 256B.4913, subdivision 5, a provider
enrolled to provide services with rates determined under this section must submit requested
cost data to the commissioner to support research on the cost of providing services that have
rates determined by the disability waiver rates system. Requested cost data may include,
but is not limited to:

(1) worker wage costs;

(2) benefits paid;

(3) supervisor wage costs;

(4) executive wage costs;

(5) vacation, sick, and training time paid;

(6) taxes, workers' compensation, and unemployment insurance costs paid;

(7) administrative costs paid;

(8) program costs paid;

(9) transportation costs paid;

(10) vacancy rates; and

(11) other data relating to costs required to provide services requested by the
commissioner.

(l) At least once in any five-year period, a provider must submit cost data for a fiscal
year that ended not more than 18 months prior to the submission date. The commissioner
shall provide each provider a 90-day notice prior to its submission due date. If a provider
fails to submit required reporting data, the commissioner shall provide notice to providers
that have not provided required data 30 days after the required submission date, and a second
notice for providers who have not provided required data 60 days after the required
submission date. The commissioner shall temporarily suspend payments to the provider if
cost data is not received 90 days after the required submission date. Withheld payments
shall be made once data is received by the commissioner.

(m) The commissioner shall conduct a random validation of data submitted under
paragraph (k) to ensure data accuracy. The commissioner shall analyze cost documentation
in paragraph (k) and provide recommendations for adjustments to cost components.

(n) The commissioner shall analyze cost documentation in paragraph (k) and, in
consultation with stakeholders identified in section 256B.4913, subdivision 5, may submit
recommendations on component values and inflationary factor adjustments to the chairs
and ranking minority members of the legislative committees with jurisdiction over human
services every four years beginning January 1, 2020. The commissioner shall make
recommendations in conjunction with reports submitted to the legislature according to
subdivision 10, paragraph (e). The commissioner shall release business cost data in an
aggregate form, and business cost data from individual providers shall not be released except
as provided for in current law.

(o) The commissioner, in consultation with stakeholders identified in section 256B.4913,
subdivision 5, shall develop and implement a process for providing training and technical
assistance necessary to support provider submission of cost documentation required under
paragraph (k).

EFFECTIVE DATE.

(a) The amendments to paragraphs (a) to (g) are effective January
1, 2018, except the amendment to paragraph (d), clause (8), which is effective January 1,
2019, and the amendment to paragraph (a), clause (10), which is effective the day following
final enactment.

(b) The amendments to paragraphs (h) to (o) are effective the day following final
enactment.

Sec. 29.

Minnesota Statutes 2016, section 256B.4914, subdivision 6, is amended to read:


Subd. 6.

Payments for residential support services.

(a) Payments for residential support
services, as defined in sections 256B.092, subdivision 11, and 256B.49, subdivision 22,
must be calculated as follows:

(1) determine the number of shared staffing and individual direct staff hours to meet a
recipient's needs provided on site or through monitoring technology;

(2) personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rates or rates derived by the commissioner as provided in subdivision
5. This is defined as the direct-care rate;

(3) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (2). This is defined as the customized direct-care rate;

(4) multiply the number of shared and individual direct staff hours provided on site or
through monitoring technology and nursing hours by the appropriate staff wages in
subdivision 5, paragraph (a), or the customized direct-care rate;

(5) multiply the number of shared and individual direct staff hours provided on site or
through monitoring technology and nursing hours by the product of the supervision span
of control ratio in subdivision 5, paragraph (b), clause (1), and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (16) (20);

(6) combine the results of clauses (4) and (5), excluding any shared and individual direct
staff hours provided through monitoring technology, and multiply the result by one plus
the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (b),
clause (2). This is defined as the direct staffing cost;

(7) for employee-related expenses, multiply the direct staffing cost, excluding any shared
and individual direct staff hours provided through monitoring technology, by one plus the
employee-related cost ratio in subdivision 5, paragraph (b), clause (3);

(8) for client programming and supports, the commissioner shall add $2,179; and

(9) for transportation, if provided, the commissioner shall add $1,680, or $3,000 if
customized for adapted transport, based on the resident with the highest assessed need.

(b) The total rate must be calculated using the following steps:

(1) subtotal paragraph (a), clauses (7) to (9), and the direct staffing cost of any shared
and individual direct staff hours provided through monitoring technology that was excluded
in clause (7);

(2) sum the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization ratio;

(3) divide the result of clause (1) by one minus the result of clause (2). This is the total
payment amount; and

(4) adjust the result of clause (3) by a factor to be determined by the commissioner to
adjust for regional differences in the cost of providing services.

(c) The payment methodology for customized living, 24-hour customized living, and
residential care services must be the customized living tool. Revisions to the customized
living tool must be made to reflect the services and activities unique to disability-related
recipient needs.

(d) For individuals enrolled prior to January 1, 2014, the days of service authorized must
meet or exceed the days of service used to convert service agreements in effect on December
1, 2013, and must not result in a reduction in spending or service utilization due to conversion
during the implementation period under section 256B.4913, subdivision 4a. If during the
implementation period, an individual's historical rate, including adjustments required under
section 256B.4913, subdivision 4a, paragraph (c), is equal to or greater than the rate
determined in this subdivision, the number of days authorized for the individual is 365.

(e) The number of days authorized for all individuals enrolling after January 1, 2014,
in residential services must include every day that services start and end.

Sec. 30.

Minnesota Statutes 2016, section 256B.4914, subdivision 7, is amended to read:


Subd. 7.

Payments for day programs.

Payments for services with day programs
including adult day care, day treatment and habilitation, prevocational services, and structured
day services must be calculated as follows:

(1) determine the number of units of service and staffing ratio to meet a recipient's needs:

(i) the staffing ratios for the units of service provided to a recipient in a typical week
must be averaged to determine an individual's staffing ratio; and

(ii) the commissioner, in consultation with service providers, shall develop a uniform
staffing ratio worksheet to be used to determine staffing ratios under this subdivision;

(2) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rates or rates derived by the commissioner as provided in subdivision
5;

(3) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (2). This is defined as the customized direct-care rate;

(4) multiply the number of day program direct staff hours and nursing hours by the
appropriate staff wage in subdivision 5, paragraph (a), or the customized direct-care rate;

(5) multiply the number of day direct staff hours by the product of the supervision span
of control ratio in subdivision 5, paragraph (d), clause (1), and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (16) (20);

(6) combine the results of clauses (4) and (5), and multiply the result by one plus the
employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (d), clause
(2). This is defined as the direct staffing rate;

(7) for program plan support, multiply the result of clause (6) by one plus the program
plan support ratio in subdivision 5, paragraph (d), clause (4);

(8) for employee-related expenses, multiply the result of clause (7) by one plus the
employee-related cost ratio in subdivision 5, paragraph (d), clause (3);

(9) for client programming and supports, multiply the result of clause (8) by one plus
the client programming and support ratio in subdivision 5, paragraph (d), clause (5);

(10) for program facility costs, add $19.30 per week with consideration of staffing ratios
to meet individual needs;

(11) for adult day bath services, add $7.01 per 15 minute unit;

(12) this is the subtotal rate;

(13) sum the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization factor ratio;

(14) divide the result of clause (12) by one minus the result of clause (13). This is the
total payment amount;

(15) adjust the result of clause (14) by a factor to be determined by the commissioner
to adjust for regional differences in the cost of providing services;

(16) for transportation provided as part of day training and habilitation for an individual
who does not require a lift, add:

(i) $10.50 for a trip between zero and ten miles for a nonshared ride in a vehicle without
a lift, $8.83 for a shared ride in a vehicle without a lift, and $9.25 for a shared ride in a
vehicle with a lift;

(ii) $15.75 for a trip between 11 and 20 miles for a nonshared ride in a vehicle without
a lift, $10.58 for a shared ride in a vehicle without a lift, and $11.88 for a shared ride in a
vehicle with a lift;

(iii) $25.75 for a trip between 21 and 50 miles for a nonshared ride in a vehicle without
a lift, $13.92 for a shared ride in a vehicle without a lift, and $16.88 for a shared ride in a
vehicle with a lift; or

(iv) $33.50 for a trip of 51 miles or more for a nonshared ride in a vehicle without a lift,
$16.50 for a shared ride in a vehicle without a lift, and $20.75 for a shared ride in a vehicle
with a lift;

(17) for transportation provided as part of day training and habilitation for an individual
who does require a lift, add:

(i) $19.05 for a trip between zero and ten miles for a nonshared ride in a vehicle with a
lift, and $15.05 for a shared ride in a vehicle with a lift;

(ii) $32.16 for a trip between 11 and 20 miles for a nonshared ride in a vehicle with a
lift, and $28.16 for a shared ride in a vehicle with a lift;

(iii) $58.76 for a trip between 21 and 50 miles for a nonshared ride in a vehicle with a
lift, and $58.76 for a shared ride in a vehicle with a lift; or

(iv) $80.93 for a trip of 51 miles or more for a nonshared ride in a vehicle with a lift,
and $80.93 for a shared ride in a vehicle with a lift.

Sec. 31.

Minnesota Statutes 2016, section 256B.4914, subdivision 8, is amended to read:


Subd. 8.

Payments for unit-based services with programming.

Payments for unit-based
services with programming, including behavior programming, housing access coordination,
in-home family support, independent living skills training, independent living skills specialist
services, individualized home supports,
hourly supported living services, employment
exploration services, employment development services,
and supported employment support
services
provided to an individual outside of any day or residential service plan must be
calculated as follows, unless the services are authorized separately under subdivision 6 or
7:

(1) determine the number of units of service to meet a recipient's needs;

(2) personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rates or rates derived by the commissioner as provided in subdivision
5;

(3) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (2). This is defined as the customized direct-care rate;

(4) multiply the number of direct staff hours by the appropriate staff wage in subdivision
5, paragraph (a), or the customized direct-care rate;

(5) multiply the number of direct staff hours by the product of the supervision span of
control ratio in subdivision 5, paragraph (e), clause (1), and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (16) (20);

(6) combine the results of clauses (4) and (5), and multiply the result by one plus the
employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (e), clause
(2). This is defined as the direct staffing rate;

(7) for program plan support, multiply the result of clause (6) by one plus the program
plan supports ratio in subdivision 5, paragraph (e), clause (4);

(8) for employee-related expenses, multiply the result of clause (7) by one plus the
employee-related cost ratio in subdivision 5, paragraph (e), clause (3);

(9) for client programming and supports, multiply the result of clause (8) by one plus
the client programming and supports ratio in subdivision 5, paragraph (e), clause (5);

(10) this is the subtotal rate;

(11) sum the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization factor ratio;

(12) divide the result of clause (10) by one minus the result of clause (11). This is the
total payment amount;

(13) for supported employment support services provided in a shared manner, divide
the total payment amount in clause (12) by the number of service recipients, not to exceed
three six. For independent living skills training and individualized home supports provided
in a shared manner, divide the total payment amount in clause (12) by the number of service
recipients, not to exceed two; and

(14) adjust the result of clause (13) by a factor to be determined by the commissioner
to adjust for regional differences in the cost of providing services.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 32.

Minnesota Statutes 2016, section 256B.4914, subdivision 9, is amended to read:


Subd. 9.

Payments for unit-based services without programming.

Payments for
unit-based services without programming, including night supervision, personal support,
respite, and companion care provided to an individual outside of any day or residential
service plan must be calculated as follows unless the services are authorized separately
under subdivision 6 or 7:

(1) for all services except respite, determine the number of units of service to meet a
recipient's needs;

(2) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rate or rates derived by the commissioner as provided in subdivision 5;

(3) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (2). This is defined as the customized direct care rate;

(4) multiply the number of direct staff hours by the appropriate staff wage in subdivision
5 or the customized direct care rate;

(5) multiply the number of direct staff hours by the product of the supervision span of
control ratio in subdivision 5, paragraph (f), clause (1), and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (16) (20);

(6) combine the results of clauses (4) and (5), and multiply the result by one plus the
employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (f), clause
(2). This is defined as the direct staffing rate;

(7) for program plan support, multiply the result of clause (6) by one plus the program
plan support ratio in subdivision 5, paragraph (f), clause (4);

(8) for employee-related expenses, multiply the result of clause (7) by one plus the
employee-related cost ratio in subdivision 5, paragraph (f), clause (3);

(9) for client programming and supports, multiply the result of clause (8) by one plus
the client programming and support ratio in subdivision 5, paragraph (f), clause (5);

(10) this is the subtotal rate;

(11) sum the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization factor ratio;

(12) divide the result of clause (10) by one minus the result of clause (11). This is the
total payment amount;

(13) for respite services, determine the number of day units of service to meet an
individual's needs;

(14) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rate or rates derived by the commissioner as provided in subdivision 5;

(15) for a recipient requiring deaf and hard-of-hearing customization under subdivision
12, add the customization rate provided in subdivision 12 to the result of clause (14). This
is defined as the customized direct care rate;

(16) multiply the number of direct staff hours by the appropriate staff wage in subdivision
5, paragraph (a);

(17) multiply the number of direct staff hours by the product of the supervisory span of
control ratio in subdivision 5, paragraph (g), clause (1), and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (16) (20);

(18) combine the results of clauses (16) and (17), and multiply the result by one plus
the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (g),
clause (2). This is defined as the direct staffing rate;

(19) for employee-related expenses, multiply the result of clause (18) by one plus the
employee-related cost ratio in subdivision 5, paragraph (g), clause (3);

(20) this is the subtotal rate;

(21) sum the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization factor ratio;

(22) divide the result of clause (20) by one minus the result of clause (21). This is the
total payment amount; and

(23) adjust the result of clauses (12) and (22) by a factor to be determined by the
commissioner to adjust for regional differences in the cost of providing services.

Sec. 33.

Minnesota Statutes 2016, section 256B.4914, subdivision 10, is amended to read:


Subd. 10.

Updating payment values and additional information.

(a) From January
1, 2014, through December 31, 2017, the commissioner shall develop and implement uniform
procedures to refine terms and adjust values used to calculate payment rates in this section.

(b) No later than July 1, 2014, the commissioner shall, within available resources, begin
to conduct research and gather data and information from existing state systems or other
outside sources on the following items:

(1) differences in the underlying cost to provide services and care across the state; and

(2) mileage, vehicle type, lift requirements, incidents of individual and shared rides, and
units of transportation for all day services, which must be collected from providers using
the rate management worksheet and entered into the rates management system; and

(3) the distinct underlying costs for services provided by a license holder under sections
245D.05, 245D.06, 245D.07, 245D.071, 245D.081, and 245D.09, and for services provided
by a license holder certified under section 245D.33.

(c) Beginning January 1, 2014, through December 31, 2018, using a statistically valid
set of rates management system data, the commissioner, in consultation with stakeholders,
shall analyze for each service the average difference in the rate on December 31, 2013, and
the framework rate at the individual, provider, lead agency, and state levels. The
commissioner shall issue semiannual reports to the stakeholders on the difference in rates
by service and by county during the banding period under section 256B.4913, subdivision
4a
. The commissioner shall issue the first report by October 1, 2014, and the final report
shall be issued by December 31, 2018
.

(d) No later than July 1, 2014, the commissioner, in consultation with stakeholders, shall
begin the review and evaluation of the following values already in subdivisions 6 to 9, or
issues that impact all services, including, but not limited to:

(1) values for transportation rates for day services;

(2) values for transportation rates in residential services;

(3) (2) values for services where monitoring technology replaces staff time;

(4) (3) values for indirect services;

(5) (4) values for nursing;

(6) component values for independent living skills;

(7) component values for family foster care that reflect licensing requirements;

(8) adjustments to other components to replace the budget neutrality factor;

(9) remote monitoring technology for nonresidential services;

(10) values for basic and intensive services in residential services;

(11) (5) values for the facility use rate in day services, and the weightings used in the
day service ratios and adjustments to those weightings;

(12) (6) values for workers' compensation as part of employee-related expenses;

(13) (7) values for unemployment insurance as part of employee-related expenses;

(14) a component value to reflect costs for individuals with rates previously adjusted
for the inclusion of group residential housing rate 3 costs, only for any individual enrolled
as of December 31, 2013; and

(15) (8) any changes in state or federal law with an a direct impact on the underlying
cost of providing home and community-based services.; and

(9) outcome measures, determined by the commissioner, for home and community-based
services rates determined under this section.

(e) The commissioner shall report to the chairs and the ranking minority members of
the legislative committees and divisions with jurisdiction over health and human services
policy and finance with the information and data gathered under paragraphs (b) to (d) on
the following dates:

(1) January 15, 2015, with preliminary results and data;

(2) January 15, 2016, with a status implementation update, and additional data and
summary information;

(3) January 15, 2017, with the full report; and

(4) January 15, 2019 2020, with another full report, and a full report once every four
years thereafter.

(f) Based on the commissioner's evaluation of the information and data collected in
paragraphs (b) to (d), the commissioner shall make recommendations to the legislature by
January 15, 2015, to address any issues identified during the first year of implementation.
After January 15, 2015, the commissioner may make recommendations to the legislature
to address potential issues.

(g) (f) The commissioner shall implement a regional adjustment factor to all rate
calculations in subdivisions 6 to 9, effective no later than January 1, 2015. Beginning July
1, 2017, the commissioner shall renew analysis and implement changes to the regional
adjustment factors when adjustments required under subdivision 5, paragraph (h), occur.
Prior to implementation, the commissioner shall consult with stakeholders on the
methodology to calculate the adjustment.

(h) (g) The commissioner shall provide a public notice via LISTSERV in October of
each year beginning October 1, 2014, containing information detailing legislatively approved
changes in:

(1) calculation values including derived wage rates and related employee and
administrative factors;

(2) service utilization;

(3) county and tribal allocation changes; and

(4) information on adjustments made to calculation values and the timing of those
adjustments.

The information in this notice must be effective January 1 of the following year.

(i) No later than July 1, 2016, the commissioner shall develop and implement, in
consultation with stakeholders, a methodology sufficient to determine the shared staffing
levels necessary to meet, at a minimum, health and welfare needs of individuals who will
be living together in shared residential settings, and the required shared staffing activities
described in subdivision 2, paragraph (l). This determination methodology must ensure
staffing levels are adaptable to meet the needs and desired outcomes for current and
prospective residents in shared residential settings.

(j) (h) When the available shared staffing hours in a residential setting are insufficient
to meet the needs of an individual who enrolled in residential services after January 1, 2014,
or insufficient to meet the needs of an individual with a service agreement adjustment
described in section 256B.4913, subdivision 4a, paragraph (f), then individual staffing hours
shall be used.

(i) The commissioner shall study the underlying cost of absence and utilization for day
services. Based on the commissioner's evaluation of the data collected under this paragraph,
the commissioner shall make recommendations to the legislature by January 15, 2018, for
changes, if any, to the absence and utilization factor ratio component value for day services.

(j) Beginning July 1, 2017, the commissioner shall collect transportation and trip
information for all day services through the rates management system.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 34.

Minnesota Statutes 2016, section 256B.4914, subdivision 16, is amended to read:


Subd. 16.

Budget neutrality adjustments.

(a) The commissioner shall use the following
adjustments to the rate generated by the framework to assure budget neutrality until the rate
information is available to implement paragraph (b). The rate generated by the framework
shall be multiplied by the appropriate factor, as designated below:

(1) for residential services: 1.003;

(2) for day services: 1.000;

(3) for unit-based services with programming: 0.941; and

(4) for unit-based services without programming: 0.796.

(b) Within 12 months of January 1, 2014, the commissioner shall compare estimated
spending for all home and community-based waiver services under the new payment rates
defined in subdivisions 6 to 9 with estimated spending for the same recipients and services
under the rates in effect on July 1, 2013. This comparison must distinguish spending under
each of subdivisions 6, 7, 8, and 9. The comparison must be based on actual recipients and
services for one or more service months after the new rates have gone into effect. The
commissioner shall consult with the commissioner of management and budget on this
analysis to ensure budget neutrality. If estimated spending under the new rates for services
under one or more subdivisions differs in this comparison by 0.3 percent or more, the
commissioner shall assure aggregate budget neutrality across all service areas by adjusting
the budget neutrality factor in paragraph (a) in each subdivision so that total estimated
spending for each subdivision under the new rates matches estimated spending under the
rates in effect on July 1, 2013.

(c) A service rate developed using values in subdivision 5, paragraph (a), clause (10),
is not subject to budget neutrality adjustments.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 35.

Minnesota Statutes 2016, section 256C.23, is amended by adding a subdivision
to read:


Subd. 1a.

Culturally affirmative.

"Culturally affirmative" describes services that are
designed and delivered within the context of the culture, language, and life experiences of
a person who is deaf, a person who is deafblind, and a person who is hard-of-hearing.

Sec. 36.

Minnesota Statutes 2016, section 256C.23, subdivision 2, is amended to read:


Subd. 2.

Deaf.

"Deaf" means a hearing loss of such severity that the individual must
depend primarily on visual communication such as American Sign Language or other signed
language, visual and manual means of communication such as signing systems in English
or Cued Speech,
writing, lip speech reading, manual communication, and gestures.

Sec. 37.

Minnesota Statutes 2016, section 256C.23, is amended by adding a subdivision
to read:


Subd. 2c.

Interpreting services.

"Interpreting services" means services that include:

(1) interpreting between a spoken language, such as English, and a visual language, such
as American Sign Language;

(2) interpreting between a spoken language and a visual representation of a spoken
language, such as Cued Speech and signing systems in English;

(3) interpreting within one language where the interpreter uses natural gestures and
silently repeats the spoken message, replacing some words or phrases to give higher visibility
on the lips;

(4) interpreting using low vision or tactile methods for persons who have a combined
hearing and vision loss or are deafblind; and

(5) interpreting from one communication mode or language into another communication
mode or language that is linguistically and culturally appropriate for the participants in the
communication exchange.

Sec. 38.

Minnesota Statutes 2016, section 256C.23, is amended by adding a subdivision
to read:


Subd. 6.

Real-time captioning.

"Real-time captioning" means a method of captioning
in which a caption is simultaneously prepared and displayed or transmitted at the time of
origination by specially trained real-time captioners.

Sec. 39.

Minnesota Statutes 2016, section 256C.233, subdivision 1, is amended to read:


Subdivision 1.

Deaf and Hard-of-Hearing Services Division.

The commissioners of
human services, education, employment and economic development, and health shall create
a distinct and separate organizational unit to be known as
advise the commissioner of human
services on the activities of
the Deaf and Hard-of-Hearing Services Division to address.
This division addresses
the developmental, social, educational, and occupational and
social-emotional
needs of persons who are deaf, persons who are deafblind, and persons
who are
hard-of-hearing persons through a statewide network of collaborative services and
by coordinating the promulgation of public policies, regulations, legislation, and programs
affecting
advocates on behalf of and provides information and training about how to best
serve persons who are
deaf, persons who are deafblind, and persons who are hard-of-hearing
persons. An interdepartmental management team shall advise the activities of the Deaf and
Hard-of-Hearing Services Division.
The commissioner of human services shall coordinate
the work of the interagency management team advisers and receive legislative appropriations
for the division.

Sec. 40.

Minnesota Statutes 2016, section 256C.233, subdivision 2, is amended to read:


Subd. 2.

Responsibilities.

The Deaf and Hard-of-Hearing Services Division shall:

(1) establish and maintain a statewide network of regional service centers culturally
affirmative services
for Minnesotans who are deaf, Minnesotans who are deafblind, and
Minnesotans who are
hard-of-hearing Minnesotans;

(2) assist work across divisions within the Departments Department of Human Services,
Education, and Employment and Economic Development to coordinate the promulgation
and implementation of public policies, regulations, legislation, programs, and services
affecting
as well as with other agencies and counties, to ensure that there is an understanding
of:

(i) the communication challenges faced by persons who are deaf, persons who are
deafblind, and persons who are hard-of-hearing persons;

(ii) the best practices for accommodating and mitigating communication challenges;
and

(iii) the legal requirements for providing access to and effective communication with
persons who are deaf, persons who are deafblind, and persons who are hard-of-hearing
; and

(3) provide a coordinated system of assess the supply and demand statewide interpreting
or
for interpreter referral services. and real-time captioning services, implement strategies
to provide greater access to these services in areas without sufficient supply, and build the
base of service providers across the state;

(4) maintain a statewide information resource that includes contact information and
professional certification credentials of interpreting service providers and real-time captioning
service providers;

(5) provide culturally affirmative mental health services to persons who are deaf, persons
who are deafblind, and persons who are hard-of-hearing who:

(i) use a visual language such as American Sign Language or a tactile form of a language;
or

(ii) otherwise need culturally affirmative therapeutic services;

(6) research and develop best practices and recommendations for emerging issues;

(7) provide as much information as practicable on the division's stand-alone Web site
in American Sign Language; and

(8) report to the chairs and ranking minority members of the legislative committees with
jurisdiction over human services biennially, beginning on January 1, 2019, on the following:

(i) the number of regional service center staff, the location of the office of each staff
person, other service providers with which they are colocated, the number of people served
by each staff person and a breakdown of whether each person was served on-site or off-site,
and for those served off-site, a list of locations where services were delivered and the number
who were served in-person and the number who were served via technology;

(ii) the amount and percentage of the division budget spent on reasonable
accommodations for staff;

(iii) the number of people who use demonstration equipment and consumer evaluations
of the experience;

(iv) the number of training sessions provided by division staff, the topics covered, the
number of participants, and consumer evaluations, including a breakdown by delivery
method such as in-person or via technology;

(v) the number of training sessions hosted at a division location provided by another
service provider, the topics covered, the number of participants, and consumer evaluations,
including a breakdown by delivery method such as in-person or via technology;

(vi) for each grant awarded, the amount awarded to the grantee and a summary of the
grantee's results, including consumer evaluations of the services or products provided;

(vii) the number of people on waiting lists for any services provided by division staff
or for services or equipment funded through grants awarded by the division;

(viii) the amount of time staff spent driving to appointments to deliver direct one-to-one
client services in locations outside of the regional service centers;

(ix) the amount spent on mileage reimbursement and the number of clients who received
mileage reimbursement for traveling to the regional service centers for services; and

(x) the regional needs and feedback on addressing service gaps identified by the advisory
committees.

Sec. 41.

Minnesota Statutes 2016, section 256C.24, subdivision 1, is amended to read:


Subdivision 1.

Location.

The Deaf and Hard-of-Hearing Services Division shall establish
up to eight at least six regional service centers for persons who are deaf and persons who
are
hard-of-hearing persons. The centers shall be distributed regionally to provide access
for persons who are deaf, persons who are deafblind, and persons who are hard-of-hearing
persons in all parts of the state.

Sec. 42.

Minnesota Statutes 2016, section 256C.24, subdivision 2, is amended to read:


Subd. 2.

Responsibilities.

Each regional service center shall:

(1) serve as a central entry point for establish connections and collaborations and explore
co-locating with other public and private entities providing services to persons who are

deaf, persons who are deafblind, and persons who are hard-of-hearing persons in need of
services and make referrals to the services needed
in the region;

(2) for those in need of services, assist in coordinating services between service providers
and persons who are deaf, persons who are deafblind, and persons who are hard-of-hearing,
and the persons' families, and make referrals to the services needed;

(2) (3) employ staff trained to work with persons who are deaf, persons who are deafblind,
and persons who are hard-of-hearing persons;

(3) (4) if adequate services are not available from another public or private service
provider in the region,
provide to all individual assistance to persons who are deaf, persons
who are
deafblind, and persons who are hard-of-hearing persons access to interpreter services
which are necessary to help them obtain services
, and the persons' families. Individual
culturally affirmative assistance may be provided using technology only in areas of the state
where a person has access to sufficient quality telecommunications or broadband services
to allow effective communication. When a person who is deaf, a person who is deafblind,
or a person who is hard-of-hearing does not have access to sufficient telecommunications
or broadband service, individual assistance shall be available in person
;

(5) identify regional training needs, work with deaf and hard-of-hearing services training
staff, and collaborate with others to deliver training for persons who are deaf, persons who
are deafblind, and persons who are hard-of-hearing, and the persons' families, and other
service providers about subjects including the persons' rights under the law, American Sign
Language, and the impact of hearing loss and options for accommodating it;

(4) implement a plan to provide loaned equipment and resource materials to deaf,
deafblind, and hard-of-hearing
(6) have a mobile or permanent lab where persons who are
deaf, persons who are deafblind, and persons who are hard-of-hearing can try a selection
of modern assistive technology and equipment to determine what would best meet the
persons' needs
;

(5) cooperate with responsible departments and administrative authorities to provide
access for deaf, deafblind, and hard-of-hearing persons to services provided by state, county,
and regional agencies;

(6) (7) collaborate with the Resource Center for the Deaf and Hard-of-Hearing Persons,
other divisions of the Department of Education, and local school districts to develop and
deliver programs and services for families with children who are deaf, children who are
deafblind, or children who are hard-of-hearing children and to support school personnel
serving these children;

(7) when possible, (8) provide training to the social service or income maintenance staff
employed by counties or by organizations with whom counties contract for services to
ensure that communication barriers which prevent persons who are deaf, persons who are
deafblind, and persons who are hard-of-hearing persons from using services are removed;

(8) when possible, (9) provide training to state and regional human service agencies in
the region
regarding program access for persons who are deaf, persons who are deafblind,
and persons who are hard-of-hearing persons; and

(9) (10) assess the ongoing need and supply of services for persons who are deaf, persons
who are
deafblind, and persons who are hard-of-hearing persons in all parts of the state,
annually consult with the division's advisory committees to identify regional needs and
solicit feedback on addressing service gaps,
and cooperate with public and private service
providers to develop these services.;

(11) provide culturally affirmative mental health services to persons who are deaf,
persons who are deafblind, and persons who are hard-of-hearing who:

(i) use a visual language such as American Sign Language or a tactile form of a language;
or

(ii) otherwise need culturally affirmative therapeutic services; and

(12) establish partnerships with state and regional entities statewide that have the
technological capacity to provide Minnesotans with virtual access to the division's services
and division-sponsored training via technology.

Sec. 43.

Minnesota Statutes 2016, section 256C.261, is amended to read:


256C.261 SERVICES FOR PERSONS WHO ARE DEAFBLIND PERSONS.

(a) The commissioner of human services shall combine the existing biennial base level
funding for deafblind services into a single grant program. At least 35 percent of the total
funding is awarded for services and other supports to deafblind children and their families
and at least 25 percent is awarded for services and other supports to deafblind adults.
use
at least 35 percent of the deafblind services biennial base level grant funding for services
and other supports for a child who is deafblind and the child's family. The commissioner
shall use at least 25 percent of the deafblind services biennial base level grant funding for
services and other supports for an adult who is deafblind.

The commissioner shall award grants for the purposes of:

(1) providing services and supports to individuals persons who are deafblind; and

(2) developing and providing training to counties and the network of senior citizen
service providers. The purpose of the training grants is to teach counties how to use existing
programs that capture federal financial participation to meet the needs of eligible persons
who are
deafblind persons and to build capacity of senior service programs to meet the
needs of seniors with a dual sensory hearing and vision loss.

(b) The commissioner may make grants:

(1) for services and training provided by organizations; and

(2) to develop and administer consumer-directed services.

(c) Consumer-directed services shall be provided in whole by grant-funded providers.
The deaf and hard-of-hearing regional service centers shall not provide any aspect of a
grant-funded consumer-directed services program.

(c) (d) Any entity that is able to satisfy the grant criteria is eligible to receive a grant
under paragraph (a).

(d) (e) Deafblind service providers may, but are not required to, provide intervenor
services as part of the service package provided with grant funds under this section.

Sec. 44. EXPANSION OF CONSUMER-DIRECTED COMMUNITY SUPPORTS
BUDGET METHODOLOGY EXCEPTION.

(a) No later than September 30, 2017, if necessary, the commissioner of human services
shall submit an amendment to the Centers for Medicare and Medicaid Services for the home
and community-based services waivers authorized under Minnesota Statutes, sections
256B.092 and 256B.49, to expand the exception to the consumer-directed community
supports budget methodology under Laws 2015, chapter 71, article 7, section 54, to provide
up to 30 percent more funds for either:

(1) consumer-directed community supports participants who have a coordinated service
and support plan which identifies the need for an increased amount of services or supports
under consumer-directed community supports than the amount they are currently receiving
under the consumer-directed community supports budget methodology:

(i) to increase the amount of time a person works or otherwise improves employment
opportunities;

(ii) to plan a transition to, move to, or live in a setting described in Minnesota Statutes,
section 256D.44, subdivision 5, paragraph (f), clause (1), item (ii), or paragraph (g); or

(iii) to develop and implement a positive behavior support plan; or

(2) home and community-based waiver participants who are currently using licensed
providers for (i) employment supports or services during the day; or (ii) residential services,
either of which cost more annually than the person would spend under a consumer-directed
community supports plan for any or all of the supports needed to meet the goals identified
in paragraph (a), clause (1), items (i), (ii), and (iii).

(b) The exception under paragraph (a), clause (1), is limited to those persons who can
demonstrate that they will have to discontinue using consumer-directed community supports
and accept other non-self-directed waiver services because their supports needed for the
goals described in paragraph (a), clause (1), items (i), (ii), and (iii), cannot be met within
the consumer-directed community supports budget limits.

(c) The exception under paragraph (a), clause (2), is limited to those persons who can
demonstrate that, upon choosing to become a consumer-directed community supports
participant, the total cost of services, including the exception, will be less than the cost of
current waiver services.

EFFECTIVE DATE.

The exception under this section is effective October 1, 2017, or
upon federal approval, whichever is later. Notwithstanding any other law to the contrary,
the exception in Laws 2016, chapter 144, section 1, remains in effect until the exception
under Laws 2015, chapter 71, article 7, section 54, or under this section becomes effective,
whichever occurs first. The commissioner of human services shall notify the revisor of
statutes when federal approval is obtained.

Sec. 45.

CONSUMER-DIRECTED COMMUNITY SUPPORTS BUDGET
METHODOLOGY EXCEPTION FOR PERSONS LEAVING INSTITUTIONS AND
CRISIS RESIDENTIAL SETTINGS.

(a) By September 30, 2017, the commissioner shall establish an institutional and crisis
bed consumer-directed community supports budget exception process in the home and
community-based services waivers under Minnesota Statutes, sections 256B.092 and
256B.49. This budget exception process shall be available for any individual who:

(1) is not offered available and appropriate services within 60 days since approval for
discharge from the individual's current institutional setting; and

(2) requires services that are more expensive than appropriate services provided in a
noninstitutional setting using the consumer-directed community supports option.

(b) Institutional settings for purposes of this exception include intermediate care facilities
for persons with developmental disabilities; nursing facilities; acute care hospitals; Anoka
Metro Regional Treatment Center; Minnesota Security Hospital; and crisis beds. The budget
exception shall be limited to no more than the amount of appropriate services provided in
a noninstitutional setting as determined by the lead agency managing the individual's home
and community-based services waiver. The lead agency shall notify the Department of
Human Services of the budget exception.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 46. CONSUMER-DIRECTED COMMUNITY SUPPORTS REVISED BUDGET
METHODOLOGY REPORT.

(a) The commissioner of human services, in consultation with stakeholders and others
including representatives of lead agencies, home and community-based services waiver
participants using consumer-directed community supports, advocacy groups, state agencies,
the Institute on Community Integration at the University of Minnesota, and service and
financial management providers, shall develop a revised consumer-directed community
supports budget methodology. The new methodology shall be based on (1) the costs of
providing services as reflected by the wage and other relevant components incorporated in
the disability waiver rate formulas under Minnesota Statutes, chapter 256B, and (2)
state-to-county waiver-funding methodologies. The new methodology should develop
individual consumer-directed community supports budgets comparable to those provided
for similar needs individuals if paying for non-consumer-directed community supports
waiver services.

(b) By December 15, 2018, the commissioner shall report a revised consumer-directed
community supports budget methodology, including proposed legislation and funding
necessary to implement the new methodology, to the chairs and ranking minority members
of the house of representatives and senate committees with jurisdiction over health and
human services.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 47. FEDERAL WAIVER AMENDMENTS.

The commissioner of human services shall submit necessary waiver amendments to the
Centers for Medicare and Medicaid Services to add employment exploration services,
employment development services, and employment support services to the home and
community-based services waivers authorized under Minnesota Statutes, sections 256B.092
and 256B.49. The commissioner shall also submit necessary waiver amendments to remove
community-based employment services from day training and habilitation and prevocational
services. The commissioner shall submit all necessary waiver amendments by October 1,
2017.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 48. TRANSPORTATION STUDY.

The commissioner of human services, with cooperation from lead agencies and in
consultation with stakeholders, shall conduct a study to identify opportunities to increase
access to transportation services for an individual who receives home and community-based
services. The commissioner shall submit a report with recommendations to the chairs and
ranking minority members of the legislative committees with jurisdiction over human
services by January 15, 2019. The report shall:

(1) study all aspects of the current transportation service network, including the fleet
available, the different rate-setting methods currently used, methods that an individual uses
to access transportation, and the diversity of available provider agencies;

(2) identify current barriers for an individual accessing transportation and for a provider
providing waiver services transportation in the marketplace;

(3) identify efficiencies and collaboration opportunities to increase available
transportation, including transportation funded by medical assistance, and available regional
transportation and transit options;

(4) study transportation solutions in other states for delivering home and community-based
services;

(5) study provider costs required to administer transportation services;

(6) make recommendations for coordinating and increasing transportation accessibility
across the state; and

(7) make recommendations for the rate setting of waivered transportation.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 49. DIRECTION TO COMMISSIONER; TELECOMMUNICATION
EQUIPMENT PROGRAM.

The commissioner of human services shall work in consultation with the Commission
of Deaf, Deafblind, and Hard-of-Hearing Minnesotans to provide recommendations by
January 15, 2018, to the chairs and ranking minority members of the house of representatives
and senate committees with jurisdiction over human services to modernize the
telecommunication equipment program. The recommendations must address:

(1) types of equipment and supports the program should provide to ensure people with
communication difficulties have equitable access to telecommunications services;

(2) additional services the program should provide, such as education about technology
options that can improve a person's access to telecommunications services; and

(3) how the current program's service delivery structure might be improved to better
meet the needs of people with communication disabilities.

The commissioner shall also provide draft legislative language to accomplish the
recommendations. Final recommendations, the final report, and draft legislative language
must be approved by both the commissioner and the chair of the Commission of Deaf,
Deafblind, and Hard-of-Hearing Minnesotans.

Sec. 50. DIRECTION TO COMMISSIONER; BILLING FOR MENTAL HEALTH
SERVICES.

By January 1, 2018, the commissioner of human services shall report to the chairs and
ranking minority members of the house of representatives and senate committees with
jurisdiction over deaf and hard-of-hearing services on the potential costs and benefits of the
Deaf and Hard-of-Hearing Services Division billing for the cost of providing mental health
services.

Sec. 51. DIRECTION TO COMMISSIONER; MnCHOICES ASSESSMENT TOOL.

The commissioner of human services shall work with lead agencies responsible for
conducting long-term consultation services under Minnesota Statutes, section 256B.0911,
to modify the MnCHOICES assessment tool and related policies to:

(1) reduce assessment times;

(2) create efficiencies within the tool and within practice and policy for conducting
assessments and support planning;

(3) implement policy changes reducing the frequency and depth of assessment and
reassessment, while ensuring federal compliance with medical assistance and disability
waiver eligibility requirements; and

(4) evaluate alternative payment methods.

Sec. 52. RANDOM MOMENT TIME STUDY EVALUATION REQUIRED.

The commissioner of human services shall evaluate the random moment time study
methodology for reimbursement of costs associated with county duties required under
Minnesota Statutes, section 256B.0911. The study must determine whether random moment
is efficient and effective in supporting functions of assessment and support planning and
the purpose under Minnesota Statutes, section 256B.0911, subdivision 1. The commissioner
shall submit a report to the chairs and ranking minority members of the house of
representatives and senate committees with jurisdiction over health and human services by
January 15, 2019. The report must provide recommendations for changes to payment
methodologies and functions related to assessment, eligibility determination, and support
planning.

Sec. 53. REPEALER.

(a) Minnesota Statutes 2016, sections 144A.351, subdivision 2; 256C.23, subdivision
3; 256C.233, subdivision 4; and 256C.25, subdivisions 1 and 2,
are repealed.

(b) Minnesota Statutes 2016, section 256B.4914, subdivision 16, is repealed effective
January 1, 2018.

(c) Laws 2012, chapter 247, article 4, section 47, as amended by Laws 2014, chapter
312, article 27, section 72, Laws 2015, chapter 71, article 7, section 58, Laws 2016, chapter
144, section 1; and Laws 2015, chapter 71, article 7, section 54,
are repealed upon the
effective date of section 44.

ARTICLE 2

HOUSING

Section 1.

Minnesota Statutes 2016, 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 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 description of 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 residents 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
consultation services under section 256B.0911 in the county in which the establishment is
located.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 2.

Minnesota Statutes 2016, section 144D.04, is amended by adding a subdivision to
read:


Subd. 2a.

Additional contract requirements.

(a) For a resident receiving one or more
health-related services from the establishment's arranged home care provider, as defined in
section 144D.01, subdivision 6, the contract must include the requirements in paragraph
(b). A restriction of a resident's rights under this subdivision is allowed only if determined
necessary for health and safety reasons identified by the home care provider's registered
nurse in an initial assessment or reassessment, as defined under section 144A.4791,
subdivision 8, and documented in the written service plan under section 144A.4791,
subdivision 9. Any restrictions of those rights for people served under sections 256B.0915
and 256B.49 must be documented in the resident's coordinated service and support plan
(CSSP), as defined under sections 256B.0915, subdivision 6 and 256B.49, subdivision 15.

(b) The contract must include a statement:

(1) regarding the ability of a resident to furnish and decorate the resident's unit within
the terms of the lease;

(2) regarding the resident's right to access food at any time;

(3) regarding a resident's right to choose the resident's visitors and times of visits;

(4) regarding the resident's right to choose a roommate if sharing a unit; and

(5) notifying the resident of the resident's right to have and use a lockable door to the
resident's unit. The landlord shall provide the locks on the unit. Only a staff member with
a specific need to enter the unit shall have keys, and advance notice must be given to the
resident before entrance, when possible.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 3.

Minnesota Statutes 2016, section 245A.03, subdivision 7, is amended to read:


Subd. 7.

Licensing moratorium.

(a) The commissioner shall not issue an initial license
for child foster care licensed under Minnesota Rules, parts 2960.3000 to 2960.3340, or adult
foster care licensed under Minnesota Rules, parts 9555.5105 to 9555.6265, under this chapter
for a physical location that will not be the primary residence of the license holder for the
entire period of licensure. If a license is issued during this moratorium, and the license
holder changes the license holder's primary residence away from the physical location of
the foster care license, the commissioner shall revoke the license according to section
245A.07. The commissioner shall not issue an initial license for a community residential
setting licensed under chapter 245D. Exceptions to the moratorium include:

(1) foster care settings that are required to be registered under chapter 144D;

(2) foster care licenses replacing foster care licenses in existence on May 15, 2009, or
community residential setting licenses replacing adult foster care licenses in existence on
December 31, 2013, and determined to be needed by the commissioner under paragraph
(b);

(3) new foster care licenses or community residential setting licenses determined to be
needed by the commissioner under paragraph (b) for the closure of a nursing facility, ICF/DD,
or regional treatment center; restructuring of state-operated services that limits the capacity
of state-operated facilities; or allowing movement to the community for people who no
longer require the level of care provided in state-operated facilities as provided under section
256B.092, subdivision 13, or 256B.49, subdivision 24;

(4) new foster care licenses or community residential setting licenses determined to be
needed by the commissioner under paragraph (b) for persons requiring hospital level care;
or

(5) new foster care licenses or community residential setting licenses determined to be
needed by the commissioner for the transition of people from personal care assistance to
the home and community-based services. When approving an exception under this paragraph,
the commissioner shall consider the resource need determination process in paragraph (h),
the availability of foster care licensed beds in the geographic area in which the licensee
seeks to operate, the results of a person's choices during their annual assessment and service
plan review, and the recommendation of the local county board. The determination by the
commissioner is final and not subject to appeal;

(6) new foster care licenses or community residential setting licenses determined to be
needed by the commissioner for the transition of people from the residential care waiver
services to foster care services. This exception applies only when:

(i) the person's case manager provided the person with information about the choice of
service, service provider, and location of service to help the person make an informed choice;
and

(ii) the person's foster care services are less than or equal to the cost of the person's
services delivered in the residential care waiver service setting as determined by the lead
agency; or

(7) new foster care licenses or community residential setting licenses for people receiving
services under chapter 245D and residing in an unlicensed setting before May 1, 2017, and
for which a license is required. This exception does not apply to people living in their own
home. For purposes of this clause, there is a presumption that a foster care or community
residential setting license is required for services provided to three or more people in a
dwelling unit when the setting is controlled by the provider. A license holder subject to this
exception may rebut the presumption that a license is required by seeking a reconsideration
of the commissioner's determination. The commissioner's disposition of a request for
reconsideration is final and not subject to appeal under chapter 14. The exception is available
until June 30, 2018. This exception is available when:

(i) the person's case manager provided the person with information about the choice of
service, service provider, and location of service, including in the person's home, to help
the person make an informed choice; and

(ii) the person's services provided in the licensed foster care or community residential
setting are less than or equal to the cost of the person's services delivered in the unlicensed
setting as determined by the lead agency
.

(b) The commissioner shall determine the need for newly licensed foster care homes or
community residential settings as defined under this subdivision. As part of the determination,
the commissioner shall consider the availability of foster care capacity in the area in which
the licensee seeks to operate, and the recommendation of the local county board. The
determination by the commissioner must be final. A determination of need is not required
for a change in ownership at the same address.

(c) When an adult resident served by the program moves out of a foster home that is not
the primary residence of the license holder according to section 256B.49, subdivision 15,
paragraph (f), or the adult community residential setting, the county shall immediately
inform the Department of Human Services Licensing Division. The department shall may
decrease the statewide licensed capacity for adult foster care settings where the physical
location is not the primary residence of the license holder, or for adult community residential
settings, if the voluntary changes described in paragraph (e) are not sufficient to meet the
savings required by reductions in licensed bed capacity under Laws 2011, First Special
Session chapter 9, article 7, sections 1 and 40, paragraph (f), and maintain statewide long-term
care residential services capacity within budgetary limits. Implementation of the statewide
licensed capacity reduction shall begin on July 1, 2013. The commissioner shall delicense
up to 128 beds by June 30, 2014, using the needs determination process. Prior to any
involuntary reduction of licensed capacity, the commissioner shall consult with lead agencies
and license holders to determine which adult foster care settings, where the physical location
is not the primary residence of the license holder, or community residential settings, are
licensed for up to five beds, but have operated at less than full capacity for 12 or more
months as of March 1, 2014. The settings that meet these criteria must be the first to be
considered for an involuntary decrease in statewide licensed capacity, up to a maximum of
35 beds. If more than 35 beds are identified that meet these criteria, the commissioner shall
prioritize the selection of those beds to be closed based on the length of time the beds have
been vacant. The longer a bed has been vacant, the higher priority it must be given for
closure. Under this paragraph, the commissioner has the authority to reduce unused licensed
capacity of a current foster care program, or the community residential settings, to accomplish
the consolidation or closure of settings. Under this paragraph, the commissioner has the
authority to manage statewide capacity, including adjusting the capacity available to each
county and adjusting statewide available capacity, to meet the statewide needs identified
through the process in paragraph (e). A decreased licensed capacity according to this
paragraph is not subject to appeal under this chapter
.

(d) Residential settings that would otherwise be subject to the decreased license capacity
established in paragraph (c) shall be exempt if the license holder's beds are occupied by
residents whose primary diagnosis is mental illness and the license holder is certified under
the requirements in subdivision 6a or section 245D.33.

(e) A resource need determination process, managed at the state level, using the available
reports required by section 144A.351, and other data and information shall be used to
determine where the reduced capacity required determined under paragraph (c) section
256B.493
will be implemented. The commissioner shall consult with the stakeholders
described in section 144A.351, and employ a variety of methods to improve the state's
capacity to meet the informed decisions of those people who want to move out of corporate
foster care or community residential settings,
long-term care service needs within budgetary
limits, including seeking proposals from service providers or lead agencies to change service
type, capacity, or location to improve services, increase the independence of residents, and
better meet needs identified by the long-term care services and supports reports and statewide
data and information. By February 1, 2013, and August 1, 2014, and each following year,
the commissioner shall provide information and data and targets on the overall capacity of
licensed long-term care services and supports, actions taken under this subdivision to manage
statewide long-term care services and supports resources, and any recommendations for
change to the legislative committees with jurisdiction over health and human services budget.

(f) At the time of application and reapplication for licensure, the applicant and the license
holder that are subject to the moratorium or an exclusion established in paragraph (a) are
required to inform the commissioner whether the physical location where the foster care
will be provided is or will be the primary residence of the license holder for the entire period
of licensure. If the primary residence of the applicant or license holder changes, the applicant
or license holder must notify the commissioner immediately. The commissioner shall print
on the foster care license certificate whether or not the physical location is the primary
residence of the license holder.

(g) License holders of foster care homes identified under paragraph (f) that are not the
primary residence of the license holder and that also provide services in the foster care home
that are covered by a federally approved home and community-based services waiver, as
authorized under section 256B.0915, 256B.092, or 256B.49, must inform the human services
licensing division that the license holder provides or intends to provide these waiver-funded
services.

(h) The commissioner may adjust capacity to address needs identified in section
144A.351. Under this authority, the commissioner may approve new licensed settings or
delicense existing settings. Delicensing of settings will be accomplished through a process
identified in section 256B.493. Annually, by August 1, the commissioner shall provide
information and data on capacity of licensed long-term services and supports, actions taken
under the subdivision to manage statewide long-term services and supports resources, and
any recommendations for change to the legislative committees with jurisdiction over the
health and human services budget.

(i) The commissioner must notify a license holder when its corporate foster care or
community residential setting licensed beds are reduced under this section. The notice of
reduction of licensed beds must be in writing and delivered to the license holder by certified
mail or personal service. The notice must state why the licensed beds are reduced and must
inform the license holder of its right to request reconsideration by the commissioner. The
license holder's request for reconsideration must be in writing. If mailed, the request for
reconsideration must be postmarked and sent to the commissioner within 20 calendar days
after the license holder's receipt of the notice of reduction of licensed beds. If a request for
reconsideration is made by personal service, it must be received by the commissioner within
20 calendar days after the license holder's receipt of the notice of reduction of licensed beds.

(j) The commissioner shall not issue an initial license for children's residential treatment
services licensed under Minnesota Rules, parts 2960.0580 to 2960.0700, under this chapter
for a program that Centers for Medicare and Medicaid Services would consider an institution
for mental diseases. Facilities that serve only private pay clients are exempt from the
moratorium described in this paragraph. The commissioner has the authority to manage
existing statewide capacity for children's residential treatment services subject to the
moratorium under this paragraph and may issue an initial license for such facilities if the
initial license would not increase the statewide capacity for children's residential treatment
services subject to the moratorium under this paragraph.

Sec. 4.

Minnesota Statutes 2016, section 245A.04, subdivision 14, is amended to read:


Subd. 14.

Policies and procedures for program administration required and
enforceable.

(a) The license holder shall develop program policies and procedures necessary
to maintain compliance with licensing requirements under Minnesota Statutes and Minnesota
Rules.

(b) The license holder shall:

(1) provide training to program staff related to their duties in implementing the program's
policies and procedures developed under paragraph (a);

(2) document the provision of this training; and

(3) monitor implementation of policies and procedures by program staff.

(c) The license holder shall keep program policies and procedures readily accessible to
staff and index the policies and procedures with a table of contents or another method
approved by the commissioner.

(d) An adult foster care license holder that provides foster care services to a resident
under section 256B.0915 must annually provide a copy of the resident termination policy
under section 245A.11, subdivision 11, to a resident covered by the policy.

Sec. 5.

Minnesota Statutes 2016, section 245A.11, is amended by adding a subdivision to
read:


Subd. 9.

Adult foster care bedrooms.

(a) A resident receiving services must have a
choice of roommate. Each roommate must consent in writing to sharing a bedroom with
one another. The license holder is responsible for notifying a resident of the resident's right
to request a change of roommate.

(b) The license holder must provide a lock for each resident's bedroom door, unless
otherwise indicated for the resident's health, safety, or well-being. A restriction on the use
of the lock must be documented and justified in the resident's individual abuse prevention
plan required by sections 245A.65, subdivision 2, paragraph (b), and 626.557, subdivision
14.For a resident served under section 256B.0915, the case manager must be part of the
interdisciplinary team under section 245A.65, subdivision 2, paragraph (b).

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 6.

Minnesota Statutes 2016, section 245A.11, is amended by adding a subdivision to
read:


Subd. 10.

Adult foster care resident rights.

(a) The license holder shall ensure that a
resident and a resident's legal representative are given, at admission:

(1) an explanation and copy of the resident's rights specified in paragraph (b);

(2) a written summary of the Vulnerable Adults Protection Act prepared by the
department; and

(3) the name, address, and telephone number of the local agency to which a resident or
a resident's legal representative may submit an oral or written complaint.

(b) Adult foster care resident rights include the right to:

(1) have daily, private access to and use of a non-coin-operated telephone for local and
long-distance telephone calls made collect or paid for by the resident;

(2) receive and send, without interference, uncensored, unopened mail or electronic
correspondence or communication;

(3) have use of and free access to common areas in the residence and the freedom to
come and go from the residence at will;

(4) have privacy for visits with the resident's spouse, next of kin, legal counsel, religious
adviser, or others, according to section 363A.09 of the Human Rights Act, including privacy
in the resident's bedroom;

(5) keep, use, and access the resident's personal clothing and possessions as space permits,
unless this right infringes on the health, safety, or rights of another resident or household
member, including the right to access the resident's personal possessions at any time;

(6) choose the resident's visitors and time of visits and participate in activities of
commercial, religious, political, and community groups without interference if the activities
do not infringe on the rights of another resident or household member;

(7) if married, privacy for visits by the resident's spouse, and, if both spouses are residents
of the adult foster home, the residents have the right to share a bedroom and bed;

(8) privacy, including use of the lock on the resident's bedroom door or unit door. A
resident's privacy must be respected by license holders, caregivers, household members,
and volunteers by knocking on the door of a resident's bedroom or bathroom and seeking
consent before entering, except in an emergency;

(9) furnish and decorate the resident's bedroom or living unit;

(10) engage in chosen activities and have an individual schedule supported by the license
holder that meets the resident's preferences;

(11) freedom and support to access food at any time;

(12) have personal, financial, service, health, and medical information kept private, and
be advised of disclosure of this information by the license holder;

(13) access records and recorded information about the resident according to applicable
state and federal law, regulation, or rule;

(14) be free from maltreatment;

(15) be treated with courtesy and respect and receive respectful treatment of the resident's
property;

(16) reasonable observance of cultural and ethnic practice and religion;

(17) be free from bias and harassment regarding race, gender, age, disability, spirituality,
and sexual orientation;

(18) be informed of and use the license holder's grievance policy and procedures,
including how to contact the highest level of authority in the program;

(19) assert the resident's rights personally, or have the rights asserted by the resident's
family, authorized representative, or legal representative, without retaliation; and

(20) give or withhold written informed consent to participate in any research or
experimental treatment.

(c) A restriction of a resident's rights under paragraph (b), clauses (1) to (4), (6), (8),
(10), and (11), is allowed only if determined necessary to ensure the health, safety, and
well-being of the resident. Any restriction of a resident's right must be documented and
justified in the resident's individual abuse prevention plan required by sections 245A.65,
subdivision 2, paragraph (b) and 626.557, subdivision 14. For a resident served under section
256B.0915, the case manager must be part of the interdisciplinary team under section
245A.65, subdivision 2, paragraph (b). The restriction must be implemented in the least
restrictive manner necessary to protect the resident and provide support to reduce or eliminate
the need for the restriction.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 7.

Minnesota Statutes 2016, section 245A.11, is amended by adding a subdivision to
read:


Subd. 11.

Adult foster care service termination for elderly waiver participants.

(a)
This subdivision applies to foster care services for a resident served under section 256B.0915.

(b) The foster care license holder must establish policies and procedures for service
termination that promote continuity of care and service coordination with the resident and
the case manager and with another licensed caregiver, if any, who also provides support to
the resident. The policy must include the requirements specified in paragraphs (c) to (h).

(c) The license holder must allow a resident to remain in the program and cannot terminate
services unless:

(1) the termination is necessary for the resident's health, safety, and well-being and the
resident's needs cannot be met in the facility;

(2) the safety of the resident or another resident in the program is endangered and positive
support strategies were attempted and have not achieved and effectively maintained safety
for the resident or another resident in the program;

(3) the health, safety, and well-being of the resident or another resident in the program
would otherwise be endangered;

(4) the program was not paid for services;

(5) the program ceases to operate; or

(6) the resident was terminated by the lead agency from waiver eligibility.

(d) Before giving notice of service termination, the license holder must document the
action taken to minimize or eliminate the need for termination. The action taken by the
license holder must include, at a minimum:

(1) consultation with the resident's interdisciplinary team to identify and resolve issues
leading to a notice of service termination; and

(2) a request to the case manager or other professional consultation or intervention
services to support the resident in the program. This requirement does not apply to a notice
of service termination issued under paragraph (c), clause (4) or (5).

(e) If, based on the best interests of the resident, the circumstances at the time of notice
were such that the license holder was unable to take the action specified in paragraph (d),
the license holder must document the specific circumstances and the reason the license
holder was unable to take the action.

(f) The license holder must notify the resident or the resident's legal representative and
the case manager in writing of the intended service termination. The notice must include:

(1) the reason for the action;

(2) except for service termination under paragraph (c), clause (4) or (5), a summary of
the action taken to minimize or eliminate the need for termination and the reason the action
failed to prevent the termination;

(3) the resident's right to appeal the service termination under section 256.045, subdivision
3, paragraph (a); and

(4) the resident's right to seek a temporary order staying the service termination according
to the procedures in section 256.045, subdivision 4a, or subdivision 6, paragraph (c).

(g) Notice of the proposed service termination must be given at least 30 days before
terminating a resident's service.

(h) After the resident receives the notice of service termination and before the services
are terminated, the license holder must:

(1) work with the support team or expanded support team to develop reasonable
alternatives to support continuity of care and to protect the resident;

(2) provide information requested by the resident or case manager; and

(3) maintain information about the service termination, including the written notice of
service termination, in the resident's record.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 8.

Minnesota Statutes 2016, section 245D.04, subdivision 3, is amended to read:


Subd. 3.

Protection-related rights.

(a) A person's protection-related rights include the
right to:

(1) have personal, financial, service, health, and medical information kept private, and
be advised of disclosure of this information by the license holder;

(2) access records and recorded information about the person in accordance with
applicable state and federal law, regulation, or rule;

(3) be free from maltreatment;

(4) be free from restraint, time out, seclusion, restrictive intervention, or other prohibited
procedure identified in section 245D.06, subdivision 5, or successor provisions, except for:
(i) emergency use of manual restraint to protect the person from imminent danger to self
or others according to the requirements in section 245D.061 or successor provisions; or (ii)
the use of safety interventions as part of a positive support transition plan under section
245D.06, subdivision 8, or successor provisions;

(5) receive services in a clean and safe environment when the license holder is the owner,
lessor, or tenant of the service site;

(6) be treated with courtesy and respect and receive respectful treatment of the person's
property;

(7) reasonable observance of cultural and ethnic practice and religion;

(8) be free from bias and harassment regarding race, gender, age, disability, spirituality,
and sexual orientation;

(9) be informed of and use the license holder's grievance policy and procedures, including
knowing how to contact persons responsible for addressing problems and to appeal under
section 256.045;

(10) know the name, telephone number, and the Web site, e-mail, and street addresses
of protection and advocacy services, including the appropriate state-appointed ombudsman,
and a brief description of how to file a complaint with these offices;

(11) assert these rights personally, or have them asserted by the person's family,
authorized representative, or legal representative, without retaliation;

(12) give or withhold written informed consent to participate in any research or
experimental treatment;

(13) associate with other persons of the person's choice;

(14) personal privacy, including the right to use the lock on the person's bedroom or unit
door
; and

(15) engage in chosen activities; and

(16) access to the person's personal possessions at any time, including financial resources.

(b) For a person residing in a residential site licensed according to chapter 245A, or
where the license holder is the owner, lessor, or tenant of the residential service site,
protection-related rights also include the right to:

(1) have daily, private access to and use of a non-coin-operated telephone for local calls
and long-distance calls made collect or paid for by the person;

(2) receive and send, without interference, uncensored, unopened mail or electronic
correspondence or communication;

(3) have use of and free access to common areas in the residence and the freedom to
come and go from the residence at will
; and

(4) choose the person's visitors and time of visits and have privacy for visits with the
person's spouse, next of kin, legal counsel, religious advisor adviser, or others, in accordance
with section 363A.09 of the Human Rights Act, including privacy in the person's bedroom.;

(5) the freedom and support to access food at any time;

(6) the freedom to furnish and decorate the person's bedroom or living unit;

(7) a setting that is clean and free from accumulation of dirt, grease, garbage, peeling
paint, mold, vermin, and insects;

(8) a setting that is free from hazards that threaten the person's health or safety;

(9) a setting that meets state and local building and zoning definitions of a dwelling unit
in a residential occupancy; and

(10) have access to potable water and three nutritionally balanced meals and nutritious
snacks between meals each day.

(c) Restriction of a person's rights under paragraph (a), clauses (13) to (15) (16), or
paragraph (b) is allowed only if determined necessary to ensure the health, safety, and
well-being of the person. Any restriction of those rights must be documented in the person's
coordinated service and support plan or coordinated service and support plan addendum.
The restriction must be implemented in the least restrictive alternative manner necessary
to protect the person and provide support to reduce or eliminate the need for the restriction
in the most integrated setting and inclusive manner. The documentation must include the
following information:

(1) the justification for the restriction based on an assessment of the person's vulnerability
related to exercising the right without restriction;

(2) the objective measures set as conditions for ending the restriction;

(3) a schedule for reviewing the need for the restriction based on the conditions for
ending the restriction to occur semiannually from the date of initial approval, at a minimum,
or more frequently if requested by the person, the person's legal representative, if any, and
case manager; and

(4) signed and dated approval for the restriction from the person, or the person's legal
representative, if any. A restriction may be implemented only when the required approval
has been obtained. Approval may be withdrawn at any time. If approval is withdrawn, the
right must be immediately and fully restored.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 9.

Minnesota Statutes 2016, section 245D.071, subdivision 3, is amended to read:


Subd. 3.

Assessment and initial service planning.

(a) Within 15 days of service initiation
the license holder must complete a preliminary coordinated service and support plan
addendum based on the coordinated service and support plan.

(b) Within the scope of services, the license holder must, at a minimum, complete
assessments in the following areas before the 45-day planning meeting:

(1) the person's ability to self-manage health and medical needs to maintain or improve
physical, mental, and emotional well-being, including, when applicable, allergies, seizures,
choking, special dietary needs, chronic medical conditions, self-administration of medication
or treatment orders, preventative screening, and medical and dental appointments;

(2) the person's ability to self-manage personal safety to avoid injury or accident in the
service setting, including, when applicable, risk of falling, mobility, regulating water
temperature, community survival skills, water safety skills, and sensory disabilities; and

(3) the person's ability to self-manage symptoms or behavior that may otherwise result
in an incident as defined in section 245D.02, subdivision 11, clauses (4) to (7), suspension
or termination of services by the license holder, or other symptoms or behaviors that may
jeopardize the health and welfare of the person or others.

Assessments must produce information about the person that describes the person's overall
strengths, functional skills and abilities, and behaviors or symptoms. Assessments must be
based on the person's status within the last 12 months at the time of service initiation.
Assessments based on older information must be documented and justified. Assessments
must be conducted annually at a minimum or within 30 days of a written request from the
person or the person's legal representative or case manager. The results must be reviewed
by the support team or expanded support team as part of a service plan review.

(c) Within 45 days of service initiation, the license holder must meet with the person,
the person's legal representative, the case manager, and other members of the support team
or expanded support team to determine the following based on information obtained from
the assessments identified in paragraph (b), the person's identified needs in the coordinated
service and support plan, and the requirements in subdivision 4 and section 245D.07,
subdivision 1a
:

(1) the scope of the services to be provided to support the person's daily needs and
activities;

(2) the person's desired outcomes and the supports necessary to accomplish the person's
desired outcomes;

(3) the person's preferences for how services and supports are provided, including how
the provider will support the person to have control of the person's schedule
;

(4) whether the current service setting is the most integrated setting available and
appropriate for the person; and

(5) how services must be coordinated across other providers licensed under this chapter
serving the person and members of the support team or expanded support team to ensure
continuity of care and coordination of services for the person.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 10.

Minnesota Statutes 2016, section 245D.11, subdivision 4, is amended to read:


Subd. 4.

Admission criteria.

The license holder must establish policies and procedures
that promote continuity of care by ensuring that admission or service initiation criteria:

(1) is consistent with the service-related rights identified in section 245D.04, subdivisions
2
, clauses (4) to (7), and 3, clause (8);

(2) identifies the criteria to be applied in determining whether the license holder can
develop services to meet the needs specified in the person's coordinated service and support
plan;

(3) requires a license holder providing services in a health care facility to comply with
the requirements in section 243.166, subdivision 4b, to provide notification to residents
when a registered predatory offender is admitted into the program or to a potential admission
when the facility was already serving a registered predatory offender. For purposes of this
clause, "health care facility" means a facility licensed by the commissioner as a residential
facility under chapter 245A to provide adult foster care or residential services to persons
with disabilities; and

(4) requires that when a person or the person's legal representative requests services
from the license holder, a refusal to admit the person must be based on an evaluation of the
person's assessed needs and the license holder's lack of capacity to meet the needs of the
person. The license holder must not refuse to admit a person based solely on the type of
residential services the person is receiving, or solely on the person's severity of disability,
orthopedic or neurological handicaps, sight or hearing impairments, lack of communication
skills, physical disabilities, toilet habits, behavioral disorders, or past failure to make progress.
Documentation of the basis for refusal must be provided to the person or the person's legal
representative and case manager upon request.; and

(5) requires the person or the person's legal representative and license holder to sign and
date the residency agreement when the license holder provides foster care or supported
living services under section 245D.03, subdivision 1, paragraph (c), clause (3), item (i) or
(ii), to a person living in a community residential setting defined in section 245D.02,
subdivision 4a; an adult foster home defined in Minnesota Rules, part 9555.5105, subpart
5; or a foster family home defined in Minnesota Rules, part 9560.0521, subpart 12. The
residency agreement must include service termination requirements specified in section
245D.10, subdivision 3a, paragraphs (b) to (f). The residency agreement must be reviewed
annually, dated, and signed by the person or the person's legal representative and license
holder.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 11.

Minnesota Statutes 2016, section 245D.24, subdivision 3, is amended to read:


Subd. 3.

Bedrooms.

(a) People Each person receiving services must have a choice of
roommate and
must mutually consent, in writing, to sharing a bedroom with one another.
No more than two people receiving services may share one bedroom.

(b) A single occupancy bedroom must have at least 80 square feet of floor space with a
7-1/2 foot ceiling. A double occupancy room must have at least 120 square feet of floor
space with a 7-1/2 foot ceiling. Bedrooms must be separated from halls, corridors, and other
habitable rooms by floor-to-ceiling walls containing no openings except doorways and must
not serve as a corridor to another room used in daily living.

(c) A person's personal possessions and items for the person's own use are the only items
permitted to be stored in a person's bedroom.

(d) Unless otherwise documented through assessment as a safety concern for the person,
each person must be provided with the following furnishings:

(1) a separate bed of proper size and height for the convenience and comfort of the
person, with a clean mattress in good repair;

(2) clean bedding appropriate for the season for each person;

(3) an individual cabinet, or dresser, shelves, and a closet, for storage of personal
possessions and clothing; and

(4) a mirror for grooming.

(e) When possible, a person must be allowed to have items of furniture that the person
personally owns in the bedroom, unless doing so would interfere with safety precautions,
violate a building or fire code, or interfere with another person's use of the bedroom. A
person may choose not to have a cabinet, dresser, shelves, or a mirror in the bedroom, as
otherwise required under paragraph (d), clause (3) or (4). A person may choose to use a
mattress other than an innerspring mattress and may choose not to have the mattress on a
mattress frame or support. If a person chooses not to have a piece of required furniture, the
license holder must document this choice and is not required to provide the item. If a person
chooses to use a mattress other than an innerspring mattress or chooses not to have a mattress
frame or support, the license holder must document this choice and allow the alternative
desired by the person.

(f) A person must be allowed to bring personal possessions into the bedroom and other
designated storage space, if such space is available, in the residence. The person must be
allowed to accumulate possessions to the extent the residence is able to accommodate them,
unless doing so is contraindicated for the person's physical or mental health, would interfere
with safety precautions or another person's use of the bedroom, or would violate a building
or fire code. The license holder must allow for locked storage of personal items. Any
restriction on the possession or locked storage of personal items, including requiring a
person to use a lock provided by the license holder, must comply with section 245D.04,
subdivision 3
, paragraph (c), and allow the person to be present if and when the license
holder opens the lock.

(g) A person must be allowed to lock the person's bedroom door. The license holder
must document and assess the physical plant and the environment, and the population served,
and identify the risk factors that require using locked doors, and the specific action taken
to minimize the safety risk to a person receiving services at the site.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 12.

Minnesota Statutes 2016, section 256.045, subdivision 3, is amended to read:


Subd. 3.

State agency hearings.

(a) State agency hearings are available for the following:

(1) any person applying for, receiving or having received public assistance, medical
care, or a program of social services granted by the state agency or a county agency or the
federal Food Stamp Act whose application for assistance is denied, not acted upon with
reasonable promptness, or whose assistance is suspended, reduced, terminated, or claimed
to have been incorrectly paid;

(2) any patient or relative aggrieved by an order of the commissioner under section
252.27;

(3) a party aggrieved by a ruling of a prepaid health plan;

(4) except as provided under chapter 245C, any individual or facility determined by a
lead investigative agency to have maltreated a vulnerable adult under section 626.557 after
they have exercised their right to administrative reconsideration under section 626.557;

(5) any person whose claim for foster care payment according to a placement of the
child resulting from a child protection assessment under section 626.556 is denied or not
acted upon with reasonable promptness, regardless of funding source;

(6) any person to whom a right of appeal according to this section is given by other
provision of law;

(7) an applicant aggrieved by an adverse decision to an application for a hardship waiver
under section 256B.15;

(8) an applicant aggrieved by an adverse decision to an application or redetermination
for a Medicare Part D prescription drug subsidy under section 256B.04, subdivision 4a;

(9) except as provided under chapter 245A, an individual or facility determined to have
maltreated a minor under section 626.556, after the individual or facility has exercised the
right to administrative reconsideration under section 626.556;

(10) except as provided under chapter 245C, an individual disqualified under sections
245C.14 and 245C.15, following a reconsideration decision issued under section 245C.23,
on the basis of serious or recurring maltreatment; a preponderance of the evidence that the
individual has committed an act or acts that meet the definition of any of the crimes listed
in section 245C.15, subdivisions 1 to 4; or for failing to make reports required under section
626.556, subdivision 3, or 626.557, subdivision 3. Hearings regarding a maltreatment
determination under clause (4) or (9) and a disqualification under this clause in which the
basis for a disqualification is serious or recurring maltreatment, shall be consolidated into
a single fair hearing. In such cases, the scope of review by the human services judge shall
include both the maltreatment determination and the disqualification. The failure to exercise
the right to an administrative reconsideration shall not be a bar to a hearing under this section
if federal law provides an individual the right to a hearing to dispute a finding of
maltreatment;

(11) any person with an outstanding debt resulting from receipt of public assistance,
medical care, or the federal Food Stamp Act who is contesting a setoff claim by the
Department of Human Services or a county agency. The scope of the appeal is the validity
of the claimant agency's intention to request a setoff of a refund under chapter 270A against
the debt;

(12) a person issued a notice of service termination under section 245D.10, subdivision
3a, from residential supports and services as defined in section 245D.03, subdivision 1,
paragraph (c), clause (3), that is not otherwise subject to appeal under subdivision 4a; or

(13) an individual disability waiver recipient based on a denial of a request for a rate
exception under section 256B.4914.; or

(14) a person issued a notice of service termination under section 245A.11, subdivision
11, that is not otherwise subject to appeal under subdivision 4a.

(b) The hearing for an individual or facility under paragraph (a), clause (4), (9), or (10),
is the only administrative appeal to the final agency determination specifically, including
a challenge to the accuracy and completeness of data under section 13.04. Hearings requested
under paragraph (a), clause (4), apply only to incidents of maltreatment that occur on or
after October 1, 1995. Hearings requested by nursing assistants in nursing homes alleged
to have maltreated a resident prior to October 1, 1995, shall be held as a contested case
proceeding under the provisions of chapter 14. Hearings requested under paragraph (a),
clause (9), apply only to incidents of maltreatment that occur on or after July 1, 1997. A
hearing for an individual or facility under paragraph (a), clauses (4), (9), and (10), is only
available when there is no district court action pending. If such action is filed in district
court while an administrative review is pending that arises out of some or all of the events
or circumstances on which the appeal is based, the administrative review must be suspended
until the judicial actions are completed. If the district court proceedings are completed,
dismissed, or overturned, the matter may be considered in an administrative hearing.

(c) For purposes of this section, bargaining unit grievance procedures are not an
administrative appeal.

(d) The scope of hearings involving claims to foster care payments under paragraph (a),
clause (5), shall be limited to the issue of whether the county is legally responsible for a
child's placement under court order or voluntary placement agreement and, if so, the correct
amount of foster care payment to be made on the child's behalf and shall not include review
of the propriety of the county's child protection determination or child placement decision.

(e) The scope of hearings under paragraph (a), clause clauses (12) and (14), shall be
limited to whether the proposed termination of services is authorized under section 245D.10,
subdivision 3a
, paragraph (b), or 245A.11, subdivision 11, and whether the requirements
of section 245D.10, subdivision 3a, paragraph paragraphs (c) to (e), or 245A.11, subdivision
2a, paragraphs (d) to (f)
, were met. If the appeal includes a request for a temporary stay of
termination of services, the scope of the hearing shall also include whether the case
management provider has finalized arrangements for a residential facility, a program, or
services that will meet the assessed needs of the recipient by the effective date of the service
termination.

(f) A vendor of medical care as defined in section 256B.02, subdivision 7, or a vendor
under contract with a county agency to provide social services is not a party and may not
request a hearing under this section, except if assisting a recipient as provided in subdivision
4.

(g) An applicant or recipient is not entitled to receive social services beyond the services
prescribed under chapter 256M or other social services the person is eligible for under state
law.

(h) The commissioner may summarily affirm the county or state agency's proposed
action without a hearing when the sole issue is an automatic change due to a change in state
or federal law.

(i) Unless federal or Minnesota law specifies a different time frame in which to file an
appeal, an individual or organization specified in this section may contest the specified
action, decision, or final disposition before the state agency by submitting a written request
for a hearing to the state agency within 30 days after receiving written notice of the action,
decision, or final disposition, or within 90 days of such written notice if the applicant,
recipient, patient, or relative shows good cause, as defined in section 256.0451, subdivision
13, why the request was not submitted within the 30-day time limit. The individual filing
the appeal has the burden of proving good cause by a preponderance of the evidence.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 13.

[256B.051] HOUSING SUPPORT SERVICES.

Subdivision 1.

Purpose.

Housing support services are established to provide housing
support services to an individual with a disability that limits the individual's ability to obtain
or maintain stable housing. The services support an individual's transition to housing in the
community and increase long-term stability in housing, to avoid future periods of being at
risk of homelessness or institutionalization.

Subd. 2.

Definitions.

(a) For the purposes of this section, the terms defined in this
subdivision have the meanings given.

(b) "At-risk of homelessness" means (1) an individual that is faced with a set of
circumstances likely to cause the individual to become homeless, or (2) an individual
previously homeless, who will be discharged from a correctional, medical, mental health,
or treatment center, who lacks sufficient resources to pay for housing and does not have a
permanent place to live.

(c) "Commissioner" means the commissioner of human services.

(d) "Homeless" means an individual or family lacking a fixed, adequate nighttime
residence.

(e) "Individual with a disability" means:

(1) an individual who is aged, blind, or disabled as determined by the criteria used by
the title 11 program of the Social Security Act, United States Code, title 42, section 416,
paragraph (i), item (1); or

(2) an individual who meets a category of eligibility under section 256D.05, subdivision
1, paragraph (a), clauses (1), (3), (5) to (9), or (14).

(f) "Institution" means a setting as defined in section 256B.0621, subdivision 2, clause
(3), and the Minnesota Security Hospital as defined in section 253.20.

Subd. 3.

Eligibility.

An individual with a disability is eligible for housing support services
if the individual:

(1) is 18 years of age or older;

(2) is enrolled in medical assistance;

(3) has an assessment of functional need that determines a need for services due to
limitations caused by the individual's disability;

(4) resides in or plans to transition to a community-based setting as defined in Code of
Federal Regulations, title 42, section 441.301(c); and

(5) has housing instability evidenced by:

(i) being homeless or at-risk of homelessness;

(ii) being in the process of transitioning from, or having transitioned in the past six
months from, an institution or licensed or registered setting;

(iii) being eligible for waiver services under section 256B.0915, 256B.092, or 256B.49;
or

(iv) having been identified by a long-term care consultation under section 256B.0911
as at risk of institutionalization.

Subd. 4.

Assessment requirements.

(a) An individual's assessment of functional need
must be conducted by one of the following methods:

(1) an assessor according to the criteria established in section 256B.0911, subdivision
3a, using a format established by the commissioner;

(2) documented need for services as verified by a professional statement of need as
defined in section 256I.03, subdivision 12; or

(3) according to the continuum of care coordinated assessment system established in
Code of Federal Regulations, title 24, section 578.3, using a format established by the
commissioner.

(b) An individual must be reassessed within one year of initial assessment, and annually
thereafter.

Subd. 5.

Housing support services.

(a) Housing support services include housing
transition services and housing and tenancy sustaining services.

(b) Housing transition services are defined as:

(1) tenant screening and housing assessment;

(2) assistance with the housing search and application process;

(3) identifying resources to cover onetime moving expenses;

(4) ensuring a new living arrangement is safe and ready for move-in;

(5) assisting in arranging for and supporting details of a move; and

(6) developing a housing support crisis plan.

(c) Housing and tenancy sustaining services include:

(1) prevention and early identification of behaviors that may jeopardize continued stable
housing;

(2) education and training on roles, rights, and responsibilities of the tenant and the
property manager;

(3) coaching to develop and maintain key relationships with property managers and
neighbors;

(4) advocacy and referral to community resources to prevent eviction when housing is
at risk;

(5) assistance with housing recertification process;

(6) coordination with the tenant to regularly review, update, and modify housing support
and crisis plan; and

(7) continuing training on being a good tenant, lease compliance, and household
management.

(d) A housing support service may include person-centered planning for people who are
not eligible to receive person-centered planning through any other service, if the
person-centered planning is provided by a consultation service provider that is under contract
with the department and enrolled as a Minnesota health care program.

Subd. 6.

Provider qualifications and duties.

A provider eligible for reimbursement
under this section shall:

(1) enroll as a medical assistance Minnesota health care program provider and meet all
applicable provider standards and requirements;

(2) demonstrate compliance with federal and state laws and policies for housing support
services as determined by the commissioner;

(3) comply with background study requirements under chapter 245C and maintain
documentation of background study requests and results; and

(4) directly provide housing support services and not use a subcontractor or reporting
agent.

Subd. 7.

Housing support supplemental service rates.

Supplemental service rates for
individuals in settings according to sections 144D.025, 256I.04, subdivision 3, paragraph
(a), clause (3), and 256I.05, subdivision 1g, shall be reduced by one-half over a two-year
period. This reduction only applies to supplemental service rates for individuals eligible for
housing support services under this section.

EFFECTIVE DATE.

(a) Subdivisions 1 to 6 are contingent upon federal approval. The
commissioner of human services shall notify the revisor of statutes when federal approval
is obtained.

(b) Subdivision 7 is contingent upon federal approval of subdivisions 1 to 6. The
commissioner of human services shall notify the revisor of statutes when federal approval
is obtained.

Sec. 14.

Minnesota Statutes 2016, section 256B.0911, subdivision 3a, is amended to read:


Subd. 3a.

Assessment and support planning.

(a) Persons requesting assessment, services
planning, or other assistance intended to support community-based living, including persons
who need assessment in order to determine waiver or alternative care program eligibility,
must be visited by a long-term care consultation team within 20 calendar days after the date
on which an assessment was requested or recommended. Upon statewide implementation
of subdivisions 2b, 2c, and 5, this requirement also applies to an assessment of a person
requesting personal care assistance services and home care nursing. The commissioner shall
provide at least a 90-day notice to lead agencies prior to the effective date of this requirement.
Face-to-face assessments must be conducted according to paragraphs (b) to (i).

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

(c) The MnCHOICES assessment provided by the commissioner to lead agencies must
be used to complete a comprehensive, 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 in a face-to-face interview with the person being
assessed and the person's legal representative. 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 services under section 256B.0915, 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 prepared
by a direct service employee with at least 20 hours of service to that client. The person
conducting the assessment or reassessment 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 and the person or the person's legal representative, and must be
considered prior to the finalization of the assessment or reassessment.

(e) The person or the person's legal representative must be provided with a written
community support plan within 40 calendar days of the assessment visit, regardless of
whether the individual is eligible for Minnesota health care programs. 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;

(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.

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

(g) 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).

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

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

(2) documentation that the most cost-effective alternatives available were offered to the
individual. For purposes of this clause, "cost-effective" means community services and
living arrangements that cost the same as or less than institutional care. For an individual
found to meet eligibility criteria for home and community-based service programs under
section 256B.0915 or 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
or the lead agency's final decisions regarding public programs eligibility according to section
256.045, subdivision 3.

(i) Face-to-face assessment completed as part of eligibility determination for the
alternative care, elderly waiver, community access for disability inclusion, community
alternative care, and brain injury waiver programs under sections 256B.0913, 256B.0915,
and 256B.49 is valid to establish service eligibility for no more than 60 calendar days after
the date of assessment.

(j) The effective eligibility start date for programs in paragraph (i) 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 (i)
cannot be prior to the date the most recent updated assessment is completed.

(k) 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 settings 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. 15.

Minnesota Statutes 2016, section 256B.0915, subdivision 1, is amended to read:


Subdivision 1.

Authority.

(a) The commissioner is authorized to apply for a home and
community-based services waiver for the elderly, authorized under section 1915(c) of the
Social Security Act, in order to obtain federal financial participation to expand the availability
of services for persons who are eligible for medical assistance. The commissioner may
apply for additional waivers or pursue other federal financial participation which is
advantageous to the state for funding home care services for the frail elderly who are eligible
for medical assistance. The provision of waivered services to elderly and disabled medical
assistance recipients must comply with the criteria for service definitions and provider
standards approved in the waiver.

(b) The commissioner shall comply with the requirements in the federally approved
transition plan for the home and community-based services waivers authorized under this
section.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 16.

Minnesota Statutes 2016, section 256B.092, subdivision 4, is amended to read:


Subd. 4.

Home and community-based services for developmental disabilities.

(a)
The commissioner shall make payments to approved vendors participating in the medical
assistance program to pay costs of providing home and community-based services, including
case management service activities provided as an approved home and community-based
service, to medical assistance eligible persons with developmental disabilities who have
been screened under subdivision 7 and according to federal requirements. Federal
requirements include those services and limitations included in the federally approved
application for home and community-based services for persons with developmental
disabilities and subsequent amendments.

(b) Effective July 1, 1995, contingent upon federal approval and state appropriations
made available for this purpose, and in conjunction with Laws 1995, chapter 207, article 8,
section 40, the commissioner of human services shall allocate resources to county agencies
for home and community-based waivered services for persons with developmental disabilities
authorized but not receiving those services as of June 30, 1995, based upon the average
resource need of persons with similar functional characteristics. To ensure service continuity
for service recipients receiving home and community-based waivered services for persons
with developmental disabilities prior to July 1, 1995, the commissioner shall make available
to the county of financial responsibility home and community-based waivered services
resources based upon fiscal year 1995 authorized levels.

(c) Home and community-based resources for all recipients shall be managed by the
county of financial responsibility within an allowable reimbursement average established
for each county. Payments for home and community-based services provided to individual
recipients shall not exceed amounts authorized by the county of financial responsibility.
For specifically identified former residents of nursing facilities, the commissioner shall be
responsible for authorizing payments and payment limits under the appropriate home and
community-based service program. Payment is available under this subdivision only for
persons who, if not provided these services, would require the level of care provided in an
intermediate care facility for persons with developmental disabilities.

(d) The commissioner shall comply with the requirements in the federally approved
transition plan for the home and community-based services waivers for the elderly authorized
under this section.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 17.

Minnesota Statutes 2016, section 256B.49, subdivision 11, is amended to read:


Subd. 11.

Authority.

(a) The commissioner is authorized to apply for home and
community-based service waivers, as authorized under section 1915(c) of the Social Security
Act to serve persons under the age of 65 who are determined to require the level of care
provided in a nursing home and persons who require the level of care provided in a hospital.
The commissioner shall apply for the home and community-based waivers in order to:

(1) promote the support of persons with disabilities in the most integrated settings;

(2) expand the availability of services for persons who are eligible for medical assistance;

(3) promote cost-effective options to institutional care; and

(4) obtain federal financial participation.

(b) The provision of waivered services to medical assistance recipients with disabilities
shall comply with the requirements outlined in the federally approved applications for home
and community-based services and subsequent amendments, including provision of services
according to a service plan designed to meet the needs of the individual. For purposes of
this section, the approved home and community-based application is considered the necessary
federal requirement.

(c) The commissioner shall provide interested persons serving on agency advisory
committees, task forces, the Centers for Independent Living, and others who request to be
on a list to receive, notice of, and an opportunity to comment on, at least 30 days before
any effective dates, (1) any substantive changes to the state's disability services program
manual, or (2) changes or amendments to the federally approved applications for home and
community-based waivers, prior to their submission to the federal Centers for Medicare
and Medicaid Services.

(d) The commissioner shall seek approval, as authorized under section 1915(c) of the
Social Security Act, to allow medical assistance eligibility under this section for children
under age 21 without deeming of parental income or assets.

(e) The commissioner shall seek approval, as authorized under section 1915(c) of the
Social Act, to allow medical assistance eligibility under this section for individuals under
age 65 without deeming the spouse's income or assets.

(f) The commissioner shall comply with the requirements in the federally approved
transition plan for the home and community-based services waivers authorized under this
section.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 18.

Minnesota Statutes 2016, section 256B.49, subdivision 15, is amended to read:


Subd. 15.

Coordinated service and support plan; comprehensive transitional service
plan; maintenance service plan.

(a) Each recipient of home and community-based waivered
services shall be provided a copy of the written coordinated service and support plan which
meets the requirements in section 256B.092, subdivision 1b.

(b) In developing the comprehensive transitional service plan, the individual receiving
services, the case manager, and the guardian, if applicable, will identify the transitional
service plan fundamental service outcome and anticipated timeline to achieve this outcome.
Within the first 20 days following a recipient's request for an assessment or reassessment,
the transitional service planning team must be identified. A team leader must be identified
who will be responsible for assigning responsibility and communicating with team members
to ensure implementation of the transition plan and ongoing assessment and communication
process. The team leader should be an individual, such as the case manager or guardian,
who has the opportunity to follow the recipient to the next level of service.

Within ten days following an assessment, a comprehensive transitional service plan must
be developed incorporating elements of a comprehensive functional assessment and including
short-term measurable outcomes and timelines for achievement of and reporting on these
outcomes. Functional milestones must also be identified and reported according to the
timelines agreed upon by the transitional service planning team. In addition, the
comprehensive transitional service plan must identify additional supports that may assist
in the achievement of the fundamental service outcome such as the development of greater
natural community support, increased collaboration among agencies, and technological
supports.

The timelines for reporting on functional milestones will prompt a reassessment of
services provided, the units of services, rates, and appropriate service providers. It is the
responsibility of the transitional service planning team leader to review functional milestone
reporting to determine if the milestones are consistent with observable skills and that
milestone achievement prompts any needed changes to the comprehensive transitional
service plan.

For those whose fundamental transitional service outcome involves the need to procure
housing, a plan for the recipient to seek the resources necessary to secure the least restrictive
housing possible should be incorporated into the plan, including employment and public
supports such as housing access and shelter needy funding.

(c) Counties and other agencies responsible for funding community placement and
ongoing community supportive services are responsible for the implementation of the
comprehensive transitional service plans. Oversight responsibilities include both ensuring
effective transitional service delivery and efficient utilization of funding resources.

(d) Following one year of transitional services, the transitional services planning team
will make a determination as to whether or not the individual receiving services requires
the current level of continuous and consistent support in order to maintain the recipient's
current level of functioning. Recipients who are determined to have not had a significant
change in functioning for 12 months must move from a transitional to a maintenance service
plan. Recipients on a maintenance service plan must be reassessed to determine if the
recipient would benefit from a transitional service plan at least every 12 months and at other
times when there has been a significant change in the recipient's functioning. This assessment
should consider any changes to technological or natural community supports.

(e) When a county is evaluating denials, reductions, or terminations of home and
community-based services under this section for an individual, the case manager shall offer
to meet with the individual or the individual's guardian in order to discuss the prioritization
of service needs within the coordinated service and support plan, comprehensive transitional
service plan, or maintenance service plan. The reduction in the authorized services for an
individual due to changes in funding for waivered services may not exceed the amount
needed to ensure medically necessary services to meet the individual's health, safety, and
welfare.

(f) At the time of reassessment, local agency case managers shall assess each recipient
of community access for disability inclusion or brain injury waivered services currently
residing in a licensed adult foster 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
recipient could appropriately be served in a community-living setting. If appropriate for the
recipient, the case manager shall offer the recipient, through a person-centered planning
process, the option to receive alternative housing and service options. In the event that the
recipient chooses to transfer from the adult foster home, the vacated bed shall not be filled
with another recipient of waiver services and group residential housing and the licensed
capacity shall be reduced accordingly, unless the savings required by the licensed bed closure
reductions under Laws 2011, First Special Session chapter 9, article 7, sections 1 and 40,
paragraph (f), for foster care settings where the physical location is not the primary residence
of the license holder are met through voluntary changes described in section 245A.03,
subdivision 7
, paragraph (e), or as provided under paragraph (a), clauses (3) and (4). If the
adult foster home becomes no longer viable due to these transfers, the county agency, with
the assistance of the department, shall facilitate a consolidation of settings or closure. This
reassessment process shall be completed by July 1, 2013.

Sec. 19.

Minnesota Statutes 2016, section 256B.493, subdivision 1, is amended to read:


Subdivision 1.

Commissioner's duties; report.

The commissioner of human services
shall solicit proposals for the conversion of services provided for persons with disabilities
in settings licensed under Minnesota Rules, parts 9555.5105 to 9555.6265, or community
residential settings licensed under chapter 245D, to other types of community settings in
conjunction with the closure of identified licensed adult foster care settings
has the authority
to manage statewide licensed corporate foster care or community residential settings capacity,
including the reduction and realignment of licensed capacity of a current foster care or
community residential settings to accomplish the consolidation or closure of settings. The
commissioner shall implement a program for planned closure of licensed corporate adult
foster care or community residential settings, necessary as a preferred method to: (1) respond
to the informed decisions of those individuals who want to move out of these settings into
other types of community settings; and (2) achieve necessary budgetary savings required
in section 245A.03, subdivision 7, paragraphs (c) and (d)
.

Sec. 20.

Minnesota Statutes 2016, section 256B.493, subdivision 2, is amended to read:


Subd. 2.

Planned closure process needs determination.

The commissioner shall
announce and implement a program for planned closure of adult foster care homes. Planned
closure shall be the preferred method for achieving necessary budgetary savings required
by the licensed bed closure budget reduction in section 245A.03, subdivision 7, paragraph
(c). If additional closures are required to achieve the necessary savings, the commissioner
shall use the process and priorities in section 245A.03, subdivision 7, paragraph (c)
A
resource need determination process, managed at the state level, using available reports
required by section 144A.351 and other data and information shall be used by the
commissioner to align capacity where needed
.

Sec. 21.

Minnesota Statutes 2016, section 256B.493, is amended by adding a subdivision
to read:


Subd. 2a.

Closure process.

(a) The commissioner shall work with stakeholders to
establish a process for the application, review, approval, and implementation of setting
closures. Voluntary proposals from license holders for consolidation and closure of adult
foster care or community residential settings are encouraged. Whether voluntary or
involuntary, all closure plans must include:

(1) a description of the proposed closure plan, identifying the home or homes and
occupied beds;

(2) the proposed timetable for the proposed closure, including the proposed dates for
notification to people living there and the affected lead agencies, commencement of closure,
and completion of closure;

(3) the proposed relocation plan jointly developed by the counties of financial
responsibility, the people living there and their legal representatives, if any, who wish to
continue to receive services from the provider, and the providers for current residents of
any adult foster care home designated for closure; and

(4) documentation from the provider in a format approved by the commissioner that all
the adult foster care homes or community residential settings receiving a planned closure
rate adjustment under the plan have accepted joint and severable for recovery of
overpayments under section 256B.0641, subdivision 2, for the facilities designated for
closure under this plan.

(b) The commissioner shall give first priority to closure plans which:

(1) target counties and geographic areas which have:

(i) need for other types of services;

(ii) need for specialized services;

(iii) higher than average per capita use of licensed corporate foster care or community
residential settings; or

(iv) residents not living in the geographic area of their choice;

(2) demonstrate savings of medical assistance expenditures; and

(3) demonstrate that alternative services are based on the recipient's choice of provider
and are consistent with federal law, state law, and federally approved waiver plans.

The commissioner shall also consider any information provided by people using services,
their legal representatives, family members, or the lead agency on the impact of the planned
closure on people and the services they need.

(c) For each closure plan approved by the commissioner, a contract must be established
between the commissioner, the counties of financial responsibility, and the participating
license holder.

Sec. 22.

Minnesota Statutes 2016, section 256D.44, subdivision 4, is amended to read:


Subd. 4.

Temporary absence due to illness.

For the purposes of this subdivision, "home"
means a residence owned or rented by a recipient or the recipient's spouse. Home does not
include a group residential housing facility.
Assistance payments for recipients who are
temporarily absent from their home due to hospitalization for illness must continue at the
same level of payment during their absence if the following criteria are met:

(1) a physician certifies that the absence is not expected to continue for more than three
months;

(2) a physician certifies that the recipient will be able to return to independent living;
and

(3) the recipient has expenses associated with maintaining a residence in the community.

Sec. 23.

Minnesota Statutes 2016, section 256D.44, subdivision 5, is amended to read:


Subd. 5.

Special needs.

(a) In addition to the state standards of assistance established
in subdivisions 1 to 4, payments are allowed for the following special needs of recipients
of Minnesota supplemental aid who are not residents of a nursing home, a regional treatment
center, or a group residential setting authorized to receive housing facility support payments
under chapter 256I
.

(a) (b) The county agency shall pay a monthly allowance for medically prescribed diets
if the cost of those additional dietary needs cannot be met through some other maintenance
benefit. The need for special diets or dietary items must be prescribed by a licensed physician.
Costs for special diets shall be determined as percentages of the allotment for a one-person
household under the thrifty food plan as defined by the United States Department of
Agriculture. The types of diets and the percentages of the thrifty food plan that are covered
are as follows:

(1) high protein diet, at least 80 grams daily, 25 percent of thrifty food plan;

(2) controlled protein diet, 40 to 60 grams and requires special products, 100 percent of
thrifty food plan;

(3) controlled protein diet, less than 40 grams and requires special products, 125 percent
of thrifty food plan;

(4) low cholesterol diet, 25 percent of thrifty food plan;

(5) high residue diet, 20 percent of thrifty food plan;

(6) pregnancy and lactation diet, 35 percent of thrifty food plan;

(7) gluten-free diet, 25 percent of thrifty food plan;

(8) lactose-free diet, 25 percent of thrifty food plan;

(9) antidumping diet, 15 percent of thrifty food plan;

(10) hypoglycemic diet, 15 percent of thrifty food plan; or

(11) ketogenic diet, 25 percent of thrifty food plan.

(b) (c) Payment for nonrecurring special needs must be allowed for necessary home
repairs or necessary repairs or replacement of household furniture and appliances using the
payment standard of the AFDC program in effect on July 16, 1996, for these expenses, as
long as other funding sources are not available.

(c) (d) A fee for guardian or conservator service is allowed at a reasonable rate negotiated
by the county or approved by the court. This rate shall not exceed five percent of the
assistance unit's gross monthly income up to a maximum of $100 per month. If the guardian
or conservator is a member of the county agency staff, no fee is allowed.

(d) (e) The county agency shall continue to pay a monthly allowance of $68 for restaurant
meals for a person who was receiving a restaurant meal allowance on June 1, 1990, and
who eats two or more meals in a restaurant daily. The allowance must continue until the
person has not received Minnesota supplemental aid for one full calendar month or until
the person's living arrangement changes and the person no longer meets the criteria for the
restaurant meal allowance, whichever occurs first.

(e) (f) A fee of ten percent of the recipient's gross income or $25, whichever is less, is
allowed for representative payee services provided by an agency that meets the requirements
under SSI regulations to charge a fee for representative payee services. This special need
is available to all recipients of Minnesota supplemental aid regardless of their living
arrangement.

(f) (g)(1) Notwithstanding the language in this subdivision, an amount equal to one-half
of
the maximum allotment authorized by the federal Food Stamp Program for a federal
Supplemental Security Income payment amount for a
single individual which is in effect
on the first day of July of each year will be added to the standards of assistance established
in subdivisions 1 to 4 for adults under the age of 65 who qualify as shelter needy in need
of housing assistance
and are:

(i) relocating from an institution, a setting authorized to receive housing support under
chapter 256I,
or an adult mental health residential treatment program under section
256B.0622; or

(ii) eligible for personal care assistance under section 256B.0659; or

(iii) home and community-based waiver recipients living in their own home or rented
or leased apartment which is not owned, operated, or controlled by a provider of service
not related by blood or marriage, unless allowed under paragraph (g)
.

(2) Notwithstanding subdivision 3, paragraph (c), an individual eligible for the shelter
needy benefit under this paragraph is considered a household of one. An eligible individual
who receives this benefit prior to age 65 may continue to receive the benefit after the age
of 65.

(3) "Shelter needy Housing assistance" means that the assistance unit incurs monthly
shelter costs that exceed 40 percent of the assistance unit's gross income before the application
of this special needs standard. "Gross income" for the purposes of this section is the
applicant's or recipient's income as defined in section 256D.35, subdivision 10, or the
standard specified in subdivision 3, paragraph (a) or (b), whichever is greater. A recipient
of a federal or state housing subsidy, that limits shelter costs to a percentage of gross income,
shall not be considered shelter needy in need of housing assistance for purposes of this
paragraph.

(g) Notwithstanding this subdivision, to access housing and services as provided in
paragraph (f), the recipient may choose housing that may be owned, operated, or controlled
by the recipient's service provider. When housing is controlled by the service provider, the
individual may choose the individual's own service provider as provided in section 256B.49,
subdivision 23
, clause (3). When the housing is controlled by the service provider, the
service provider shall implement a plan with the recipient to transition the lease to the
recipient's name. Within two years of signing the initial lease, the service provider shall
transfer the lease entered into under this subdivision to the recipient. In the event the landlord
denies this transfer, the commissioner may approve an exception within sufficient time to
ensure the continued occupancy by the recipient. This paragraph expires June 30, 2016.

EFFECTIVE DATE.

Paragraphs (a) to (f) are effective July 1, 2017. Paragraph (g),
clause (1), is effective July 1, 2020, except paragraph (g), clause (1), items (ii) and (iii), are
effective July 1, 2017.

Sec. 24.

Minnesota Statutes 2016, section 256I.03, subdivision 8, is amended to read:


Subd. 8.

Supplementary services.

"Supplementary services" means housing support
services provided to residents of group residential housing providers individuals in addition
to room and board including, but not limited to, oversight and up to 24-hour supervision,
medication reminders, assistance with transportation, arranging for meetings and
appointments, and arranging for medical and social services.

Sec. 25.

Minnesota Statutes 2016, section 256I.04, subdivision 1, is amended to read:


Subdivision 1.

Individual eligibility requirements.

An individual is eligible for and
entitled to a group residential housing support payment to be made on the individual's behalf
if the agency has approved the individual's residence in a group residential setting where
the individual will receive
housing setting support and the individual meets the requirements
in paragraph (a) or, (b), or (c).

(a) The individual is aged, blind, or is over 18 years of age and disabled as determined
under the criteria used by the title II program of the Social Security Act, and meets the
resource restrictions and standards of section 256P.02, and the individual's countable income
after deducting the (1) exclusions and disregards of the SSI program, (2) the medical
assistance personal needs allowance under section 256B.35, and (3) an amount equal to the
income actually made available to a community spouse by an elderly waiver participant
under the provisions of sections 256B.0575, paragraph (a), clause (4), and 256B.058,
subdivision 2
, is less than the monthly rate specified in the agency's agreement with the
provider of group residential housing support in which the individual resides.

(b) The individual meets a category of eligibility under section 256D.05, subdivision 1,
paragraph (a), clauses (1), (3), (5) to (9), and (14), and paragraph (b), if applicable, and the
individual's resources are less than the standards specified by section 256P.02, and the
individual's countable income as determined under section 256P.06, less the medical
assistance personal needs allowance under section 256B.35 is less than the monthly rate
specified in the agency's agreement with the provider of group residential housing support
in which the individual resides.

(c) The individual receives licensed residential crisis stabilization services under section
256B.0624, subdivision 7, and is receiving medical assistance. The individual may receive
concurrent housing support payments if receiving licensed residential crisis stabilization
services under section 256B.0624, subdivision 7.

EFFECTIVE DATE.

Paragraph (c) is effective October 1, 2017.

Sec. 26.

Minnesota Statutes 2016, section 256I.04, subdivision 2d, is amended to read:


Subd. 2d.

Conditions of payment; commissioner's right to suspend or terminate
agreement.

(a) Group residential Housing or supplementary services support must be
provided to the satisfaction of the commissioner, as determined at the sole discretion of the
commissioner's authorized representative, and in accordance with all applicable federal,
state, and local laws, ordinances, rules, and regulations, including business registration
requirements of the Office of the Secretary of State. A provider shall not receive payment
for room and board or supplementary services or housing found by the commissioner to be
performed or provided in violation of federal, state, or local law, ordinance, rule, or
regulation.

(b) The commissioner has the right to suspend or terminate the agreement immediately
when the commissioner determines the health or welfare of the housing or service recipients
is endangered, or when the commissioner has reasonable cause to believe that the provider
has breached a material term of the agreement under subdivision 2b.

(c) Notwithstanding paragraph (b), if the commissioner learns of a curable material
breach of the agreement by the provider, the commissioner shall provide the provider with
a written notice of the breach and allow ten days to cure the breach. If the provider does
not cure the breach within the time allowed, the provider shall be in default of the agreement
and the commissioner may terminate the agreement immediately thereafter. If the provider
has breached a material term of the agreement and cure is not possible, the commissioner
may immediately terminate the agreement.

Sec. 27.

Minnesota Statutes 2016, section 256I.04, subdivision 2g, is amended to read:


Subd. 2g.

Crisis shelters.

Secure crisis shelters for battered women and their children
designated by the Minnesota Department of Corrections are not group residences eligible
for housing support
under this chapter.

Sec. 28.

Minnesota Statutes 2016, section 256I.04, subdivision 3, is amended to read:


Subd. 3.

Moratorium on development of group residential housing support beds.

(a) Agencies shall not enter into agreements for new group residential housing support beds
with total rates in excess of the MSA equivalent rate except:

(1) for group residential housing establishments licensed under chapter 245D provided
the facility is needed to meet the census reduction targets for persons with developmental
disabilities at regional treatment centers;

(2) up to 80 beds in a single, specialized facility located in Hennepin County that will
provide housing for chronic inebriates who are repetitive users of detoxification centers and
are refused placement in emergency shelters because of their state of intoxication, and
planning for the specialized facility must have been initiated before July 1, 1991, in
anticipation of receiving a grant from the Housing Finance Agency under section 462A.05,
subdivision 20a
, paragraph (b);

(3) notwithstanding the provisions of subdivision 2a, for up to 190 226 supportive
housing units in Anoka, Dakota, Hennepin, or Ramsey County for homeless adults with a
mental illness, a history of substance abuse, or human immunodeficiency virus or acquired
immunodeficiency syndrome. For purposes of this section, "homeless adult" means a person
who is living on the street or in a shelter or discharged from a regional treatment center,
community hospital, or residential treatment program and has no appropriate housing
available and lacks the resources and support necessary to access appropriate housing. At
least 70 percent of the supportive housing units must serve homeless adults with mental
illness, substance abuse problems, or human immunodeficiency virus or acquired
immunodeficiency syndrome who are about to be or, within the previous six months, has
been discharged from a regional treatment center, or a state-contracted psychiatric bed in
a community hospital, or a residential mental health or chemical dependency treatment
program. If a person meets the requirements of subdivision 1, paragraph (a), and receives
a federal or state housing subsidy, the group residential housing support rate for that person
is limited to the supplementary rate under section 256I.05, subdivision 1a, and is determined
by subtracting the amount of the person's countable income that exceeds the MSA equivalent
rate from the group residential housing support supplementary service rate. A resident in a
demonstration project site who no longer participates in the demonstration program shall
retain eligibility for a group residential housing support payment in an amount determined
under section 256I.06, subdivision 8, using the MSA equivalent rate. Service funding under
section 256I.05, subdivision 1a, will end June 30, 1997, if federal matching funds are
available and the services can be provided through a managed care entity. If federal matching
funds are not available, then service funding will continue under section 256I.05, subdivision
1a
;

(4) for an additional two beds, resulting in a total of 32 beds, for a facility located in
Hennepin County providing services for recovering and chemically dependent men that has
had a group residential housing support contract with the county and has been licensed as
a board and lodge facility with special services since 1980;

(5) for a group residential housing support provider located in the city of St. Cloud, or
a county contiguous to the city of St. Cloud, that operates a 40-bed facility, that received
financing through the Minnesota Housing Finance Agency Ending Long-Term Homelessness
Initiative and serves chemically dependent clientele, providing 24-hour-a-day supervision;

(6) for a new 65-bed facility in Crow Wing County that will serve chemically dependent
persons, operated by a group residential housing support provider that currently operates a
304-bed facility in Minneapolis, and a 44-bed facility in Duluth;

(7) for a group residential housing support provider that operates two ten-bed facilities,
one located in Hennepin County and one located in Ramsey County, that provide community
support and 24-hour-a-day supervision to serve the mental health needs of individuals who
have chronically lived unsheltered; and

(8) for a group residential facility authorized for recipients of housing support in Hennepin
County with a capacity of up to 48 beds that has been licensed since 1978 as a board and
lodging facility and that until August 1, 2007, operated as a licensed chemical dependency
treatment program.

(b) An agency may enter into a group residential housing support agreement for beds
with rates in excess of the MSA equivalent rate in addition to those currently covered under
a group residential housing support agreement if the additional beds are only a replacement
of beds with rates in excess of the MSA equivalent rate which have been made available
due to closure of a setting, a change of licensure or certification which removes the beds
from group residential housing support payment, or as a result of the downsizing of a group
residential housing
setting authorized for recipients of housing support. The transfer of
available beds from one agency to another can only occur by the agreement of both agencies.

Sec. 29.

Minnesota Statutes 2016, section 256I.05, subdivision 1a, is amended to read:


Subd. 1a.

Supplementary service rates.

(a) Subject to the provisions of section 256I.04,
subdivision 3
, the county agency may negotiate a payment not to exceed $426.37 for other
services necessary to provide room and board provided by the group residence if the residence
is licensed by or registered by the Department of Health, or licensed by the Department of
Human Services to provide services in addition to room and board, and if the provider of
services is not also concurrently receiving funding for services for a recipient under a home
and community-based waiver under title XIX of the Social Security Act; or funding from
the medical assistance program under section 256B.0659, for personal care services for
residents in the setting; or residing in a setting which receives funding under section 245.73.
If funding is available for other necessary services through a home and community-based
waiver, or personal care services under section 256B.0659, then the GRH housing support
rate is limited to the rate set in subdivision 1. Unless otherwise provided in law, in no case
may the supplementary service rate exceed $426.37. The registration and licensure
requirement does not apply to establishments which are exempt from state licensure because
they are located on Indian reservations and for which the tribe has prescribed health and
safety requirements. Service payments under this section may be prohibited under rules to
prevent the supplanting of federal funds with state funds. The commissioner shall pursue
the feasibility of obtaining the approval of the Secretary of Health and Human Services to
provide home and community-based waiver services under title XIX of the Social Security
Act for residents who are not eligible for an existing home and community-based waiver
due to a primary diagnosis of mental illness or chemical dependency and shall apply for a
waiver if it is determined to be cost-effective.

(b) The commissioner is authorized to make cost-neutral transfers from the GRH housing
support
fund for beds under this section to other funding programs administered by the
department after consultation with the county or counties in which the affected beds are
located. The commissioner may also make cost-neutral transfers from the GRH housing
support
fund to county human service agencies for beds permanently removed from the
GRH housing support census under a plan submitted by the county agency and approved
by the commissioner. The commissioner shall report the amount of any transfers under this
provision annually to the legislature.

(c) Counties must not negotiate supplementary service rates with providers of group
residential
housing support that are licensed as board and lodging with special services and
that do not encourage a policy of sobriety on their premises and make referrals to available
community services for volunteer and employment opportunities for residents.

Sec. 30.

Minnesota Statutes 2016, section 256I.05, subdivision 1c, is amended to read:


Subd. 1c.

Rate increases.

An agency may not increase the rates negotiated for group
residential
housing support above those in effect on June 30, 1993, except as provided in
paragraphs (a) to (f).

(a) An agency may increase the rates for group residential housing settings room and
board
to the MSA equivalent rate for those settings whose current rate is below the MSA
equivalent rate.

(b) An agency may increase the rates for residents in adult foster care whose difficulty
of care has increased. The total group residential housing support rate for these residents
must not exceed the maximum rate specified in subdivisions 1 and 1a. Agencies must not
include nor increase group residential housing difficulty of care rates for adults in foster
care whose difficulty of care is eligible for funding by home and community-based waiver
programs under title XIX of the Social Security Act.

(c) The room and board rates will be increased each year when the MSA equivalent rate
is adjusted for SSI cost-of-living increases by the amount of the annual SSI increase, less
the amount of the increase in the medical assistance personal needs allowance under section
256B.35.

(d) When a group residential housing rate is used to pay support pays for an individual's
room and board, or other costs necessary to provide room and board, the rate payable to the
residence must continue for up to 18 calendar days per incident that the person is temporarily
absent from the residence, not to exceed 60 days in a calendar year, if the absence or absences
have received the prior approval of the county agency's social service staff. Prior approval
is not required for emergency absences due to crisis, illness, or injury.

(e) For facilities meeting substantial change criteria within the prior year. Substantial
change criteria exists if the group residential housing establishment experiences a 25 percent
increase or decrease in the total number of its beds, if the net cost of capital additions or
improvements is in excess of 15 percent of the current market value of the residence, or if
the residence physically moves, or changes its licensure, and incurs a resulting increase in
operation and property costs.

(f) Until June 30, 1994, an agency may increase by up to five percent the total rate paid
for recipients of assistance under sections 256D.01 to 256D.21 or 256D.33 to 256D.54 who
reside in residences that are licensed by the commissioner of health as a boarding care home,
but are not certified for the purposes of the medical assistance program. However, an increase
under this clause must not exceed an amount equivalent to 65 percent of the 1991 medical
assistance reimbursement rate for nursing home resident class A, in the geographic grouping
in which the facility is located, as established under Minnesota Rules, parts 9549.0051 to
9549.0058.

Sec. 31.

Minnesota Statutes 2016, section 256I.05, subdivision 1e, is amended to read:


Subd. 1e.

Supplementary rate for certain facilities.

(a) Notwithstanding the provisions
of subdivisions 1a and 1c, beginning July 1, 2005, a county agency shall negotiate a
supplementary rate in addition to the rate specified in subdivision 1, not to exceed $700 per
month, including any legislatively authorized inflationary adjustments, for a group residential
housing support provider that:

(1) is located in Hennepin County and has had a group residential housing support
contract with the county since June 1996;

(2) operates in three separate locations a 75-bed facility, a 50-bed facility, and a 26-bed
facility; and

(3) serves a chemically dependent clientele, providing 24 hours per day supervision and
limiting a resident's maximum length of stay to 13 months out of a consecutive 24-month
period.

(b) Notwithstanding subdivisions 1a and 1c, a county agency shall negotiate a
supplementary rate in addition to the rate specified in subdivision 1, not to exceed $700 per
month, including any legislatively authorized inflationary adjustments, of a group residential
housing support
provider that:

(1) is located in St. Louis County and has had a group residential housing support contract
with the county since 2006;

(2) operates a 62-bed facility; and

(3) serves a chemically dependent adult male clientele, providing 24 hours per day
supervision and limiting a resident's maximum length of stay to 13 months out of a
consecutive 24-month period.

(c) Notwithstanding subdivisions 1a and 1c, beginning July 1, 2013, a county agency
shall negotiate a supplementary rate in addition to the rate specified in subdivision 1, not
to exceed $700 per month, including any legislatively authorized inflationary adjustments,
for the group residential provider described under paragraphs (a) and (b), not to exceed an
additional 115 beds.

Sec. 32.

Minnesota Statutes 2016, section 256I.05, subdivision 1j, is amended to read:


Subd. 1j.

Supplementary rate for certain facilities; Crow Wing County.

Notwithstanding the provisions of subdivisions 1a and 1c, beginning July 1, 2007, a county
agency shall negotiate a supplementary rate in addition to the rate specified in subdivision
1, not to exceed $700 per month, including any legislatively authorized inflationary
adjustments, for a new 65-bed facility in Crow Wing County that will serve chemically
dependent persons operated by a group residential housing support provider that currently
operates a 304-bed facility in Minneapolis and a 44-bed facility in Duluth which opened in
January of 2006.

Sec. 33.

Minnesota Statutes 2016, section 256I.05, subdivision 1m, is amended to read:


Subd. 1m.

Supplemental rate for certain facilities; Hennepin and Ramsey Counties.

(a) Notwithstanding the provisions of this section, beginning July 1, 2007, a county agency
shall negotiate a supplemental service rate in addition to the rate specified in subdivision
1, not to exceed $700 per month or the existing monthly rate, whichever is higher, including
any legislatively authorized inflationary adjustments, for a group residential housing support
provider that operates two ten-bed facilities, one located in Hennepin County and one located
in Ramsey County, which provide community support and serve the mental health needs
of individuals who have chronically lived unsheltered, providing 24-hour-per-day supervision.

(b) An individual who has lived in one of the facilities under paragraph (a), who is being
transitioned to independent living as part of the program plan continues to be eligible for
group residential housing room and board and the supplemental service rate negotiated with
the county under paragraph (a).

Sec. 34.

Minnesota Statutes 2016, section 256I.05, is amended by adding a subdivision
to read:


Subd. 1p.

Supplementary rate; St. Louis County.

Notwithstanding the provisions of
subdivisions 1a and 1c, beginning July 1, 2017, a county agency shall negotiate a
supplementary rate in addition to the rate specified in subdivision 1, not to exceed $700 per
month, including any legislatively authorized inflationary adjustments, for a housing support
provider that:

(1) is located in St. Louis County and has had a housing support contract with the county
since July 2016;

(2) operates a 35-bed facility;

(3) serves women who are chemically dependent, mentally ill, or both;

(4) provides 24-hour per day supervision;

(5) provides on-site support with skilled professionals, including a licensed practical
nurse, registered nurses, peer specialists, and resident counselors; and

(6) provides independent living skills training and assistance with family reunification.

Sec. 35.

Minnesota Statutes 2016, section 256I.05, is amended by adding a subdivision
to read:


Subd. 1q.

Supplemental rate; Olmsted County.

Notwithstanding the provisions of
subdivisions 1a and 1c, beginning July 1, 2017, a county agency shall negotiate a
supplementary rate in addition to the rate specified in subdivision 1, not to exceed $750 per
month, including any legislatively authorized inflationary adjustments, for a housing support
provider located in Olmsted County that operates long-term residential facilities with a total
of 104 beds that serve chemically dependent men and women and provide 24-hour-a-day
supervision and other support services.

Sec. 36.

Minnesota Statutes 2016, section 256I.05, is amended by adding a subdivision
to read:


Subd. 1r.

Supplemental rate; Anoka County.

Notwithstanding the provisions in this
section, a county agency shall negotiate a supplemental rate for 42 beds in addition to the
rate specified in subdivision 1, not to exceed the maximum rate allowed under subdivision
1a, including any legislatively authorized inflationary adjustments, for a housing support
provider that is located in Anoka County and provides emergency housing on the former
Anoka Regional Treatment Center campus.

Sec. 37.

Minnesota Statutes 2016, section 256I.05, is amended by adding a subdivision
to read:


Subd. 11.

Transfer of emergency shelter funds.

(a) The commissioner shall make a
cost-neutral transfer of funding from the housing support fund to county human service
agencies for emergency shelter beds removed from the housing support census under a
biennial plan submitted by the county and approved by the commissioner. The plan must
describe: (1) anticipated and actual outcomes for persons experiencing homelessness in
emergency shelters; (2) improved efficiencies in administration; (3) requirements for
individual eligibility; and (4) plans for quality assurance monitoring and quality assurance
outcomes. The commissioner shall review the county plan to monitor implementation and
outcomes at least biennially, and more frequently if the commissioner deems necessary.

(b) The funding under paragraph (a) may be used for the provision of room and board
or supplemental services according to section 256I.03, subdivisions 2 and 8. Providers must
meet the requirements of section 256I.04, subdivisions 2a to 2f. Funding must be allocated
annually, and the room and board portion of the allocation shall be adjusted according to
the percentage change in the housing support room and board rate. The room and board
portion of the allocation shall be determined at the time of transfer. The commissioner or
county may return beds to the housing support fund with 180 days' notice, including financial
reconciliation.

EFFECTIVE DATE.

This section is effective July 1, 2017.

Sec. 38.

Minnesota Statutes 2016, section 256I.06, subdivision 2, is amended to read:


Subd. 2.

Time of payment.

A county agency may make payments to a group residence
in advance for an individual whose stay in the group residence is expected to last beyond
the calendar month for which the payment is made. Group residential Housing support
payments made by a county agency on behalf of an individual who is not expected to remain
in the group residence beyond the month for which payment is made must be made
subsequent to the individual's departure from the group residence.

EFFECTIVE DATE.

This section is effective July 1, 2017.

Sec. 39.

Minnesota Statutes 2016, section 256I.06, subdivision 8, is amended to read:


Subd. 8.

Amount of group residential housing support payment.

(a) The amount of
a group residential housing room and board payment to be made on behalf of an eligible
individual is determined by subtracting the individual's countable income under section
256I.04, subdivision 1, for a whole calendar month from the group residential housing
charge
room and board rate for that same month. The group residential housing charge
support payment
is determined by multiplying the group residential housing support rate
times the period of time the individual was a resident or temporarily absent under section
256I.05, subdivision 1c, paragraph (d).

(b) For an individual with earned income under paragraph (a), prospective budgeting
must be used to determine the amount of the individual's payment for the following six-month
period. An increase in income shall not affect an individual's eligibility or payment amount
until the month following the reporting month. A decrease in income shall be effective the
first day of the month after the month in which the decrease is reported.

(c) For an individual who receives licensed residential crisis stabilization services under
section 256B.0624, subdivision 7, the amount of housing support payment is determined
by multiplying the housing support rate times the period of time the individual was a resident.

EFFECTIVE DATE.

Paragraph (c) is effective October 1, 2017.

Sec. 40.

[256I.09] COMMUNITY LIVING INFRASTRUCTURE.

The commissioner shall awards grants to agencies through an annual competitive process.
Grants awarded under this section may be used for: (1) outreach to locate and engage people
who are homeless or residing in segregated settings to screen for basic needs and assist with
referral to community living resources; (2) building capacity to provide technical assistance
and consultation on housing and related support service resources for persons with both
disabilities and low income; or (3) streamlining the administration and monitoring activities
related to housing support funds. Agencies may collaborate and submit a joint application
for funding under this section.

Sec. 41. DIRECTION TO COMMISSIONER; HOUSING SUPPORT STUDY.

Within available appropriations, the commissioner of human services shall study the
housing support supplementary service rates under Minnesota Statutes, section 256I.05,
and make recommendations on the supplementary service rate structure to the chairs and
ranking minority members of the legislative committees with jurisdiction over human
services policy and finance by January 15, 2018.

Sec. 42. REVISOR'S INSTRUCTION.

In each section of Minnesota Statutes referred to in column A, the revisor of statutes
shall change the phrase in column B to the phrase in column C. The revisor may make
technical and other necessary changes to sentence structure to preserve the meaning of the
text. The revisor shall make other changes in chapter titles; section, subdivision, part, and
subpart headnotes; and in other terminology necessary as a result of the enactment of this
section.

Column A
Column B
Column C
144A.071, subdivision 4d
group residential housing
housing support under chapter
256I
201.061, subdivision 3
group residential housing
setting authorized to provide
housing support
244.052, subdivision 4c
group residential housing
facility
licensed setting authorized to
provide housing support
under section 256I.04
245.466, subdivision 7
under group residential
housing
by housing support under
chapter 256I
245.466, subdivision 7
from group residential housing
from housing support
245.4661, subdivision 6
group residential housing
housing support under chapter
256I
245C.10, subdivision 11
group residential housing or
supplementary services
housing support
256.01, subdivision 18
group residential housing
housing support under chapter
256I
256.017, subdivision 1
group residential housing
housing support
256.98, subdivision 8
group residential housing
housing support under chapter
256I
256B.49, subdivision 15
group residential housing
housing support under chapter
256I
256B.4914, subdivision 10
group residential housing rate
3 costs
housing support rate 3 costs
under chapter 256I
256B.501, subdivision 4b
group residential housing
housing support
256B.77, subdivision 12
residential services covered
under the group residential
housing program
housing support services
under chapter 256I
256D.44, subdivision 2
group residential housing
facility
setting authorized to provide
housing support
256G.01, subdivision 3
group residential housing
housing support under chapter
256I
256I.01
Group Residential Housing
Housing Support
256I.02
Group Residential Housing
Housing Support
256I.03, subdivision 2
"Group residential housing"
"Room and board"
256I.03, subdivision 2
Group residential housing
The room and board
256I.03, subdivision 3
"Group residential housing"
"Housing support"
256I.03, subdivision 6
group residential housing
room and board
256I.03, subdivisions 7 and 9
group residential housing
housing support
256I.04, subdivisions 1a, 1b,
1c, and 2
group residential housing
housing support
256I.04, subdivision 2a
provide group residential
housing
provide housing support
256I.04, subdivision 2a
of group residential housing
or supplementary services
of housing support
256I.04, subdivision 2a
complete group residential
housing
complete housing support
256I.04, subdivision 2b
group residential housing or
supplementary services
housing support
256I.04, subdivision 2b
provision of group residential
housing
provision of housing support
256I.04, subdivision 2c
group residential housing or
supplementary services
housing support
256I.04, subdivision 2e
group residential housing or
supplementary services
housing support
256I.04, subdivision 4
group residential housing
payment for room and board
room and board rate
256I.05, subdivision 1
living in group residential
housing
receiving housing support
256I.05, subdivisions 1h, 1k,
1l, 7b, and 7c
group residential housing
housing support
256I.05, subdivision 2
group residential housing
room and board
256I.05, subdivision 3
group residential housing
room and board
256I.05, subdivision 6
reside in group residential
housing
receive housing support
256I.06, subdivisions 1, 3, 4,
and 6
group residential housing
housing support
256I.06, subdivision 7
group residential housing
the housing support
256I.08
group residential housing
housing support
256P.03, subdivision 1
group residential housing
housing support
256P.05, subdivision 1
group residential housing
housing support
256P.07, subdivision 1
group residential housing
housing support
256P.08, subdivision 1
group residential housing
housing support
290A.03, subdivision 8
accepts group residential
housing
accepts housing support
290A.03, subdivision 8
the group residential housing
program
the housing support program

ARTICLE 3

CONTINUING CARE

Section 1.

Minnesota Statutes 2016, section 144.0724, subdivision 4, is amended to read:


Subd. 4.

Resident assessment schedule.

(a) A facility must conduct and electronically
submit to the commissioner of health MDS assessments that conform with the assessment
schedule defined by Code of Federal Regulations, title 42, section 483.20, and published
by the United States Department of Health and Human Services, Centers for Medicare and
Medicaid Services, in the Long Term Care Assessment Instrument User's Manual, version
3.0, and subsequent updates when issued by the Centers for Medicare and Medicaid Services.
The commissioner of health may substitute successor manuals or question and answer
documents published by the United States Department of Health and Human Services,
Centers for Medicare and Medicaid Services, to replace or supplement the current version
of the manual or document.

(b) The assessments used to determine a case mix classification for reimbursement
include the following:

(1) a new admission assessment;

(2) an annual assessment which must have an assessment reference date (ARD) within
92 days of the previous assessment and the previous comprehensive assessment;

(3) a significant change in status assessment must be completed within 14 days of the
identification of a significant change, whether improvement or decline, and regardless of
the amount of time since the last significant change in status assessment
;

(4) all quarterly assessments must have an assessment reference date (ARD) within 92
days of the ARD of the previous assessment;

(5) any significant correction to a prior comprehensive assessment, if the assessment
being corrected is the current one being used for RUG classification; and

(6) any significant correction to a prior quarterly assessment, if the assessment being
corrected is the current one being used for RUG classification.

(c) In addition to the assessments listed in paragraph (b), the assessments used to
determine nursing facility level of care include the following:

(1) preadmission screening completed under section 256.975, subdivisions 7a to 7c, by
the Senior LinkAge Line or other organization under contract with the Minnesota Board on
Aging; and

(2) a nursing facility level of care determination as provided for under section 256B.0911,
subdivision 4e
, as part of a face-to-face long-term care consultation assessment completed
under section 256B.0911, by a county, tribe, or managed care organization under contract
with the Department of Human Services.

Sec. 2.

Minnesota Statutes 2016, section 144.0724, subdivision 6, is amended to read:


Subd. 6.

Penalties for late or nonsubmission.

(a) A facility that fails to complete or
submit an assessment according to subdivisions 4 and 5 for a RUG-IV classification within
seven days of the time requirements listed in the Long-Term Care Facility Resident
Assessment Instrument User's Manual is subject to a reduced rate for that resident. The
reduced rate shall be the lowest rate for that facility. The reduced rate is effective on the
day of admission for new admission assessments, on the ARD for significant change in
status assessments, or on the day that the assessment was due for all other assessments and
continues in effect until the first day of the month following the date of submission and
acceptance of the resident's assessment.

(b) If loss of revenue due to penalties incurred by a facility for any period of 92 days
are equal to or greater than 1.0 0.1 percent of the total operating costs on the facility's most
recent annual statistical and cost report, a facility may apply to the commissioner of human
services for a reduction in the total penalty amount. The commissioner of human services,
in consultation with the commissioner of health, may, at the sole discretion of the
commissioner of human services, limit the penalty for residents covered by medical assistance
to 15 ten days.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 3.

Minnesota Statutes 2016, section 144.562, subdivision 2, is amended to read:


Subd. 2.

Eligibility for license condition.

(a) A hospital is not eligible to receive a
license condition for swing beds unless (1) it either has a licensed bed capacity of less than
50 beds defined in the federal Medicare regulations, Code of Federal Regulations, title 42,
section 482.66, or it has a licensed bed capacity of 50 beds or more and has swing beds that
were approved for Medicare reimbursement before May 1, 1985, or it has a licensed bed
capacity of less than 65 beds and the available nursing homes within 50 miles have had, in
the aggregate, an average occupancy rate of 96 percent or higher in the most recent two
years as documented on the statistical reports to the Department of Health; and (2) it is
located in a rural area as defined in the federal Medicare regulations, Code of Federal
Regulations, title 42, section 482.66.

(b) Except for those critical access hospitals established under section 144.1483, clause
(9), and section 1820 of the federal Social Security Act, United States Code, title 42, section
1395i-4, that have an attached nursing home or that owned a nursing home located in the
same municipality as of May 1, 2005, eligible hospitals are allowed a total of 2,000 days
of swing bed use per year. Critical access hospitals that have an attached nursing home or
that owned a nursing home located in the same municipality as of May 1, 2005, are allowed
swing bed use as provided in federal law.

(c) Except for critical access hospitals that have an attached nursing home or that owned
a nursing home located in the same municipality as of May 1, 2005, the commissioner of
health may approve swing bed use beyond 2,000 days as long as there are no Medicare
certified skilled nursing facility beds available within 25 miles of that hospital that are
willing to admit the patient and the patient agrees to the referral being sent to the skilled
nursing facility
. Critical access hospitals exceeding 2,000 swing bed days must maintain
documentation that they have contacted skilled nursing facilities within 25 miles to determine
if any skilled nursing facility beds are available that are willing to admit the patient and the
patient agrees to the referral being sent to the skilled nursing facility
.

(d) After reaching 2,000 days of swing bed use in a year, an eligible hospital to which
this limit applies may admit six additional patients to swing beds each year without seeking
approval from the commissioner or being in violation of this subdivision. These six swing
bed admissions are exempt from the limit of 2,000 annual swing bed days for hospitals
subject to this limit.

(e) A health care system that is in full compliance with this subdivision may allocate its
total limit of swing bed days among the hospitals within the system, provided that no hospital
in the system without an attached nursing home may exceed 2,000 swing bed days per year.

Sec. 4.

Minnesota Statutes 2016, section 144A.071, subdivision 4d, is amended to read:


Subd. 4d.

Consolidation of nursing facilities.

(a) The commissioner of health, in
consultation with the commissioner of human services, may approve a request for
consolidation of nursing facilities which includes the closure of one or more facilities and
the upgrading of the physical plant of the remaining nursing facility or facilities, the costs
of which exceed the threshold project limit under subdivision 2, clause (a). The
commissioners shall consider the criteria in this section, section 144A.073, and section
256B.437 256R.40, in approving or rejecting a consolidation proposal. In the event the
commissioners approve the request, the commissioner of human services shall calculate an
external fixed costs rate adjustment according to clauses (1) to (3):

(1) the closure of beds shall not be eligible for a planned closure rate adjustment under
section 256B.437, subdivision 6 256R.40, subdivision 5;

(2) the construction project permitted in this clause shall not be eligible for a threshold
project rate adjustment under section 256B.434, subdivision 4f, or a moratorium exception
adjustment under section 144A.073; and

(3) the payment rate for external fixed costs for a remaining facility or facilities shall
be increased by an amount equal to 65 percent of the projected net cost savings to the state
calculated in paragraph (b), divided by the state's medical assistance percentage of medical
assistance dollars, and then divided by estimated medical assistance resident days, as
determined in paragraph (c), of the remaining nursing facility or facilities in the request in
this paragraph. The rate adjustment is effective on the later of the first day of the month
following
first day of the month of January or July, whichever date occurs first following
both the
completion of the construction upgrades in the consolidation plan or the first day
of the month following
and the complete closure of a facility closure of the facility or
facilities
designated for closure in the consolidation plan. If more than one facility is receiving
upgrades in the consolidation plan, each facility's date of construction completion must be
evaluated separately.

(b) For purposes of calculating the net cost savings to the state, the commissioner shall
consider clauses (1) to (7):

(1) the annual savings from estimated medical assistance payments from the net number
of beds closed taking into consideration only beds that are in active service on the date of
the request and that have been in active service for at least three years;

(2) the estimated annual cost of increased case load of individuals receiving services
under the elderly waiver;

(3) the estimated annual cost of elderly waiver recipients receiving support under group
residential housing;

(4) the estimated annual cost of increased case load of individuals receiving services
under the alternative care program;

(5) the annual loss of license surcharge payments on closed beds;

(6) the savings from not paying planned closure rate adjustments that the facilities would
otherwise be eligible for under section 256B.437 256R.40; and

(7) the savings from not paying external fixed costs payment rate adjustments from
submission of renovation costs that would otherwise be eligible as threshold projects under
section 256B.434, subdivision 4f.

(c) For purposes of the calculation in paragraph (a), clause (3), the estimated medical
assistance resident days of the remaining facility or facilities shall be computed assuming
95 percent occupancy multiplied by the historical percentage of medical assistance resident
days of the remaining facility or facilities, as reported on the facility's or facilities' most
recent nursing facility statistical and cost report filed before the plan of closure is submitted,
multiplied by 365.

(d) For purposes of net cost of savings to the state in paragraph (b), the average occupancy
percentages will be those reported on the facility's or facilities' most recent nursing facility
statistical and cost report filed before the plan of closure is submitted, and the average
payment rates shall be calculated based on the approved payment rates in effect at the time
the consolidation request is submitted.

(e) To qualify for the external fixed costs payment rate adjustment under this subdivision,
the closing facilities shall:

(1) submit an application for closure according to section 256B.437, subdivision 3
256R.40, subdivision 2
; and

(2) follow the resident relocation provisions of section 144A.161.

(f) The county or counties in which a facility or facilities are closed under this subdivision
shall not be eligible for designation as a hardship area under subdivision 3 for five years
from the date of the approval of the proposed consolidation. The applicant shall notify the
county of this limitation and the county shall acknowledge this in a letter of support.

EFFECTIVE DATE.

This section is effective for consolidations occurring after July
1, 2017.

Sec. 5.

Minnesota Statutes 2016, section 144A.74, is amended to read:


144A.74 MAXIMUM CHARGES.

A supplemental nursing services agency must not bill or receive payments from a nursing
home licensed under this chapter at a rate higher than 150 percent of the sum of the weighted
average wage rate, plus a factor determined by the commissioner to incorporate payroll
taxes as defined in Minnesota Rules, part 9549.0020, subpart 33 section 256R.02, subdivision
37
, for the applicable employee classification for the geographic group to which the nursing
home is assigned under Minnesota Rules, part 9549.0052 specified in section 256R.23,
subdivision 4
. The weighted average wage rates must be determined by the commissioner
of human services and reported to the commissioner of health on an annual basis. Wages
are defined as hourly rate of pay and shift differential, including weekend shift differential
and overtime. Facilities shall provide information necessary to determine weighted average
wage rates to the commissioner of human services in a format requested by the commissioner.
The maximum rate must include all charges for administrative fees, contract fees, or other
special charges in addition to the hourly rates for the temporary nursing pool personnel
supplied to a nursing home. A nursing home that pays for the actual travel and housing costs
for supplemental nursing services agency staff working at the facility and that pays these
costs to the employee, the agency, or another vendor, is not violating the limitation on
charges described in this section.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 6.

Minnesota Statutes 2016, 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 service must provide long-term care options counseling by assisting older adults,
caregivers, 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, and service options;

(5) conduct an outreach campaign to assist older adults 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 consultation related to long-term care options;

(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 seniors and their caregivers with a particular focus on
establishing a clear presence in places that seniors recognize and:

(i) place a significant emphasis on improved outreach and service to seniors 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 seniors;

(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 seniors and their caregivers and professionals recognize the Senior
LinkAge Line as the place to call for aging services and information;

(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, former residents of nursing homes who
were discharged to community settings, and older adults who request service after
consultation with the Senior LinkAge Line under clause (13). The Senior LinkAge Line
shall also receive referrals from the residents or staff of nursing homes.
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 for
discharge
by developing targeting criteria and creating a profile in consultation with the
commissioner who. 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 discharge planning 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.

EFFECTIVE DATE.

This section is effective July 1, 2017.

Sec. 7.

Minnesota Statutes 2016, section 256.975, is amended by adding a subdivision to
read:


Subd. 12.

Self-directed caregiver grants.

Beginning on July 1, 2019, the Minnesota
Board on Aging shall administer self-directed caregiver grants to support at risk family
caregivers of older adults or others eligible under the Older Americans Act of 1965, United
States Code, title 42, chapter 35, sections 3001 to 3058ff, to sustain family caregivers in
the caregivers' roles so older adults can remain at home longer. The board shall give priority
to consumers referred under section 256.975, subdivision 7, paragraph (d).

EFFECTIVE DATE.

This section is effective July 1, 2017.

Sec. 8.

[256.9755] CAREGIVER SUPPORT PROGRAMS.

Subdivision 1.

Program goals.

It is the goal of all area agencies on aging and caregiver
support programs to support family caregivers of persons with Alzheimer's disease or other
related dementias who are living in the community by:

(1) promoting caregiver support programs that serve Minnesotans in their homes and
communities; and

(2) providing, within the limits of available funds, the caregiver support services that
will enable the family caregiver to access caregiver support programs in the most
cost-effective and efficient manner.

Subd. 2.

Authority.

The Minnesota Board on Aging shall allocate to area agencies on
aging the state and federal funds which are received for the caregiver support program in a
manner consistent with federal requirements.

Subd. 3.

Caregiver support services.

Funds allocated to an area agency on aging for
caregiver support services must be used in a manner consistent with the National Family
Caregiver Support Program to reach family caregivers of persons with Alzheimer's disease
or related dementias. The funds must be used to provide social, nonmedical,
community-based services and activities that provide respite for caregivers and social
interaction for participants.

Sec. 9.

Minnesota Statutes 2016, section 256B.0911, subdivision 3a, is amended to read:


Subd. 3a.

Assessment and support planning.

(a) Persons requesting assessment, services
planning, or other assistance intended to support community-based living, including persons
who need assessment in order to determine waiver or alternative care program eligibility,
must be visited by a long-term care consultation team within 20 calendar days after the date
on which an assessment was requested or recommended. Upon statewide implementation
of subdivisions 2b, 2c, and 5, this requirement also applies to an assessment of a person
requesting personal care assistance services and home care nursing. The commissioner shall
provide at least a 90-day notice to lead agencies prior to the effective date of this requirement.
Face-to-face assessments must be conducted according to paragraphs (b) to (i).

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

(c) The MnCHOICES assessment provided by the commissioner to lead agencies must
be used to complete a comprehensive, 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 in a face-to-face interview with the person being
assessed and the person's legal representative. 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 section 256B.0915, 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 prepared by a direct service employee with at least 20 hours of service to that client.
The person conducting the assessment or reassessment 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 and the person or the person's legal representative, and
must be considered prior to the finalization of the assessment or reassessment.

(e) The person or the person's legal representative must be provided with a written
community support plan within 40 calendar days of the assessment visit, regardless of
whether the individual is eligible for Minnesota health care programs.

(f) For a person being assessed for elderly waiver services under section 256B.0915, a
provider who submitted information under paragraph (d) shall receive a copy of the
assessment, the final written community support plan when available, the case mix level,
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;

(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.

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

(g) (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).

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

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

(2) documentation that the most cost-effective alternatives available were offered to the
individual. For purposes of this clause, "cost-effective" means community services and
living arrangements that cost the same as or less than institutional care. For an individual
found to meet eligibility criteria for home and community-based service programs under
section 256B.0915 or 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
or the lead agency's final decisions regarding public programs eligibility according to section
256.045, subdivision 3.

(i) (k) Face-to-face assessment completed as part of eligibility determination for the
alternative care, elderly waiver, community access for disability inclusion, community
alternative care, and brain injury waiver programs under sections 256B.0913, 256B.0915,
and 256B.49 is valid to establish service eligibility for no more than 60 calendar days after
the date of assessment.

(j) (l) The effective eligibility start date for programs in paragraph (i)(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 (i)
(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.

Sec. 10.

Minnesota Statutes 2016, section 256B.0915, subdivision 3a, is amended to read:


Subd. 3a.

Elderly waiver cost limits.

(a) Effective on the first day of the state fiscal
year in which the resident assessment system as described in section 256B.438 256R.17 for
nursing home rate determination is implemented and the first day of each subsequent state
fiscal year, the monthly limit for the cost of waivered services to an individual elderly waiver
client shall be the monthly limit of the case mix resident class to which the waiver client
would be assigned under Minnesota Rules, parts 9549.0051 to 9549.0059, in effect on the
last day of the previous state fiscal year, adjusted by any legislatively adopted home and
community-based services percentage rate adjustment. If a legislatively authorized increase
is service-specific, the monthly cost limit shall be adjusted based on the overall average
increase to the elderly waiver program.

(b) The monthly limit for the cost of waivered services under paragraph (a) to an
individual elderly waiver client assigned to a case mix classification A with:

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

(2) up to two dependencies in bathing, dressing, grooming, walking, and eating when
the dependency score in eating is three or greater as determined by an assessment performed
under section 256B.0911 shall be $1,750 per month effective on July 1, 2011, for all new
participants enrolled in the program on or after July 1, 2011. This monthly limit shall be
applied to all other participants who meet this criteria at reassessment. This monthly limit
shall be increased annually as described in paragraphs (a) and (e).

(c) If extended medical supplies and equipment or environmental modifications are or
will be purchased for an elderly waiver client, the costs may be prorated for up to 12
consecutive months beginning with the month of purchase. If the monthly cost of a recipient's
waivered services exceeds the monthly limit established in paragraph (a), (b), (d), or (e),
the annual cost of all waivered services shall be determined. In this event, the annual cost
of all waivered services shall not exceed 12 times the monthly limit of waivered services
as described in paragraph (a), (b), (d), or (e).

(d) Effective July 1, 2013, the monthly cost limit of waiver services, including any
necessary home care services described in section 256B.0651, subdivision 2, for individuals
who meet the criteria as ventilator-dependent given in section 256B.0651, subdivision 1,
paragraph (g), shall be the average of the monthly medical assistance amount established
for home care services as described in section 256B.0652, subdivision 7, and the annual
average contracted amount established by the commissioner for nursing facility services
for ventilator-dependent individuals. This monthly limit shall be increased annually as
described in paragraphs (a) and (e).

(e) Effective July 1, 2016 January 1, 2018, and each July January 1 thereafter, the monthly
cost limits for elderly waiver services in effect on the previous June 30 December 31 shall
be increased by the difference between any legislatively adopted home and community-based
provider rate increases effective on July January 1 or since the previous July January 1 and
the average statewide percentage increase in nursing facility operating payment rates under
sections 256B.431, 256B.434, and 256B.441 chapter 256R, effective the previous January
1. This paragraph shall only apply if the average statewide percentage increase in nursing
facility operating payment rates is greater than any legislatively adopted home and
community-based provider rate increases effective on July January 1, or occurring since
the previous July January 1.

Sec. 11.

Minnesota Statutes 2016, section 256B.0915, subdivision 3e, is amended to read:


Subd. 3e.

Customized living service rate.

(a) Payment for customized living services
shall be a monthly rate authorized by the lead agency within the parameters established by
the commissioner. The payment agreement must delineate the amount of each component
service included in the recipient's customized living service plan. The lead agency, with
input from the provider of customized living services, shall ensure that there is a documented
need within the parameters established by the commissioner for all component customized
living services authorized.

(b) The payment rate must be based on the amount of component services to be provided
utilizing component rates established by the commissioner. Counties and tribes shall use
tools issued by the commissioner to develop and document customized living service plans
and rates.

(c) Component service rates must not exceed payment rates for comparable elderly
waiver or medical assistance services and must reflect economies of scale. Customized
living services must not include rent or raw food costs.

(d) With the exception of individuals described in subdivision 3a, paragraph (b), the
individualized monthly authorized payment for the customized living service plan shall not
exceed 50 percent of the greater of either the statewide or any of the geographic groups'
weighted average monthly nursing facility rate of the case mix resident class to which the
elderly waiver eligible client would be assigned under Minnesota Rules, parts 9549.0051
to 9549.0059, less the maintenance needs allowance as described in subdivision 1d, paragraph
(a). Effective On July 1 of the state fiscal each year in which the resident assessment system
as described in section 256B.438 for nursing home rate determination is implemented and
July 1 of each subsequent state fiscal year
, the individualized monthly authorized payment
for the services described in this clause shall not exceed the limit which was in effect on
June 30 of the previous state fiscal year updated annually based on legislatively adopted
changes to all service rate maximums for home and community-based service providers.

(e) For rates effective on or after January 1, 2022, the elderly waiver payment for
customized living services includes a cognitive and behavioral needs factor equal to an
additional 15 percent applied to the component service rates for a client:

(1) for whom the total monthly hours for customized living services divided by 30.4 is
less than 3.62; and

(2) who is determined, based on responses to questions 45 and 51 of the Minnesota
long-term care consultation assessment form, to have either:

(i) wandering or orientation issues; or

(ii) anxiety, verbal aggression, physical aggression, repetitive behavior, agitation,
self-injurious behavior, or behavior related to property destruction.

(e) Effective July 1, 2011, (f) The individualized monthly payment for the customized
living service plan for individuals described in subdivision 3a, paragraph (b), must be the
monthly authorized payment limit for customized living for individuals classified as case
mix A, reduced by 25 percent. This rate limit must be applied to all new participants enrolled
in the program on or after July 1, 2011, who meet the criteria described in subdivision 3a,
paragraph (b). This monthly limit also applies to all other participants who meet the criteria
described in subdivision 3a, paragraph (b), at reassessment.

(f) (g) Customized living services are delivered by a provider licensed by the Department
of Health as a class A or class F home care provider and provided in a building that is
registered as a housing with services establishment under chapter 144D. Licensed home
care providers are subject to section 256B.0651, subdivision 14.

(g) (h) A provider may not bill or otherwise charge an elderly waiver participant or their
family for additional units of any allowable component service beyond those available under
the service rate limits described in paragraph (d) (e), nor for additional units of any allowable
component service beyond those approved in the service plan by the lead agency.

(h) (i) Effective July 1, 2016 January 1, 2018, and each July January 1 thereafter,
individualized service rate limits for customized living services under this subdivision shall
be increased by the difference between any legislatively adopted home and community-based
provider rate increases effective on July January 1 or since the previous July January 1 and
the average statewide percentage increase in nursing facility operating payment rates under
sections 256B.431, 256B.434, and 256B.441 chapter 256R, effective the previous January
1. This paragraph shall only apply if the average statewide percentage increase in nursing
facility operating payment rates is greater than any legislatively adopted home and
community-based provider rate increases effective on July January 1, or occurring since
the previous July January 1.

EFFECTIVE DATE.

This section prevails over any conflicting amendment regardless
of the order of enactment.

Sec. 12.

Minnesota Statutes 2016, section 256B.0915, subdivision 3h, is amended to read:


Subd. 3h.

Service rate limits; 24-hour customized living services.

(a) The payment
rate for 24-hour customized living services is a monthly rate authorized by the lead agency
within the parameters established by the commissioner of human services. The payment
agreement must delineate the amount of each component service included in each recipient's
customized living service plan. The lead agency, with input from the provider of customized
living services, shall ensure that there is a documented need within the parameters established
by the commissioner for all component customized living services authorized. The lead
agency shall not authorize 24-hour customized living services unless there is a documented
need for 24-hour supervision.

(b) For purposes of this section, "24-hour supervision" means that the recipient requires
assistance due to needs related to one or more of the following:

(1) intermittent assistance with toileting, positioning, or transferring;

(2) cognitive or behavioral issues;

(3) a medical condition that requires clinical monitoring; or

(4) for all new participants enrolled in the program on or after July 1, 2011, and all other
participants at their first reassessment after July 1, 2011, dependency in at least three of the
following activities of daily living as determined by assessment under section 256B.0911:
bathing; dressing; grooming; walking; or eating when the dependency score in eating is
three or greater; and needs medication management and at least 50 hours of service per
month. The lead agency shall ensure that the frequency and mode of supervision of the
recipient and the qualifications of staff providing supervision are described and meet the
needs of the recipient.

(c) The payment rate for 24-hour customized living services must be based on the amount
of component services to be provided utilizing component rates established by the
commissioner. Counties and tribes will use tools issued by the commissioner to develop
and document customized living plans and authorize rates.

(d) Component service rates must not exceed payment rates for comparable elderly
waiver or medical assistance services and must reflect economies of scale.

(e) The individually authorized 24-hour customized living payments, in combination
with the payment for other elderly waiver services, including case management, must not
exceed the recipient's community budget cap specified in subdivision 3a. Customized living
services must not include rent or raw food costs.

(f) The individually authorized 24-hour customized living payment rates shall not exceed
the 95 percentile of statewide monthly authorizations for 24-hour customized living services
in effect and in the Medicaid management information systems on March 31, 2009, for each
case mix resident class under Minnesota Rules, parts 9549.0051 to 9549.0059, to which
elderly waiver service clients are assigned. When there are fewer than 50 authorizations in
effect in the case mix resident class, the commissioner shall multiply the calculated service
payment rate maximum for the A classification by the standard weight for that classification
under Minnesota Rules, parts 9549.0051 to 9549.0059, to determine the applicable payment
rate maximum. Service payment rate maximums shall be updated annually based on
legislatively adopted changes to all service rates for home and community-based service
providers.

(g) Notwithstanding the requirements of paragraphs (d) and (f), the commissioner may
establish alternative payment rate systems for 24-hour customized living services in housing
with services establishments which are freestanding buildings with a capacity of 16 or fewer,
by applying a single hourly rate for covered component services provided in either:

(1) licensed corporate adult foster homes; or

(2) specialized dementia care units which meet the requirements of section 144D.065
and in which:

(i) each resident is offered the option of having their own apartment; or

(ii) the units are licensed as board and lodge establishments with maximum capacity of
eight residents, and which meet the requirements of Minnesota Rules, part 9555.6205,
subparts 1, 2, 3, and 4, item A.

(h) Twenty-four-hour customized living services are delivered by a provider licensed
by the Department of Health as a class A or class F home care provider and provided in a
building that is registered as a housing with services establishment under chapter 144D.
Licensed home care providers are subject to section 256B.0651, subdivision 14.

(i) A provider may not bill or otherwise charge an elderly waiver participant or their
family for additional units of any allowable component service beyond those available under
the service rate limits described in paragraph (e), nor for additional units of any allowable
component service beyond those approved in the service plan by the lead agency.

(j) Effective July 1, 2016 January 1, 2018, and each July January 1 thereafter,
individualized service rate limits for 24-hour customized living services under this
subdivision shall be increased by the difference between any legislatively adopted home
and community-based provider rate increases effective on July January 1 or since the previous
July January 1 and the average statewide percentage increase in nursing facility operating
payment rates under sections 256B.431, 256B.434, and 256B.441 chapter 256R, effective
the previous January 1. This paragraph shall only apply if the average statewide percentage
increase in nursing facility operating payment rates is greater than any legislatively adopted
home and community-based provider rate increases effective on July January 1, or occurring
since the previous July January 1.

Sec. 13.

Minnesota Statutes 2016, section 256B.0915, subdivision 5, is amended to read:


Subd. 5.

Assessments and reassessments for waiver clients.

(a) Each client shall
receive an initial assessment of strengths, informal supports, and need for services in
accordance with section 256B.0911, subdivisions 3, 3a, and 3b. A reassessment of a client
served under the elderly waiver must be conducted at least every 12 months and at other
times when the case manager determines that there has been significant change in the client's
functioning. This may include instances where the client is discharged from the hospital
.
There must be a determination that the client requires nursing facility level of care as defined
in section 256B.0911, subdivision 4e, at initial and subsequent assessments to initiate and
maintain participation in the waiver program.

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

(c) The lead agency shall conduct a change-in-condition reassessment before the annual
reassessment in cases where a client's condition changed due to a major health event, an
emerging need or risk, worsening health condition, or cases where the current services do
not meet the client's needs. A change-in-condition reassessment may be initiated by the lead
agency, or it may be requested by the client or requested on the client's behalf by another
party, such as a provider of services. The lead agency shall complete a change-in-condition
reassessment no later than 20 calendar days from the request. The lead agency shall conduct
these assessments in a timely manner and expedite urgent requests. The lead agency shall
evaluate urgent requests based on the client's needs and risk to the client if a reassessment
is not completed.

Sec. 14.

Minnesota Statutes 2016, section 256B.0915, is amended by adding a subdivision
to read:


Subd. 11.

Payment rates; application.

The payment methodologies in subdivisions 12
to 16 apply to elderly waiver and elderly waiver customized living under this section,
alternative care under section 256B.0913, essential community supports under section
256B.0922, and community access for disability inclusion customized living, brain injury
customized living, and elderly waiver foster care and residential care.

Sec. 15.

Minnesota Statutes 2016, section 256B.0915, is amended by adding a subdivision
to read:


Subd. 12.

Payment rates; phase-in.

(a) Effective January 1, 2019, through December
31, 2020, all rates and rate components for services under subdivision 11 shall be the sum
of 12 percent of the rates calculated under subdivisions 13 to 16 and 88 percent of the rates
calculated using the rate methodology in effect as of June 30, 2017.

(b) Effective January 1, 2021, all rates and rate components for services under subdivision
11 shall be the sum of 20 percent of the rates calculated under subdivisions 13 to 16 and 80
percent of the rates calculated using the rate methodology in effect as of June 30, 2017.

Sec. 16.

Minnesota Statutes 2016, section 256B.0915, is amended by adding a subdivision
to read:


Subd. 13.

Payment rates; establishment.

(a) The commissioner shall use standard
occupational classification (SOC) codes from the Bureau of Labor Statistics as defined in
the most recent edition of the Occupational Handbook and data from the most recent and
available nursing facility cost report, to establish rates and component rates every January
1 using Minnesota-specific wages taken from job descriptions.

(b) In creating the rates and component rates, the commissioner shall establish a base
wage calculation for each component service and value, and add the following factors:

(1) payroll taxes and benefits;

(2) general and administrative;

(3) program plan support;

(4) registered nurse management and supervision; and

(5) social worker supervision.

Sec. 17.

Minnesota Statutes 2016, section 256B.0915, is amended by adding a subdivision
to read:


Subd. 14.

Payment rates; base wage index.

(a) Base wages are calculated for customized
living, foster care, and residential care component services as follows:

(1) the home management and support services base wage equals 33.33 percent of the
Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for personal and home
care aide (SOC code 39-9021); 33.33 percent of the Minneapolis-St. Paul-Bloomington,
MN-WI MetroSA average wage for food preparation workers (SOC code 35-2021); and
33.34 percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage
for maids and housekeeping cleaners (SOC code 37-2012);

(2) the home care aide base wage equals 50 percent of the Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA average wage for home health aides (SOC code
31-1011); and 50 percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA
average wage for nursing assistants (SOC code 31-1014);

(3) the home health aide base wage equals 20 percent of the Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA average wage for licensed practical and licensed
vocational nurses (SOC code 29-2061); and 80 percent of the Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants (SOC code
31-1014); and

(4) the medication setups by licensed practical nurse base wage equals ten percent of
the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for licensed practical
and licensed vocational nurses (SOC code 29-2061); and 90 percent of the Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA average wage for registered nurses (SOC code
29-1141).

(b) Base wages are calculated for the following services as follows:

(1) the chore services base wage equals 100 percent of the Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA average wage for landscaping and groundskeeping
workers (SOC code 37-3011);

(2) the companion services base wage equals 50 percent of the Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA average wage for personal and home care aides (SOC
code 39-9021); and 50 percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA
average wage for maids and housekeeping cleaners (SOC code 37-2012);

(3) the homemaker services and assistance with personal care base wage equals 60
percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for
personal and home care aide (SOC code 39-9021); 20 percent of the Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants (SOC code
31-1014); and 20 percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA
average wage for maids and housekeeping cleaners (SOC code 37-2012);

(4) the homemaker services and cleaning base wage equals 60 percent of the
Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for personal and home
care aide (SOC code 39-9021); 20 percent of the Minneapolis-St. Paul-Bloomington, MN-WI
MetroSA average wage for nursing assistants (SOC code 31-1014); and 20 percent of the
Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for maids and
housekeeping cleaners (SOC code 37-2012);

(5) the homemaker services and home management base wage equals 60 percent of the
Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for personal and home
care aide (SOC code 39-9021); 20 percent of the Minneapolis-St. Paul-Bloomington, MN-WI
MetroSA average wage for nursing assistants (SOC code 31-1014); and 20 percent of the
Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for maids and
housekeeping cleaners (SOC code 37-2012);

(6) the in-home respite care services base wage equals five percent of the Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA average wage for registered nurses (SOC code
29-1141); 75 percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average
wage for nursing assistants (SOC code 31-1014); and 20 percent of the Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA average wage for licensed practical and licensed
vocational nurses (SOC code 29-2061);

(7) the out-of-home respite care services base wage equals five percent of the
Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for registered nurses
(SOC code 29-1141); 75 percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA
average wage for nursing assistants (SOC code 31-1014); and 20 percent of the
Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for licensed practical
and licensed vocational nurses (SOC code 29-2061); and

(8) the individual community living support base wage equals 20 percent of the
Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for licensed practical
and licensed vocational nurses (SOC code 29-2061); and 80 percent of the Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants (SOC code
31-1014).

(c) Base wages are calculated for the following values as follows:

(1) the registered nurse base wage equals 100 percent of the Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA average wage for registered nurses (SOC code
29-1141); and

(2) the social worker base wage equals 100 percent of the Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA average wage for medical and public health social
workers (SOC code 21-1022).

(d) If any of the SOC codes and positions are no longer available, the commissioner
shall, in consultation with stakeholders, select a new SOC code and position that is the
closest match to the previously used SOC position.

Sec. 18.

Minnesota Statutes 2016, section 256B.0915, is amended by adding a subdivision
to read:


Subd. 15.

Payment rates; factors.

The commissioner shall use the following factors:

(1) the payroll taxes and benefits factor is the sum of net payroll taxes and benefits
divided by the sum of all salaries for all nursing facilities on the most recent and available
cost report;

(2) the general and administrative factor is the sum of net general and administrative
expenses minus administrative salaries divided by total operating expenses for all nursing
facilities on the most recent and available cost report;

(3) the program plan support factor is defined as the direct service staff needed to provide
support for the home and community-based service when not engaged in direct contact with
clients. Based on the 2016 Non-Wage Provider Costs in Home and Community-Based
Disability Waiver Services Report, this factor equals 12.8 percent;

(4) the registered nurse management and supervision factor equals 15 percent of the
product of the position's base wage and the sum of the factors in clauses (1) to (3); and

(5) the social worker supervision factor equals 15 percent of the product of the position's
base wage and the sum of the factors in clauses (1) to (3).

Sec. 19.

Minnesota Statutes 2016, section 256B.0915, is amended by adding a subdivision
to read:


Subd. 16.

Payment rates; component rates.

(a) For the purposes of this subdivision,
the "adjusted base wage" for a position equals the position's base wage plus:

(1) the position's base wage multiplied by the payroll taxes and benefits factor;

(2) the position's base wage multiplied by the general and administrative factor; and

(3) the position's base wage multiplied by the program plan support factor.

(b) For medication setups by licensed nurse, registered nurse, and social worker services,
the component rate for each service equals the respective position's adjusted base wage.

(c) For home management and support services, home care aide, and home health aide
services, the component rate for each service equals the respective position's adjusted base
wage plus the registered nurse management and supervision factor.

(d) The home management and support services component rate shall be used for payment
for socialization and transportation component rates under elderly waiver customized living.

(e) The 15-minute unit rates for chore services and companion services are calculated
as follows:

(1) sum the adjusted base wage for the respective position and the social worker factor;
and

(2) divide the result of clause (1) by four.

(f) The 15-minute unit rates for homemaker services and assistance with personal care,
homemaker services and cleaning, and homemaker services and home management are
calculated as follows:

(1) sum the adjusted base wage for the respective position and the registered nurse
management and supervision factor; and

(2) divide the result of clause (1) by four.

(g) The 15-minute unit rate for in-home respite care services is calculated as follows:

(1) sum the adjusted base wage for in-home respite care services and the registered nurse
management and supervision factor; and

(2) divide the result of clause (1) by four.

(h) The in-home respite care services daily rate equals the in-home respite care services
15-minute unit rate multiplied by 18.

(i) The 15-minute unit rate for out-of-home respite care is calculated as follows:

(1) sum the out-of-home respite care services adjusted base wage and the registered
nurse management and supervision factor; and

(2) divide the result of clause (1) by four.

(j) The out-of-home respite care services daily rate equals the out-of-home respite care
services 15-minute unit rate multiplied by 18.

(k) The individual community living support rate is calculated as follows:

(1) sum the adjusted base wage for the home care aide rate in subdivision 14, paragraph
(a), clause (2), and the social worker factor; and

(2) divide the result of clause (1) by four.

(l) The home delivered meals rate equals $9.30. Beginning July 1, 2018, the commissioner
shall increase the home delivered meals rate every July 1 by the percent increase in the
nursing facility dietary per diem using the two most recent nursing facility cost reports.

(m) The adult day services rate is based on the home care aide rate in subdivision 14,
paragraph (a), clause (2), plus the additional factors from subdivision 15, except that the
general and administrative factor used shall be 20 percent. The nonregistered nurse portion
of the rate shall be multiplied by 0.25, to reflect an assumed-ratio staffing of one caregiver
to four clients, and divided by four to determine the 15-minute unit rate. The registered
nurse portion is divided by four to determine the 15-minute unit rate and $0.63 per 15-minute
unit is added to cover the cost of meals.

(n) The adult day services bath 15-minute unit rate is the same as the calculation of the
adult day services 15-minute unit rate without the adjustment for staffing ratio.

(o) If a bath is authorized for an adult day services client, at least two 15-minute units
must be authorized to allow for adequate time to meet client needs. Adult day services may
be authorized for up to 48 units, or 12 hours, per day based on client and family caregiver
needs.

Sec. 20.

Minnesota Statutes 2016, section 256B.0915, is amended by adding a subdivision
to read:


Subd. 17.

Evaluation of rate methodology.

The commissioner, in consultation with
stakeholders, shall conduct a study to evaluate the following:

(1) base wages in subdivision 14, to determine if the standard occupational classification
codes for each rate and component rate are an appropriate representation of staff who deliver
the services; and

(2) factors in subdivision 15, and adjusted base wage calculation in subdivision 16, to
determine if the factors and calculations appropriately address nonwage provider costs.

By January 1, 2019, the commissioner shall submit a report to the legislature on the
changes to the rate methodology in this statute, based on the results of the evaluation. Where
feasible, the report shall address the impact of the new rates on the workforce situation and
client access to services. The report should include any changes to the rate calculations
methods that the commissioner recommends.

Sec. 21.

Minnesota Statutes 2016, section 256B.0922, subdivision 1, is amended to read:


Subdivision 1.

Essential community supports.

(a) The purpose of the essential
community supports program is to provide targeted services to persons age 65 and older
who need essential community support, but whose needs do not meet the level of care
required for nursing facility placement under section 144.0724, subdivision 11.

(b) Essential community supports are available not to exceed $400 $600 per person per
month. Essential community supports may be used as authorized within an authorization
period not to exceed 12 months. Services must be available to a person who:

(1) is age 65 or older;

(2) is not eligible for medical assistance;

(3) has received a community assessment under section 256B.0911, subdivision 3a or
3b, and does not require the level of care provided in a nursing facility;

(4) meets the financial eligibility criteria for the alternative care program under section
256B.0913, subdivision 4;

(5) has a community support plan; and

(6) has been determined by a community assessment under section 256B.0911,
subdivision 3a or 3b, to be a person who would require provision of at least one of the
following services, as defined in the approved elderly waiver plan, in order to maintain their
community residence:

(i) adult day services;

(ii) family caregiver support services;

(iii) respite care;

(iii) (iv) homemaker support;

(v) companion services;

(iv) (vi) chores;

(v) (vii) a personal emergency response device or system;

(vi) (viii) home-delivered meals; or

(vii) (ix) community living assistance as defined by the commissioner.

(c) The person receiving any of the essential community supports in this subdivision
must also receive service coordination, not to exceed $600 in a 12-month authorization
period, as part of their community support plan.

(d) A person who has been determined to be eligible for essential community supports
must be reassessed at least annually and continue to meet the criteria in paragraph (b) to
remain eligible for essential community supports.

(e) The commissioner is authorized to use federal matching funds for essential community
supports as necessary and to meet demand for essential community supports as outlined in
subdivision 2, and that amount of federal funds is appropriated to the commissioner for this
purpose.

Sec. 22.

Minnesota Statutes 2016, section 256B.431, subdivision 10, is amended to read:


Subd. 10.

Property rate adjustments and construction projects.

A nursing facility
completing a construction project that is eligible for a rate adjustment under section
256B.434, subdivision 4f, and that was not approved through the moratorium exception
process in section 144A.073 must request from the commissioner a property-related payment
rate adjustment. If the request is made within 60 days after the construction project's
completion date,
The effective date of the rate adjustment is the first of the month of January
or July, whichever occurs first
following both the construction project's completion date
and submission of the provider's rate adjustment request
. If the request is made more than
60 days after the completion date, the rate adjustment is effective on the first of the month
following the request.
The commissioner shall provide a rate notice reflecting the allowable
costs within 60 days after receiving all the necessary information to compute the rate
adjustment. No sooner than the effective date of the rate adjustment for the construction
project, a nursing facility may adjust its rates by the amount anticipated to be allowed. Any
amounts collected from private pay residents in excess of the allowable rate must be repaid
to private pay residents with interest at the rate used by the commissioner of revenue for
the late payment of taxes and in effect on the date the rate increase is effective. Construction
projects with completion dates within one year of the completion date associated with the
property rate adjustment request and phased projects with project completion dates within
three years of the last phase of the phased project must be aggregated for purposes of the
minimum thresholds in subdivisions 16 and 17, and the maximum threshold in section
144A.071, subdivision 2. "Construction project" and "project construction costs" have the
meanings given them in Minnesota Statutes, section 144A.071, subdivision 1a.

EFFECTIVE DATE.

This section is effective for projects completed after January 1,
2018.

Sec. 23.

Minnesota Statutes 2016, section 256B.431, subdivision 16, is amended to read:


Subd. 16.

Major additions and replacements; equity incentive.

For rate years beginning
after June 30, 1993, if a nursing facility acquires capital assets in connection with a project
approved under the moratorium exception process in section 144A.073 or in connection
with an addition to or replacement of buildings, attached fixtures, or land improvements
for which the total historical cost of those capital asset additions exceeds the lesser of
$150,000 or ten percent of the most recent appraised value, the nursing facility shall be
eligible for an equity incentive payment rate as in paragraphs (a) to (d). This computation
is separate from the determination of the nursing facility's rental rate. An equity incentive
payment rate as computed under this subdivision is limited to one in a 12-month period.

(a) An eligible nursing facility shall receive an equity incentive payment rate equal to
the allowable historical cost of the capital asset acquired, minus the allowable debt directly
identified to that capital asset, multiplied by the equity incentive factor as described in
paragraphs (b) and (c), and divided by the nursing facility's occupancy factor under
subdivision 3f, paragraph (c). This amount shall be added to the nursing facility's total
payment rate and shall be effective the same day as the incremental increase in paragraph
(d) or subdivision 17. The allowable historical cost of the capital assets and the allowable
debt shall be determined as provided in Minnesota Rules, parts 9549.0010 to 9549.0080,
and this section.

(b) The equity incentive factor shall be determined under clauses (1) to (4):

(1) divide the initial allowable debt in paragraph (a) by the initial historical cost of the
capital asset additions referred to in paragraph (a), then cube the quotient,

(2) subtract the amount calculated in clause (1) from the number one,

(3) determine the difference between the rental factor and the lesser of two percentage
points above the posted yield for standard conventional fixed rate mortgages of the Federal
Home Loan Mortgage Corporation as published in the Wall Street Journal and in effect on
the first day of the month the debt or cost is incurred, or 16 percent,

(4) multiply the amount calculated in clause (2) by the amount calculated in clause (3).

(c) The equity incentive payment rate shall be limited to the term of the allowable debt
in paragraph (a), not greater than 20 years nor less than ten years. If no debt is incurred in
acquiring the capital asset, the equity incentive payment rate shall be paid for ten years. The
sale of a nursing facility under subdivision 14 shall terminate application of the equity
incentive payment rate effective on the date provided in subdivision 14, paragraph (f), for
the sale.

(d) A nursing facility with an addition to or a renovation of its buildings, attached fixtures,
or land improvements meeting the criteria in this subdivision and not receiving the
property-related payment rate adjustment in subdivision 17, shall receive the incremental
increase in the nursing facility's rental rate as determined under Minnesota Rules, parts
9549.0010 to 9549.0080, and this section. The incremental increase shall be added to the
nursing facility's property-related payment rate. The effective date of this incremental
increase shall be the first day of the month of January or July, whichever occurs first
following the month in date on which the addition or replacement is completed.

EFFECTIVE DATE.

This section is effective for additions or replacements completed
after January 1, 2018.

Sec. 24.

Minnesota Statutes 2016, section 256B.431, subdivision 30, is amended to read:


Subd. 30.

Bed layaway and delicensure.

(a) For rate years beginning on or after July
1, 2000, a nursing facility reimbursed under this section which has placed beds on layaway
shall, for purposes of application of the downsizing incentive in subdivision 3a, paragraph
(c), and calculation of the rental per diem, have those beds given the same effect as if the
beds had been delicensed so long as the beds remain on layaway. At the time of a layaway,
a facility may change its single bed election for use in calculating capacity days under
Minnesota Rules, part 9549.0060, subpart 11. The property payment rate increase shall be
effective the first day of the month of January or July, whichever occurs first following the
month in date on which the layaway of the beds becomes effective under section 144A.071,
subdivision 4b
.

(b) For rate years beginning on or after July 1, 2000, notwithstanding any provision to
the contrary under section 256B.434, a nursing facility reimbursed under that section which
that
has placed beds on layaway shall, for so long as the beds remain on layaway, be allowed
to:

(1) aggregate the applicable investment per bed limits based on the number of beds
licensed immediately prior to entering the alternative payment system;

(2) retain or change the facility's single bed election for use in calculating capacity days
under Minnesota Rules, part 9549.0060, subpart 11; and

(3) establish capacity days based on the number of beds immediately prior to the layaway
and the number of beds after the layaway.

The commissioner shall increase the facility's property payment rate by the incremental
increase in the rental per diem resulting from the recalculation of the facility's rental per
diem applying only the changes resulting from the layaway of beds and clauses (1), (2), and
(3). If a facility reimbursed under section 256B.434 completes a moratorium exception
project after its base year, the base year property rate shall be the moratorium project property
rate. The base year rate shall be inflated by the factors in section 256B.434, subdivision 4,
paragraph (c). The property payment rate increase shall be effective the first day of the
month of January or July, whichever occurs first following the month in date on which the
layaway of the beds becomes effective.

(c) If a nursing facility removes a bed from layaway status in accordance with section
144A.071, subdivision 4b, the commissioner shall establish capacity days based on the
number of licensed and certified beds in the facility not on layaway and shall reduce the
nursing facility's property payment rate in accordance with paragraph (b).

(d) For the rate years beginning on or after July 1, 2000, notwithstanding any provision
to the contrary under section 256B.434, a nursing facility reimbursed under that section,
which
that has delicensed beds after July 1, 2000, by giving notice of the delicensure to the
commissioner of health according to the notice requirements in section 144A.071, subdivision
4b
, shall be allowed to:

(1) aggregate the applicable investment per bed limits based on the number of beds
licensed immediately prior to entering the alternative payment system;

(2) retain or change the facility's single bed election for use in calculating capacity days
under Minnesota Rules, part 9549.0060, subpart 11; and

(3) establish capacity days based on the number of beds immediately prior to the
delicensure and the number of beds after the delicensure.

The commissioner shall increase the facility's property payment rate by the incremental
increase in the rental per diem resulting from the recalculation of the facility's rental per
diem applying only the changes resulting from the delicensure of beds and clauses (1), (2),
and (3). If a facility reimbursed under section 256B.434 completes a moratorium exception
project after its base year, the base year property rate shall be the moratorium project property
rate. The base year rate shall be inflated by the factors in section 256B.434, subdivision 4,
paragraph (c). The property payment rate increase shall be effective the first day of the
month of January or July, whichever occurs first following the month in date on which the
delicensure of the beds becomes effective.

(e) For nursing facilities reimbursed under this section or section 256B.434, any beds
placed on layaway shall not be included in calculating facility occupancy as it pertains to
leave days defined in Minnesota Rules, part 9505.0415.

(f) For nursing facilities reimbursed under this section or section 256B.434, the rental
rate calculated after placing beds on layaway may not be less than the rental rate prior to
placing beds on layaway.

(g) A nursing facility receiving a rate adjustment as a result of this section shall comply
with section 256B.47, subdivision 2 256R.06, subdivision 5.

(h) A facility that does not utilize the space made available as a result of bed layaway
or delicensure under this subdivision to reduce the number of beds per room or provide
more common space for nursing facility uses or perform other activities related to the
operation of the nursing facility shall have its property rate increase calculated under this
subdivision reduced by the ratio of the square footage made available that is not used for
these purposes to the total square footage made available as a result of bed layaway or
delicensure.

EFFECTIVE DATE.

This section is effective for layaways occurring after July 1, 2017.

Sec. 25.

Minnesota Statutes 2016, section 256B.434, subdivision 4, is amended to read:


Subd. 4.

Alternate rates for nursing facilities.

Effective for the rate years beginning
on and after January 1, 2019,
a nursing facility's case mix property payment rates rate for
the second and subsequent years of a facility's contract under this section are the previous
rate year's contract property payment rates rate plus an inflation adjustment and, for facilities
reimbursed under this section or section 256B.431, an adjustment to include the cost of any
increase in Health Department licensing fees for the facility taking effect on or after July
1, 2001
. The index for the inflation adjustment must be based on the change in the Consumer
Price Index-All Items (United States City average) (CPI-U) forecasted by the commissioner
of management and budget's national economic consultant
Reports and Forecasts Division
of the Department of Human Services
, as forecasted in the fourth quarter of the calendar
year preceding the rate year. The inflation adjustment must be based on the 12-month period
from the midpoint of the previous rate year to the midpoint of the rate year for which the
rate is being determined. For the rate years beginning on July 1, 1999, July 1, 2000, July 1,
2001, July 1, 2002, July 1, 2003, July 1, 2004, July 1, 2005, July 1, 2006, July 1, 2007, July
1, 2008, October 1, 2009, and October 1, 2010, this paragraph shall apply only to the
property-related payment rate. For the rate years beginning on October 1, 2011, October 1,
2012, October 1, 2013, October 1, 2014, October 1, 2015, January 1, 2016, and January 1,
2017, the rate adjustment under this paragraph shall be suspended. Beginning in 2005,
adjustment to the property payment rate under this section and section 256B.431 shall be
effective on October 1. In determining the amount of the property-related payment rate
adjustment under this paragraph, the commissioner shall determine the proportion of the
facility's rates that are property-related based on the facility's most recent cost report.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 26.

Minnesota Statutes 2016, section 256B.434, subdivision 4f, is amended to read:


Subd. 4f.

Construction project rate adjustments effective October 1, 2006.

(a)
Effective October 1, 2006, facilities reimbursed under this section may receive a property
rate adjustment for construction projects exceeding the threshold in section 256B.431,
subdivision 16, and below the threshold in section 144A.071, subdivision 2, clause (a). For
these projects, capital assets purchased shall be counted as construction project costs for a
rate adjustment request made by a facility if they are: (1) purchased within 24 months of
the completion of the construction project; (2) purchased after the completion date of any
prior construction project; and (3) are not purchased prior to July 14, 2005. Except as
otherwise provided in this subdivision, the definitions, rate calculation methods, and
principles in sections 144A.071 and 256B.431 and Minnesota Rules, parts 9549.0010 to
9549.0080, shall be used to calculate rate adjustments for allowable construction projects
under this subdivision and section 144A.073. Facilities completing construction projects
between October 1, 2005, and October 1, 2006, are eligible to have a property rate adjustment
effective October 1, 2006. Facilities completing projects after October 1, 2006, are eligible
for a property rate adjustment effective on the first day of the month following the completion
date. Facilities completing projects after January 1, 2018, are eligible for a property rate
adjustment effective on the first day of the month of January or July, whichever occurs
immediately following the completion date.

(b) Notwithstanding subdivision 18, as of July 14, 2005, facilities with rates set under
section 256B.431 and Minnesota Rules, parts 9549.0010 to 9549.0080, that commenced a
construction project on or after October 1, 2004, and do not have a contract under subdivision
3 by September 30, 2006, are eligible to request a rate adjustment under section 256B.431,
subdivision 10, through September 30, 2006. If the request results in the commissioner
determining a rate adjustment is allowable, the rate adjustment is effective on the first of
the month following project completion. These facilities shall be allowed to accumulate
construction project costs for the period October 1, 2004, to September 30, 2006.

(c) Facilities shall be allowed construction project rate adjustments no sooner than 12
months after completing a previous construction project. Facilities must request the rate
adjustment according to section 256B.431, subdivision 10.

(d) Capacity days shall be computed according to Minnesota Rules, part 9549.0060,
subpart 11. For rate calculations under this section, the number of licensed beds in the
nursing facility shall be the number existing after the construction project is completed and
the number of days in the nursing facility's reporting period shall be 365.

(e) The value of assets to be recognized for a total replacement project as defined in
section 256B.431, subdivision 17d, shall be computed as described in clause (1). The value
of assets to be recognized for all other projects shall be computed as described in clause
(2).

(1) Replacement-cost-new limits under section 256B.431, subdivision 17e, and the
number of beds allowed under subdivision 3a, paragraph (c), shall be used to compute the
maximum amount of assets allowable in a facility's property rate calculation. If a facility's
current request for a rate adjustment results from the completion of a construction project
that was previously approved under section 144A.073, the assets to be used in the rate
calculation cannot exceed the lesser of the amount determined under sections 144A.071,
subdivision 2, and 144A.073, subdivision 3b, or the actual allowable costs of the construction
project. A current request that is not the result of a project under section 144A.073 cannot
exceed the limit under section 144A.071, subdivision 2, paragraph (a). Applicable credits
must be deducted from the cost of the construction project.

(2)(i) Replacement-cost-new limits under section 256B.431, subdivision 17e, and the
number of beds allowed under section 256B.431, subdivision 3a, paragraph (c), shall be
used to compute the maximum amount of assets allowable in a facility's property rate
calculation.

(ii) The value of a facility's assets to be compared to the amount in item (i) begins with
the total appraised value from the last rate notice a facility received when its rates were set
under section 256B.431 and Minnesota Rules, parts 9549.0010 to 9549.0080. This value
shall be indexed by the factor in section 256B.431, subdivision 3f, paragraph (a), for each
rate year the facility received an inflation factor on its property-related rate when its rates
were set under this section. The value of assets listed as previous capital additions, capital
additions, and special projects on the facility's base year rate notice and the value of assets
related to a construction project for which the facility received a rate adjustment when its
rates were determined under this section shall be added to the indexed appraised value.

(iii) The maximum amount of assets to be recognized in computing a facility's rate
adjustment after a project is completed is the lesser of the aggregate replacement-cost-new
limit computed in (i) minus the assets recognized in (ii) or the actual allowable costs of the
construction project.

(iv) If a facility's current request for a rate adjustment results from the completion of a
construction project that was previously approved under section 144A.073, the assets to be
added to the rate calculation cannot exceed the lesser of the amount determined under
sections 144A.071, subdivision 2, and 144A.073, subdivision 3b, or the actual allowable
costs of the construction project. A current request that is not the result of a project under
section 144A.073 cannot exceed the limit stated in section 144A.071, subdivision 2,
paragraph (a). Assets disposed of as a result of a construction project and applicable credits
must be deducted from the cost of the construction project.

(f) For construction projects approved under section 144A.073, allowable debt may
never exceed the lesser of the cost of the assets purchased, the threshold limit in section
144A.071, subdivision 2, or the replacement-cost-new limit less previously existing capital
debt.

(g) For construction projects that were not approved under section 144A.073, allowable
debt is limited to the lesser of the threshold in section 144A.071, subdivision 2, for such
construction projects or the applicable limit in paragraph (e), clause (1) or (2), less previously
existing capital debt. Amounts of debt taken out that exceed the costs of a construction
project shall not be allowed regardless of the use of the funds.

For all construction projects being recognized, interest expense and average debt shall
be computed based on the first 12 months following project completion. "Previously existing
capital debt" means capital debt recognized on the last rate determined under section
256B.431 and Minnesota Rules, parts 9549.0010 to 9549.0080, and the amount of debt
recognized for a construction project for which the facility received a rate adjustment when
its rates were determined under this section.

For a total replacement project as defined in section 256B.431, subdivision 17d, the
value of previously existing capital debt shall be zero.

(h) In addition to the interest expense allowed from the application of paragraph (f), the
amounts allowed under section 256B.431, subdivision 17a, paragraph (a), clauses (2) and
(3), will be added to interest expense.

(i) The equity portion of the construction project shall be computed as the allowable
assets in paragraph (e), less the average debt in paragraph (f). The equity portion must be
multiplied by 5.66 percent and the allowable interest expense in paragraph (f) must be added.
This sum must be divided by 95 percent of capacity days to compute the construction project
rate adjustment.

(j) For projects that are not a total replacement of a nursing facility, the amount in
paragraph (i) is adjusted for nonreimbursable areas and then added to the current property
payment rate of the facility.

(k) For projects that are a total replacement of a nursing facility, the amount in paragraph
(i) becomes the new property payment rate after being adjusted for nonreimbursable areas.
Any amounts existing in a facility's rate before the effective date of the construction project
for equity incentives under section 256B.431, subdivision 16; capital repairs and replacements
under section 256B.431, subdivision 15; or refinancing incentives under section 256B.431,
subdivision 19, shall be removed from the facility's rates.

(l) No additional equipment allowance is allowed under Minnesota Rules, part 9549.0060,
subpart 10, as the result of construction projects under this section. Allowable equipment
shall be included in the construction project costs.

(m) Capital assets purchased after the completion date of a construction project shall be
counted as construction project costs for any future rate adjustment request made by a facility
under section 144A.071, subdivision 2, clause (a), if they are purchased within 24 months
of the completion of the future construction project.

(n) In subsequent rate years, the property payment rate for a facility that results from
the application of this subdivision shall be the amount inflated in subdivision 4.

(o) Construction projects are eligible for an equity incentive under section 256B.431,
subdivision 16. When computing the equity incentive for a construction project under this
subdivision, only the allowable costs and allowable debt related to the construction project
shall be used. The equity incentive shall not be a part of the property payment rate and not
inflated under subdivision 4. Effective October 1, 2006, all equity incentives for nursing
facilities reimbursed under this section shall be allowed for a duration determined under
section 256B.431, subdivision 16, paragraph (c).

EFFECTIVE DATE.

This section is effective January 1, 2018.

Sec. 27.

Minnesota Statutes 2016, section 256B.50, subdivision 1b, is amended to read:


Subd. 1b.

Filing an appeal.

To appeal, the provider shall file with the commissioner a
written notice of appeal; the appeal must be postmarked or received by the commissioner
within 60 days of the publication date the determination of the payment rate was mailed or
personally received by a provider, whichever is earlier
printed on the rate notice. The notice
of appeal must specify each disputed item; the reason for the dispute; the total dollar amount
in dispute for each separate disallowance, allocation, or adjustment of each cost item or part
of a cost item; the computation that the provider believes is correct; the authority in statute
or rule upon which the provider relies for each disputed item; the name and address of the
person or firm with whom contacts may be made regarding the appeal; and other information
required by the commissioner.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 28.

Minnesota Statutes 2016, section 256B.5012, is amended by adding a subdivision
to read:


Subd. 3a.

Therapeutic leave days.

Notwithstanding Minnesota Rules, part 9505.0415,
subpart 7, a vacant bed in an intermediate care facility for persons with developmental
disabilities shall be counted as a reserved bed when determining occupancy rates and
eligibility for payment of a therapeutic leave day.

Sec. 29.

Minnesota Statutes 2016, section 256B.5012, is amended by adding a subdivision
to read:


Subd. 17.

ICF/DD rate increase effective July 1, 2017; Murray County.

Effective
July 1, 2017, the daily rate for an intermediate care facility for persons with developmental
disabilities located in Murray County that is classified as a class B facility and licensed for
14 beds is $400. This increase is in addition to any other increase that is effective on July
1, 2017.

Sec. 30.

Minnesota Statutes 2016, section 256R.02, subdivision 4, is amended to read:


Subd. 4.

Administrative costs.

"Administrative costs" means the identifiable costs for
administering the overall activities of the nursing home. These costs include salaries and
wages of the administrator, assistant administrator, business office employees, security
guards, and associated fringe benefits and payroll taxes, fees, contracts, or purchases related
to business office functions, licenses, and permits except as provided in the external fixed
costs category, employee recognition, travel including meals and lodging, all training except
as specified in subdivision 17, voice and data communication or transmission, office supplies,
property and liability insurance and other forms of insurance not designated to other areas
except insurance that is a fringe benefit under subdivision 22
, personnel recruitment, legal
services, accounting services, management or business consultants, data processing,
information technology, Web site, central or home office costs, business meetings and
seminars, postage, fees for professional organizations, subscriptions, security services,
advertising, board of directors fees, working capital interest expense, and bad debts, and
bad debt collection fees, and costs incurred for travel and housing for persons employed by
a supplemental nursing services agency as defined in section 144A.70, subdivision 6
.

EFFECTIVE DATE.

This section is effective October 1, 2017.

Sec. 31.

Minnesota Statutes 2016, section 256R.02, subdivision 17, is amended to read:


Subd. 17.

Direct care costs.

"Direct care costs" means costs for the wages of nursing
administration, direct care registered nurses, licensed practical nurses, certified nursing
assistants, trained medication aides, employees conducting training in resident care topics
and associated fringe benefits and payroll taxes; services from a supplemental nursing
services agency; supplies that are stocked at nursing stations or on the floor and distributed
or used individually, including, but not limited to: alcohol, applicators, cotton balls,
incontinence pads, disposable ice bags, dressings, bandages, water pitchers, tongue
depressors, disposable gloves, enemas, enema equipment, soap, medication cups, diapers,
plastic waste bags, sanitary products, thermometers, hypodermic needles and syringes,
clinical reagents or similar diagnostic agents, drugs that are not paid on a separate fee
schedule by the medical assistance program or any other payer, and technology related to
the provision of nursing care to residents, such as electronic charting systems; costs of
materials used for resident care training, and training courses outside of the facility attended
by direct care staff on resident care topics; and costs for nurse consultants, pharmacy
consultants, and medical directors. Salaries and payroll taxes for nurse consultants who
work out of a central office must be allocated proportionately by total resident days or by
direct identification to the nursing facilities served by those consultants
.

Sec. 32.

Minnesota Statutes 2016, section 256R.02, subdivision 18, is amended to read:


Subd. 18.

Employer health insurance costs.

"Employer health insurance costs" means
premium expenses for group coverage and reinsurance,; actual expenses incurred for
self-insured plans, including reinsurance; and employer contributions to employee health
reimbursement and health savings accounts. Premium and expense costs and contributions
are allowable for (1) all employees and (2) the spouse and dependents of those employees
who meet the definition of full-time employees under the federal Affordable Care Act,
Public Law 111-148
are employed on average at least 30 hours per week.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 33.

Minnesota Statutes 2016, section 256R.02, subdivision 19, is amended to read:


Subd. 19.

External fixed costs.

"External fixed costs" means costs related to the nursing
home surcharge under section 256.9657, subdivision 1; licensure fees under section 144.122;
family advisory council fee under section 144A.33; scholarships under section 256R.37;
planned closure rate adjustments under section 256R.40; consolidation rate adjustments
under section 144A.071, subdivisions 4c, paragraph (a), clauses (5) and (6), and 4d;
single-bed room incentives under section 256R.41; property taxes, assessments, and payments
in lieu of taxes; employer health insurance costs; quality improvement incentive payment
rate adjustments under section 256R.39; performance-based incentive payments under
section 256R.38; special dietary needs under section 256R.51; rate adjustments for
compensation-related costs for minimum wage changes under section 256R.49 provided
on or after January 1, 2018;
and Public Employees Retirement Association employer costs.

Sec. 34.

Minnesota Statutes 2016, section 256R.02, subdivision 22, is amended to read:


Subd. 22.

Fringe benefit costs.

"Fringe benefit costs" means the costs for group life,
dental, workers' compensation, and other employee insurances and short- and long-term
disability, long-term care insurance, accident insurance, supplemental insurance, legal
assistance insurance, profit sharing, health insurance costs not covered under subdivision
18, including costs associated with part-time employee family members or retirees, and

pension and retirement plan contributions, except for the Public Employees Retirement
Association and employer health insurance costs; profit sharing; and retirement plans for
which the employer pays all or a portion of the
costs.

Sec. 35.

Minnesota Statutes 2016, section 256R.02, subdivision 42, is amended to read:


Subd. 42.

Raw food costs.

"Raw food costs" means the cost of food provided to nursing
facility residents and the allocation of dietary credits. Also included are special dietary
supplements used for tube feeding or oral feeding, such as elemental high nitrogen diet.

Sec. 36.

Minnesota Statutes 2016, section 256R.02, is amended by adding a subdivision
to read:


Subd. 42a.

Real estate taxes.

"Real estate taxes" means the real estate tax liability shown
on the annual property tax statement of the nursing facility for the reporting period. The
term does not include personnel costs or fees for late payment.

Sec. 37.

Minnesota Statutes 2016, section 256R.02, is amended by adding a subdivision
to read:


Subd. 48a.

Special assessments.

"Special assessments" means the actual special
assessments and related interest paid during the reporting period. The term does not include
personnel costs or fees for late payment.

Sec. 38.

Minnesota Statutes 2016, section 256R.02, subdivision 52, is amended to read:


Subd. 52.

Therapy costs.

"Therapy costs" means any costs related to medical assistance
therapy services provided to residents that are not billed separately billable from the daily
operating rate.

Sec. 39.

Minnesota Statutes 2016, section 256R.06, subdivision 5, is amended to read:


Subd. 5.

Notice to residents.

(a) No increase in nursing facility rates for private paying
residents shall be effective unless the nursing facility notifies the resident or person
responsible for payment of the increase in writing 30 days before the increase takes effect.
The notice must include the amount of the rate increase, the new payment rate, and the date
the rate increase takes effect.

A nursing facility may adjust its rates without giving the notice required by this
subdivision when the purpose of the rate adjustment is to reflect a change in the case mix
classification of the resident. The nursing facility shall notify private pay residents of any
rate increase related to a change in case mix classifications in a timely manner after
confirmation of the case mix classification change is received from the Department of
Health.

If the state fails to set rates as required by section 256R.09, subdivision 1, the time
required for giving notice is decreased by the number of days by which the state was late
in setting the rates.

(b) If the state does not set rates by the date required in section 256R.09, subdivision 1,
or otherwise provides nursing facilities with retroactive notification of the amount of a rate
increase,
nursing facilities shall meet the requirement for advance notice by informing the
resident or person responsible for payments, on or before the effective date of the increase,
that a rate increase will be effective on that date. The requirements of paragraph (a) do not
apply to situations described in this paragraph.

If the exact amount has not yet been determined, the nursing facility may raise the rates
by the amount anticipated to be allowed. Any amounts collected from private pay residents
in excess of the allowable rate must be repaid to private pay residents with interest at the
rate used by the commissioner of revenue for the late payment of taxes and in effect on the
date the rate increase is effective.

Sec. 40.

Minnesota Statutes 2016, section 256R.07, is amended by adding a subdivision
to read:


Subd. 6.

Electronic signature.

For documentation requiring a signature under this
chapter or section 256B.431 or 256B.434, use of an electronic signature as defined under
section 325L.02, paragraph (h), is allowed.

Sec. 41.

Minnesota Statutes 2016, section 256R.10, is amended by adding a subdivision
to read:


Subd. 7.

Not specified allowed costs.

When the cost category for allowed cost items or
services is not specified in this chapter or the provider reimbursement manual, the
commissioner, in consultation with stakeholders, shall determine the cost category for the
allowed cost item or service.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 42.

[256R.18] REPORT BY COMMISSIONER OF HUMAN SERVICES.

Beginning January 1, 2019, the commissioner shall provide to the house of representatives
and senate committees with jurisdiction over nursing facility payment rates a biennial report
on the effectiveness of the reimbursement system in improving quality, restraining costs,
and any other features of the system as determined by the commissioner.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 43.

Minnesota Statutes 2016, section 256R.37, is amended to read:


256R.37 SCHOLARSHIPS.

(a) For the 27-month period beginning October 1, 2015, through December 31, 2017,
the commissioner shall allow a scholarship per diem of up to 25 cents for each nursing
facility with no scholarship per diem that is requesting a scholarship per diem to be added
to the external fixed payment rate to be used:

(1) for employee scholarships that satisfy the following requirements:

(i) scholarships are available to all employees who work an average of at least ten hours
per week at the facility except the administrator, and to reimburse student loan expenses
for newly hired and recently graduated registered nurses and licensed practical nurses, and
training expenses for nursing assistants as specified in section 144A.611, subdivisions 2
and 4, who are newly hired and have graduated within the last 12 months; and

(ii) the course of study is expected to lead to career advancement with the facility or in
long-term care, including medical care interpreter services and social work; and

(2) to provide job-related training in English as a second language.

(b) All facilities may annually request a rate adjustment under this section by submitting
information to the commissioner on a schedule and in a form supplied by the commissioner.
The commissioner shall allow a scholarship payment rate equal to the reported and allowable
costs divided by resident days.

(c) In calculating the per diem under paragraph (b), the commissioner shall allow costs
related to tuition, direct educational expenses, and reasonable costs as defined by the
commissioner for child care costs and transportation expenses related to direct educational
expenses.

(d) The rate increase under this section is an optional rate add-on that the facility must
request from the commissioner in a manner prescribed by the commissioner. The rate
increase must be used for scholarships as specified in this section.

(e) For instances in which a rate adjustment will be 15 cents or greater, nursing facilities
that close beds during a rate year may request to have their scholarship adjustment under
paragraph (b) recalculated by the commissioner for the remainder of the rate year to reflect
the reduction in resident days compared to the cost report year.

Sec. 44.

Minnesota Statutes 2016, section 256R.40, subdivision 1, is amended to read:


Subdivision 1.

Definitions.

(a) The definitions in this subdivision apply to this section.

(b) "Closure" means the cessation of operations of a nursing facility and delicensure and
decertification of all beds within the facility.

(c) "Closure plan" means a plan to close a nursing facility and reallocate a portion of
the resulting savings to provide planned closure rate adjustments at other facilities.

(d) "Commencement of closure" means the date on which residents and designated
representatives are notified of a planned closure as provided in section 144A.161, subdivision
5a, as part of an approved closure plan.

(e) "Completion of closure" means the date on which the final resident of the nursing
facility designated for closure in an approved closure plan is discharged from the facility
or the date that beds from a partial closure are delicensed and decertified
.

(f) "Partial closure" means the delicensure and decertification of a portion of the beds
within the facility.

(g) "Planned closure rate adjustment" means an increase in a nursing facility's operating
rates resulting from a planned closure or a planned partial closure of another facility.

Sec. 45.

Minnesota Statutes 2016, section 256R.40, subdivision 5, is amended to read:


Subd. 5.

Planned closure rate adjustment.

(a) The commissioner shall calculate the
amount of the planned closure rate adjustment available under subdivision 6 according to
clauses (1) to (4):

(1) the amount available is the net reduction of nursing facility beds multiplied by $2,080;

(2) the total number of beds in the nursing facility or facilities receiving the planned
closure rate adjustment must be identified;

(3) capacity days are determined by multiplying the number determined under clause
(2) by 365; and

(4) the planned closure rate adjustment is the amount available in clause (1), divided by
capacity days determined under clause (3).

(b) A planned closure rate adjustment under this section is effective on the first day of
the month of January or July, whichever occurs immediately following completion of closure
of the facility designated for closure in the application and becomes part of the nursing
facility's external fixed payment rate.

(c) Upon the request of a closing facility, the commissioner must allow the facility a
closure rate adjustment as provided under section 144A.161, subdivision 10.

(d) A facility that has received a planned closure rate adjustment may reassign it to
another facility that is under the same ownership at any time within three years of its effective
date. The amount of the adjustment is computed according to paragraph (a).

(e) If the per bed dollar amount specified in paragraph (a), clause (1), is increased, the
commissioner shall recalculate planned closure rate adjustments for facilities that delicense
beds under this section on or after July 1, 2001, to reflect the increase in the per bed dollar
amount. The recalculated planned closure rate adjustment is effective from the date the per
bed dollar amount is increased.

EFFECTIVE DATE.

This section is effective for closures occurring after July 1, 2017.

Sec. 46.

Minnesota Statutes 2016, section 256R.41, is amended to read:


256R.41 SINGLE-BED ROOM INCENTIVE.

(a) Beginning July 1, 2005, the operating payment rate for nursing facilities reimbursed
under this chapter shall be increased by 20 percent multiplied by the ratio of the number of
new single-bed rooms created divided by the number of active beds on July 1, 2005, for
each bed closure that results in the creation of a single-bed room after July 1, 2005. The
commissioner may implement rate adjustments for up to 3,000 new single-bed rooms each
year. For eligible bed closures for which the commissioner receives a notice from a facility
during a calendar quarter that a bed has been delicensed and a new single-bed room has
been established, the rate adjustment in this paragraph shall be effective on either the first
day of the second month of January or July, whichever occurs first following that calendar
quarter
the date of the bed delicensure.

(b) A nursing facility is prohibited from discharging residents for purposes of establishing
single-bed rooms. A nursing facility must submit documentation to the commissioner in a
form prescribed by the commissioner, certifying the occupancy status of beds closed to
create single-bed rooms. In the event that the commissioner determines that a facility has
discharged a resident for purposes of establishing a single-bed room, the commissioner shall
not provide a rate adjustment under paragraph (a).

EFFECTIVE DATE.

This section is effective for closures occurring after July 1, 2017.

Sec. 47.

Minnesota Statutes 2016, section 256R.47, is amended to read:


256R.47 RATE ADJUSTMENT FOR CRITICAL ACCESS NURSING
FACILITIES.

(a) The commissioner, in consultation with the commissioner of health, may designate
certain nursing facilities as critical access nursing facilities. The designation shall be granted
on a competitive basis, within the limits of funds appropriated for this purpose.

(b) The commissioner shall request proposals from nursing facilities every two years.
Proposals must be submitted in the form and according to the timelines established by the
commissioner. In selecting applicants to designate, the commissioner, in consultation with
the commissioner of health, and with input from stakeholders, shall develop criteria designed
to preserve access to nursing facility services in isolated areas, rebalance long-term care,
and improve quality. To the extent practicable, the commissioner shall ensure an even
distribution of designations across the state.

(c) The commissioner shall allow the benefits in clauses (1) to (5) for nursing facilities
designated as critical access nursing facilities:

(1) partial rebasing, with the commissioner allowing a designated facility operating
payment rates being the sum of up to 60 percent of the operating payment rate determined
in accordance with section 256R.21, subdivision 3, and at least 40 percent, with the sum of
the two portions being equal to 100 percent, of the operating payment rate that would have
been allowed had the facility not been designated. The commissioner may adjust these
percentages by up to 20 percent and may approve a request for less than the amount allowed;

(2) enhanced payments for leave days. Notwithstanding section 256R.43, upon
designation as a critical access nursing facility, the commissioner shall limit payment for
leave days to 60 percent of that nursing facility's total payment rate for the involved resident,
and shall allow this payment only when the occupancy of the nursing facility, inclusive of
bed hold days, is equal to or greater than 90 percent;

(3) two designated critical access nursing facilities, with up to 100 beds in active service,
may jointly apply to the commissioner of health for a waiver of Minnesota Rules, part
4658.0500, subpart 2, in order to jointly employ a director of nursing. The commissioner
of health shall consider each waiver request independently based on the criteria under
Minnesota Rules, part 4658.0040;

(4) the minimum threshold under section 256B.431, subdivision 15, paragraph (e), shall
be 40 percent of the amount that would otherwise apply; and

(5) the quality-based rate limits under section 256R.23, subdivisions 5 to 7, apply to
designated critical access nursing facilities.

(d) Designation of a critical access nursing facility is for a period of two years, after
which the benefits allowed under paragraph (c) shall be removed. Designated facilities may
apply for continued designation.

(e) This section is suspended and no state or federal funding shall be appropriated or
allocated for the purposes of this section from January 1, 2016, to December 31, 2017 2019.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 48.

Minnesota Statutes 2016, section 256R.49, subdivision 1, is amended to read:


Subdivision 1.

Rate adjustments for compensation-related costs.

(a) Operating payment
rates of all nursing facilities that are reimbursed under this chapter shall be increased effective
for rate years beginning on and after October 1, 2014, to address changes in compensation
costs for nursing facility employees paid less than $14 per hour in accordance with this
section.
Rate increases provided under this section before October 1, 2016, expire effective
January 1, 2018, and rate increases provided on or after October 1, 2016, expire effective
January 1, 2019.

(b) Nursing facilities that receive approval of the applications in subdivision 2 must
receive rate adjustments according to subdivision 4. The rate adjustments must be used to
pay compensation costs for nursing facility employees paid less than $14 per hour.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 49.

Minnesota Statutes 2016, section 256R.53, subdivision 2, is amended to read:


Subd. 2.

Nursing facility facilities in Breckenridge border cities.

The operating
payment rate of a nonprofit nursing facility that exists on January 1, 2015, is located within
the boundaries of the city cities of Breckenridge or Moorhead, and is reimbursed under this
chapter, is equal to the greater of:

(1) the operating payment rate determined under section 256R.21, subdivision 3; or

(2) the median case mix adjusted rates, including comparable rate components as
determined by the median case mix adjusted rates, including comparable rate components
as determined by the commissioner, for the equivalent case mix indices of the nonprofit
nursing facility or facilities located in an adjacent city in another state and in cities contiguous
to the adjacent city. The commissioner shall make the comparison required in this subdivision
on November 1 of each year and shall apply it to the rates to be effective on the following
January 1.
The Minnesota facility's operating payment rate with a case mix index of 1.0 is
computed by dividing the adjacent city's nursing facility or facilities' median operating
payment rate with an index of 1.02 by 1.02. If the adjustments under this subdivision result
in a rate that exceeds the limits in section 256R.23, subdivision 5, and whose costs exceed
the rate in section 256R.24, subdivision 3, in a given rate year, the facility's rate shall not
be subject to the limits in section 256R.23, subdivision 5, and shall not be limited to the
rate established in section 256R.24, subdivision 3, for that rate year.

EFFECTIVE DATE.

The rate increases for a facility located in Moorhead are effective
for the rate year beginning January 1, 2020, and annually thereafter.

Sec. 50. DIRECTION TO COMMISSIONER; ADULT DAY SERVICES STAFFING
RATIOS.

The commissioner of human services shall study the staffing ratio for adult day services
clients and shall provide the chairs and ranking minority members of the house of
representatives and senate committees with jurisdiction over adult day services with
recommendations to adjust staffing ratios based on client needs by January 1, 2018.

Sec. 51.

ALZHEIMER'S DISEASE WORKING GROUP.

Subdivision 1.

Members.

(a) The Minnesota Board on Aging must appoint 16 members
to an Alzheimer's disease working group, as follows:

(1) a caregiver of a person who has been diagnosed with Alzheimer's disease;

(2) a person who has been diagnosed with Alzheimer's disease;

(3) two representatives from the nursing facility or senior housing profession;

(4) a representative of the home care or adult day services profession;

(5) two geriatricians, one of whom serves a diverse or underserved community;

(6) a psychologist who specializes in dementia care;

(7) an Alzheimer's researcher;

(8) a representative of the Alzheimer's Association;

(9) two members from community-based organizations serving one or more diverse or
underserved communities;

(10) the commissioner of human services or a designee;

(11) the commissioner of health or a designee;

(12) the ombudsman for long-term care or a designee; and

(13) one member of the Minnesota Board on Aging, selected by the board.

(b) The executive director of the Minnesota Board on Aging serves on the working group
as a nonvoting member.

(c) The appointing authorities under this subdivision must complete their appointments
no later than December 15, 2017.

(d) To the extent practicable, the membership of the working group must reflect the
diversity in Minnesota, and must include representatives from rural and metropolitan areas
and representatives of different ethnicities, races, genders, ages, cultural groups, and abilities.

Subd. 2.

Duties; recommendations.

The Alzheimer's disease working group must
review and revise the 2011 report, Preparing Minnesota for Alzheimer's: the Budgetary,
Social and Personal Impacts. The working group shall consider and make recommendations
and findings on the following issues as related to Alzheimer's disease or other dementias:

(1) analysis and assessment of public health and health care data to accurately determine
trends and disparities in cognitive decline;

(2) public awareness, knowledge, and attitudes, including knowledge gaps, stigma,
availability of information, and supportive community environments;

(3) risk reduction, including health education and health promotion on risk factors,
safety, and potentially avoidable hospitalizations;

(4) diagnosis and treatment, including early detection, access to diagnosis, quality of
dementia care, and cost of treatment;

(5) professional education and training, including geriatric education for licensed health
care professionals and dementia-specific training for direct care workers, first responders,
and other professionals in communities;

(6) residential services, including cost to families as well as regulation and licensing
gaps; and

(7) cultural competence and responsiveness to reduce health disparities and improve
access to high-quality dementia care.

Subd. 3.

Meetings.

The Board on Aging must convene the first meeting of the working
group no later than January 15, 2018. Before the first meeting, the Board on Aging must
designate one member to serve as chair. Meetings of the working group must be open to
the public, and to the extent practicable, technological means, such as Web casts, shall be
used to reach the greatest number of people throughout the state. The working group may
not meet more than five times.

Subd. 4.

Compensation.

Members of the working group serve without compensation,
but may be reimbursed for allowed actual and necessary expenses incurred in the performance
of the member's duties for the working group in the same manner and amount as authorized
by the commissioner's plan adopted under Minnesota Statutes, section 43A.18, subdivision
2.

Subd. 5.

Administrative support.

The Minnesota Board on Aging shall provide
administrative support and arrange meeting space for the working group.

Subd. 6.

Report.

The Board on Aging must submit a report providing the findings and
recommendations of the working group, including any draft legislation necessary to
implement the recommendations, to the governor and chairs and ranking minority members
of the legislative committees with jurisdiction over health care by January 15, 2019.

Subd. 7.

Expiration.

The working group expires June 30, 2019, or the day after the
working group submits the report required in subdivision 6, whichever is earlier.

Sec. 52. ELECTRONIC SERVICE DELIVERY DOCUMENTATION SYSTEM.

Subdivision 1.

Documentation; establishment.

The commissioner of human services
shall establish implementation requirements and standards for an electronic service delivery
documentation system to comply with the 21st Century Cures Act, Public Law 114-255.

Subd. 2.

Definitions.

(a) For purposes of this section, the terms in this subdivision have
the meanings given them.

(b) "Electronic service delivery documentation" means the electronic documentation of
the:

(1) type of service performed;

(2) individual receiving the service;

(3) date of the service;

(4) location of the service delivery;

(5) individual providing the service; and

(6) time the service begins and ends.

(c) "Electronic service delivery documentation system" means a system that provides
electronic service delivery documentation that complies with the 21st Century Cures Act,
Public Law 114-255, and the requirements of subdivision 3.

(d) "Service" means one of the following:

(1) personal care assistance services as defined in Minnesota Statutes, section 256B.0625,
subdivision 19a, and provided according to Minnesota Statutes, section 256B.0659; or

(2) community first services and supports under Minnesota Statutes, section 256B.85.

Subd. 3.

Requirements.

(a) In developing implementation requirements for an electronic
service delivery documentation system, the commissioner shall consider electronic visit
verification systems and other electronic service delivery documentation methods. The
commissioner shall convene stakeholders that will be impacted by an electronic service
delivery system, including service providers and their representatives, service recipients
and their representatives, and, as appropriate, those with expertise in the development and
operation of an electronic service delivery documentation system, to ensure that the
requirements:

(1) are minimally administratively and financially burdensome to a provider;

(2) are minimally burdensome to the service recipient and the least disruptive to the
service recipient in receiving and maintaining allowed services;

(3) consider existing best practices and use of electronic service delivery documentation;

(4) are conducted according to all state and federal laws;

(5) are effective methods for preventing fraud when balanced against the requirements
of clauses (1) and (2); and

(6) are consistent with the Department of Human Services' policies related to covered
services, flexibility of service use, and quality assurance.

(b) The commissioner shall make training available to providers on the electronic service
delivery documentation system requirements.

(c) The commissioner shall establish baseline measurements related to preventing fraud
and establish measures to determine the effect of electronic service delivery documentation
requirements on program integrity.

Subd. 4.

Legislative report.

(a) The commissioner shall submit a report by January 15,
2018, to the chairs and ranking minority members of the legislative committees with
jurisdiction over human services with recommendations, based on the requirements of
subdivision 3, to establish electronic service delivery documentation system requirements
and standards. The report shall identify:

(1) the essential elements necessary to operationalize a base-level electronic service
delivery documentation system to be implemented by January 1, 2019; and

(2) enhancements to the base-level electronic service delivery documentation system to
be implemented by January 1, 2019, or after, with projected operational costs and the costs
and benefits for system enhancements.

(b) The report must also identify current regulations on service providers that are either
inefficient, minimally effective, or will be unnecessary with the implementation of an
electronic service delivery documentation system.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 53. DIRECTION TO COMMISSIONER; ICF/DD PAYMENT RATE STUDY.

Within available appropriations, the commissioner of human services shall study the
intermediate care facility for persons with developmental disabilities payment rates under
Minnesota Statutes, sections 256B.5011 to 256B.5013, and make recommendations on the
rate structure to the chairs and ranking minority members of the legislative committees with
jurisdiction over human services policy and finance by January 15, 2018.

Sec. 54. REVISOR'S INSTRUCTION.

The revisor of statutes, in consultation with the House Research Department, Office of
Senate Counsel, Research, and Fiscal Analysis, and Department of Human Services shall
prepare legislation for the 2018 legislative session to recodify laws governing the elderly
waiver program in Minnesota Statutes, chapter 256B.

EFFECTIVE DATE.

This section is effective the day following final enactment.

ARTICLE 4

HEALTH CARE

Section 1.

Minnesota Statutes 2016, section 3.972, is amended by adding a subdivision
to read:


Subd. 2a.

Audits of Department of Human Services.

(a) To ensure continuous
legislative oversight and accountability, the legislative auditor shall give high priority to
auditing the programs, services, and benefits administered by the Department of Human
Services. The audits shall determine whether the department offered programs and provided
services and benefits only to eligible persons and organizations, and complied with applicable
legal requirements.

(b) The legislative auditor shall, based on an assessment of risk and using professional
standards to provide a statistically significant sample, no less than three times each year,
test a representative sample of persons enrolled in a medical assistance program or
MinnesotaCare to determine whether they are eligible to receive benefits under those
programs. The legislative auditor shall report the results to the commissioner of human
services and recommend corrective actions. The commissioner shall provide a response to
the legislative auditor within 20 business days, including corrective actions to be taken to
address any problems identified by the legislative auditor and anticipated completion dates.
The legislative auditor shall monitor the commissioner's implementation of corrective actions
and periodically report the results to the Legislative Audit Commission and the chairs and
ranking minority members of the legislative committees with jurisdiction over health and
human services policy and finance. The legislative auditor's reports to the commission and
the chairs and ranking minority members must include recommendations for any legislative
actions needed to ensure that medical assistance and MinnesotaCare benefits are provided
only to eligible persons.

Sec. 2.

Minnesota Statutes 2016, section 3.972, is amended by adding a subdivision to
read:


Subd. 2b.

Audits of managed care organizations.

(a) The legislative auditor shall audit
each managed care organization that contracts with the commissioner of human services to
provide health care services under sections 256B.69, 256B.692, and 256L.12. The legislative
auditor shall design the audits to determine if a managed care organization used the public
money in compliance with federal and state laws, rules, and in accordance with provisions
in the managed care organization's contract with the commissioner of human services. The
legislative auditor shall determine the schedule and scope of the audit work and may contract
with vendors to assist with the audits. The managed care organization must cooperate with
the legislative auditor and must provide the legislative auditor with all data, documents, and
other information, regardless of classification, that the legislative auditor requests to conduct
an audit. The legislative auditor shall periodically report audit results and recommendations
to the Legislative Audit Commission and the chairs and ranking minority members of the
legislative committees with jurisdiction over health and human services policy and finance.

(b) For purposes of this subdivision, a "managed care organization" means a
demonstration provider as defined under section 256B.69, subdivision 2.

Sec. 3.

Minnesota Statutes 2016, section 13.69, subdivision 1, is amended to read:


Subdivision 1.

Classifications.

(a) The following government data of the Department
of Public Safety are private data:

(1) medical data on driving instructors, licensed drivers, and applicants for parking
certificates and special license plates issued to physically disabled persons;

(2) other data on holders of a disability certificate under section 169.345, except that (i)
data that are not medical data may be released to law enforcement agencies, and (ii) data
necessary for enforcement of sections 169.345 and 169.346 may be released to parking
enforcement employees or parking enforcement agents of statutory or home rule charter
cities and towns;

(3) Social Security numbers in driver's license and motor vehicle registration records,
except that Social Security numbers must be provided to the Department of Revenue for
purposes of tax administration, the Department of Labor and Industry for purposes of
workers' compensation administration and enforcement, and the Department of Natural
Resources for purposes of license application administration, and except that the last four
digits of the Social Security number must be provided to the Department of Human Services
for purposes of recovery of Minnesota health care program benefits paid
; and

(4) data on persons listed as standby or temporary custodians under section 171.07,
subdivision 11
, except that the data must be released to:

(i) law enforcement agencies for the purpose of verifying that an individual is a designated
caregiver; or

(ii) law enforcement agencies who state that the license holder is unable to communicate
at that time and that the information is necessary for notifying the designated caregiver of
the need to care for a child of the license holder.

The department may release the Social Security number only as provided in clause (3)
and must not sell or otherwise provide individual Social Security numbers or lists of Social
Security numbers for any other purpose.

(b) The following government data of the Department of Public Safety are confidential
data: data concerning an individual's driving ability when that data is received from a member
of the individual's family.

EFFECTIVE DATE.

This section is effective July 1, 2017.

Sec. 4.

[62J.815] HEALTH CARE PROVIDERS PRICE DISCLOSURES.

(a) Each health care provider, as defined by section 62J.03, subdivision 8, except hospitals
and outpatient surgical centers subject to the requirements of section 62J.82, shall maintain
a list of the services or procedures that correspond with the 35 most frequent current
procedural terminology (CPT) codes, and a list of the ten most frequent CPT codes for
preventive services used by the provider for reimbursement purposes and the provider's
charge for each of these services or procedures that the provider would charge to patients
who are not covered by private or public health care coverage.

(b) This list must be updated annually and be readily available on site at no cost to the
public. The provider must also post this information on the provider's Web site or the health
care clinic's Web site where the provider practices.

Sec. 5.

Minnesota Statutes 2016, section 256.9686, subdivision 8, is amended to read:


Subd. 8.

Rate year.

"Rate year" means a calendar year from January 1 to December 31.
Effective with the 2012 base year, rate year means a state fiscal year from July 1 to June
30.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 6.

Minnesota Statutes 2016, section 256.969, subdivision 1, is amended to read:


Subdivision 1.

Hospital cost index.

(a) The hospital cost index shall be the change in
the Centers for Medicare and Medicaid Services Inpatient Hospital Market Basket. The
commissioner shall use the indices as forecasted for the midpoint of the prior rate year to
the midpoint of the current rate year.

(b) Except as authorized under this section, for fiscal years beginning on or after July
1, 1993, the commissioner of human services shall not provide automatic annual inflation
adjustments for hospital payment rates under medical assistance.

EFFECTIVE DATE.

This section is effective July 1, 2017.

Sec. 7.

Minnesota Statutes 2016, section 256.969, subdivision 2b, is amended to read:


Subd. 2b.

Hospital payment rates.

(a) For discharges occurring on or after November
1, 2014, hospital inpatient services for hospitals located in Minnesota shall be paid according
to the following:

(1) critical access hospitals as defined by Medicare shall be paid using a cost-based
methodology;

(2) long-term hospitals as defined by Medicare shall be paid on a per diem methodology
under subdivision 25;

(3) rehabilitation hospitals or units of hospitals that are recognized as rehabilitation
distinct parts as defined by Medicare shall be paid according to the methodology under
subdivision 12; and

(4) all other hospitals shall be paid on a diagnosis-related group (DRG) methodology.

(b) For the period beginning January 1, 2011, through October 31, 2014, rates shall not
be rebased, except that a Minnesota long-term hospital shall be rebased effective January
1, 2011, based on its most recent Medicare cost report ending on or before September 1,
2008, with the provisions under subdivisions 9 and 23, based on the rates in effect on
December 31, 2010. For rate setting periods after November 1, 2014, in which the base
years are updated, a Minnesota long-term hospital's base year shall remain within the same
period as other hospitals.

(c) Effective for discharges occurring on and after November 1, 2014, payment rates
for hospital inpatient services provided by hospitals located in Minnesota or the local trade
area, except for the hospitals paid under the methodologies described in paragraph (a),
clauses (2) and (3), shall be rebased, incorporating cost and payment methodologies in a
manner similar to Medicare. The base year for the rates effective November 1, 2014, shall
be calendar year 2012. The rebasing under this paragraph shall be budget neutral, ensuring
that the total aggregate payments under the rebased system are equal to the total aggregate
payments that were made for the same number and types of services in the base year. Separate
budget neutrality calculations shall be determined for payments made to critical access
hospitals and payments made to hospitals paid under the DRG system. Only the rate increases
or decreases under subdivision 3a or 3c that applied to the hospitals being rebased during
the entire base period shall be incorporated into the budget neutrality calculation.

(d) For discharges occurring on or after November 1, 2014, through the next rebasing
that occurs, the rebased rates under paragraph (c) that apply to hospitals under paragraph
(a), clause (4), shall include adjustments to the projected rates that result in no greater than
a five percent increase or decrease from the base year payments for any hospital. Any
adjustments to the rates made by the commissioner under this paragraph and paragraph (e)
shall maintain budget neutrality as described in paragraph (c).

(e) For discharges occurring on or after November 1, 2014, through the next two rebasing
that occurs periods the commissioner may make additional adjustments to the rebased rates,
and when evaluating whether additional adjustments should be made, the commissioner
shall consider the impact of the rates on the following:

(1) pediatric services;

(2) behavioral health services;

(3) trauma services as defined by the National Uniform Billing Committee;

(4) transplant services;

(5) obstetric services, newborn services, and behavioral health services provided by
hospitals outside the seven-county metropolitan area;

(6) outlier admissions;

(7) low-volume providers; and

(8) services provided by small rural hospitals that are not critical access hospitals.

(f) Hospital payment rates established under paragraph (c) must incorporate the following:

(1) for hospitals paid under the DRG methodology, the base year payment rate per
admission is standardized by the applicable Medicare wage index and adjusted by the
hospital's disproportionate population adjustment;

(2) for critical access hospitals, payment rates for discharges between November 1, 2014,
and June 30, 2015, shall be set to the same rate of payment that applied for discharges on
October 31, 2014;

(3) the cost and charge data used to establish hospital payment rates must only reflect
inpatient services covered by medical assistance; and

(4) in determining hospital payment rates for discharges occurring on or after the rate
year beginning January 1, 2011, through December 31, 2012, the hospital payment rate per
discharge shall be based on the cost-finding methods and allowable costs of the Medicare
program in effect during the base year or years. In determining hospital payment rates for
discharges in subsequent base years, the per discharge rates shall be based on the cost-finding
methods and allowable costs of the Medicare program in effect during the base year or
years.

(g) The commissioner shall validate the rates effective November 1, 2014, by applying
the rates established under paragraph (c), and any adjustments made to the rates under
paragraph (d) or (e), to hospital claims paid in calendar year 2013 to determine whether the
total aggregate payments for the same number and types of services under the rebased rates
are equal to the total aggregate payments made during calendar year 2013.

(h) Effective for discharges occurring on or after July 1, 2017, and every two years
thereafter, payment rates under this section shall be rebased to reflect only those changes
in hospital costs between the existing base year and the next base year. Changes in costs
between base years shall be measured using the lower of the hospital cost index defined in
subdivision 1, paragraph (a), or the percentage change in the case mix adjusted cost per
claim.
The commissioner shall establish the base year for each rebasing period considering
the most recent year for which filed Medicare cost reports are available. The estimated
change in the average payment per hospital discharge resulting from a scheduled rebasing
must be calculated and made available to the legislature by January 15 of each year in which
rebasing is scheduled to occur, and must include by hospital the differential in payment
rates compared to the individual hospital's costs.

(i) Effective for discharges occurring on or after July 1, 2015, inpatient payment rates
for critical access hospitals located in Minnesota or the local trade area shall be determined
using a new cost-based methodology. The commissioner shall establish within the
methodology tiers of payment designed to promote efficiency and cost-effectiveness.
Payment rates for hospitals under this paragraph shall be set at a level that does not exceed
the total cost for critical access hospitals as reflected in base year cost reports. Until the
next rebasing that occurs, the new methodology shall result in no greater than a five percent
decrease from the base year payments for any hospital, except a hospital that had payments
that were greater than 100 percent of the hospital's costs in the base year shall have their
rate set equal to 100 percent of costs in the base year. The rates paid for discharges on and
after July 1, 2016, covered under this paragraph shall be increased by the inflation factor
in subdivision 1, paragraph (a). The new cost-based rate shall be the final rate and shall not
be settled to actual incurred costs. Hospitals shall be assigned a payment tier based on the
following criteria:

(1) hospitals that had payments at or below 80 percent of their costs in the base year
shall have a rate set that equals 85 percent of their base year costs;

(2) hospitals that had payments that were above 80 percent, up to and including 90
percent of their costs in the base year shall have a rate set that equals 95 percent of their
base year costs; and

(3) hospitals that had payments that were above 90 percent of their costs in the base year
shall have a rate set that equals 100 percent of their base year costs.

(j) The commissioner may refine the payment tiers and criteria for critical access hospitals
to coincide with the next rebasing under paragraph (h). The factors used to develop the new
methodology may include, but are not limited to:

(1) the ratio between the hospital's costs for treating medical assistance patients and the
hospital's charges to the medical assistance program;

(2) the ratio between the hospital's costs for treating medical assistance patients and the
hospital's payments received from the medical assistance program for the care of medical
assistance patients;

(3) the ratio between the hospital's charges to the medical assistance program and the
hospital's payments received from the medical assistance program f