Office of the Revisor of Statutes
Minnesota Session Laws - 1997, Regular Session
Key: (1) language to be deleted (2) new language
CHAPTER 113-S.F.No. 333
An act relating to home care; modifying an exemption
from the definition of provider; requiring rules to
include certain standards; establishing an assisted
living home care provider license; redefining elderly
housing with services establishment; modifying
reimbursement procedures for assisted living services
under medical assistance and alternative care;
defining certain housing with services establishments
as a permitted single family residential use of
property for zoning purposes; requiring a study;
amending Minnesota Statutes 1996, sections 144A.43,
subdivision 4; 144A.45, subdivision 1, and by adding a
subdivision; 144A.46, subdivisions 1 and 3; 144D.01,
subdivisions 4, 5, 6, and by adding a subdivision;
144D.03, subdivision 1; 144D.06; 157.17, subdivisions
2 and 5; 245A.03, subdivision 2; 256B.0913,
subdivision 5; 256B.0915, subdivision 3; 256I.04,
subdivision 2a; and 462.357, subdivision 7; proposing
coding for new law in Minnesota Statutes, chapters
144A; and 144D; repealing Minnesota Statutes 1996,
sections 144A.45, subdivision 3; 144A.49; 144B.01;
144B.02; 144B.03; 144B.04; 144B.05; 144B.06; 144B.07;
144B.08; 144B.09; 144B.10; 144B.11; 144B.12; 144B.13;
144B.14; 144B.15; 144B.16; and 144B.17.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Section 1. Minnesota Statutes 1996, section 144A.43,
subdivision 4, is amended to read:
Subd. 4. [HOME CARE PROVIDER.] "Home care provider" means
an individual, organization, association, corporation, unit of
government, or other entity that is regularly engaged in the
delivery, directly or by contractual arrangement, of home care
services for a fee. At least one home care service must be
provided directly, although additional home care services may be
provided by contractual arrangements. "Home care provider"
includes a hospice program defined in section 144A.48. "Home
care provider" does not include:
(1) any home care or nursing services conducted by and for
the adherents of any recognized church or religious denomination
for the purpose of providing care and services for those who
depend upon spiritual means, through prayer alone, for healing;
(2) an individual who only provides services to a relative;
(3) an individual not connected with a home care provider
who provides assistance with home management services or
personal care needs if the assistance is provided primarily as a
contribution and not as a business;
(4) an individual not connected with a home care provider
who shares housing with and provides primarily housekeeping or
homemaking services to an elderly or disabled person in return
for free or reduced-cost housing;
(5) an individual or agency providing home-delivered meal
services;
(6) an agency providing senior companion services and other
older American volunteer programs established under the Domestic
Volunteer Service Act of 1973, Public Law Number 98-288;
(7) an employee of a nursing home licensed under this
chapter or an employee of a boarding care home licensed under
sections 144.50 to 144.56 who provides responds to occasional
emergency services to calls from individuals residing in an
apartment unit attached to a residential setting that is
attached to or located on property contiguous to the nursing
home or boarding care home;
(8) a member of a professional corporation organized under
sections 319A.01 to 319A.22 that does not regularly offer or
provide home care services as defined in subdivision 3;
(9) the following organizations established to provide
medical or surgical services that do not regularly offer or
provide home care services as defined in subdivision 3: a
business trust organized under sections 318.01 to 318.04, a
nonprofit corporation organized under chapter 317A, a
partnership organized under chapter 323, or any other entity
determined by the commissioner;
(10) an individual or agency that provides medical supplies
or durable medical equipment, except when the provision of
supplies or equipment is accompanied by a home care service;
(11) an individual licensed under chapter 147; or
(12) an individual who provides home care services to a
person with a developmental disability who lives in a place of
residence with a family, foster family, or primary caregiver.
Sec. 2. Minnesota Statutes 1996, section 144A.45,
subdivision 1, is amended to read:
Subdivision 1. [RULES.] The commissioner shall adopt rules
for the regulation of home care providers pursuant to sections
144A.43 to 144A.49. The rules shall include the following:
(a) provisions to assure, to the extent possible, the
health, safety and well-being, and appropriate treatment of
persons who receive home care services;
(b) requirements that home care providers furnish the
commissioner with specified information necessary to implement
sections 144A.43 to 144A.49;
(c) standards of training of home care provider personnel,
which may vary according to the nature of the services provided
or the health status of the consumer;
(d) standards for medication management which may vary
according to the nature of the services provided, the setting in
which the services are provided or the status of the consumer.
Medication management includes the central storage, handling,
distribution, and administration of medications;
(e) standards of for supervision of home care services
requiring supervision by a registered nurse or other appropriate
health care professionals of personnel providing home care
services, which may vary according to the nature of the services
provided or the health status of the consumer professional which
must occur on site at least every 62 days, or more frequently if
indicated by a clinical assessment, and in accordance with
sections 148.171 to 148.285 and rules adopted thereunder;
(f) standards for client evaluation or assessment which may
vary according to the nature of the services provided or the
status of the consumer;
(e) (g) requirements for the involvement of a consumer's
physician, the documentation of physicians' orders, if required,
and the consumer's treatment plan, and the maintenance of
accurate, current clinical records;
(f) (h) the establishment of different classes of licenses
for different types of providers and different standards and
requirements for different kinds of home care services; and
(g) (i) operating procedures required to implement the home
care bill of rights.
Sec. 3. Minnesota Statutes 1996, section 144A.45, is
amended by adding a subdivision to read:
Subd. 4. [MEDICAID REIMBURSEMENT.] Notwithstanding the
provisions of section 256B.071 or state plan requirements to the
contrary, certification by the federal Medicare program must not
be a requirement of Medicaid payment for services delivered
under section 144A.4605.
Sec. 4. Minnesota Statutes 1996, section 144A.46,
subdivision 1, is amended to read:
Subdivision 1. [LICENSE REQUIRED.] (a) A home care
provider may not operate in the state without a current license
issued by the commissioner of health. A home care provider may
hold a separate license for each class of home care licensure.
(b) Within ten days after receiving an application for a
license, the commissioner shall acknowledge receipt of the
application in writing. The acknowledgment must indicate
whether the application appears to be complete or whether
additional information is required before the application will
be considered complete. Within 90 days after receiving a
complete application, the commissioner shall either grant or
deny the license. If an applicant is not granted or denied a
license within 90 days after submitting a complete application,
the license must be deemed granted. An applicant whose license
has been deemed granted must provide written notice to the
commissioner before providing a home care service.
(c) Each application for a home care provider license, or
for a renewal of a license, shall be accompanied by a fee to be
set by the commissioner under section 144.122.
Sec. 5. Minnesota Statutes 1996, section 144A.46,
subdivision 3, is amended to read:
Subd. 3. [ENFORCEMENT.] (a) The commissioner may refuse to
grant or renew a license, or may suspend or revoke a license,
for violation of statutes or rules relating to home care
services or for conduct detrimental to the welfare of the
consumer. Prior to any suspension, revocation, or refusal to
renew a license, the home care provider shall be entitled to
notice and a hearing as provided by sections 14.57 to 14.69. In
addition to any other remedy provided by law, the commissioner
may, without a prior contested case hearing, temporarily suspend
a license or prohibit delivery of services by a provider for not
more than 60 days if the commissioner determines that the health
or safety of a consumer is in imminent danger, provided (1)
advance notice is given to the provider; (2) after notice, the
provider fails to correct the problem; (3) the commissioner has
reason to believe that other administrative remedies are not
likely to be effective; and (4) there is an opportunity for a
contested case hearing within the 60 days. The process of
suspending or revoking a license must include a plan for
transferring affected clients to other providers.
(b) The owner and managerial officials, as defined in the
home care licensure rules, Minnesota Rules, chapter 4668, of a
home care provider whose Minnesota license has not been renewed
or has been revoked because of noncompliance with applicable law
or rule shall not be eligible to apply for nor will be granted a
license for five years following the effective date of the
nonrenewal or revocation.
(c) The commissioner shall not issue a license to a home
care provider if an owner or managerial official includes any
individual who was an owner or managerial official of a home
care provider whose Minnesota license was not renewed or was
revoked as described in paragraph (b) for five years following
the effective date of nonrenewal or revocation.
(d) Notwithstanding the provisions of paragraph (a), the
commissioner shall not renew, or shall suspend or revoke the
license of any home care provider which includes any individual
as an owner or managerial official who was an owner or
managerial official of a home care provider whose Minnesota
license was not renewed or was revoked as described in paragraph
(b) for five years following the effective date of the
nonrenewal or revocation. The commissioner shall notify the
home care provider 30 days in advance of the date of nonrenewal,
suspension, or revocation of the license. Within ten days after
the receipt of this notification, the home care provider may
request, in writing, that the commissioner stay the nonrenewal,
revocation, or suspension of the license. The home care
provider shall specify the reasons for requesting the stay; the
steps that will be taken to attain or maintain compliance with
the licensure laws and regulations; any limits on the authority
or responsibility of the owners or managerial officials whose
actions resulted in the notice of nonrenewal, revocation, or
suspension; and any other information to establish that the
continuing affiliation with these individuals will not
jeopardize client health, safety or well being. The
commissioner shall determine whether the stay will be granted
within 30 days of receiving the provider's request. The
commissioner may propose additional restrictions or limitations
on the provider's license and require that the granting of the
stay be contingent upon compliance with those provisions. The
commissioner shall take into consideration the following factors
when determining whether the stay should be granted:
(1) the threat that continued involvement of the owners and
managerial officials in the home care provider poses to client
health, safety and well being;
(2) the compliance history of the home care provider; and
(3) the appropriateness of any limits suggested by the home
care provider.
If the commissioner grants the stay, the order shall include any
restrictions or limitation on the provider's license. The
failure of the provider to comply with any restrictions or
limitations shall result in the immediate removal of the stay
and the commissioner shall take immediate action to suspend,
revoke or not renew the license.
(e) The provisions contained in paragraphs (b) and (c)
shall apply to any nonrenewal or revocation of a home care
license occurring after June 1, 1993, the effective date of the
home care licensure rules.
(f) For the purposes of this subdivision, owners of a home
care provider are those individuals whose ownership interest
provides sufficient authority or control to affect or change
decisions related to the operation of the home care provider.
An owner includes a sole proprietor, a general partner, or any
other individual whose individual ownership interest can affect
the management and direction of the policies of the home care
provider. For the purposes of this subdivision, managerial
officials are those individuals who had the responsibility for
the ongoing management or direction of the policies, services or
employees of the home care provider relating to the areas of
noncompliance which led to the license revocation or nonrenewal.
Sec. 6. [144A.4605] [ASSISTED LIVING HOME CARE PROVIDER.]
Subdivision 1. [DEFINITIONS.] For purposes of this
section, the term "assisted living home care provider" means a
home care provider who provides nursing services, delegated
nursing services, other services performed by unlicensed
personnel, or central storage of medications solely for
residents of one or more housing with services establishments
registered under chapter 144D.
Subd. 2. [ASSISTED LIVING HOME CARE LICENSE
ESTABLISHED.] A home care provider license category entitled
assisted living home care provider is hereby established. A
home care provider may obtain an assisted living license if the
program meets the following requirements:
(a) nursing services, delegated nursing services, other
services performed by unlicensed personnel, or central storage
of medications under the assisted living license are provided
solely for residents of one or more housing with services
establishments registered under chapter 144D;
(b) unlicensed personnel perform home health aide and home
care aide tasks identified in Minnesota Rules, parts 4668.0100,
subparts 1 and 2, and 4668.0110, subpart 1. Qualifications to
perform these tasks shall be established in accordance with
subdivision 3;
(c) periodic supervision of unlicensed personnel is
provided as required by rule;
(d) notwithstanding Minnesota Rules, part 4668.0160,
subpart 6, item D, client records shall include:
(1) a weekly summary of the client's status and home care
services provided;
(2) documentation each time medications are administered to
a client; and
(3) documentation on the day of occurrence of any
significant change in the client's status or any significant
incident, such as a fall or refusal to take medications.
All entries must be signed by the staff providing the
services and entered into the record no later than two weeks
after the end of the service day, except as specified in clauses
(2) and (3);
(e) medication and treatment orders, if any, are included
in the client record and are renewed at least every 12 months,
or more frequently when indicated by a clinical assessment;
(f) the central storage of medications in a housing with
services establishment registered under chapter 144D is managed
under a system that is established by a registered nurse and
addresses the control of medications, handling of medications,
medication containers, medication records, and disposition of
medications; and
(g) in other respects meets the requirements established by
rules adopted under sections 144A.45 to 144A.48.
Subd. 3. [TRAINING OR COMPETENCY EVALUATIONS REQUIRED.] (a)
Unlicensed personnel must:
(1) satisfy the training or competency requirements
established by rule under sections 144A.45 to 144A.48; or
(2) be trained or determined competent by a registered
nurse in each task identified under Minnesota Rules, part
4668.0100, subparts 1 and 2, when offered to clients in a
housing with services establishment as described in paragraphs
(b) to (e).
(b) Training for tasks identified under Minnesota Rules,
part 4668.0100, subparts 1 and 2, shall use a curriculum which
meets the requirements in Minnesota Rules, part 4668.0130.
(c) Competency evaluations for tasks identified under
Minnesota Rules, part 4668.0100, subparts 1 and 2, must be
completed and documented by a registered nurse.
(d) Unlicensed personnel performing tasks identified under
Minnesota Rules, part 4668.0100, subparts 1 and 2, shall be
trained or demonstrate competency in the following topics:
(1) an overview of sections 144A.43 to 144A.49 and rules
adopted thereunder;
(2) recognition and handling of emergencies and use of
emergency services;
(3) reporting the maltreatment of vulnerable minors or
adults under sections 626.556 and 626.557;
(4) home care bill of rights;
(5) handling of clients' complaints and reporting of
complaints to the office of health facility complaints;
(6) services of the ombudsman for older Minnesotans;
(7) observation, reporting, and documentation of client
status and of the care or services provided;
(8) basic infection control;
(9) maintenance of a clean, safe, and healthy environment;
(10) communication skills;
(11) basic elements of body functioning and changes in body
function that must be reported to an appropriate health care
professional; and
(12) physical, emotional, and developmental needs of
clients, and ways to work with clients who have problems in
these areas, including respect for the client, the client's
property, and the client's family.
(e) Unlicensed personnel who administer medications must
comply with rules relating to the administration of medications
in Minnesota Rules, part 4668.0100, subpart 2, except that
unlicensed personnel need not comply with the requirements of
Minnesota Rules, part 4668.0100, subpart 5.
Subd. 4. [LICENSE REQUIRED.] (a) A housing with services
establishment registered under chapter 144D that is required to
obtain a home care license must obtain an assisted living home
care license according to this section or a class A license
according to rule.
(b) A board and lodging establishment registered for
special services as of December 31, 1996, and also registered as
a housing with services establishment under chapter 144D, must
deliver home care services according to sections 144A.43 to
144A.49, and may apply for a waiver from requirements under
Minnesota Rules, parts 4668.0002 to 4668.0240, to operate a
licensed agency under the standards of section 157.17. Such
waivers as may be granted by the department will expire upon
promulgation of home care rules implementing section 144A.4605.
(c) An adult foster care provider licensed by the
department of human services and registered under chapter 144D
may continue to provide health-related services under its foster
care license until the promulgation of home care rules
implementing this section.
Subd. 5. [LICENSE FEES.] The license fees for assisted
living home care providers shall be as follows:
(1) $125 annually for those providers serving a monthly
average of 15 or fewer clients, and for assisted living
providers of all sizes during the first year of operation;
(2) $200 annually for those providers serving a monthly
average of 16 to 30 clients;
(3) $375 annually for those providers serving a monthly
average of 31 to 50 clients; and
(4) $625 annually for those providers serving a monthly
average of 50 or more clients.
Subd. 6. [WAIVER.] Upon request of the home care provider,
the commissioner may waive the provisions of this section
relating to registered nurse duties.
Sec. 7. Minnesota Statutes 1996, section 144D.01,
subdivision 4, is amended to read:
Subd. 4. [ELDERLY HOUSING WITH SERVICES ESTABLISHMENT OR
ESTABLISHMENT.] "Elderly Housing with services establishment" or
"establishment" means an establishment providing sleeping
accommodations to one or more adult residents, at least 80
percent of which are 55 years of age or older, and offering or
providing, for a fee, one or more regularly scheduled
health-related services or two or more regularly scheduled
supportive service services, whether offered or provided
directly by the establishment or by another entity arranged for
by the establishment.
Elderly Housing with services establishment does not
include:
(1) a nursing home licensed under chapter 144A;
(2) a hospital, boarding care home, or supervised living
facility licensed under sections 144.50 to 144.56;
(3) a board and lodging establishment licensed under
chapter 157 and Minnesota Rules, parts 9520.0500 to 9520.0670,
9525.0215 to 9525.0355, 9525.0500 to 9525.0660, or 9530.4100 to
9530.4450;
(4) a board and lodging establishment which serves as a
shelter for battered women or other similar purpose;
(5) a family adult foster care home licensed under
Minnesota Rules, parts 9543.0010 to 9543.0150 by the department
of human services; or
(6) private homes in which the residents are related by
kinship, law, or affinity with the providers of services;
(7) a home-sharing arrangement such as when an elderly or
disabled person or single-parent family makes lodging in a
private residence available to another person in exchange for
services or rent, or both;
(8) a duly organized condominium, cooperative, common
interest community, or owners' association of the foregoing
where at least 80 percent of the units that comprise the
condominium, cooperative, or common interest community are
occupied by individuals who are the owners, members, or
shareholders of the units; or
(9) services for persons with developmental disabilities
that are provided under a license according to Minnesota Rules,
parts 9525.2000 to 9525.2140.
Sec. 8. Minnesota Statutes 1996, section 144D.01,
subdivision 5, is amended to read:
Subd. 5. [SUPPORTIVE SERVICES.] "Supportive services"
means arranging for medical services, health-related services,
social services, transportation, help with personal laundry, or
handling or assisting with personal funds of residents, or
arranging for medical services, health-related services, social
services, or transportation to medical or social services
appointments. Arranging for services does not include making
referrals, assisting a resident in contacting a service provider
of the resident's choice, or contacting a service provider in an
emergency.
Sec. 9. Minnesota Statutes 1996, section 144D.01,
subdivision 6, is amended to read:
Subd. 6. [HEALTH-RELATED SERVICES.] "Health-related
services" include professional nursing services, home health
aide tasks, and home care aide tasks identified in Minnesota
Rules, parts 4668.0100, subparts 1 and 2; and 4668.0110, subpart
1,; or the central storage of medication for residents under
section 144A.485, subdivision 2, clause (6).
Sec. 10. Minnesota Statutes 1996, section 144D.01, is
amended by adding a subdivision to read:
Subd. 7. [FAMILY ADULT FOSTER CARE HOME.] "Family adult
foster care home" means an adult foster care home that is
licensed by the department of human services, that is the
primary residence of the license holder, and in which the
license holder is the primary caregiver.
Sec. 11. Minnesota Statutes 1996, section 144D.03,
subdivision 1, is amended to read:
Subdivision 1. [REGISTRATION PROCEDURES.] The commissioner
shall establish forms and procedures for annual registration
of elderly housing with services establishments. The
commissioner shall charge an annual registration fee of $35. No
fee shall be refunded. A registered establishment shall notify
the commissioner within 30 days of the date it is no longer
required to be registered under this chapter or of any change in
the business name or address of the establishment, the name or
mailing address of the owner or owners, or the name or mailing
address of the managing agent. There shall be no fee for
submission of the notice.
Sec. 12. [144D.07] [RESTRAINTS.]
Residents must be free from any physical or chemical
restraints imposed for purposes of discipline or convenience.
Sec. 13. Minnesota Statutes 1996, section 144D.06, is
amended to read:
144D.06 [OTHER LAWS.]
An elderly A housing with services establishment shall
obtain and maintain all other licenses, permits, registrations,
or other governmental approvals required of it in addition to
registration under this chapter, except that an establishment
registered under this chapter is exempt, at its option, from the
requirement of obtaining and maintaining an adult foster care
license under Minnesota Rules, parts 9543.0010 to 9543.0150, or
a lodging license under chapter 157. An elderly. A housing
with services establishment is subject to the provisions of
sections 504.01 to 504.28 and 566.01 to 566.175. An elderly
housing with services establishment which is also described in
section 157.17 is exempt from the requirements of that section
while it is registered under this chapter.
Sec. 14. Minnesota Statutes 1996, section 157.17,
subdivision 2, is amended to read:
Subd. 2. [REGISTRATION.] At the time of licensure or
license renewal, a boarding and lodging establishment or a
lodging establishment that provides supportive services or
health supervision services must be registered with the
commissioner, and must register annually thereafter. The
registration must include the name, address, and telephone
number of the establishment, the name of the operator, the types
of services that are being provided, a description of the
residents being served, the type and qualifications of staff in
the facility, and other information that is necessary to
identify the needs of the residents and the types of services
that are being provided. The commissioner shall develop and
furnish to the boarding and lodging establishment or lodging
establishment the necessary form for submitting the
registration. The requirement for registration is effective
until the rules required by sections 144B.01 to 144B.17 are
effective.
Housing with services establishments registered under
chapter 144D shall be considered registered under this section
for all purposes except that:
(1) the establishments shall operate under the requirements
of chapter 144D; and
(2) the criminal background check requirements of sections
299C.66 to 299C.71 apply. The criminal background check
requirements of section 144.057 apply only to personnel
providing home care services under sections 144A.43 to 144A.48.
Sec. 15. Minnesota Statutes 1996, section 157.17,
subdivision 5, is amended to read:
Subd. 5. [SERVICES THAT MAY NOT BE PROVIDED IN A BOARDING
AND LODGING ESTABLISHMENT OR LODGING ESTABLISHMENT.] Except
those facilities registered under chapter 144D, a boarding and
lodging establishment or lodging establishment may not admit or
retain individuals who:
(1) would require assistance from establishment staff
because of the following needs: bowel incontinence, catheter
care, use of injectable or parenteral medications, wound care,
or dressing changes or irrigations of any kind; or
(2) require a level of care and supervision beyond
supportive services or health supervision services.
Sec. 16. Minnesota Statutes 1996, section 245A.03,
subdivision 2, is amended to read:
Subd. 2. [EXCLUSION FROM LICENSURE.] Sections 245A.01 to
245A.16 do not apply to:
(1) residential or nonresidential programs that are
provided to a person by an individual who is related unless the
residential program is a foster care placement made by a local
social services agency or a licensed child-placing agency,
except as provided in subdivision 2a;
(2) nonresidential programs that are provided by an
unrelated individual to persons from a single related family;
(3) residential or nonresidential programs that are
provided to adults who do not abuse chemicals or who do not have
a chemical dependency, a mental illness, mental retardation or a
related condition, a functional impairment, or a physical
handicap;
(4) sheltered workshops or work activity programs that are
certified by the commissioner of economic security;
(5) programs for children enrolled in kindergarten to the
12th grade and prekindergarten special education in a school as
defined in section 120.101, subdivision 4, and programs serving
children in combined special education and regular
prekindergarten programs that are operated or assisted by the
commissioner of children, families, and learning;
(6) nonresidential programs primarily for children that
provide care or supervision, without charge for ten or fewer
days a year, and for periods of less than three hours a day
while the child's parent or legal guardian is in the same
building as the nonresidential program or present within another
building that is directly contiguous to the building in which
the nonresidential program is located;
(7) nursing homes or hospitals licensed by the commissioner
of health except as specified under section 245A.02;
(8) board and lodge facilities licensed by the commissioner
of health that provide services for five or more persons whose
primary diagnosis is mental illness who have refused an
appropriate residential program offered by a county agency.
This exclusion expires on July 1, 1990;
(9) homes providing programs for persons placed there by a
licensed agency for legal adoption, unless the adoption is not
completed within two years;
(10) programs licensed by the commissioner of corrections;
(11) recreation programs for children or adults that
operate for fewer than 40 calendar days in a calendar year;
(12) programs operated by a school as defined in section
120.101, subdivision 4, whose primary purpose is to provide
child care to school-age children, provided the program is
approved by the district's school board;
(13) head start nonresidential programs which operate for
less than 31 days in each calendar year;
(14) noncertified boarding care homes unless they provide
services for five or more persons whose primary diagnosis is
mental illness or mental retardation;
(15) nonresidential programs for nonhandicapped children
provided for a cumulative total of less than 30 days in any
12-month period;
(16) residential programs for persons with mental illness,
that are located in hospitals, until the commissioner adopts
appropriate rules;
(17) the religious instruction of school-age children;
Sabbath or Sunday schools; or the congregate care of children by
a church, congregation, or religious society during the period
used by the church, congregation, or religious society for its
regular worship;
(18) camps licensed by the commissioner of health under
Minnesota Rules, chapter 4630;
(19) mental health outpatient services for adults with
mental illness or children with emotional disturbance;
(20) residential programs serving school-age children whose
sole purpose is cultural or educational exchange, until the
commissioner adopts appropriate rules;
(21) unrelated individuals who provide out-of-home respite
care services to persons with mental retardation or related
conditions from a single related family for no more than 90 days
in a 12-month period and the respite care services are for the
temporary relief of the person's family or legal representative;
(22) respite care services provided as a home and
community-based service to a person with mental retardation or a
related condition, in the person's primary residence;
(23) community support services programs as defined in
section 245.462, subdivision 6, and family community support
services as defined in section 245.4871, subdivision 17; or
(24) the placement of a child by a birth parent or legal
guardian in a preadoptive home for purposes of adoption as
authorized by section 259.47; or
(25) settings registered under chapter 144D which provide
home care services licensed by the commissioner of health to
fewer than seven adults.
For purposes of clause (6), a building is directly
contiguous to a building in which a nonresidential program is
located if it shares a common wall with the building in which
the nonresidential program is located or is attached to that
building by skyway, tunnel, atrium, or common roof.
Sec. 17. Minnesota Statutes 1996, section 256B.0913,
subdivision 5, is amended to read:
Subd. 5. [SERVICES COVERED UNDER ALTERNATIVE CARE.] (a)
Alternative care funding may be used for payment of costs of:
(1) adult foster care;
(2) adult day care;
(3) home health aide;
(4) homemaker services;
(5) personal care;
(6) case management;
(7) respite care;
(8) assisted living;
(9) residential care services;
(10) care-related supplies and equipment;
(11) meals delivered to the home;
(12) transportation;
(13) skilled nursing;
(14) chore services;
(15) companion services;
(16) nutrition services;
(17) training for direct informal caregivers; and
(18) telemedicine devices to monitor recipients in their
own homes as an alternative to hospital care, nursing home care,
or home visits.
(b) The county agency must ensure that the funds are used
only to supplement and not supplant services available through
other public assistance or services programs.
(c) Unless specified in statute, the service standards for
alternative care services shall be the same as the service
standards defined in the elderly waiver. Persons or agencies
must be employed by or under a contract with the county agency
or the public health nursing agency of the local board of health
in order to receive funding under the alternative care program.
(d) The adult foster care rate shall be considered a
difficulty of care payment and shall not include room and
board. The adult foster care daily rate shall be negotiated
between the county agency and the foster care provider. The
rate established under this section shall not exceed 75 percent
of the state average monthly nursing home payment for the case
mix classification to which the individual receiving foster care
is assigned, and it must allow for other alternative care
services to be authorized by the case manager.
(e) Personal care services may be provided by a personal
care provider organization. A county agency may contract with a
relative of the client to provide personal care services, but
must ensure nursing supervision. Covered personal care services
defined in section 256B.0627, subdivision 4, must meet
applicable standards in Minnesota Rules, part 9505.0335.
(f) A county may use alternative care funds to purchase
medical supplies and equipment without prior approval from the
commissioner when: (1) there is no other funding source; (2)
the supplies and equipment are specified in the individual's
care plan as medically necessary to enable the individual to
remain in the community according to the criteria in Minnesota
Rules, part 9505.0210, item A; and (3) the supplies and
equipment represent an effective and appropriate use of
alternative care funds. A county may use alternative care funds
to purchase supplies and equipment from a non-Medicaid certified
vendor if the cost for the items is less than that of a Medicaid
vendor. A county is not required to contract with a provider of
supplies and equipment if the monthly cost of the supplies and
equipment is less than $250.
(g) For purposes of this section, residential care services
are services which are provided to individuals living in
residential care homes. Residential care homes are currently
licensed as board and lodging establishments and are registered
with the department of health as providing special services.
Residential care services are defined as "supportive services"
and "health-related services." "Supportive services" means the
provision of up to 24-hour supervision and oversight.
Supportive services includes: (1) transportation, when provided
by the residential care center only; (2) socialization, when
socialization is part of the plan of care, has specific goals
and outcomes established, and is not diversional or recreational
in nature; (3) assisting clients in setting up meetings and
appointments; (4) assisting clients in setting up medical and
social services; (5) providing assistance with personal laundry,
such as carrying the client's laundry to the laundry room.
Assistance with personal laundry does not include any laundry,
such as bed linen, that is included in the room and board rate.
Health-related services are limited to minimal assistance with
dressing, grooming, and bathing and providing reminders to
residents to take medications that are self-administered or
providing storage for medications, if requested. Individuals
receiving residential care services cannot receive both personal
care services and residential care services.
(h) For the purposes of this section, "assisted living"
refers to supportive services provided by a single vendor to
clients who reside in the same apartment building of three or
more units which are not subject to registration under chapter
144D. Assisted living services are defined as up to 24-hour
supervision, and oversight, supportive services as defined in
clause (1), individualized home care aide tasks as defined in
clause (2), and individualized home management tasks as defined
in clause (3) provided to residents of a residential center
living in their units or apartments with a full kitchen and
bathroom. A full kitchen includes a stove, oven, refrigerator,
food preparation counter space, and a kitchen utensil storage
compartment. Assisted living services must be provided by the
management of the residential center or by providers under
contract with the management or with the county.
(1) Supportive services include:
(i) socialization, when socialization is part of the plan
of care, has specific goals and outcomes established, and is not
diversional or recreational in nature;
(ii) assisting clients in setting up meetings and
appointments; and
(iii) providing transportation, when provided by the
residential center only.
Individuals receiving assisted living services will not
receive both assisted living services and homemaking or personal
care services. Individualized means services are chosen and
designed specifically for each resident's needs, rather than
provided or offered to all residents regardless of their
illnesses, disabilities, or physical conditions.
(2) Home care aide tasks means:
(i) preparing modified diets, such as diabetic or low
sodium diets;
(ii) reminding residents to take regularly scheduled
medications or to perform exercises;
(iii) household chores in the presence of technically
sophisticated medical equipment or episodes of acute illness or
infectious disease;
(iv) household chores when the resident's care requires the
prevention of exposure to infectious disease or containment of
infectious disease; and
(v) assisting with dressing, oral hygiene, hair care,
grooming, and bathing, if the resident is ambulatory, and if the
resident has no serious acute illness or infectious disease.
Oral hygiene means care of teeth, gums, and oral prosthetic
devices.
(3) Home management tasks means:
(i) housekeeping;
(ii) laundry;
(iii) preparation of regular snacks and meals; and
(iv) shopping.
Assisted living services as defined in this section shall
not be authorized in boarding and lodging establishments
licensed according to sections 157.011 and 157.15 to 157.22.
(i) For establishments registered under chapter 144D,
assisted living services under this section means the services
described and licensed under section 144A.4605.
(j) For the purposes of this section, reimbursement for
assisted living services and residential care services shall be
a monthly rate negotiated and authorized by the county
agency based on an individualized service plan for each resident.
The rate shall not exceed the nonfederal share of the greater of
either the statewide or any of the geographic groups' weighted
average monthly medical assistance nursing facility payment rate
of the case mix resident class to which the 180-day eligible
client would be assigned under Minnesota Rules, parts 9549.0050
to 9549.0059. For alternative care assisted living projects
established under Laws 1988, chapter 689, article 2, section
256, monthly rates may not exceed 65 percent of the greater of
either statewide or any of the geographic groups' weighted
average monthly medical assistance nursing facility payment rate
of the case mix resident class to which the 180-day eligible
client would be assigned under Minnesota Rules, parts 9549.0050
to 9549.0059. The rate may not cover rent and direct food
costs, unless the services are provided by a home care provider
licensed by the department of health and are provided in a
building that is registered as a housing with services
establishment under chapter 144D and that provides 24-hour
supervision.
(j) (k) For purposes of this section, companion services
are defined as nonmedical care, supervision and oversight,
provided to a functionally impaired adult. Companions may
assist the individual with such tasks as meal preparation,
laundry and shopping, but do not perform these activities as
discrete services. The provision of companion services does not
entail hands-on medical care. Providers may also perform light
housekeeping tasks which are incidental to the care and
supervision of the recipient. This service must be approved by
the case manager as part of the care plan. Companion services
must be provided by individuals or nonprofit organizations who
are under contract with the local agency to provide the
service. Any person related to the waiver recipient by blood,
marriage or adoption cannot be reimbursed under this service.
Persons providing companion services will be monitored by the
case manager.
(k) (l) For purposes of this section, training for direct
informal caregivers is defined as a classroom or home course of
instruction which may include: transfer and lifting skills,
nutrition, personal and physical cares, home safety in a home
environment, stress reduction and management, behavioral
management, long-term care decision making, care coordination
and family dynamics. The training is provided to an informal
unpaid caregiver of a 180-day eligible client which enables the
caregiver to deliver care in a home setting with high levels of
quality. The training must be approved by the case manager as
part of the individual care plan. Individuals, agencies, and
educational facilities which provide caregiver training and
education will be monitored by the case manager.
Sec. 18. Minnesota Statutes 1996, section 256B.0915,
subdivision 3, is amended to read:
Subd. 3. [LIMITS OF CASES, RATES, REIMBURSEMENT, AND
FORECASTING.] (a) The number of medical assistance waiver
recipients that a county may serve must be allocated according
to the number of medical assistance waiver cases open on July 1
of each fiscal year. Additional recipients may be served with
the approval of the commissioner.
(b) The monthly limit for the cost of waivered services to
an individual waiver client shall be the statewide average
payment rate of the case mix resident class to which the waiver
client would be assigned under the medical assistance case mix
reimbursement system. If medical supplies and equipment or
adaptations are or will be purchased for an elderly waiver
services recipient, the costs may be prorated on a monthly basis
throughout the year in which they are purchased. If the monthly
cost of a recipient's other waivered services exceeds the
monthly limit established in this paragraph, the annual cost of
the waivered services shall be determined. In this event, the
annual cost of waivered services shall not exceed 12 times the
monthly limit calculated in this paragraph. The statewide
average payment rate is calculated by determining the statewide
average monthly nursing home rate, effective July 1 of the
fiscal year in which the cost is incurred, less the statewide
average monthly income of nursing home residents who are age 65
or older, and who are medical assistance recipients in the month
of March of the previous state fiscal year. The annual cost
divided by 12 of elderly or disabled waivered services for a
person who is a nursing facility resident at the time of
requesting a determination of eligibility for elderly or
disabled waivered services shall not exceed the monthly payment
for the resident class assigned under Minnesota Rules, parts
9549.0050 to 9549.0059, for that resident in the nursing
facility where the resident currently resides. The following
costs must be included in determining the total monthly costs
for the waiver client:
(1) cost of all waivered services, including extended
medical supplies and equipment; and
(2) cost of skilled nursing, home health aide, and personal
care services reimbursable by medical assistance.
(c) Medical assistance funding for skilled nursing
services, private duty nursing, home health aide, and personal
care services for waiver recipients must be approved by the case
manager and included in the individual care plan.
(d) For both the elderly waiver and the nursing facility
disabled waiver, a county may purchase extended supplies and
equipment without prior approval from the commissioner when
there is no other funding source and the supplies and equipment
are specified in the individual's care plan as medically
necessary to enable the individual to remain in the community
according to the criteria in Minnesota Rules, part 9505.0210,
items A and B. A county is not required to contract with a
provider of supplies and equipment if the monthly cost of the
supplies and equipment is less than $250.
(e) For the fiscal year beginning on July 1, 1993, and for
subsequent fiscal years, the commissioner of human services
shall not provide automatic annual inflation adjustments for
home and community-based waivered services. The commissioner of
finance shall include as a budget change request in each
biennial detailed expenditure budget submitted to the
legislature under section 16A.11, annual adjustments in
reimbursement rates for home and community-based waivered
services, based on the forecasted percentage change in the Home
Health Agency Market Basket of Operating Costs, for the fiscal
year beginning July 1, compared to the previous fiscal year,
unless otherwise adjusted by statute. The Home Health Agency
Market Basket of Operating Costs is published by Data Resources,
Inc. The forecast to be used is the one published for the
calendar quarter beginning January 1, six months prior to the
beginning of the fiscal year for which rates are set. The adult
foster care rate shall be considered a difficulty of care
payment and shall not include room and board.
(f) The adult foster care daily rate for the elderly and
disabled waivers shall be negotiated between the county agency
and the foster care provider. The rate established under this
section shall not exceed the state average monthly nursing home
payment for the case mix classification to which the individual
receiving foster care is assigned; the rate must allow for other
waiver and medical assistance home care services to be
authorized by the case manager.
(g) The assisted living and residential care service rates
for elderly and community alternatives for disabled individuals
(CADI) waivers shall be made to the vendor as a monthly rate
negotiated with the county agency based on an individualized
service plan for each resident. The rate shall not exceed the
nonfederal share of the greater of either the statewide or any
of the geographic groups' weighted average monthly medical
assistance nursing facility payment rate of the case mix
resident class to which the elderly or disabled client would be
assigned under Minnesota Rules, parts 9549.0050 to 9549.0059,
unless the services are provided by a home care provider
licensed by the department of health and are provided in a
building that is registered as a housing with services
establishment under chapter 144D and that provides 24-hour
supervision. For alternative care assisted living projects
established under Laws 1988, chapter 689, article 2, section
256, monthly rates may not exceed 65 percent of the greater of
either the statewide or any of the geographic groups' weighted
average monthly medical assistance nursing facility payment rate
for the case mix resident class to which the elderly or disabled
client would be assigned under Minnesota Rules, parts 9549.0050
to 9549.0059. The rate may not cover direct rent or food costs.
(h) The county shall negotiate individual rates with
vendors and may be reimbursed for actual costs up to the greater
of the county's current approved rate or 60 percent of the
maximum rate in fiscal year 1994 and 65 percent of the maximum
rate in fiscal year 1995 for each service within each program.
(i) On July 1, 1993, the commissioner shall increase the
maximum rate for home-delivered meals to $4.50 per meal.
(j) Reimbursement for the medical assistance recipients
under the approved waiver shall be made from the medical
assistance account through the invoice processing procedures of
the department's Medicaid Management Information System (MMIS),
only with the approval of the client's case manager. The budget
for the state share of the Medicaid expenditures shall be
forecasted with the medical assistance budget, and shall be
consistent with the approved waiver.
(k) Beginning July 1, 1991, the state shall reimburse
counties according to the payment schedule in section 256.025
for the county share of costs incurred under this subdivision on
or after January 1, 1991, for individuals who are receiving
medical assistance.
Sec. 19. Minnesota Statutes 1996, section 256I.04,
subdivision 2a, is amended to read:
Subd. 2a. [LICENSE REQUIRED.] A county agency may not
enter into an agreement with an establishment to provide group
residential housing unless:
(1) the establishment is licensed by the department of
health as a hotel and restaurant; a board and lodging
establishment; a residential care home; a boarding care home
before March 1, 1985; or a supervised living facility, and the
service provider for residents of the facility is licensed under
chapter 245A. However, an establishment licensed by the
department of health to provide lodging need not also be
licensed to provide board if meals are being supplied to
residents under a contract with a food vendor who is licensed by
the department of health; or
(2) the residence is licensed by the commissioner of human
services under Minnesota Rules, parts 9555.5050 to 9555.6265, or
certified by a county human services agency prior to July 1,
1992, using the standards under Minnesota Rules, parts 9555.5050
to 9555.6265; or
(3) the establishment is registered under chapter 144D and
provides three meals a day.
The requirements under clauses (1) and, (2), and (3) do not
apply to establishments exempt from state licensure because they
are located on Indian reservations and subject to tribal health
and safety requirements.
Sec. 20. Minnesota Statutes 1996, section 462.357,
subdivision 7, is amended to read:
Subd. 7. [PERMITTED SINGLE FAMILY USE.] A state licensed
residential facility or a housing with services establishment
registered under chapter 144D serving six or fewer persons, a
licensed day care facility serving 12 or fewer persons, and a
group family day care facility licensed under Minnesota Rules,
parts 9502.0315 to 9502.0445 to serve 14 or fewer children shall
be considered a permitted single family residential use of
property for the purposes of zoning, except that a residential
facility whose primary purpose is to treat juveniles who have
violated criminal statutes relating to sex offenses or have been
adjudicated delinquent on the basis of conduct in violation of
criminal statutes relating to sex offenses shall not be
considered a permitted use.
Sec. 21. [STUDY OF NURSING HOME PROVISION OF HOME CARE
SERVICES.]
The commissioner of health shall perform a study to
determine the most appropriate and cost-effective way to enable
licensing nursing home and boarding care home providers to use
their existing pool of trained staff to provide home care
services in a housing with services establishment registered
according to Minnesota Statutes, chapter 144D, that is attached
to or located on property contiguous to the nursing home or
boarding care home. The study shall evaluate comparability of
current home care licensing, enforcement, and quality assurance
provisions with alternative regulatory structures, including but
not limited to private contracts, home care license options, and
nursing home license options. The commissioner shall convene an
advisory group that is representative of the affected parties to
advise the department of the feasibility of proposed options.
The commissioner shall submit a report to the chairs of the
senate health and family security committee and the house of
representatives health and human services committee no later
than January 15, 1998.
Sec. 22. [REPEALER.]
Minnesota Statutes 1996, sections 144A.45, subdivision 3;
144A.49; 144B.01; 144B.02; 144B.03; 144B.04; 144B.05; 144B.06;
144B.07; 144B.08; 144B.09; 144B.10; 144B.11; 144B.12; 144B.13;
144B.14; 144B.15; 144B.16; and 144B.17, are repealed.
Presented to the governor May 7, 1997
Signed by the governor May 8, 1997, 11:14 a.m.
Official Publication of the State of Minnesota
Revisor of Statutes