1.1                          A bill for an act 
  1.2             relating to human services; expanding consumer support 
  1.3             grant services; extending a provision related to 
  1.4             hardship waivers; clarifying resource allocation for 
  1.5             the home and community-based waiver for persons with 
  1.6             mental retardation and related conditions; providing a 
  1.7             choice of case manager and modifying other provisions 
  1.8             related to services for persons with mental 
  1.9             retardation or related conditions; appropriating 
  1.10            money; amending Minnesota Statutes 2000, sections 
  1.11            256.476, subdivision 4; 256B.0625, subdivision 19a; 
  1.12            256B.0916, subdivisions 1, 7, 9, and by adding a 
  1.13            subdivision; and 256B.092, subdivision 2a. 
  1.14  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.15     Section 1.  Minnesota Statutes 2000, section 256.476, 
  1.16  subdivision 4, is amended to read: 
  1.17     Subd. 4.  [SUPPORT GRANTS; CRITERIA AND LIMITATIONS.] (a) A 
  1.18  county board may choose to participate in the consumer support 
  1.19  grant program.  If a county has not chosen to participate by 
  1.20  September 1, 2001, the commissioner shall contract with another 
  1.21  county or other entity to provide consumer support grant 
  1.22  services to residents of the nonparticipating county.  If a 
  1.23  county board chooses to participate in the program, The local 
  1.24  agency or contracted agency shall establish written procedures 
  1.25  and criteria to determine the amount and use of support grants.  
  1.26  These procedures must include, at least, the availability of 
  1.27  respite care, assistance with daily living, and adaptive aids.  
  1.28  The local agency may establish monthly or annual maximum amounts 
  1.29  for grants and procedures where exceptional resources may be 
  2.1   required to meet the health and safety needs of the person on a 
  2.2   time-limited basis, however, the total amount awarded to each 
  2.3   individual may not exceed the limits established in subdivision 
  2.4   5, paragraph (f). 
  2.5      (b) Support grants to a person or a person's family will be 
  2.6   provided through a monthly subsidy payment and be in the form of 
  2.7   cash, voucher, or direct county payment to vendor.  Support 
  2.8   grant amounts must be determined by the local agency.  Each 
  2.9   service and item purchased with a support grant must meet all of 
  2.10  the following criteria:  
  2.11     (1) it must be over and above the normal cost of caring for 
  2.12  the person if the person did not have functional limitations; 
  2.13     (2) it must be directly attributable to the person's 
  2.14  functional limitations; 
  2.15     (3) it must enable the person or the person's family to 
  2.16  delay or prevent out-of-home placement of the person; and 
  2.17     (4) it must be consistent with the needs identified in the 
  2.18  service plan, when applicable. 
  2.19     (c) Items and services purchased with support grants must 
  2.20  be those for which there are no other public or private funds 
  2.21  available to the person or the person's family.  Fees assessed 
  2.22  to the person or the person's family for health and human 
  2.23  services are not reimbursable through the grant. 
  2.24     (d) In approving or denying applications, the local agency 
  2.25  shall consider the following factors:  
  2.26     (1) the extent and areas of the person's functional 
  2.27  limitations; 
  2.28     (2) the degree of need in the home environment for 
  2.29  additional support; and 
  2.30     (3) the potential effectiveness of the grant to maintain 
  2.31  and support the person in the family environment or the person's 
  2.32  own home. 
  2.33     (e) At the time of application to the program or screening 
  2.34  for other services, the person or the person's family shall be 
  2.35  provided sufficient information to ensure an informed choice of 
  2.36  alternatives by the person, the person's legal representative, 
  3.1   if any, or the person's family.  The application shall be made 
  3.2   to the local agency and shall specify the needs of the person 
  3.3   and family, the form and amount of grant requested, the items 
  3.4   and services to be reimbursed, and evidence of eligibility for 
  3.5   medical assistance or alternative care program. 
  3.6      (f) Upon approval of an application by the local agency and 
  3.7   agreement on a support plan for the person or person's family, 
  3.8   the local agency shall make grants to the person or the person's 
  3.9   family.  The grant shall be in an amount for the direct costs of 
  3.10  the services or supports outlined in the service agreement.  
  3.11     (g) Reimbursable costs shall not include costs for 
  3.12  resources already available, such as special education classes, 
  3.13  day training and habilitation, case management, other services 
  3.14  to which the person is entitled, medical costs covered by 
  3.15  insurance or other health programs, or other resources usually 
  3.16  available at no cost to the person or the person's family. 
  3.17     (h) The state of Minnesota, the county boards participating 
  3.18  in the consumer support grant program, or the agencies acting on 
  3.19  behalf of the county boards in the implementation and 
  3.20  administration of the consumer support grant program shall not 
  3.21  be liable for damages, injuries, or liabilities sustained 
  3.22  through the purchase of support by the individual, the 
  3.23  individual's family, or the authorized representative under this 
  3.24  section with funds received through the consumer support grant 
  3.25  program.  Liabilities include but are not limited to:  workers' 
  3.26  compensation liability, the Federal Insurance Contributions Act 
  3.27  (FICA), or the Federal Unemployment Tax Act (FUTA).  For 
  3.28  purposes of this section, participating county boards and 
  3.29  agencies acting on behalf of county boards are exempt from the 
  3.30  provisions of section 268.04. 
  3.31     Sec. 2.  Minnesota Statutes 2000, section 256B.0625, 
  3.32  subdivision 19a, is amended to read: 
  3.33     Subd. 19a.  [PERSONAL CARE SERVICES.] Medical assistance 
  3.34  covers personal care services in a recipient's home.  To qualify 
  3.35  for personal care services, recipients or responsible parties 
  3.36  must be able to identify the recipient's needs, direct and 
  4.1   evaluate task accomplishment, and provide for health and 
  4.2   safety.  Approved hours may be used outside the home when normal 
  4.3   life activities take them outside the home and when, without the 
  4.4   provision of personal care, their health and safety would be 
  4.5   jeopardized.  To use personal care services at school, the 
  4.6   recipient or responsible party must provide written 
  4.7   authorization in the care plan identifying the chosen provider 
  4.8   and the daily amount of services to be used at school.  Total 
  4.9   hours for services, whether actually performed inside or outside 
  4.10  the recipient's home, cannot exceed that which is otherwise 
  4.11  allowed for personal care services in an in-home setting 
  4.12  according to section 256B.0627.  Medical assistance does not 
  4.13  cover personal care services for residents of a hospital, 
  4.14  nursing facility, intermediate care facility, health care 
  4.15  facility licensed by the commissioner of health, or unless a 
  4.16  resident who is otherwise eligible is on leave from the facility 
  4.17  and the facility either pays for the personal care services or 
  4.18  forgoes the facility per diem for the leave days that personal 
  4.19  care services are used.  All personal care services must be 
  4.20  provided according to section 256B.0627.  Personal care services 
  4.21  may not be reimbursed if the personal care assistant is the 
  4.22  spouse or legal guardian of the recipient or the parent of a 
  4.23  recipient under age 18, or the responsible party or the foster 
  4.24  care provider of a recipient who cannot direct the recipient's 
  4.25  own care unless, in the case of a foster care provider, a county 
  4.26  or state case manager visits the recipient as needed, but not 
  4.27  less than every six months, to monitor the health and safety of 
  4.28  the recipient and to ensure the goals of the care plan are met.  
  4.29  Parents of adult recipients, adult children of the recipient or 
  4.30  adult siblings of the recipient may be reimbursed for personal 
  4.31  care services if they are not the recipient's legal guardian and 
  4.32  are granted a waiver under section 256B.0627.  Until July 1, 
  4.33  2001, and Notwithstanding the provisions of section 256B.0627, 
  4.34  subdivision 4, paragraph (b), clause (4), the noncorporate legal 
  4.35  guardian or conservator of an adult, who is not the responsible 
  4.36  party and not the personal care provider organization, may be 
  5.1   granted a hardship waiver under section 256B.0627, to be 
  5.2   reimbursed to provide personal care assistant services to the 
  5.3   recipient, and shall not be considered to have a service 
  5.4   provider interest for purposes of participation on the screening 
  5.5   team under section 256B.092, subdivision 7. 
  5.6      Sec. 3.  Minnesota Statutes 2000, section 256B.0916, 
  5.7   subdivision 1, is amended to read: 
  5.8      Subdivision 1.  [REDUCTION OF WAITING LIST.] (a) The 
  5.9   legislature recognizes that as of January 1, 1999, 3,300 persons 
  5.10  with mental retardation or related conditions have been screened 
  5.11  and determined eligible for the home and community-based waiver 
  5.12  services program for persons with mental retardation or related 
  5.13  conditions.  Many wait for several years before receiving 
  5.14  service. 
  5.15     (b) The waiting list for this program shall be reduced or 
  5.16  eliminated by June 30, 2003.  In order to reduce the number of 
  5.17  eligible persons waiting for identified services provided 
  5.18  through the home and community-based waiver for persons with 
  5.19  mental retardation or related conditions, during the period from 
  5.20  July 1, 1999, to June 30, 2003, funding shall be increased to 
  5.21  add 100 additional eligible persons each year beyond the 
  5.22  February 1999 medical assistance forecast. 
  5.23     (c) The commissioner shall allocate resources in such a 
  5.24  manner as to use all resources budgeted during a biennium for 
  5.25  the home and community-based waiver for persons with mental 
  5.26  retardation or related conditions according to the priorities 
  5.27  listed in subdivision 2, paragraph (b), and then to serve other 
  5.28  persons on the waiting list.  Resources allocated for a fiscal 
  5.29  year to serve persons affected by public and private sector 
  5.30  ICF/MR closures, but not expected to be expended for that 
  5.31  purpose, must be reallocated within that fiscal year to serve 
  5.32  other persons on the waiting list, and the number of waiver 
  5.33  diversion slots shall be adjusted accordingly. 
  5.34     (d) For fiscal year 2001, at least one-half of the increase 
  5.35  in funding over the previous year provided in the February 1999 
  5.36  medical assistance forecast for the home and community-based 
  6.1   waiver for persons with mental retardation and related 
  6.2   conditions, including changes made by the 1999 legislature, must 
  6.3   be used to serve persons who are not affected by public and 
  6.4   private sector ICF/MR closures. 
  6.5      (e) The commissioner of finance shall not reduce the 
  6.6   spending forecast for the coming biennium, if at the time of the 
  6.7   forecast there is a waiting list for waiver services for persons 
  6.8   with mental retardation or related conditions who need services 
  6.9   within the next 30 months.  Funds that would have resulted from 
  6.10  a projected reduction in spending must be used by the 
  6.11  commissioner of human services to serve persons with 
  6.12  developmental disabilities through the home and community-based 
  6.13  waiver for persons with mental retardation or related conditions.
  6.14     Sec. 4.  Minnesota Statutes 2000, section 256B.0916, is 
  6.15  amended by adding a subdivision to read: 
  6.16     Subd. 6a.  [STATEWIDE AVAILABILITY OF CONSUMER-DIRECTED 
  6.17  COMMUNITY SUPPORT SERVICES.] The commissioner shall submit to 
  6.18  the federal Health Care Financing Administration by August 1, 
  6.19  2001, an amendment to the home and community-based waiver for 
  6.20  persons with mental retardation or related conditions to make 
  6.21  consumer-directed community support services available in every 
  6.22  county of the state by January 1, 2002.  If a county declines to 
  6.23  meet the requirements for provision of consumer-directed 
  6.24  community supports, the commissioner shall contract with another 
  6.25  county, a group of counties, or a private agency to plan for and 
  6.26  administer consumer-directed community supports in that county. 
  6.27     Sec. 5.  Minnesota Statutes 2000, section 256B.0916, 
  6.28  subdivision 7, is amended to read: 
  6.29     Subd. 7.  [ANNUAL REPORT BY COMMISSIONER.] Beginning 
  6.30  October 1, 1999, and each October 1 November 1, 2001, and each 
  6.31  November 1 thereafter, the commissioner shall issue an annual 
  6.32  report on county and state use of available resources for the 
  6.33  home and community-based waiver for persons with mental 
  6.34  retardation or related conditions.  For each county or county 
  6.35  partnership, the report shall include: 
  6.36     (1) the amount of funds allocated but not used; 
  7.1      (2) the county specific allowed reserve amount approved and 
  7.2   used; 
  7.3      (3) the number, ages, and living situations of individuals 
  7.4   screened and waiting for services; 
  7.5      (4) the urgency of need for services to begin within one, 
  7.6   two, or more than two years for each individual; 
  7.7      (5) the services needed; 
  7.8      (6) the number of additional persons served by approval of 
  7.9   increased capacity within existing allocations; 
  7.10     (7) results of action by the commissioner to streamline 
  7.11  administrative requirements and improve county resource 
  7.12  management; and 
  7.13     (8) additional action that would decrease the number of 
  7.14  those eligible and waiting for waivered services. 
  7.15  The commissioner shall specify intended outcomes for the program 
  7.16  and the degree to which these specified outcomes are attained. 
  7.17     Sec. 6.  Minnesota Statutes 2000, section 256B.0916, 
  7.18  subdivision 9, is amended to read: 
  7.19     Subd. 9.  [LEGAL REPRESENTATIVE PARTICIPATION EXCEPTION.] 
  7.20  The commissioner, in cooperation with representatives of 
  7.21  counties, service providers, service recipients, family members, 
  7.22  legal representatives and advocates, shall develop criteria to 
  7.23  allow legal representatives to be reimbursed for providing 
  7.24  specific support services to meet the person's needs when a plan 
  7.25  which assures health and safety has been agreed upon and carried 
  7.26  out by the legal representative, the person, and the county.  
  7.27  Legal representatives providing support under consumer-directed 
  7.28  community support services pursuant to section 256B.092, 
  7.29  subdivision 4, the home and community-based waiver for persons 
  7.30  with mental retardation or related conditions or the consumer 
  7.31  support grant program pursuant to section 256B.092, subdivision 
  7.32  7 256.476, shall not be considered to have a direct or indirect 
  7.33  service provider interest under section 256B.092, subdivision 7, 
  7.34  if a health and safety plan which meets the criteria established 
  7.35  has been agreed upon and implemented.  By October 1, 1999 August 
  7.36  1, 2001, the commissioner shall submit, for federal approval, 
  8.1   amendments to allow legal representatives to provide support and 
  8.2   receive reimbursement under the consumer-directed community 
  8.3   support services section of the home and community-based waiver 
  8.4   plan. 
  8.5      Sec. 7.  Minnesota Statutes 2000, section 256B.092, 
  8.6   subdivision 2a, is amended to read: 
  8.7      Subd. 2a.  [MEDICAL ASSISTANCE FOR CASE MANAGEMENT 
  8.8   ACTIVITIES UNDER THE STATE PLAN MEDICAID OPTION.] (a) Upon 
  8.9   receipt of federal approval, the commissioner shall make 
  8.10  payments to approved vendors counties, private individuals, and 
  8.11  agencies enrolled as providers of case management services 
  8.12  participating in the medical assistance program to reimburse 
  8.13  costs for providing case management service activities to 
  8.14  medical assistance eligible persons with mental retardation or a 
  8.15  related condition, in accordance with the state Medicaid plan, 
  8.16  the home and community-based waiver for persons with mental 
  8.17  retardation and related conditions plan, and federal 
  8.18  requirements and limitations.  
  8.19     (b) The commissioner shall ensure that each eligible person 
  8.20  is given a choice of county and private agency case management 
  8.21  service providers.  Case management service providers are 
  8.22  prohibited from providing any other service to the person 
  8.23  receiving case management services. 
  8.24     Sec. 8.  [FEDERAL APPROVAL.] 
  8.25     The commissioner of human services, by September 1, 2001, 
  8.26  shall request any federal approval and plan amendments necessary 
  8.27  to implement the choice of case manager provision in section 
  8.28  256B.092, subdivision 2a, paragraph (b). 
  8.29     Sec. 9.  [APPROPRIATION TO COMMISSIONER FOR WAIVER 
  8.30  SERVICES.] 
  8.31     The amount of funds for the home and community-based waiver 
  8.32  for persons with mental retardation or related conditions 
  8.33  reduced in the November 2000 and February 2001 forecasts, due to 
  8.34  a change in the average cost per person served, is appropriated 
  8.35  to the commissioner of human services for the biennium ending 
  8.36  June 30, 2003, to meet the needs of persons with mental 
  9.1   retardation or related conditions waiting for waiver services.