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

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

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