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Minnesota Legislature

Office of the Revisor of Statutes

Key: (1) language to be deleted (2) new language

                            CHAPTER 474-H.F.No. 3409 
                  An act relating to human services; modifying 
                  provisions in continuing care services for persons 
                  with disabilities; amending Minnesota Statutes 1998, 
                  sections 62D.09, subdivision 8; 252.28, by adding a 
                  subdivision; and 256B.0625, subdivision 19a; Minnesota 
                  Statutes 1999 Supplement, sections 62Q.73, subdivision 
                  2; 245.462, subdivision 4; 245.4871, subdivision 4; 
                  256B.0625, subdivision 19c; 256B.0627, subdivisions 1, 
                  5, 8, and 11; 256B.501, subdivision 8a; 256B.5011, 
                  subdivision 2; 256B.5013, subdivision 1, and by adding 
                  subdivisions; and 256B.77, subdivision 8. 
        BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
           Section 1.  Minnesota Statutes 1998, section 62D.09, 
        subdivision 8, is amended to read: 
           Subd. 8.  Each health maintenance organization shall issue 
        a membership card to its enrollees.  The membership card must: 
           (1) identify the health maintenance organization; 
           (2) include the name, address, and telephone number to call 
        if the enrollee has a complaint; 
           (3) include the telephone number to call or the instruction 
        on how to receive authorization for emergency care; and 
           (4) include one of the following: 
           (i) the telephone number to call to appeal to or file a 
        complaint with the commissioner of health; or 
           (ii) for persons enrolled under section 256B.69, 256B.77, 
        256D.03, or 256L.12, the telephone number to call to file a 
        complaint with the ombudsperson designated by the commissioner 
        of human services under section 256B.69 or the office of the 
        ombudsman for mental health and mental retardation under section 
        256B.77 and the address to appeal to the commissioner of human 
        services.  The ombudsperson shall annually provide the 
        commissioner of health with a summary of complaints and actions 
        taken. 
           Sec. 2.  Minnesota Statutes 1999 Supplement, section 
        62Q.73, subdivision 2, is amended to read: 
           Subd. 2.  [EXCEPTION.] (a) This section does not apply to 
        governmental programs except as permitted under paragraph (b). 
        For purposes of this subdivision, "governmental programs" means 
        the prepaid medical assistance program, the MinnesotaCare 
        program, the prepaid general assistance medical care 
        program, the demonstration project for people with disabilities, 
        and the federal Medicare program. 
           (b) In the course of a recipient's appeal of a medical 
        determination to the commissioner of human services under 
        section 256.045, the recipient may request an expert medical 
        opinion be arranged by the external review entity under contract 
        to provide independent external reviews under this section.  If 
        such a request is made, the cost of the review shall be paid by 
        the commissioner of human services.  Any medical opinion 
        obtained under this paragraph shall only be used by a state 
        human services referee as evidence in the recipient's appeal to 
        the commissioner of human services under section 256.045.  
           (c) Nothing in this subdivision shall be construed to limit 
        or restrict the appeal rights provided in section 256.045 for 
        governmental program recipients. 
           Sec. 3.  Minnesota Statutes 1999 Supplement, section 
        245.462, subdivision 4, is amended to read: 
           Subd. 4.  [CASE MANAGEMENT SERVICE PROVIDER.] (a) "Case 
        management service provider" means a case manager or case 
        manager associate employed by the county or other entity 
        authorized by the county board to provide case management 
        services specified in section 245.4711.  
           (b) A case manager must: 
           (1) be skilled in the process of identifying and assessing 
        a wide range of client needs; 
           (2) be knowledgeable about local community resources and 
        how to use those resources for the benefit of the client; 
           (3) have a bachelor's degree in one of the behavioral 
        sciences or related fields including, but not limited to, social 
        work, psychology, or nursing from an accredited college or 
        university.  A case manager must have at least 2,000 hours of 
        supervised experience in the delivery of services to adults with 
        mental illness, must be skilled in the process of identifying 
        and assessing a wide range of client needs, and must be 
        knowledgeable about local community resources and how to use 
        those resources for the benefit of the client or meet the 
        requirements of paragraph (c); and 
           (4) meet the supervision and continuing education 
        requirements described in paragraphs (d), (e), and (f), as 
        applicable.  
           (b) Supervision for a case manager during the first year of 
        service providing case management services shall be one hour per 
        week of clinical supervision from a case management supervisor.  
        After the first year, the case manager shall receive regular 
        ongoing supervision totaling 38 hours per year, of which at 
        least one hour per month must be clinical supervision regarding 
        individual service delivery with a case management supervisor.  
        The remainder may be provided by a case manager with two years 
        of experience.  Group supervision may not constitute more than 
        one-half of the required supervision hours.  Clinical 
        supervision must be documented in the client record. 
           (c) A case manager with a bachelor's degree who is not 
        licensed, registered, or certified by a health-related licensing 
        board must receive 30 hours of continuing education and training 
        in mental illness and mental health services annually.  
           (d) A case manager with a bachelor's degree but without 
        2,000 hours of supervised experience described in paragraph (a), 
        must complete 40 hours of training approved by the commissioner 
        covering case management skills and the characteristics and 
        needs of adults with serious and persistent mental illness.  
           (e) (c) Case managers without a bachelor's degree must meet 
        one of the requirements in clauses (1) to (3):  
           (1) have three or four years of experience as a case 
        manager associate as defined in this section; 
           (2) be a registered nurse without a bachelor's degree and 
        have a combination of specialized training in psychiatry and 
        work experience consisting of community interaction and 
        involvement or community discharge planning in a mental health 
        setting totaling three years; or 
           (3) be a person who qualified as a case manager under the 
        1998 department of human service federal waiver provision and 
        meet the continuing education and mentoring requirements in this 
        section.  
           (d) A case manager with at least 2,000 hours of supervised 
        experience in the delivery of services to adults with mental 
        illness must receive regular ongoing supervision and clinical 
        supervision totaling 38 hours per year of which at least one 
        hour per month must be clinical supervision regarding individual 
        service delivery with a case management supervisor.  The 
        remaining 26 hours of supervision may be provided by a case 
        manager with two years of experience.  Group supervision may not 
        constitute more than one-half of the required supervision 
        hours.  Clinical supervision must be documented in the client 
        record. 
           (e) A case manager without 2,000 hours of supervised 
        experience in the delivery of services to adults with mental 
        illness must: 
           (1) receive clinical supervision regarding individual 
        service delivery from a mental health professional at least one 
        hour per week until the requirement of 2,000 hours of experience 
        is met; and 
           (2) complete 40 hours of training approved by the 
        commissioner in case management skills and the characteristics 
        and needs of adults with serious and persistent mental illness.  
           (f) A case manager who is not licensed, registered, or 
        certified by a health-related licensing board must receive 30 
        hours of continuing education and training in mental illness and 
        mental health services annually. 
           (g) A case manager associate (CMA) must: 
           (1) work under the direction of a case manager or case 
        management supervisor and must; 
           (2) be at least 21 years of age.  A case manager associate 
        must also; 
           (3) have at least a high school diploma or its equivalent; 
        and 
           (4) meet one of the following criteria: 
           (1) (i) have an associate of arts degree in one of the 
        behavioral sciences or human services; 
           (2) (ii) be a registered nurse without a bachelor's degree; 
           (3) (iii) within the previous ten years, have three years 
        of life experience with serious and persistent mental illness as 
        defined in section 245.462, subdivision 20; or as a child had 
        severe emotional disturbance as defined in section 245.4871, 
        subdivision 6; or have three years life experience as a primary 
        caregiver to an adult with serious and persistent mental illness 
        within the previous ten years; 
           (4) (iv) have 6,000 hours work experience as a nondegreed 
        state hospital technician; or 
           (5) (v) be a mental health practitioner as defined in 
        section 245.462, subdivision 17, clause (2). 
           Individuals meeting one of the criteria in clauses (1) to 
        (4) items (i) to (iv), may qualify as a case manager after four 
        years of supervised work experience as a case manager 
        associate.  Individuals meeting the criteria in clause (5) item 
        (v), may qualify as a case manager after three years of 
        supervised experience as a case manager associate. 
           (h) A case management associates associate must meet the 
        following supervision, mentoring, and continuing education 
        requirements:  
           (1) have 40 hours of preservice training described under 
        paragraph (d) and (e), clause (2); 
           (2) receive at least 40 hours of continuing education in 
        mental illness and mental health services annually.  Case 
        manager associates shall; and 
           (3) receive at least five hours of mentoring per week from 
        a case management mentor.  
        A "case management mentor" means a qualified, practicing case 
        manager or case management supervisor who teaches or advises and 
        provides intensive training and clinical supervision to one or 
        more case manager associates.  Mentoring may occur while 
        providing direct services to consumers in the office or in the 
        field and may be provided to individuals or groups of case 
        manager associates.  At least two mentoring hours per week must 
        be individual and face-to-face. 
           (g) (i) A case management supervisor must meet the criteria 
        for mental health professionals, as specified in section 
        245.462, subdivision 18. 
           (h) (j) An immigrant who does not have the qualifications 
        specified in this subdivision may provide case management 
        services to adult immigrants with serious and persistent mental 
        illness who are members of the same ethnic group as the case 
        manager if the person:  
           (1) is currently enrolled in and is actively pursuing 
        credits toward the completion of a bachelor's degree in one of 
        the behavioral sciences or a related field including, but not 
        limited to, social work, psychology, or nursing from an 
        accredited college or university; 
           (2) completes 40 hours of training as specified in this 
        subdivision; and 
           (3) receives clinical supervision at least once a week 
        until the requirements of this subdivision are met. 
           Sec. 4.  Minnesota Statutes 1999 Supplement, section 
        245.4871, subdivision 4, is amended to read: 
           Subd. 4.  [CASE MANAGEMENT SERVICE PROVIDER.] (a) "Case 
        management service provider" means a case manager or case 
        manager associate employed by the county or other entity 
        authorized by the county board to provide case management 
        services specified in subdivision 3 for the child with severe 
        emotional disturbance and the child's family.  A case manager 
        must have experience and training in working with children. 
           (b) A case manager must: 
           (1) have experience and training in working with children; 
           (2) have at least a bachelor's degree in one of the 
        behavioral sciences or a related field including, but not 
        limited to, social work, psychology, or nursing from an 
        accredited college or university or meet the requirements of 
        paragraph (d); 
           (2) have at least 2,000 hours of supervised experience in 
        the delivery of mental health services to children; 
           (3) have experience and training in identifying and 
        assessing a wide range of children's needs; and 
           (4) be knowledgeable about local community resources and 
        how to use those resources for the benefit of children and their 
        families; and 
           (5) meets the supervision and continuing education 
        requirements of paragraphs (e), (f), and (g), as applicable. 
           (c) The A case manager may be a member of any professional 
        discipline that is part of the local system of care for children 
        established by the county board. 
           (d) A case manager without a bachelor's degree must meet 
        one of the requirements in clauses (1) to (3):  
           (1) have three or four years of experience as a case 
        manager associate; 
           (2) be a registered nurse without a bachelor's degree who 
        has a combination of specialized training in psychiatry and work 
        experience consisting of community interaction and involvement 
        or community discharge planning in a mental health setting 
        totaling three years; or 
           (3) be a person who qualified as a case manager under the 
        1998 department of human services waiver provision and meets the 
        continuing education, supervision, and mentoring requirements in 
        this section. 
           (e) The A case manager shall with at least 2,000 hours of 
        supervised experience in the delivery of mental health services 
        to children must receive regular ongoing supervision and 
        clinical supervision totaling 38 hours per year, of which at 
        least one hour per month must be clinical supervision regarding 
        individual service delivery with a case management supervisor.  
        The remainder other 26 hours of supervision may be provided by a 
        case manager with two years of experience.  Group supervision 
        may not constitute more than one-half of the required 
        supervision hours. 
           (e) (f) A case managers with a bachelor's degree 
        but manager without 2,000 hours of supervised experience in the 
        delivery of mental health services to children with emotional 
        disturbance must: 
           (1) begin 40 hours of training approved by the commissioner 
        of human services in case management skills and in the 
        characteristics and needs of children with severe emotional 
        disturbance before beginning to provide case management 
        services; and 
           (2) receive clinical supervision regarding individual 
        service delivery from a mental health professional at least one 
        hour each week until the requirement of 2,000 hours of 
        experience is met. 
           (g) A case manager who is not licensed, registered, or 
        certified by a health-related licensing board must receive 30 
        hours of continuing education and training in severe emotional 
        disturbance and mental health services annually.  
           (f) (h) Clinical supervision must be documented in the 
        child's record.  When the case manager is not a mental health 
        professional, the county board must provide or contract for 
        needed clinical supervision. 
           (g) (i) The county board must ensure that the case manager 
        has the freedom to access and coordinate the services within the 
        local system of care that are needed by the child. 
           (h) Case managers who have a bachelor's degree but are not 
        licensed, registered, or certified by a health-related licensing 
        board must receive 30 hours of continuing education and training 
        in severe emotional disturbance and mental health services 
        annually. 
           (i) Case managers without a bachelor's degree must meet one 
        of the requirements in clauses (1) to (3): 
           (1) have three or four years of experience as a case 
        manager associate; 
           (2) be a registered nurse without a bachelor's degree who 
        has a combination of specialized training in psychiatry and work 
        experience consisting of community interaction and involvement 
        or community discharge planning in a mental health setting 
        totaling three years; or 
           (3) be a person who qualified as a case manager under the 
        1998 department of human service federal waiver provision and 
        meets the continuing education and mentoring requirements in 
        this section. 
           (j) A case manager associate (CMA) must: 
           (1) work under the direction of a case manager or case 
        management supervisor and must; 
           (2) be at least 21 years of age.  A case manager associate 
        must also; 
           (3) have at least a high school diploma or its equivalent; 
        and 
           (4) meet one of the following criteria: 
           (1) (i) have an associate of arts degree in one of the 
        behavioral sciences or human services; 
           (2) (ii) be a registered nurse without a bachelor's degree; 
           (3) (iii) have three years of life experience as a primary 
        caregiver to a child with serious emotional disturbance as 
        defined in section 245.4871, subdivision 6, within the previous 
        ten years; 
           (4) (iv) have 6,000 hours work experience as a nondegreed 
        state hospital technician; or 
           (5) (v) be a mental health practitioner as defined in 
        section 245.462, subdivision 17 26, clause (2). 
           Individuals meeting one of the criteria in clauses 
        (1) items (i) to (4) (iv) may qualify as a case manager after 
        four years of supervised work experience as a case manager 
        associate.  Individuals meeting the criteria in clause (5) item 
        (v) may qualify as a case manager after three years of 
        supervised experience as a case manager associate. 
           (k) Case manager associates must meet the following 
        supervision, mentoring, and continuing education requirements; 
           (1) have 40 hours of preservice training described under 
        paragraph (e) (f), clause (1), and; 
           (2) receive at least 40 hours of continuing education in 
        severe emotional disturbance and mental health service 
        annually.  Case manager associates shall; and 
           (3) receive at least five hours of mentoring per week from 
        a case management mentor.  A "case management mentor" means a 
        qualified, practicing case manager or case management supervisor 
        who teaches or advises and provides intensive training and 
        clinical supervision to one or more case manager associates.  
        Mentoring may occur while providing direct services to consumers 
        in the office or in the field and may be provided to individuals 
        or groups of case manager associates.  At least two mentoring 
        hours per week must be individual and face-to-face. 
           (k) (l) A case management supervisor must meet the criteria 
        for a mental health professional as specified in section 
        245.4871, subdivision 27. 
           (l) (m) An immigrant who does not have the qualifications 
        specified in this subdivision may provide case management 
        services to child immigrants with severe emotional disturbance 
        of the same ethnic group as the immigrant if the person:  
           (1) is currently enrolled in and is actively pursuing 
        credits toward the completion of a bachelor's degree in one of 
        the behavioral sciences or related fields at an accredited 
        college or university; 
           (2) completes 40 hours of training as specified in this 
        subdivision; and 
           (3) receives clinical supervision at least once a week 
        until the requirements of obtaining a bachelor's degree and 
        2,000 hours of supervised experience are met. 
           Sec. 5.  Minnesota Statutes 1998, section 252.28, is 
        amended by adding a subdivision to read: 
           Subd. 3b.  [OLMSTED COUNTY LICENSING EXEMPTION.] (a) 
        Notwithstanding subdivision 3, the commissioner may license 
        service sites each accommodating up to five residents moving 
        from a 43-bed intermediate care facility for persons with mental 
        retardation or related conditions located in Olmsted county that 
        is closing under section 252.292. 
           (b) Notwithstanding the provisions of any other state law 
        or administrative rule, the rate provisions of section 256I.05, 
        subdivision 1, apply to the exception in this subdivision. 
           Sec. 6.  Minnesota Statutes 1998, section 256B.0625, 
        subdivision 19a, is amended to read: 
           Subd. 19a.  [PERSONAL CARE SERVICES.] Medical assistance 
        covers personal care services in a recipient's home.  To qualify 
        for personal care services, 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 and when, without the 
        provision of personal care, their health and safety would be 
        jeopardized.  To use personal care 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 services in an in-home setting 
        according to section 256B.0627.  Medical assistance does not 
        cover personal care 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 services or 
        forgoes the facility per diem for the leave days that personal 
        care services are used.  All personal care services must be 
        provided according to section 256B.0627.  Personal care services 
        may not be reimbursed if the personal care assistant is the 
        spouse or legal guardian of the recipient or the parent of a 
        recipient under age 18, or the responsible party or the 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.  
        Parents of adult recipients, adult children of the recipient or 
        adult siblings of the recipient may be reimbursed for personal 
        care services if they are not the recipient's legal guardian and 
        are granted a waiver under section 256B.0627.  Until July 1, 
        2001, and notwithstanding the provisions of section 256B.0627, 
        subdivision 4, paragraph (b), clause (4), the noncorporate legal 
        guardian or conservator of an adult, who is not the responsible 
        party and not the personal care provider organization, may be 
        granted a hardship waiver under section 256B.0627, to be 
        reimbursed to provide personal care assistant services to the 
        recipient, 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. 7.  Minnesota Statutes 1999 Supplement, section 
        256B.0625, subdivision 19c, is amended to read: 
           Subd. 19c.  [PERSONAL CARE.] Medical assistance covers 
        personal care services provided by an individual who is 
        qualified to provide the services according to subdivision 19a 
        and section 256B.0627, where the services are prescribed by a 
        physician in accordance with a plan of treatment and are 
        supervised by the recipient under the fiscal agent option 
        according to section 256B.0627, subdivision 10, or a qualified 
        professional.  "Qualified professional" means a mental health 
        professional as defined in section 245.462, subdivision 18, or 
        245.4871, subdivision 26 27; or a registered nurse as defined in 
        sections 148.171 to 148.285.  As part of the assessment, the 
        county public health nurse will consult with the recipient or 
        responsible party and identify the most appropriate person to 
        provide supervision of the personal care assistant.  The 
        qualified professional shall perform the duties described in 
        Minnesota Rules, part 9505.0335, subpart 4.  
           Sec. 8.  Minnesota Statutes 1999 Supplement, section 
        256B.0627, subdivision 1, is amended to read: 
           Subdivision 1.  [DEFINITION.] (a) "Assessment" means a 
        review and evaluation of a recipient's need for home care 
        services conducted in person.  Assessments for private duty 
        nursing shall be conducted by a registered private duty nurse.  
        Assessments for home health agency services shall be conducted 
        by a home health agency nurse.  Assessments for personal care 
        assistant services shall be conducted by the county public 
        health nurse or a certified public health nurse under contract 
        with the county.  A face-to-face assessment must include:  a 
        documentation of health status assessment and, determination of 
        need, evaluation of service outcomes, collection of case data 
        effectiveness, identification of appropriate services and, 
        service plan development or modification, coordination of 
        services, referrals and follow-up to appropriate payers and 
        community resources, completion of required reports, obtaining 
        recommendation of service authorization, and consumer 
        education.  Once the need for personal care assistant services 
        is determined under this section, the county public health nurse 
        or certified public health nurse under contract with the county 
        is responsible for communicating this recommendation to the 
        commissioner and the recipient.  A face-to-face assessment for 
        personal care services is conducted on those recipients who have 
        never had a county public health nurse assessment.  A 
        face-to-face assessment must occur at least annually or when 
        there is a significant change in the recipient's condition or 
        when there is a change in the need for personal care assistant 
        services.  A service update may substitute for the annual 
        face-to-face assessment when there is not a significant change 
        in recipient condition or a change in the need for personal care 
        assistant service.  A service update or review for temporary 
        increase includes a review of initial baseline data, evaluation 
        of service outcomes effectiveness, redetermination of service 
        need, modification of service plan and appropriate referrals, 
        update of initial forms, obtaining service authorization, and on 
        going consumer education.  Assessments for medical assistance 
        home care services for mental retardation or related conditions 
        and alternative care services for developmentally disabled home 
        and community-based waivered recipients may be conducted by the 
        county public health nurse to ensure coordination and avoid 
        duplication.  Assessments must be completed on forms provided by 
        the commissioner within 30 days of a request for home care 
        services by a recipient or responsible party. 
           (b) "Care plan" means a written description of personal 
        care assistant services developed by the qualified professional 
        with the recipient or responsible party to be used by the 
        personal care assistant with a copy provided to the recipient or 
        responsible party. 
           (c) "Home care services" means a health service, determined 
        by the commissioner as medically necessary, that is ordered by a 
        physician and documented in a service plan that is reviewed by 
        the physician at least once every 62 days for the provision of 
        home health services, or private duty nursing, or at least once 
        every 365 days for personal care.  Home care services are 
        provided to the recipient at the recipient's residence that is a 
        place other than a hospital or long-term care facility or as 
        specified in section 256B.0625.  
           (d) "Medically necessary" has the meaning given in 
        Minnesota Rules, parts 9505.0170 to 9505.0475.  
           (e) "Personal care assistant" means a person who:  (1) is 
        at least 18 years old, except for persons 16 to 18 years of age 
        who participated in a related school-based job training program 
        or have completed a certified home health aide competency 
        evaluation; (2) is able to effectively communicate with the 
        recipient and personal care provider organization; (3) effective 
        July 1, 1996, has completed one of the training requirements as 
        specified in Minnesota Rules, part 9505.0335, subpart 3, items A 
        to D; (4) has the ability to, and provides covered personal care 
        services according to the recipient's care plan, responds 
        appropriately to recipient needs, and reports changes in the 
        recipient's condition to the supervising qualified professional; 
        (5) is not a consumer of personal care services; and (6) is 
        subject to criminal background checks and procedures specified 
        in section 245A.04.  
           (f) "Personal care provider organization" means an 
        organization enrolled to provide personal care services under 
        the medical assistance program that complies with the 
        following:  (1) owners who have a five percent interest or more, 
        and managerial officials are subject to a background study as 
        provided in section 245A.04.  This applies to currently enrolled 
        personal care provider organizations and those agencies seeking 
        enrollment as a personal care provider organization.  An 
        organization will be barred from enrollment if an owner or 
        managerial official of the organization has been convicted of a 
        crime specified in section 245A.04, or a comparable crime in 
        another jurisdiction, unless the owner or managerial official 
        meets the reconsideration criteria specified in section 245A.04; 
        (2) the organization must maintain a surety bond and liability 
        insurance throughout the duration of enrollment and provides 
        proof thereof.  The insurer must notify the department of human 
        services of the cancellation or lapse of policy; and (3) the 
        organization must maintain documentation of services as 
        specified in Minnesota Rules, part 9505.2175, subpart 7, as well 
        as evidence of compliance with personal care assistant training 
        requirements. 
           (g) "Responsible party" means an individual residing with a 
        recipient of personal care services who is capable of providing 
        the supportive care necessary to assist the recipient to live in 
        the community, is at least 18 years old, and is not a personal 
        care assistant.  Responsible parties who are parents of minors 
        or guardians of minors or incapacitated persons may delegate the 
        responsibility to another adult during a temporary absence of at 
        least 24 hours but not more than six months.  The person 
        delegated as a responsible party must be able to meet the 
        definition of responsible party, except that the delegated 
        responsible party is required to reside with the recipient only 
        while serving as the responsible party.  Foster care license 
        holders may be designated the responsible party for residents of 
        the foster care home if case management is provided as required 
        in section 256B.0625, subdivision 19a.  For persons who, as of 
        April 1, 1992, are sharing personal care services in order to 
        obtain the availability of 24-hour coverage, an employee of the 
        personal care provider organization may be designated as the 
        responsible party if case management is provided as required in 
        section 256B.0625, subdivision 19a. 
           (h) "Service plan" means a written description of the 
        services needed based on the assessment developed by the nurse 
        who conducts the assessment together with the recipient or 
        responsible party.  The service plan shall include a description 
        of the covered home care services, frequency and duration of 
        services, and expected outcomes and goals.  The recipient and 
        the provider chosen by the recipient or responsible party must 
        be given a copy of the completed service plan within 30 calendar 
        days of the request for home care services by the recipient or 
        responsible party. 
           (i) "Skilled nurse visits" are provided in a recipient's 
        residence under a plan of care or service plan that specifies a 
        level of care which the nurse is qualified to provide.  These 
        services are: 
           (1) nursing services according to the written plan of care 
        or service plan and accepted standards of medical and nursing 
        practice in accordance with chapter 148; 
           (2) services which due to the recipient's medical condition 
        may only be safely and effectively provided by a registered 
        nurse or a licensed practical nurse; 
           (3) assessments performed only by a registered nurse; and 
           (4) teaching and training the recipient, the recipient's 
        family, or other caregivers requiring the skills of a registered 
        nurse or licensed practical nurse. 
           Sec. 9.  Minnesota Statutes 1999 Supplement, section 
        256B.0627, subdivision 5, is amended to read: 
           Subd. 5.  [LIMITATION ON PAYMENTS.] Medical assistance 
        payments for home care services shall be limited according to 
        this subdivision.  
           (a)  [LIMITS ON SERVICES WITHOUT PRIOR AUTHORIZATION.] A 
        recipient may receive the following home care services during a 
        calendar year: 
           (1) up to two face-to-face assessments to determine a 
        recipient's need for personal care assistant services; 
           (2) one service update done to determine a recipient's need 
        for personal care services; and 
           (3) up to five skilled nurse visits.  
           (b)  [PRIOR AUTHORIZATION; EXCEPTIONS.] All home care 
        services above the limits in paragraph (a) must receive the 
        commissioner's prior authorization, except when: 
           (1) the home care services were required to treat an 
        emergency medical condition that if not immediately treated 
        could cause a recipient serious physical or mental disability, 
        continuation of severe pain, or death.  The provider must 
        request retroactive authorization no later than five working 
        days after giving the initial service.  The provider must be 
        able to substantiate the emergency by documentation such as 
        reports, notes, and admission or discharge histories; 
           (2) the home care services were provided on or after the 
        date on which the recipient's eligibility began, but before the 
        date on which the recipient was notified that the case was 
        opened.  Authorization will be considered if the request is 
        submitted by the provider within 20 working days of the date the 
        recipient was notified that the case was opened; 
           (3) a third-party payor for home care services has denied 
        or adjusted a payment.  Authorization requests must be submitted 
        by the provider within 20 working days of the notice of denial 
        or adjustment.  A copy of the notice must be included with the 
        request; 
           (4) the commissioner has determined that a county or state 
        human services agency has made an error; or 
           (5) the professional nurse determines an immediate need for 
        up to 40 skilled nursing or home health aide visits per calendar 
        year and submits a request for authorization within 20 working 
        days of the initial service date, and medical assistance is 
        determined to be the appropriate payer. 
           (c)  [RETROACTIVE AUTHORIZATION.] A request for retroactive 
        authorization will be evaluated according to the same criteria 
        applied to prior authorization requests.  
           (d)  [ASSESSMENT AND SERVICE PLAN.] Assessments under 
        section 256B.0627, subdivision 1, paragraph (a), shall be 
        conducted initially, and at least annually thereafter, in person 
        with the recipient and result in a completed service plan using 
        forms specified by the commissioner.  Within 30 days of 
        recipient or responsible party request for home care services, 
        the assessment, the service plan, and other information 
        necessary to determine medical necessity such as diagnostic or 
        testing information, social or medical histories, and hospital 
        or facility discharge summaries shall be submitted to the 
        commissioner.  For personal care services: 
           (1) The amount and type of service authorized based upon 
        the assessment and service plan will follow the recipient if the 
        recipient chooses to change providers.  
           (2) If the recipient's medical need changes, the 
        recipient's provider may assess the need for a change in service 
        authorization and request the change from the county public 
        health nurse.  Within 30 days of the request, the public health 
        nurse will determine whether to request the change in services 
        based upon the provider assessment, or conduct a home visit to 
        assess the need and determine whether the change is appropriate. 
           (3) To continue to receive personal care services after the 
        first year, the recipient or the responsible party, in 
        conjunction with the public health nurse, may complete a service 
        update on forms developed by the commissioner according to 
        criteria and procedures in subdivision 1.  
           (e)  [PRIOR AUTHORIZATION.] The commissioner, or the 
        commissioner's designee, shall review the assessment, service 
        update, request for temporary services, service plan, and any 
        additional information that is submitted.  The commissioner 
        shall, within 30 days after receiving a complete request, 
        assessment, and service plan, authorize home care services as 
        follows:  
           (1)  [HOME HEALTH SERVICES.] All home health services 
        provided by a licensed nurse or a home health aide must be prior 
        authorized by the commissioner or the commissioner's designee.  
        Prior authorization must be based on medical necessity and 
        cost-effectiveness when compared with other care options.  When 
        home health services are used in combination with personal care 
        and private duty nursing, the cost of all home care services 
        shall be considered for cost-effectiveness.  The commissioner 
        shall limit nurse and home health aide visits to no more than 
        one visit each per day. 
           (2)  [PERSONAL CARE SERVICES.] (i) All personal care 
        services and supervision by a qualified professional must be 
        prior authorized by the commissioner or the commissioner's 
        designee except for the assessments established in paragraph 
        (a).  The amount of personal care services authorized must be 
        based on the recipient's home care rating.  A child may not be 
        found to be dependent in an activity of daily living if because 
        of the child's age an adult would either perform the activity 
        for the child or assist the child with the activity and the 
        amount of assistance needed is similar to the assistance 
        appropriate for a typical child of the same age.  Based on 
        medical necessity, the commissioner may authorize: 
           (A) up to two times the average number of direct care hours 
        provided in nursing facilities for the recipient's comparable 
        case mix level; or 
           (B) up to three times the average number of direct care 
        hours provided in nursing facilities for recipients who have 
        complex medical needs or are dependent in at least seven 
        activities of daily living and need physical assistance with 
        eating or have a neurological diagnosis; or 
           (C) up to 60 percent of the average reimbursement rate, as 
        of July 1, 1991, for care provided in a regional treatment 
        center for recipients who have Level I behavior, plus any 
        inflation adjustment as provided by the legislature for personal 
        care service; or 
           (D) up to the amount the commissioner would pay, as of July 
        1, 1991, plus any inflation adjustment provided for home care 
        services, for care provided in a regional treatment center for 
        recipients referred to the commissioner by a regional treatment 
        center preadmission evaluation team.  For purposes of this 
        clause, home care services means all services provided in the 
        home or community that would be included in the payment to a 
        regional treatment center; or 
           (E) up to the amount medical assistance would reimburse for 
        facility care for recipients referred to the commissioner by a 
        preadmission screening team established under section 256B.0911 
        or 256B.092; and 
           (F) a reasonable amount of time for the provision of 
        supervision by a qualified professional of personal care 
        services.  
           (ii) The number of direct care hours shall be determined 
        according to the annual cost report submitted to the department 
        by nursing facilities.  The average number of direct care hours, 
        as established by May 1, 1992, shall be calculated and 
        incorporated into the home care limits on July 1, 1992.  These 
        limits shall be calculated to the nearest quarter hour. 
           (iii) The home care rating shall be determined by the 
        commissioner or the commissioner's designee based on information 
        submitted to the commissioner by the county public health nurse 
        on forms specified by the commissioner.  The home care rating 
        shall be a combination of current assessment tools developed 
        under sections 256B.0911 and 256B.501 with an addition for 
        seizure activity that will assess the frequency and severity of 
        seizure activity and with adjustments, additions, and 
        clarifications that are necessary to reflect the needs and 
        conditions of recipients who need home care including children 
        and adults under 65 years of age.  The commissioner shall 
        establish these forms and protocols under this section and shall 
        use an advisory group, including representatives of recipients, 
        providers, and counties, for consultation in establishing and 
        revising the forms and protocols. 
           (iv) A recipient shall qualify as having complex medical 
        needs if the care required is difficult to perform and because 
        of recipient's medical condition requires more time than 
        community-based standards allow or requires more skill than 
        would ordinarily be required and the recipient needs or has one 
        or more of the following: 
           (A) daily tube feedings; 
           (B) daily parenteral therapy; 
           (C) wound or decubiti care; 
           (D) postural drainage, percussion, nebulizer treatments, 
        suctioning, tracheotomy care, oxygen, mechanical ventilation; 
           (E) catheterization; 
           (F) ostomy care; 
           (G) quadriplegia; or 
           (H) other comparable medical conditions or treatments the 
        commissioner determines would otherwise require institutional 
        care.  
           (v) A recipient shall qualify as having Level I behavior if 
        there is reasonable supporting evidence that the recipient 
        exhibits, or that without supervision, observation, or 
        redirection would exhibit, one or more of the following 
        behaviors that cause, or have the potential to cause: 
           (A) injury to the recipient's own body; 
           (B) physical injury to other people; or 
           (C) destruction of property. 
           (vi) Time authorized for personal care relating to Level I 
        behavior in subclause (v), items (A) to (C), shall be based on 
        the predictability, frequency, and amount of intervention 
        required. 
           (vii) A recipient shall qualify as having Level II behavior 
        if the recipient exhibits on a daily basis one or more of the 
        following behaviors that interfere with the completion of 
        personal care services under subdivision 4, paragraph (a): 
           (A) unusual or repetitive habits; 
           (B) withdrawn behavior; or 
           (C) offensive behavior. 
           (viii) A recipient with a home care rating of Level II 
        behavior in subclause (vii), items (A) to (C), shall be rated as 
        comparable to a recipient with complex medical needs under 
        subclause (iv).  If a recipient has both complex medical needs 
        and Level II behavior, the home care rating shall be the next 
        complex category up to the maximum rating under subclause (i), 
        item (B). 
           (3)  [PRIVATE DUTY NURSING SERVICES.] All private duty 
        nursing services shall be prior authorized by the commissioner 
        or the commissioner's designee.  Prior authorization for private 
        duty nursing services shall be based on medical necessity and 
        cost-effectiveness when compared with alternative care options.  
        The commissioner may authorize medically necessary private duty 
        nursing services in quarter-hour units when: 
           (i) the recipient requires more individual and continuous 
        care than can be provided during a nurse visit; or 
           (ii) the cares are outside of the scope of services that 
        can be provided by a home health aide or personal care assistant.
           The commissioner may authorize: 
           (A) up to two times the average amount of direct care hours 
        provided in nursing facilities statewide for case mix 
        classification "K" as established by the annual cost report 
        submitted to the department by nursing facilities in May 1992; 
           (B) private duty nursing in combination with other home 
        care services up to the total cost allowed under clause (2); 
           (C) up to 16 hours per day if the recipient requires more 
        nursing than the maximum number of direct care hours as 
        established in item (A) and the recipient meets the hospital 
        admission criteria established under Minnesota Rules, parts 
        9505.0500 to 9505.0540.  
           The commissioner may authorize up to 16 hours per day of 
        medically necessary private duty nursing services or up to 24 
        hours per day of medically necessary private duty nursing 
        services until such time as the commissioner is able to make a 
        determination of eligibility for recipients who are 
        cooperatively applying for home care services under the 
        community alternative care program developed under section 
        256B.49, or until it is determined by the appropriate regulatory 
        agency that a health benefit plan is or is not required to pay 
        for appropriate medically necessary health care services.  
        Recipients or their representatives must cooperatively assist 
        the commissioner in obtaining this determination.  Recipients 
        who are eligible for the community alternative care program may 
        not receive more hours of nursing under this section than would 
        otherwise be authorized under section 256B.49. 
           (4)  [VENTILATOR-DEPENDENT RECIPIENTS.] If the recipient is 
        ventilator-dependent, the monthly medical assistance 
        authorization for home care services shall not exceed what the 
        commissioner would pay for care at the highest cost hospital 
        designated as a long-term hospital under the Medicare program.  
        For purposes of this clause, home care services means all 
        services provided in the home that would be included in the 
        payment for care at the long-term hospital.  
        "Ventilator-dependent" means an individual who receives 
        mechanical ventilation for life support at least six hours per 
        day and is expected to be or has been dependent for at least 30 
        consecutive days.  
           (f)  [PRIOR AUTHORIZATION; TIME LIMITS.] The commissioner 
        or the commissioner's designee shall determine the time period 
        for which a prior authorization shall be effective.  If the 
        recipient continues to require home care services beyond the 
        duration of the prior authorization, the home care provider must 
        request a new prior authorization.  Under no circumstances, 
        other than the exceptions in paragraph (b), shall a prior 
        authorization be valid prior to the date the commissioner 
        receives the request or for more than 12 months.  A recipient 
        who appeals a reduction in previously authorized home care 
        services may continue previously authorized services, other than 
        temporary services under paragraph (h), pending an appeal under 
        section 256.045.  The commissioner must provide a detailed 
        explanation of why the authorized services are reduced in amount 
        from those requested by the home care provider.  
           (g)  [APPROVAL OF HOME CARE SERVICES.] The commissioner or 
        the commissioner's designee shall determine the medical 
        necessity of home care services, the level of caregiver 
        according to subdivision 2, and the institutional comparison 
        according to this subdivision, the cost-effectiveness of 
        services, and the amount, scope, and duration of home care 
        services reimbursable by medical assistance, based on the 
        assessment, primary payer coverage determination information as 
        required, the service plan, the recipient's age, the cost of 
        services, the recipient's medical condition, and diagnosis or 
        disability.  The commissioner may publish additional criteria 
        for determining medical necessity according to section 256B.04. 
           (h)  [PRIOR AUTHORIZATION REQUESTS; TEMPORARY SERVICES.] 
        The agency nurse, the independently enrolled private duty nurse, 
        or county public health nurse may request a temporary 
        authorization for home care services by telephone.  The 
        commissioner may approve a temporary level of home care services 
        based on the assessment, and service or care plan information, 
        and primary payer coverage determination information as required.
        Authorization for a temporary level of home care services 
        including nurse supervision is limited to the time specified by 
        the commissioner, but shall not exceed 45 days, unless extended 
        because the county public health nurse has not completed the 
        required assessment and service plan, or the commissioner's 
        determination has not been made.  The level of services 
        authorized under this provision shall have no bearing on a 
        future prior authorization. 
           (i)  [PRIOR AUTHORIZATION REQUIRED IN FOSTER CARE SETTING.] 
        Home care services provided in an adult or child foster care 
        setting must receive prior authorization by the department 
        according to the limits established in paragraph (a). 
           The commissioner may not authorize: 
           (1) home care services that are the responsibility of the 
        foster care provider under the terms of the foster care 
        placement agreement and administrative rules.  Requests for home 
        care services for recipients residing in a foster care setting 
        must include the foster care placement agreement and 
        determination of difficulty of care; 
           (2) personal care services when the foster care license 
        holder is also the personal care provider or personal care 
        assistant unless the recipient can direct the recipient's own 
        care, or case management is provided as required in section 
        256B.0625, subdivision 19a; 
           (3) personal care services when the responsible party is an 
        employee of, or under contract with, or has any direct or 
        indirect financial relationship with the personal care provider 
        or personal care assistant, unless case management is provided 
        as required in section 256B.0625, subdivision 19a; or 
           (4) home personal care assistant and private duty nursing 
        services when the number of foster care residents is greater 
        than four unless the county responsible for the recipient's 
        foster placement made the placement prior to April 1, 1992, 
        requests that home personal care assistant and private duty 
        nursing services be provided, and case management is provided as 
        required in section 256B.0625, subdivision 19a; or. 
           (5) home care services when combined with foster care 
        payments, other than room and board payments that exceed the 
        total amount that public funds would pay for the recipient's 
        care in a medical institution. 
           Sec. 10.  Minnesota Statutes 1999 Supplement, section 
        256B.0627, subdivision 8, is amended to read: 
           Subd. 8.  [SHARED PERSONAL CARE ASSISTANT SERVICES.] (a) 
        Medical assistance payments for shared personal care assistance 
        services shall be limited according to this subdivision. 
           (b) Recipients of personal care assistant services may 
        share staff and the commissioner shall provide a rate system for 
        shared personal care assistant services.  For two persons 
        sharing services, the rate paid to a provider shall not exceed 
        1-1/2 times the rate paid for serving a single individual, and 
        for three persons sharing services, the rate paid to a provider 
        shall not exceed twice the rate paid for serving a single 
        individual.  These rates apply only to situations in which all 
        recipients were present and received shared services on the date 
        for which the service is billed.  No more than three persons may 
        receive shared services from a personal care assistant in a 
        single setting. 
           (c) Shared service is the provision of personal care 
        services by a personal care assistant to two or three recipients 
        at the same time and in the same setting.  For the purposes of 
        this subdivision, "setting" means: 
           (1) the home or foster care home of one of the individual 
        recipients; or 
           (2) a child care program in which all recipients served by 
        one personal care assistant are participating, which is licensed 
        under chapter 245A or operated by a local school district or 
        private school.; or 
           (3) outside the home or foster care home of one of the 
        recipients when normal life activities take the recipients 
        outside the home.  
           The provisions of this subdivision do not apply when a 
        personal care assistant is caring for multiple recipients in 
        more than one setting. 
           (d) The recipient or the recipient's responsible party, in 
        conjunction with the county public health nurse, shall determine:
           (1) whether shared personal care assistant services is an 
        appropriate option based on the individual needs and preferences 
        of the recipient; and 
           (2) the amount of shared services allocated as part of the 
        overall authorization of personal care services. 
           The recipient or the responsible party, in conjunction with 
        the supervising qualified professional, shall arrange the 
        setting and grouping of shared services based on the individual 
        needs and preferences of the recipients.  Decisions on the 
        selection of recipients to share services must be based on the 
        ages of the recipients, compatibility, and coordination of their 
        care needs. 
           (e) The following items must be considered by the recipient 
        or the responsible party and the supervising qualified 
        professional, and documented in the recipient's health service 
        record: 
           (1) the additional qualifications needed by the personal 
        care assistant to provide care to several recipients in the same 
        setting; 
           (2) the additional training and supervision needed by the 
        personal care assistant to ensure that the needs of the 
        recipient are met appropriately and safely.  The provider must 
        provide on-site supervision by a qualified professional within 
        the first 14 days of shared services, and monthly thereafter; 
           (3) the setting in which the shared services will be 
        provided; 
           (4) the ongoing monitoring and evaluation of the 
        effectiveness and appropriateness of the service and process 
        used to make changes in service or setting; and 
           (5) a contingency plan which accounts for absence of the 
        recipient in a shared services setting due to illness or other 
        circumstances and staffing contingencies. 
           (f) The provider must offer the recipient or the 
        responsible party the option of shared or one-on-one personal 
        care assistant services.  The recipient or the responsible party 
        can withdraw from participating in a shared services arrangement 
        at any time. 
           (g) In addition to documentation requirements under 
        Minnesota Rules, part 9505.2175, a personal care provider must 
        meet documentation requirements for shared personal care 
        assistant services and must document the following in the health 
        service record for each individual recipient sharing services: 
           (1) permission by the recipient or the recipient's 
        responsible party, if any, for the maximum number of shared 
        services hours per week chosen by the recipient; 
           (2) permission by the recipient or the recipient's 
        responsible party, if any, for personal care assistant services 
        provided outside the recipient's residence; 
           (3) permission by the recipient or the recipient's 
        responsible party, if any, for others to receive shared services 
        in the recipient's residence; 
           (4) revocation by the recipient or the recipient's 
        responsible party, if any, of the shared service authorization, 
        or the shared service to be provided to others in the 
        recipient's residence, or the shared service to be provided 
        outside the recipient's residence; 
           (5) supervision of the shared personal care assistant 
        services by the qualified professional, including the date, time 
        of day, number of hours spent supervising the provision of 
        shared services, whether the supervision was face-to-face or 
        another method of supervision, changes in the recipient's 
        condition, shared services scheduling issues and 
        recommendations; 
           (6) documentation by the qualified professional of 
        telephone calls or other discussions with the personal care 
        assistant regarding services being provided to the recipient; 
        and 
           (7) daily documentation of the shared services provided by 
        each identified personal care assistant including: 
           (i) the names of each recipient receiving shared services 
        together; 
           (ii) the setting for the shared services, including the 
        starting and ending times that the recipient received shared 
        services; and 
           (iii) notes by the personal care assistant regarding 
        changes in the recipient's condition, problems that may arise 
        from the sharing of services, scheduling issues, care issues, 
        and other notes as required by the qualified professional. 
           (h) Unless otherwise provided in this subdivision, all 
        other statutory and regulatory provisions relating to personal 
        care services apply to shared services. 
           Nothing in this subdivision shall be construed to reduce 
        the total number of hours authorized for an individual recipient.
           Sec. 11.  Minnesota Statutes 1999 Supplement, section 
        256B.0627, subdivision 11, is amended to read: 
           Subd. 11.  [SHARED PRIVATE DUTY NURSING CARE OPTION.] (a) 
        Medical assistance payments for shared private duty nursing 
        services by a private duty nurse shall be limited according to 
        this subdivision.  For the purposes of this section, "private 
        duty nursing agency" means an agency licensed under chapter 144A 
        to provide private duty nursing services. 
           (b) Recipients of private duty nursing services may share 
        nursing staff and the commissioner shall provide a rate 
        methodology for shared private duty nursing.  For two persons 
        sharing nursing care, the rate paid to a provider shall not 
        exceed 1.5 times the nonwaivered private duty nursing rates paid 
        for serving a single individual who is not ventilator dependent, 
        by a registered nurse or licensed practical nurse.  These rates 
        apply only to situations in which both recipients are present 
        and receive shared private duty nursing care on the date for 
        which the service is billed.  No more than two persons may 
        receive shared private duty nursing services from a private duty 
        nurse in a single setting. 
           (c) Shared private duty nursing care is the provision of 
        nursing services by a private duty nurse to two recipients at 
        the same time and in the same setting.  For the purposes of this 
        subdivision, "setting" means: 
           (1) the home or foster care home of one of the individual 
        recipients; or 
           (2) a child care program licensed under chapter 245A or 
        operated by a local school district or private school; or 
           (3) an adult day care service licensed under chapter 245A.; 
        or 
           (4) outside the home or foster care home of one of the 
        recipients when normal life activities take the recipients 
        outside the home.  
           This subdivision does not apply when a private duty nurse 
        is caring for multiple recipients in more than one setting. 
           (d) The recipient or the recipient's legal representative, 
        and the recipient's physician, in conjunction with the home 
        health care agency, shall determine: 
           (1) whether shared private duty nursing care is an 
        appropriate option based on the individual needs and preferences 
        of the recipient; and 
           (2) the amount of shared private duty nursing services 
        authorized as part of the overall authorization of nursing 
        services. 
           (e) The recipient or the recipient's legal representative, 
        in conjunction with the private duty nursing agency, shall 
        approve the setting, grouping, and arrangement of shared private 
        duty nursing care based on the individual needs and preferences 
        of the recipients.  Decisions on the selection of recipients to 
        share services must be based on the ages of the recipients, 
        compatibility, and coordination of their care needs. 
           (f) The following items must be considered by the recipient 
        or the recipient's legal representative and the private duty 
        nursing agency, and documented in the recipient's health service 
        record: 
           (1) the additional training needed by the private duty 
        nurse to provide care to several two recipients in the same 
        setting and to ensure that the needs of the recipients are met 
        appropriately and safely; 
           (2) the setting in which the shared private duty nursing 
        care will be provided; 
           (3) the ongoing monitoring and evaluation of the 
        effectiveness and appropriateness of the service and process 
        used to make changes in service or setting; 
           (4) a contingency plan which accounts for absence of the 
        recipient in a shared private duty nursing setting due to 
        illness or other circumstances; 
           (5) staffing backup contingencies in the event of employee 
        illness or absence; and 
           (6) arrangements for additional assistance to respond to 
        urgent or emergency care needs of the recipients. 
           (g) The provider must offer the recipient or responsible 
        party the option of shared or one-on-one private duty nursing 
        services.  The recipient or responsible party can withdraw from 
        participating in a shared service arrangement at any time. 
           (h) The private duty nursing agency must document the 
        following in the health service record for each individual 
        recipient sharing private duty nursing care: 
           (1) permission by the recipient or the recipient's legal 
        representative for the maximum number of shared nursing care 
        hours per week chosen by the recipient; 
           (2) permission by the recipient or the recipient's legal 
        representative for shared private duty nursing services provided 
        outside the recipient's residence; 
           (3) permission by the recipient or the recipient's legal 
        representative for others to receive shared private duty nursing 
        services in the recipient's residence; 
           (4) revocation by the recipient or the recipient's legal 
        representative of the shared private duty nursing care 
        authorization, or the shared care to be provided to others in 
        the recipient's residence, or the shared private duty nursing 
        services to be provided outside the recipient's residence; and 
           (5) daily documentation of the shared private duty nursing 
        services provided by each identified private duty nurse, 
        including: 
           (i) the names of each recipient receiving shared private 
        duty nursing services together; 
           (ii) the setting for the shared services, including the 
        starting and ending times that the recipient received shared 
        private duty nursing care; and 
           (iii) notes by the private duty nurse regarding changes in 
        the recipient's condition, problems that may arise from the 
        sharing of private duty nursing services, and scheduling and 
        care issues. 
           (i) Unless otherwise provided in this subdivision, all 
        other statutory and regulatory provisions relating to private 
        duty nursing services apply to shared private duty nursing 
        services. 
           Nothing in this subdivision shall be construed to reduce 
        the total number of private duty nursing hours authorized for an 
        individual recipient under subdivision 5. 
           Sec. 12.  Minnesota Statutes 1999 Supplement, section 
        256B.501, subdivision 8a, is amended to read: 
           Subd. 8a.  [PAYMENT FOR PERSONS WITH SPECIAL NEEDS FOR 
        CRISIS INTERVENTION SERVICES.] Community-based crisis services 
        authorized by the commissioner or the commissioner's designee 
        for a resident of an intermediate care facility for persons with 
        mental retardation (ICF/MR) reimbursed under this section shall 
        be paid by medical assistance in accordance with the paragraphs 
        (a) to (g). 
           (a) "Crisis services" means the specialized services listed 
        in clauses (1) to (3) provided to prevent the recipient from 
        requiring placement in a more restrictive institutional setting 
        such as an inpatient hospital or regional treatment center and 
        to maintain the recipient in the present community setting. 
           (1) The crisis services provider shall assess the 
        recipient's behavior and environment to identify factors 
        contributing to the crisis. 
           (2) The crisis services provider shall develop a 
        recipient-specific intervention plan in coordination with the 
        service planning team and provide recommendations for revisions 
        to the individual service plan if necessary to prevent or 
        minimize the likelihood of future crisis situations.  The 
        intervention plan shall include a transition plan to aid the 
        recipient in returning to the community-based ICF/MR if the 
        recipient is receiving residential crisis services.  
           (3) The crisis services provider shall consult with and 
        provide training and ongoing technical assistance to the 
        recipient's service providers to aid in the implementation of 
        the intervention plan and revisions to the individual service 
        plan. 
           (b) "Residential crisis services" means crisis services 
        that are provided to a recipient admitted to an alternative, 
        state-licensed site approved by the commissioner, because the 
        ICF/MR receiving reimbursement under this section is not able, 
        as determined by the commissioner, to provide the intervention 
        and protection of the recipient and others living with the 
        recipient that is necessary to prevent the recipient from 
        requiring placement in a more restrictive institutional setting. 
           (c) Residential crisis services providers must maintain a 
        license from the commissioner for the residence when providing 
        crisis services for short-term crisis intervention, and must not 
        be located in a private residence. 
           (d) Payment rates shall be established consistent with 
        county negotiated crisis intervention services.  
           (e) Payment for residential crisis services is limited to 
        21 days, unless an additional period is authorized by the 
        commissioner or part of an approved regional plan.  
           (f) Payment for crisis services shall be made only for 
        services provided while the ICF/MR receiving reimbursement under 
        this section: 
           (1) has a shared services agreement with the crisis 
        services provider in effect under section 246.57; and 
           (2) has executed a cooperative agreement with the crisis 
        services provider to implement the intervention plan and 
        revisions to the individual service plan as necessary to prevent 
        or minimize the likelihood of future crisis situations, to 
        maintain the recipient in the present community setting, and to 
        prevent the recipient from requiring a more restrictive 
        institutional setting. 
           (g) Payment to the ICF/MR receiving reimbursement under 
        this section shall be made for up to 18 therapeutic leave days 
        during which the recipient is receiving residential crisis 
        services, if the ICF/MR is otherwise eligible to receive payment 
        for a therapeutic leave day under Minnesota Rules, part 
        9505.0415.  Payment under this paragraph shall be terminated if 
        the commissioner determines that the ICF/MR is not meeting the 
        terms of the shared cooperative service agreement under 
        paragraph (f) or that the recipient will not return to the 
        ICF/MR. 
           Sec. 13.  Minnesota Statutes 1999 Supplement, section 
        256B.5011, subdivision 2, is amended to read: 
           Subd. 2.  [CONTRACT PROVISIONS.] (a) The service contract 
        with each intermediate care facility must include provisions for:
           (1) modifying payments when significant changes occur in 
        the needs of the consumers; 
           (2) the establishment and use of continuous a quality 
        improvement processes using the results attained through service 
        quality monitoring plan.  Using criteria and options for 
        performance measures developed by the commissioner, each 
        intermediate care facility must identify a minimum of one 
        performance measure on which to focus its efforts for quality 
        improvement during the contract period; 
           (3) appropriate and necessary statistical information 
        required by the commissioner; 
           (4) annual aggregate facility financial information; and 
           (5) additional requirements for intermediate care 
        facilities not meeting the standards set forth in the service 
        contract. 
           (b) The commissioner shall recommend to the legislature by 
        January 15, 2000, whether the contract should include service 
        quality monitoring that may utilize performance indicators that 
        measure consumer and program outcomes.  Performance measurement 
        shall not increase or duplicate regulatory requirements. 
           (b) The commissioner of human services and the commissioner 
        of health, in consultation with representatives from counties, 
        advocacy organizations, and the provider community, shall review 
        the consolidated standards under chapter 245B and the supervised 
        living facility rule under Minnesota Rules, chapter 4665, to 
        determine what provisions in Minnesota Rules, chapter 4665, may 
        be waived by the commissioner of health for intermediate care 
        facilities in order to enable facilities to implement the 
        performance measures in their contract and provide quality 
        services to residents without a duplication of or increase in 
        regulatory requirements.  
           Sec. 14.  Minnesota Statutes 1999 Supplement, section 
        256B.5013, subdivision 1, is amended to read: 
           Subdivision 1.  [VARIABLE RATE ADJUSTMENTS.] For rate years 
        beginning on or after October 1, 2000, when there is a 
        documented increase in the resource needs of a current ICF/MR 
        recipient or recipients, or a person is admitted to a facility 
        who requires additional resources, the county of financial 
        responsibility may approve recommend approval of an enhanced a 
        variable rate for one or more persons in the to enable the 
        facility to meet the needs based on the recipient's screening.  
        Resource needs directly attributable to an individual that may 
        be considered under the variable rate adjustment include 
        increased direct staff hours and other specialized services, 
        equipment, and human resources.  The guidelines in paragraphs 
        (a) to (d) apply for the payment rate adjustments under this 
        section. 
           (a) All persons must be screened according to section 
        256B.092, subdivisions 7 and 8, prior to implementation of the 
        new payment system, and annually thereafter, and when a variable 
        rate is being requested due to changes in the needs of the 
        recipient.  Screening data shall be analyzed to develop broad 
        profiles of the functional characteristics of recipients.  Three 
        components shall Criteria to be used to distinguish recipients 
        based on the following broad develop these profiles shall 
        include, but not be limited to: 
           (1) the functional ability of a recipient to care for and 
        maintain one's the recipient's own basic needs; 
           (2) the intensity of any aggressive or destructive 
        behavior; and 
           (3) any history of obstructive behavior in combination with 
        a diagnosis of psychosis or neurosis.; 
           (4) a need for resources due to a change in resident day 
        program participation because the resident:  (i) has reached the 
        age of 65 or has a change in health condition that makes it 
        difficult for the person to participate in day training and 
        habilitation services over an extended period of time because it 
        is medically contraindicated; and (ii) has expressed a desire 
        for change through the developmental disabilities screening 
        process under section 256B.092; and 
           (5) a need for additional resources for intensive 
        short-term training which is necessary prior to a recipient's 
        discharge to a less restrictive, more integrated setting. 
           The profile groups recipients' screenings shall be used to 
        link resource needs to funding.  The resource profile shall 
        determine the level of funding that may be authorized by the 
        county.  The county of financial responsibility may approve a 
        rate adjustment for an individual.  The commissioner shall 
        recommend to the legislature by January 15, 2000, a methodology 
        using the profile groups to determine variable rates.  The 
        variable rate must be applied to expenses related to increased 
        direct staff hours and other specialized services, equipment, 
        and human resources.  This variable rate component plus the 
        facility's current operating payment rate equals the 
        individual's total operating payment rate. 
           (b) A recipient must be screened by the county of financial 
        responsibility using the developmental disabilities screening 
        document completed immediately prior to approval of a variable 
        rate by the county.  A comparison of the updated screening and 
        the previous screening must demonstrate an increase in resource 
        needs. 
           (c) Rate adjustments projected to exceed the authorized 
        funding level associated with the person's profile must be 
        submitted to the commissioner. 
           (d) The new rate approved through this process shall not be 
        averaged across all persons living at a facility but shall be an 
        individual rate.  The county of financial responsibility must 
        indicate the projected length of time that the additional 
        funding may be needed by for the individual.  The need to 
        continue an individual variable rate must be reviewed at the end 
        of the anticipated duration of need but at least annually 
        through the completion of the developmental disabilities 
        screening document. 
           Sec. 15.  Minnesota Statutes 1999 Supplement, section 
        256B.5013, is amended by adding a subdivision to read: 
           Subd. 5.  [REQUIRED DATA; PAYMENT ADJUSTMENTS.] Facilities 
        shall maintain and submit monthly bed use data in the form of 
        resident days and variable rate information.  When a variable 
        rate is reported by a facility, monthly bed use data shall be 
        used to track the amount and time span of the rate adjustment.  
        The total payments made to a facility may be adjusted based on 
        concurrent changes in the needs of recipients that are covered 
        by a variable rate adjustment.  Any adjustment for multiple 
        resident changes shall not result in a decrease to the facility 
        base rate. 
           Sec. 16.  Minnesota Statutes 1999 Supplement, section 
        256B.5013, is amended by adding a subdivision to read: 
           Subd. 6.  [COMMISSIONER REVIEW.] During the initial 
        contracting period, the commissioner shall review the process of 
        variable rate adjustments to determine if the variable rate 
        process is being effectively implemented and whether the 
        variable rate process minimizes unnecessary detailed 
        recordkeeping and meets recipient needs.  
           Sec. 17.  Minnesota Statutes 1999 Supplement, section 
        256B.77, subdivision 8, is amended to read: 
           Subd. 8.  [RESPONSIBILITIES OF THE COUNTY ADMINISTRATIVE 
        ENTITY.] (a) The county administrative entity shall meet the 
        requirements of this subdivision, unless the county authority or 
        the commissioner, with written approval of the county authority, 
        enters into a service delivery contract with a service delivery 
        organization for any or all of the requirements contained in 
        this subdivision. 
           (b) The county administrative entity shall enroll eligible 
        individuals regardless of health or disability status. 
           (c) The county administrative entity shall provide all 
        enrollees timely access to the medical assistance benefit set.  
        Alternative services and additional services are available to 
        enrollees at the option of the county administrative entity and 
        may be provided if specified in the personal support plan.  
        County authorities are not required to seek prior authorization 
        from the department as required by the laws and rules governing 
        medical assistance. 
           (d) The county administrative entity shall cover necessary 
        services as a result of an emergency without prior 
        authorization, even if the services were rendered outside of the 
        provider network. 
           (e) The county administrative entity shall authorize 
        necessary and appropriate services when needed and requested by 
        the enrollee or the enrollee's legal representative in response 
        to an urgent situation.  Enrollees shall have 24-hour access to 
        urgent care services coordinated by experienced disability 
        providers who have information about enrollees' needs and 
        conditions. 
           (f) The county administrative entity shall accept the 
        capitation payment from the commissioner in return for the 
        provision of services for enrollees. 
           (g) The county administrative entity shall maintain 
        internal grievance and complaint procedures, including an 
        expedited informal complaint process in which the county 
        administrative entity must respond to verbal complaints within 
        ten calendar days, and a formal grievance process, in which the 
        county administrative entity must respond to written complaints 
        within 30 calendar days. 
           (h) The county administrative entity shall provide a 
        certificate of coverage, upon enrollment, to each enrollee and 
        the enrollee's legal representative, if any, which describes the 
        benefits covered by the county administrative entity, any 
        limitations on those benefits, and information about providers 
        and the service delivery network.  This information must also be 
        made available to prospective enrollees.  This certificate must 
        be approved by the commissioner. 
           (i) The county administrative entity shall present evidence 
        of an expedited process to approve exceptions to benefits, 
        provider network restrictions, and other plan limitations under 
        appropriate circumstances. 
           (j) The county administrative entity shall provide 
        enrollees or their legal representatives with written notice of 
        their appeal rights under subdivision 16, and of ombudsman and 
        advocacy programs under subdivisions 13 and 14, at the following 
        times:  upon enrollment, upon submission of a written complaint, 
        when a service is reduced, denied, or terminated, or when 
        renewal of authorization for ongoing service is refused. 
           (k) The county administrative entity shall determine 
        immediate needs, including services, support, and assessments, 
        within 30 calendar days after enrollment, or within a shorter 
        time frame if specified in the intergovernmental contract. 
           (l) The county administrative entity shall assess the need 
        for services of new enrollees within 60 calendar days after 
        enrollment, or within a shorter time frame if specified in the 
        intergovernmental contract, and periodically reassess the need 
        for services for all enrollees. 
           (m) The county administrative entity shall ensure the 
        development of a personal support plan for each person within 60 
        calendar days of enrollment, or within a shorter time frame if 
        specified in the intergovernmental contract, unless otherwise 
        agreed to by the enrollee and the enrollee's legal 
        representative, if any.  Until a personal support plan is 
        developed and agreed to by the enrollee, enrollees must have 
        access to the same amount, type, setting, duration, and 
        frequency of covered services that they had at the time of 
        enrollment unless other covered services are needed.  For an 
        enrollee who is not receiving covered services at the time of 
        enrollment and for enrollees whose personal support plan is 
        being revised, access to the medical assistance benefit set must 
        be assured until a personal support plan is developed or 
        revised.  If an enrollee chooses not to develop a personal 
        support plan, the enrollee will be subject to the network and 
        prior authorization requirements of the county administrative 
        entity or service delivery organization 60 days after 
        enrollment.  An enrollee can choose to have a personal support 
        plan developed at any time.  The personal support plan must be 
        based on choices, preferences, and assessed needs and strengths 
        of the enrollee.  The service coordinator shall develop the 
        personal support plan, in consultation with the enrollee or the 
        enrollee's legal representative and other individuals requested 
        by the enrollee.  The personal support plan must be updated as 
        needed or as requested by the enrollee.  Enrollees may choose 
        not to have a personal support plan. 
           (n) The county administrative entity shall ensure timely 
        authorization, arrangement, and continuity of needed and covered 
        supports and services. 
           (o) The county administrative entity shall offer service 
        coordination that fulfills the responsibilities under 
        subdivision 12 and is appropriate to the enrollee's needs, 
        choices, and preferences, including a choice of service 
        coordinator. 
           (p) The county administrative entity shall contract with 
        schools and other agencies as appropriate to provide otherwise 
        covered medically necessary medical assistance services as 
        described in an enrollee's individual family support plan, as 
        described in sections 125A.26 to 125A.48, or individual 
        education plan, as described in chapter 125A. 
           (q) The county administrative entity shall develop and 
        implement strategies, based on consultation with affected 
        groups, to respect diversity and ensure culturally competent 
        service delivery in a manner that promotes the physical, social, 
        psychological, and spiritual well-being of enrollees and 
        preserves the dignity of individuals, families, and their 
        communities. 
           (r) When an enrollee changes county authorities, county 
        administrative entities shall ensure coordination with the 
        entity that is assuming responsibility for administering the 
        medical assistance benefit set to ensure continuity of supports 
        and services for the enrollee. 
           (s) The county administrative entity shall comply with 
        additional requirements as specified in the intergovernmental 
        contract.  
           (t) To the extent that alternatives are approved under 
        subdivision 17, county administrative entities must provide for 
        the health and safety of enrollees and protect the rights to 
        privacy and to provide informed consent. 
           (u) Prepaid health plans serving counties with a nonprofit 
        community clinic or community health services agency must 
        contract with the clinic or agency to provide services to 
        clients who choose to receive services from the clinic or 
        agency, if the clinic or agency agrees to payment rates that are 
        competitive with rates paid to other health plan providers for 
        the same or similar services. 
           For purposes of this paragraph, "nonprofit community 
        clinic" includes, but is not limited to, a community mental 
        health center as defined in sections 245.62 and 256B.0625, 
        subdivision 5. 
           Sec. 18.  [EFFECTIVE DATE.] 
           Section 6, amending section 256B.0625, subdivision 19a, is 
        effective the day following final enactment. 
           Presented to the governor May 11, 2000 
           Signed by the governor May 15, 2000, 10:27 a.m.