SF 348

2nd Engrossment - 87th Legislature (2011 - 2012) Posted on 03/06/2012 02:06pm

A bill for an act
relating to human services; modifying personal care assistance services;
amending Minnesota Statutes 2010, sections 256B.0625, subdivision 19a;
256B.0652, subdivision 6; Laws 2009, chapter 79, article 13, section 3,
subdivision 8, as amended.

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

Section 1.

Minnesota Statutes 2010, section 256B.0625, subdivision 19a, is amended to
read:

Subd. 19a.

Personal care assistance services.

Medical assistance covers personal
care assistance services in a recipient's home. Effective January 1, 2010, to qualify for
personal care assistance services, a recipient must require assistance and be determined
dependent in one activity of daily living as defined in section 256B.0659, subdivision 1,
paragraph (b), or in a Level I behavior as defined in section 256B.0659, subdivision 1,
paragraph (c). deleted text begin Beginning July 1, 2011, to qualify for personal care assistance services, a
recipient must require assistance and be determined dependent in at least two activities
of daily living as defined in section 256B.0659. deleted text end Recipients or responsible parties must
be able to identify the recipient's needs, direct and evaluate task accomplishment, and
provide for health and safety. Approved hours may be used outside the home when normal
life activities take them outside the home. To use personal care assistance services at
school, the recipient or responsible party must provide written authorization in the care
plan identifying the chosen provider and the daily amount of services to be used at school.
Total hours for services, whether actually performed inside or outside the recipient's
home, cannot exceed that which is otherwise allowed for personal care assistance services
in an in-home setting according to sections 256B.0651 to 256B.0656. Medical assistance
does not cover personal care assistance services for residents of a hospital, nursing facility,
intermediate care facility, health care facility licensed by the commissioner of health, or
unless a resident who is otherwise eligible is on leave from the facility and the facility
either pays for the personal care assistance services or forgoes the facility per diem for the
leave days that personal care assistance services are used. All personal care assistance
services must be provided according to sections 256B.0651 to 256B.0656. Personal care
assistance services may not be reimbursed if the personal care assistant is the spouse or
paid guardian of the recipient or the parent of a recipient under age 18, or the responsible
party or the family foster care provider of a recipient who cannot direct the recipient's own
care unless, in the case of a foster care provider, a county or state case manager visits
the recipient as needed, but not less than every six months, to monitor the health and
safety of the recipient and to ensure the goals of the care plan are met. Notwithstanding
the provisions of section 256B.0659, the unpaid guardian or conservator of an adult,
who is not the responsible party and not the personal care provider organization, may be
reimbursed to provide personal care assistance services to the recipient if the guardian or
conservator meets all criteria for a personal care assistant according to section 256B.0659,
and shall not be considered to have a service provider interest for purposes of participation
on the screening team under section 256B.092, subdivision 7.

Sec. 2.

Minnesota Statutes 2010, section 256B.0652, subdivision 6, is amended to read:

Subd. 6.

Authorization; personal care assistance and qualified professional.

(a) All personal care assistance services, supervision by a qualified professional, and
additional services beyond the limits established in subdivision 11, must be authorized
by the commissioner or the commissioner's designee before services begin except for the
assessments established in subdivision 11 and section 256B.0911. The authorization for
personal care assistance and qualified professional services under section 256B.0659 must
be completed within 30 days after receiving a complete request.

(b) The amount of personal care assistance services authorized must be based
on the recipient's home care rating. The home care rating shall be determined by the
commissioner or the commissioner's designee based on information submitted to the
commissioner identifying the following new text begin for recipients with dependencies in two or more
activities of daily living new text end :

(1) total number of dependencies of activities of daily living as defined in section
256B.0659;

(2) presence of complex health-related needs as defined in section 256B.0659; and

(3) presence of Level I behavior as defined in section 256B.0659.

(c) new text begin For persons meeting the criteria in paragraph (b), new text end the methodology to determine
total time for personal care assistance services for each home care rating is based on
the median paid units per day for each home care rating from fiscal year 2007 data for
the personal care assistance program. Each home care rating has a base level of hours
assigned. Additional time is added through the assessment and identification of the
following:

(1) 30 additional minutes per day for a dependency in each critical activity of daily
living as defined in section 256B.0659;

(2) 30 additional minutes per day for each complex health-related function as
defined in section 256B.0659; and

(3) 30 additional minutes per day for each behavior issue as defined in section
256B.0659, subdivision 4, paragraph (d).

(d) new text begin Effective July 1, 2011, the home care rating for recipients who have a dependency
in one activity of daily living or level one behavior shall equal no more than two units per
day. Recipients with this home care rating are not subject to the methodology in paragraph
(c), and are not eligible for more than two units per day.
new text end

new text begin (e) new text end A limit of 96 units of qualified professional supervision may be authorized for
each recipient receiving personal care assistance services. A request to the commissioner
to exceed this total in a calendar year must be requested by the personal care provider
agency on a form approved by the commissioner.

Sec. 3.

Laws 2009, chapter 79, article 13, section 3, subdivision 8, as amended by
Laws 2009, chapter 173, article 2, section 1, subdivision 8, Laws 2010, First Special
Session chapter 1, article 15, section 5, and Laws 2010, First Special Session chapter 1,
article 25, section 16, is amended to read:

Subd. 8. Continuing Care Grants

The amounts that may be spent from the
appropriation for each purpose are as follows:

(a) Aging and Adult Services Grants

13,499,000

15,805,000

Base Adjustment. The general fund base is
increased by $5,751,000 in fiscal year 2012
and $6,705,000 in fiscal year 2013.

Information and Assistance
Reimbursement. Federal administrative
reimbursement obtained from information
and assistance services provided by the
Senior LinkAge or Disability Linkage lines
to people who are identified as eligible for
medical assistance shall be appropriated to
the commissioner for this activity.

Community Service Development Grant
Reduction. Funding for community service
development grants must be reduced by
$260,000 for fiscal year 2010; $284,000 in
fiscal year 2011; $43,000 in fiscal year 2012;
and $43,000 in fiscal year 2013. Base level
funding shall be restored in fiscal year 2014.

Community Service Development Grant
Community Initiative. Funding for
community service development grants shall
be used to offset the cost of aging support
grants. Base level funding shall be restored
in fiscal year 2014.

Senior Nutrition Use of Federal Funds.
For fiscal year 2010, general fund grants
for home-delivered meals and congregate
dining shall be reduced by $500,000. The
commissioner must replace these general
fund reductions with equal amounts from
federal funding for senior nutrition from the
American Recovery and Reinvestment Act
of 2009.

(b) Alternative Care Grants

50,234,000

48,576,000

Base Adjustment. The general fund base is
decreased by $3,598,000 in fiscal year 2012
and $3,470,000 in fiscal year 2013.

Alternative Care Transfer. Any money
allocated to the alternative care program that
is not spent for the purposes indicated does
not cancel but must be transferred to the
medical assistance account.

(c) Medical Assistance Grants; Long-Term Care Facilities.

367,444,000

419,749,000

(d) Medical Assistance Long-Term Care Waivers and Home Care Grants

853,567,000

1,039,517,000

Manage Growth in TBI and CADI
Waivers. During the fiscal years beginning
on July 1, 2009, and July 1, 2010, the
commissioner shall allocate money for home
and community-based waiver programs
under Minnesota Statutes, section 256B.49,
to ensure a reduction in state spending that is
equivalent to limiting the caseload growth of
the TBI waiver to 12.5 allocations per month
each year of the biennium and the CADI
waiver to 95 allocations per month each year
of the biennium. Limits do not apply: (1)
when there is an approved plan for nursing
facility bed closures for individuals under
age 65 who require relocation due to the
bed closure; (2) to fiscal year 2009 waiver
allocations delayed due to unallotment; or (3)
to transfers authorized by the commissioner
from the personal care assistance program
of individuals having a home care rating
of "CS," "MT," or "HL." Priorities for the
allocation of funds must be for individuals
anticipated to be discharged from institutional
settings or who are at imminent risk of a
placement in an institutional setting.

Manage Growth in DD Waiver. The
commissioner shall manage the growth in
the DD waiver by limiting the allocations
included in the February 2009 forecast to 15
additional diversion allocations each month
for the calendar years that begin on January
1, 2010, and January 1, 2011. Additional
allocations must be made available for
transfers authorized by the commissioner
from the personal care program of individuals
having a home care rating of "CS," "MT,"
or "HL."

Adjustment to Lead Agency Waiver
Allocations. Prior to the availability of the
alternative license defined in Minnesota
Statutes, section 245A.11, subdivision 8,
the commissioner shall reduce lead agency
waiver allocations for the purposes of
implementing a moratorium on corporate
foster care.

deleted text begin Alternatives to Personal Care Assistance
Services. Base level funding of $3,237,000
in fiscal year 2012 and $4,856,000 in
fiscal year 2013 is to implement alternative
services to personal care assistance services
for persons with mental health and other
behavioral challenges who can benefit
from other services that more appropriately
meet their needs and assist them in living
independently in the community. These
services may include, but not be limited to, a
1915(i) state plan option.
deleted text end

(e) Mental Health Grants

Appropriations by Fund
General	77,739,000	77,739,000
Health Care Access	750,000	750,000
Lottery Prize	1,508,000	1,508,000

Funding Usage. Up to 75 percent of a fiscal
year's appropriation for adult mental health
grants may be used to fund allocations in that
portion of the fiscal year ending December
31.

(f) Deaf and Hard-of-Hearing Grants

1,930,000

1,917,000

(g) Chemical Dependency Entitlement Grants

111,303,000

122,822,000

Payments for Substance Abuse Treatment.
For placements beginning during fiscal years
2010 and 2011, county-negotiated rates and
provider claims to the consolidated chemical
dependency fund must not exceed the lesser
of:

(1) rates charged for these services on
January 1, 2009; deleted text begin and deleted text end or

(2) 160 percent of the average rate on January
1, 2009, for each group of vendors with
similar attributes.

Rates for fiscal years 2010 and 2011 must
not exceed 160 percent of the average rate on
January 1, 2009, for each group of vendors
with similar attributes.

Effective July 1, 2010, rates that were above
the average rate on January 1, 2009, are
reduced by five percent from the rates in
effect on June 1, 2010. Rates below the
average rate on January 1, 2009, are reduced
by 1.8 percent from the rates in effect on
June 1, 2010. Services provided under
this section by state-operated services are
exempt from the rate reduction. For services
provided in fiscal years 2012 and 2013, the
statewide aggregate payment under the new
rate methodology to be developed under
Minnesota Statutes, section 254B.12, must
not exceed the projected aggregate payment
under the rates in effect for fiscal year 2011
excluding the rate reduction for rates that
were below the average on January 1, 2009,
plus a state share increase of $3,787,000 for
fiscal year 2012 and $5,023,000 for fiscal
year 2013. Notwithstanding any provision
to the contrary in this article, this provision
expires on June 30, 2013.

Chemical Dependency Special Revenue
Account. For fiscal year 2010, $750,000
must be transferred from the consolidated
chemical dependency treatment fund
administrative account and deposited into the
general fund.

County CD Share of MA Costs for
ARRA Compliance. Notwithstanding the
provisions of Minnesota Statutes, chapter
254B, for chemical dependency services
provided during the period October 1, 2008,
to December 31, 2010, and reimbursed by
medical assistance at the enhanced federal
matching rate provided under the American
Recovery and Reinvestment Act of 2009, the
county share is 30 percent of the nonfederal
share. This provision is effective the day
following final enactment.

(h) Chemical Dependency Nonentitlement Grants

1,729,000

1,729,000

(i) Other Continuing Care Grants

19,201,000

17,528,000

Base Adjustment. The general fund base is
increased by $2,639,000 in fiscal year 2012
and increased by $3,854,000 in fiscal year
2013.

Technology Grants. $650,000 in fiscal
year 2010 and $1,000,000 in fiscal year
2011 are for technology grants, case
consultation, evaluation, and consumer
information grants related to developing and
supporting alternatives to shift-staff foster
care residential service models.

Other Continuing Care Grants; HIV
Grants. Money appropriated for the HIV
drug and insurance grant program in fiscal
year 2010 may be used in either year of the
biennium.

Quality Assurance Commission. Effective
July 1, 2009, state funding for the quality
assurance commission under Minnesota
Statutes, section 256B.0951, is canceled.