1.1 	A bill for an act
1.2 	relating to human services; amending continuing care policy provisions; making 
1.3 	changes to the telephone equipment program; making changes to disability 
1.4 	services provisions; reforming comprehensive assessments and case management 
1.5 	services; making changes to nursing facility provisions; making technical and 
1.6 	conforming changes; providing for rulemaking authority; requiring reports;
1.7 	amending Minnesota Statutes 2010, sections 144A.071, subdivisions 3, 4a, 
1.8 	5a; 144A.073, subdivision 3c, by adding a subdivision; 144D.03, subdivision 
1.9 	2; 144D.04, subdivision 2; 237.50; 237.51; 237.52; 237.53; 237.54; 237.55; 
1.10 	237.56; 245A.03, subdivision 7; 245A.11, subdivision 8; 245B.02, subdivision 
1.11 	20; 245B.06, subdivision 7; 252.32, subdivision 1a; 252.40; 252.41, subdivisions 
1.12 	1, 3; 252.42; 252.43; 252.44; 252.45; 252.451, subdivisions 2, 5; 252.46, 
1.13 	subdivision 1a; 252A.21, subdivision 2; 256.476, subdivision 11; 256B.0625, 
1.14 	subdivision 19c; 256B.0659, subdivisions 1, 2, 3, 3a, 4, 9, 11, 13, 14, 19, 21, 
1.15 	30; 256B.0911, subdivisions 1, 1a, 2b, 2c, 3, 3a, 3b, 3c, 4a, 4c, 6; 256B.0913, 
1.16 	subdivisions 7, 8; 256B.0915, subdivisions 1a, 1b, 3c, 6; 256B.0916, subdivision 
1.17 	7; 256B.092, subdivisions 1, 1a, 1b, 1e, 1g, 2, 3, 5, 7, 8, 8a, 9, 11; 256B.096, 
1.18 	subdivision 5; 256B.19, subdivision 1e; 256B.431, subdivisions 2t, 26; 
1.19 	256B.438, subdivisions 1, 3, 4, by adding a subdivision; 256B.441, subdivision 
1.20 	55a, by adding a subdivision; 256B.49, subdivisions 13, 14, 15, 21; 256B.4912; 
1.21 	256B.501, subdivision 4b; 256B.5013, subdivision 1; 256B.5015, subdivision 
1.22 	1; 256B.765; 256G.02, subdivision 6; Laws 2009, chapter 79, article 8, section 
1.23 	81, as amended; proposing coding for new law in Minnesota Statutes, chapter 
1.24 	252; repealing Minnesota Statutes 2010, sections 144A.073, subdivisions 4, 
1.25 	5; 252.46, subdivisions 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 16, 17, 18, 19, 20, 21; 
1.26 	256.0112, subdivision 6; 256B.092, subdivision 8a; 256B.49, subdivision 16a; 
1.27 	256B.501, subdivision 8.
1.28 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.29 	ARTICLE 1
1.30 	TELEPHONE EQUIPMENT PROGRAM

1.31 	Section 1. Minnesota Statutes 2010, section 237.50, is amended to read:
1.32 	237.50 DEFINITIONS.
2.1 		Subdivision 1.Scope. The terms used in sections 237.50 to 237.56 have the 
2.2 	meanings given them in this section. 
2.3 		Subd. 3.Communication ~~impaired~~ disability. "Communication ~~impaired~~
2.4 	disability" means certified as ~~deaf, severely hearing impaired, hard-of-hearing~~ having 
2.5 	a hearing loss, speech ~~impaired, deaf and blind~~ disability, or ~~mobility impaired if the~~ 
2.6 	~~mobility impairment significantly impedes the ability~~ physical disability that makes it 
2.7 	difficult or impossible to use ~~standard customer premises~~ telecommunications services 
2.8 	and equipment.
2.9 		~~Subd. 4.Communication device.~~ ~~"Communication device" means a device that~~ 
2.10 	~~when connected to a telephone enables a communication-impaired person to communicate~~ 
2.11 	~~with another person utilizing the telephone system. A "communication device" includes a~~ 
2.12 	~~ring signaler, an amplification device, a telephone device for the deaf, a Brailling device~~ 
2.13 	~~for use with a telephone, and any other device the Department of Human Services deems~~ 
2.14 	~~necessary.~~
2.15 		Subd. 4a.Deaf. "Deaf" means a hearing ~~impairment~~ loss of such severity that the 
2.16 	individual must depend primarily upon visual communication such as writing, lip reading, 
2.17 	~~manual communication~~ sign language, and gestures.
2.18 		~~Subd. 5.Exchange.~~ ~~"Exchange" means a unit area established and described by the~~ 
2.19 	~~tariff of a telephone company for the administration of telephone service in a specified~~ 
2.20 	~~geographical area, usually embracing a city, town, or village and its environs, and served~~ 
2.21 	~~by one or more central offices, together with associated facilities used in providing~~ 
2.22 	~~service within that area.~~
2.23 		Subd. 6.Fund. "Fund" means the telecommunications access Minnesota fund 
2.24 	established in section 237.52. 
2.25 		Subd. 6a.Hard-of-hearing. "Hard-of-hearing" means a hearing ~~impairment~~ loss
2.26 	resulting in a functional ~~loss~~ limitation, but not to the extent that the individual must 
2.27 	depend primarily upon visual communication.
2.28 		~~Subd. 7.Interexchange service.~~ ~~"Interexchange service" means telephone service~~ 
2.29 	~~between points in two or more exchanges.~~
2.30 		~~Subd. 8.Inter-LATA interexchange service.~~ ~~"Inter-LATA interexchange service"~~ 
2.31 	~~means interexchange service originating and terminating in different LATAs.~~
2.32 		~~Subd. 9.Local access and transport area.~~ ~~"Local access and transport area~~ 
2.33 	~~(LATA)" means a geographical area designated by the Modification of Final Judgment~~ 
2.34 	~~in U.S. v. Western Electric Co., Inc., 552 F. Supp. 131 (D.D.C. 1982), including~~ 
2.35 	~~modifications in effect on the effective date of sections 237.51 to 237.54.~~
3.1 		~~Subd. 10.Local exchange service.~~ ~~"Local exchange service" means telephone~~ 
3.2 	~~service between points within an exchange.~~
3.3 		Subd. 10a.Telecommunications device. "Telecommunications device" means 
3.4 	a device that (1) allows a person with a communication disability to have access to 
3.5 	telecommunications services as defined in subdivision 13, and (2) is specifically 
3.6 	selected by the Department of Human Services for its capacity to allow persons with 
3.7 	communication disabilities to use telecommunications services in a manner that is 
3.8 	functionally equivalent to the ability of an individual who does not have a communication 
3.9 	disability. A telecommunications device may include a ring signaler, an amplified 
3.10 	telephone, a hands-free telephone, a text telephone, a captioned telephone, a wireless 
3.11 	device, a device that produces Braille output for use with a telephone, and any other 
3.12 	device the Department of Human Services deems appropriate.
3.13 		Subd. 11.~~Telecommunication~~ Telecommunications Relay ~~service~~ Services.
 3.14 	"~~Telecommunication~~ Telecommunications Relay ~~service~~ Services" or "TRS" means 
3.15 	~~a central statewide service through which a communication-impaired person,~~ 
3.16 	~~using a communication device, may send and receive messages to and from a~~ 
3.17 	~~non-communication-impaired person whose telephone is not equipped with a~~ 
3.18 	~~communication device and through which a non-communication-impaired person~~ 
3.19 	~~may, by using voice communication, send and receive messages to and from a~~ 
3.20 	~~communication-impaired person~~ the telecommunications transmission services required 
3.21 	under Federal Communications Commission (FCC) regulations at Code of Federal 
3.22 	Regulations, title 47, sections 64.604 to 64.606. TRS allows an individual who has 
3.23 	a communication disability to use telecommunications services in a manner that is 
3.24 	functionally equivalent to the ability of an individual who does not have a communication 
3.25 	disability.
3.26 		Subd. 12.Telecommunications. "Telecommunications" means the transmission, 
3.27 	between or among points specified by the user, of information of the user's choosing, 
3.28 	without change in the form or content of the information as sent and received.
3.29 		Subd. 13.Telecommunications services. "Telecommunications services" means 
3.30 	the offering of telecommunications for fee directly to the public, or to such classes of users 
3.31 	as to be effectively available to the public, regardless of the facilities used.

3.32 	Sec. 2. Minnesota Statutes 2010, section 237.51, is amended to read:
3.33 	237.51 TELECOMMUNICATIONS ACCESS MINNESOTA PROGRAM 
3.34 	ADMINISTRATION.
3.35 		Subdivision 1.Creation. The commissioner of commerce shall:
4.1 	(1) administer through interagency agreement with the commissioner of human 
4.2 	services a program to distribute ~~communication~~ telecommunications devices to eligible 
4.3 	~~communication-impaired~~ persons who have communication disabilities; and
4.4 	(2) contract with ~~a~~ one or more  qualified ~~vendor~~ vendors  that ~~serves~~ 
4.5 	~~communication-impaired~~ serve persons who have communication disabilities to ~~create~~ 
4.6 	~~and maintain a telecommunication~~ provide telecommunications relay ~~service~~ services.
4.7 	For purposes of sections 237.51 to 237.56, the Department of Commerce and any 
4.8 	organization with which it contracts pursuant to this section or section 237.54, subdivision 
4.9 	2, are not telephone companies or telecommunications carriers as defined in section 
4.10 	237.01. 
4.11 		Subd. 5.Commissioner of commerce duties. In addition to any duties specified 
4.12 	elsewhere in sections 237.51 to 237.56, the commissioner of commerce shall: 
4.13 	(1) prepare the reports required by section 237.55; 
4.14 	(2) administer the fund created in section 237.52; and 
4.15 	(3) adopt rules under chapter 14 to implement the provisions of sections 237.50
4.16 	to 237.56. 
4.17 		Subd. 5a.~~Department~~ Commissioner of human services duties. (a) In addition to 
4.18 	any duties specified elsewhere in sections 237.51 to 237.56, the commissioner of human 
4.19 	services shall: 
4.20 	(1) define economic hardship, special needs, and household criteria so as to 
4.21 	determine the priority of eligible applicants for initial distribution of devices and to 
4.22 	determine circumstances necessitating provision of more than one ~~communication~~
4.23 	telecommunications device per household;
4.24 	(2) establish a method to verify eligibility requirements;
4.25 	(3) establish specifications for ~~communication~~ telecommunications devices to be 
4.26 	~~purchased~~ provided under section 237.53, subdivision 3; ~~and~~
4.27 	(4) inform the public and specifically ~~the community of communication-impaired~~
4.28 	persons who have communication disabilities of the program~~.~~; and
4.29 	(5) provide devices based on the assessed need of eligible applicants. 
4.30 	(b) The commissioner may establish an advisory board to advise the department 
4.31 	in carrying out the duties specified in this section and to advise the commissioner of 
4.32 	commerce in carrying out duties under section 237.54. If so established, the advisory 
4.33 	board must include, at a minimum, the following ~~communication-impaired~~ persons: 
4.34 	(1) at least one member who is deaf;
4.35 	(2) at least one member who ~~is~~ has a speech ~~impaired~~ disability;
5.1 	(3) at least one member who ~~is mobility impaired~~ has a physical disability that 
5.2 	makes it difficult or impossible for the person to access telecommunications services; and
5.3 	(4) at least one member who is hard-of-hearing.
5.4 	The membership terms, compensation, and removal of members and the filling of 
5.5 	membership vacancies are governed by section 15.059. Advisory board meetings shall be 
5.6 	held at the discretion of the commissioner. 

5.7 	Sec. 3. Minnesota Statutes 2010, section 237.52, is amended to read:
5.8 	237.52 TELECOMMUNICATIONS ACCESS MINNESOTA FUND.
5.9 		Subdivision 1.Fund established. A telecommunications access Minnesota fund is 
5.10 	established as an account in the state treasury. Earnings, such as interest, dividends, and 
5.11 	any other earnings arising from fund assets, must be credited to the fund.
5.12 		Subd. 2.Assessment. (a) The commissioner of commerce, the commissioner 
5.13 	of employment and economic development, and the commissioner of human services 
5.14 	shall annually recommend to the Public Utilities Commission (PUC) an adequate and 
5.15 	appropriate surcharge and budget to implement sections 237.50 to 237.56, 248.062, 
5.16 	and 256C.30, respectively. The maximum annual budget for section 248.062 must not 
5.17 	exceed $100,000 and for section 256C.30 must not exceed $300,000. The Public Utilities 
5.18 	Commission shall review the budgets for reasonableness and may modify the budget 
5.19 	to the extent it is unreasonable. The commission shall annually determine the funding 
5.20 	mechanism to be used within 60 days of receipt of the recommendation of the departments 
5.21 	and shall order the imposition of surcharges effective on the earliest practicable date. The 
5.22 	commission shall establish a monthly charge no greater than 20 cents for each customer 
5.23 	access line, including trunk equivalents as designated by the commission pursuant to 
5.24 	section 403.11, subdivision 1.
5.25 	(b) If the fund balance falls below a level capable of fully supporting all programs 
5.26 	eligible under subdivision 5 and sections 248.062 and 256C.30, expenditures under 
5.27 	sections 248.062 and 256C.30 shall be reduced on a pro rata basis and expenditures under 
5.28 	sections 237.53 and 237.54 shall be fully funded. Expenditures under sections 248.062
5.29 	and 256C.30 shall resume at fully funded levels when the commissioner of commerce 
5.30 	determines there is a sufficient fund balance to fully fund those expenditures.
5.31 		Subd. 3.Collection. Every ~~telephone company or communications carrier that~~ 
5.32 	~~provides service~~ provider of services capable of originating a ~~telecommunications relay~~
5.33 	TRS call, including cellular communications and other nonwire access services, in this 
5.34 	state shall collect the charges established by the commission under subdivision 2 and 
5.35 	transfer amounts collected to the commissioner of public safety in the same manner as 
6.1 	provided in section 403.11, subdivision 1, paragraph (d). The commissioner of public 
6.2 	safety must deposit the receipts in the fund established in subdivision 1. 
6.3 		Subd. 4.Appropriation. Money in the fund is appropriated to the commissioner of 
6.4 	commerce to implement sections 237.51 to 237.56, to the commissioner of employment 
6.5 	and economic development to implement section 248.062, and to the commissioner of 
6.6 	human services to implement section 256C.30.
6.7 		Subd. 5.Expenditures. (a) Money in the fund may only be used for:
6.8 	(1) expenses of the Department of Commerce, including personnel cost, public 
6.9 	relations, advisory board members' expenses, preparation of reports, and other reasonable 
6.10 	expenses not to exceed ten percent of total program expenditures;
6.11 	(2) reimbursing the commissioner of human services for purchases made or services 
6.12 	provided pursuant to section 237.53; 
6.13 	(3) reimbursing telephone companies for purchases made or services provided 
6.14 	under section 237.53, subdivision 5; and 
6.15 	(4) contracting for ~~establishment and operation of the telecommunication relay~~ 
6.16 	~~service~~ the provision of TRS required by section 237.54. 
6.17 	(b) All costs directly associated with the establishment of the program, the purchase 
6.18 	and distribution of ~~communication~~ telecommunications devices, and the ~~establishment~~ 
6.19 	~~and operation of the telecommunication relay service~~ provision of TRS are either 
6.20 	reimbursable or directly payable from the fund after authorization by the commissioner 
6.21 	of commerce. The commissioner of commerce shall contract with ~~the message relay~~ 
6.22 	~~service operator~~ one or more TRS providers to indemnify the ~~local exchange carriers of~~ 
6.23 	~~the relay~~ telecommunications service providers for any fines imposed by the Federal 
6.24 	Communications Commission related to the failure of the relay service to comply with 
6.25 	federal service standards. Notwithstanding section 16A.41, the commissioner may 
6.26 	advance money to the ~~contractor of the telecommunication relay service~~ TRS providers if 
6.27 	the ~~contractor establishes~~providers establish to the commissioner's satisfaction that the 
6.28 	advance payment is necessary for the ~~operation~~ provision of the service. The advance 
6.29 	payment may be used only for working capital reserve for the operation of the service. 
6.30 	The advance payment must be offset or repaid by the end of the contract fiscal year 
6.31 	together with interest accrued from the date of payment. 

6.32 	Sec. 4. Minnesota Statutes 2010, section 237.53, is amended to read:
6.33 	237.53 ~~COMMUNICATION~~ TELECOMMUNICATIONS DEVICE.
7.1 		Subdivision 1.Application. A person applying for a ~~communication~~
7.2 	telecommunications device under this section must apply to the program administrator on 
7.3 	a form prescribed by the Department of Human Services.
7.4 		Subd. 2.Eligibility. To be eligible to obtain a ~~communication~~ telecommunications
7.5 	device under this section, a person must ~~be~~:
7.6 	(1) be able to benefit from and use the equipment for its intended purpose;
7.7 	(2) have a communication ~~impaired~~ disability;
7.8 	(3) be a resident of the state;
7.9 	(4) be a resident in a household that has a median income at or below the applicable 
7.10 	median household income in the state, except a ~~deaf and blind~~ person who has both 
7.11 	hearing and vision loss applying for a ~~telebraille unit~~ Braille device may reside in a 
7.12 	household that has a median income no more than 150 percent of the applicable median 
7.13 	household income in the state; and
7.14 	(5) be a resident in a household that has ~~telephone~~ telecommunications service 
7.15 	or that has made application for service and has been assigned a telephone number; or 
7.16 	a resident in a residential care facility, such as a nursing home or group home where 
7.17 	~~telephone~~ telecommunications service is not included as part of overall service provision.
7.18 		Subd. 3.Distribution. The commissioner of human services shall purchase and 
7.19 	distribute a sufficient number of ~~communication~~ telecommunications devices so that each 
7.20 	eligible household receives ~~an~~ appropriate ~~device~~ devices as determined under section 
7.21 	237.51, subdivision 5a. The commissioner of human services shall distribute the devices 
7.22 	to eligible households ~~in each service area~~ free of charge ~~as determined under section~~ 
7.23 	~~237.51, subdivision 5a~~. 
7.24 		Subd. 4.Training; maintenance. The commissioner of human services shall 
7.25 	maintain the ~~communication~~ telecommunications devices until the warranty period 
7.26 	expires, and provide training, without charge, to first-time users of the devices.
7.27 		~~Subd. 5~~.~~Wiring installation.~~ ~~If acommunication-impaired person is not served by~~ 
7.28 	~~telephone service and is subject to economic hardship as determined by the Department~~ 
7.29 	~~of Human Services, the telephone company providing local serviceshall at the direction~~ 
7.30 	~~of the administrator of the program install necessary outside wiring without charge to~~ 
7.31 	~~the household.~~
7.32 		Subd. 6.Ownership. ~~All communication~~ Telecommunications devices purchased 
7.33 	pursuant to subdivision 3 ~~will become~~ are the property of the state of Minnesota. Policies 
7.34 	and procedures for the return of devices from individuals who withdraw from the program 
7.35 	or whose eligibility status changes shall be determined by the commissioner of human 
7.36 	services.
8.1 		Subd. 7.Standards. The ~~communication~~ telecommunications devices distributed 
8.2 	under this section must comply with the electronic industries ~~association~~ alliance standards 
8.3 	and be approved by the Federal Communications Commission. The commissioner of 
8.4 	human services must provide each eligible person a choice of several models of devices, 
8.5 	the retail value of which may not exceed $600 for a ~~communication device for the deaf~~
8.6 	text telephone, and a retail value of $7,000 for a ~~telebraille~~ Braille device, or an amount 
8.7 	authorized by the Department of Human Services for ~~a telephone device for the deaf with~~ 
8.8 	~~auxiliary equipment~~ all other telecommunications devices and auxiliary equipment it 
8.9 	deems cost-effective and appropriate to distribute according to sections 237.51 to 237.56.

8.10 	Sec. 5. Minnesota Statutes 2010, section 237.54, is amended to read:
8.11 	237.54 ~~TELECOMMUNICATION~~ TELECOMMUNICATIONS RELAY 
8.12 	~~SERVICE~~ SERVICES (TRS).
8.13 		Subd. 2.Operation. (a) The commissioner of commerce shall contract with 
8.14 	~~a~~ one or more  qualified ~~vendor~~ vendors for the ~~operation and maintenance of the~~ 
8.15 	~~telecommunication relay system~~ provision of Telecommunications Relay Services (TRS).
8.16 	(b) The ~~telecommunication relay service provider~~ TRS providers shall operate the 
8.17 	relay service within the state of Minnesota. The ~~operator of the system~~ TRS providers
8.18 	shall ~~keep all messages confidential, shall train personnel in the unique needs of~~ 
8.19 	~~communication-impaired people, and shall inform communication-impaired persons~~ 
8.20 	~~and the public of the availability and use of the system. Except in the case of a speech-~~ 
8.21 	~~or mobility-impaired person, the operator shall not relay a message unless it originates~~ 
8.22 	~~or terminates through a communication device for the deaf or a Brailling device for use~~ 
8.23 	~~with a telephone~~ comply with all current and subsequent FCC regulations at Code of 
8.24 	Federal Regulations, title 47, sections 64.601 to 64.606, and shall inform persons who 
8.25 	have communication disabilities and the public of the availability and use of TRS.

8.26 	Sec. 6. Minnesota Statutes 2010, section 237.55, is amended to read:
8.27 	237.55 ANNUAL REPORT ON ~~COMMUNICATION~~
8.28 	TELECOMMUNICATIONS ACCESS.
8.29 	The commissioner of commerce must prepare a report for presentation to the Public 
8.30 	Utilities Commission by January 31 of each year. Each report must review the accessibility 
8.31 	of ~~the telephone system to communication-impaired persons, review the ability of~~ 
8.32 	~~non-communication-impaired persons to communicate with communication-impaired~~ 
8.33 	~~persons via the telephone system~~ telecommunications services to persons who have 
8.34 	communication disabilities, describe services provided, account for ~~money received and~~ 
9.1 	~~disbursed annually~~ annual revenues and expenditures for each aspect of the ~~program~~ fund
9.2 	to date, and include predicted program future operation.

9.3 	Sec. 7. Minnesota Statutes 2010, section 237.56, is amended to read:
9.4 	237.56 ADEQUATE SERVICE ENFORCEMENT.
9.5 	The services required to be provided under sections 237.50 to 237.55 may be 
9.6 	enforced under section 237.081 upon a complaint of at least two ~~communication-impaired~~
9.7 	persons within the service area of any one ~~telephone company~~ telecommunications 
9.8 	service provider, provided that if only one person within the service area of a company 
9.9 	is receiving service under sections 237.50 to 237.55, the ~~commission~~ Public Utilities 
9.10 	Commission may proceed upon a complaint from that person. 

9.11 	ARTICLE 2
9.12 	DISABILITY SERVICES

9.13 	Section 1. Minnesota Statutes 2010, section 245A.03, subdivision 7, is amended to 
9.14 	read:
9.15 		Subd. 7.Licensing moratorium. (a) The commissioner shall not issue an 
9.16 	initial license for child foster care licensed under Minnesota Rules, parts 2960.3000 to 
9.17 	2960.3340, or adult foster care licensed under Minnesota Rules, parts 9555.5105 to 
9.18 	9555.6265, under this chapter for a physical location that will not be the primary residence 
9.19 	of the license holder for the entire period of licensure. If a license is issued during this 
9.20 	moratorium, and the license holder changes the license holder's primary residence away 
9.21 	from the physical location of the foster care license, the commissioner shall revoke the 
9.22 	license according to section 245A.07. Exceptions to the moratorium include:
9.23 	(1) foster care settings that are required to be registered under chapter 144D;
9.24 	(2) foster care licenses replacing foster care licenses in existence on May 15, 2009, 
9.25 	and determined to be needed by the commissioner under paragraph (b);
9.26 	(3) new foster care licenses determined to be needed by the commissioner under 
9.27 	paragraph (b) for the closure or downsizing of a nursing facility, ICF/MR, or regional 
9.28 	treatment center;
9.29 	(4) new foster care licenses determined to be needed by the commissioner under 
9.30 	paragraph (b) for persons requiring hospital level care; or
9.31 	(5) new foster care licenses determined to be needed by the commissioner for the 
9.32 	transition of people from personal care assistance to the home and community-based 
9.33 	services.
10.1 	(b) The commissioner shall determine the need for newly licensed foster care homes 
10.2 	as defined under this subdivision. As part of the determination, the commissioner shall 
10.3 	consider the availability of foster care capacity in the area in which the licensee seeks to 
10.4 	operate, and the recommendation of the local county board. The determination by the 
10.5 	commissioner must be final. A determination of need is not required for a change in 
10.6 	ownership at the same address.
10.7 	~~(c) Residential settings that would otherwise be subject to the moratorium established~~ 
10.8 	~~in paragraph (a), that are in the process of receiving an adult or child foster care license as~~ 
10.9 	~~of July 1, 2009, shall be allowed to continue to complete the process of receiving an adult~~ 
10.10 	~~or child foster care license. For this paragraph, all of the following conditions must be met~~ 
10.11 	~~to be considered in the process of receiving an adult or child foster care license:~~
10.12 	~~(1) participants have made decisions to move into the residential setting, including~~ 
10.13 	~~documentation in each participant's care plan;~~
10.14 	~~(2) the provider has purchased housing or has made a financial investment in the~~ 
10.15 	~~property;~~
10.16 	~~(3) the lead agency has approved the plans, including costs for the residential setting~~ 
10.17 	~~for each individual;~~
10.18 	~~(4) the completion of the licensing process, including all necessary inspections, is~~ 
10.19 	~~the only remaining component prior to being able to provide services; and~~
10.20 	~~(5) the needs of the individuals cannot be met within the existing capacity in that~~ 
10.21 	~~county.~~
10.22 	~~To qualify for the process under this paragraph, the lead agency must submit~~ 
10.23 	~~documentation to the commissioner by August 1, 2009, that all of the above criteria are~~ 
10.24 	~~met.~~
10.25 	~~(d)~~ (c) The commissioner shall study the effects of the license moratorium under this 
10.26 	subdivision and shall report back to the legislature by January 15, 2011. This study shall 
10.27 	include, but is not limited to the following:
10.28 	(1) the overall capacity and utilization of foster care beds where the physical location 
10.29 	is not the primary residence of the license holder prior to and after implementation 
10.30 	of the moratorium;
10.31 	(2) the overall capacity and utilization of foster care beds where the physical 
10.32 	location is the primary residence of the license holder prior to and after implementation 
10.33 	of the moratorium; and
10.34 	(3) the number of licensed and occupied ICF/MR beds prior to and after 
10.35 	implementation of the moratorium.
11.1 	(d) At the time of application and reapplication for licensure, the applicant and the 
11.2 	license holder that are subject to the moratorium or an exclusion established in paragraph 
11.3 	(a) are required to inform the commissioner whether the physical location where the foster 
11.4 	care will be provided is or will be the primary residence of the license holder for the entire 
11.5 	period of licensure. If the primary residence of the applicant or license holder changes, the 
11.6 	applicant or license holder must notify the commissioner immediately. The commissioner 
11.7 	shall print on the foster care license certificate whether or not the physical location is the 
11.8 	primary residence of the license holder.
11.9 	(e) License holders of foster care homes identified under paragraph (e) that are not 
11.10 	the primary residence of the license holder and that also provide services in the foster care 
11.11 	home that are covered by a federally approved home and community-based services 
11.12 	waiver, as authorized under section 256B.0915, 256B.092, or 256B.49 must inform the 
11.13 	human services licensing division that the license holder provides or intends to provide 
11.14 	these waiver-funded services. These license holders must be considered registered under 
11.15 	section 256B.092, subdivision 11, paragraph (c), and this registration status must be 
11.16 	identified on their license certificates.

11.17 	Sec. 2. Minnesota Statutes 2010, section 245A.11, subdivision 8, is amended to read:
11.18 		Subd. 8.Community residential setting license. (a) The commissioner shall 
11.19 	establish provider standards for residential support services that integrate service standards 
11.20 	and the residential setting under one license. The commissioner shall propose statutory 
11.21 	language and an implementation plan for licensing requirements for residential support 
11.22 	services to the legislature by January 15, ~~2011~~ 2012, as a component of the quality outcome 
11.23 	standards recommendations required by Laws 2010, chapter 352, article 1, section 24.
11.24 	(b) Providers licensed under chapter 245B, and providing, contracting, or arranging 
11.25 	for services in settings licensed as adult foster care under Minnesota Rules, parts 
11.26 	9555.5105 to 9555.6265, or child foster care under Minnesota Rules, parts 2960.3000 to 
11.27 	2960.3340; and meeting the provisions of section 256B.092, subdivision 11, paragraph 
11.28 	(b), must be required to obtain a community residential setting license.

11.29 	Sec. 3. Minnesota Statutes 2010, section 252.32, subdivision 1a, is amended to read:
11.30 		Subd. 1a.Support grants. (a) Provision of support grants must be limited to 
11.31 	families who require support and whose dependents are under the age of 21 and who 
11.32 	have been certified disabled under section 256B.055, subdivision 12, paragraphs (a), 
11.33 	(b), (c), (d), and (e). Families who are receiving: home and community-based waivered 
11.34 	services for persons with ~~developmental~~ disabilities authorized under section 256B.092 or 
12.1 	256B.49; personal care assistance under section 256B.0652; or a consumer support grant 
12.2 	under section 256.476 are not eligible for support grants.
12.3 	Families whose annual adjusted gross income is $60,000 or more are not eligible for 
12.4 	support grants except in cases where extreme hardship is demonstrated. Beginning in state 
12.5 	fiscal year 1994, the commissioner shall adjust the income ceiling annually to reflect the 
12.6 	projected change in the average value in the United States Department of Labor Bureau of 
12.7 	Labor Statistics Consumer Price Index (all urban) for that year.
12.8 	(b) Support grants may be made available as monthly subsidy grants and lump-sum 
12.9 	grants.
12.10 	(c) Support grants may be issued in the form of cash, voucher, and direct county 
12.11 	payment to a vendor.
12.12 	(d) Applications for the support grant shall be made by the legal guardian to the 
12.13 	county social service agency. The application shall specify the needs of the families, the 
12.14 	form of the grant requested by the families, and the items and services to be reimbursed.

12.15 	Sec. 4. [252.34] REPORT BY COMMISSIONER.
12.16 	Beginning January 1, 2013, the commissioner shall provide a biennial report to the 
12.17 	chairs of the legislative committees with jurisdiction over health and human services 
12.18 	policy and funding. The report must provide a summary of overarching goals and priorities 
12.19 	for persons with disabilities, including the status of how each of the following programs 
12.20 	administered by the commissioner is supporting the overarching goals and priorities:
12.21 	(1) home and community-based services waivers for persons with disabilities under 
12.22 	sections 256B.092 and 256B.49;
12.23 	(2) home care services under section 256B.0652; and
12.24 	(3) other relevant programs and services as determined by the commissioner.

12.25 	Sec. 5. Minnesota Statutes 2010, section 252.40, is amended to read:
12.26 	252.40 SERVICE PRINCIPLES AND RATE-SETTING PROCEDURES.
12.27 	(a) Sections 252.40 to 252.46 apply to day training and habilitation services for 
12.28 	adults with developmental disabilities when the services are authorized to be funded by a 
12.29 	county and provided under a contract between a county board and a vendor as defined 
12.30 	in section 252.41. Nothing in sections 252.40 to 252.46 absolves intermediate care 
12.31 	facilities for persons with developmental disabilities of the responsibility for providing 
12.32 	active treatment and habilitation under federal regulations with which those facilities must 
12.33 	comply to be certified by the Minnesota Department of Health.
13.1 	(b) This section expires January 1, 2013, or on the date the commissioner adopts 
13.2 	rules for the administration of home and community-based services waivers under section 
13.3 	256B.4912, subdivision 4, whichever is sooner.

13.4 	Sec. 6. Minnesota Statutes 2010, section 252.41, subdivision 3, is amended to read:
13.5 		Subd. 3.Day training and habilitation services for adults with developmental 
13.6 	disabilities. "Day training and habilitation services for adults with developmental 
13.7 	disabilities" means services that:
13.8 	(1) include supervision, training, assistance, and supported employment, 
13.9 	work-related activities, or other community-integrated activities designed and 
13.10 	implemented in accordance with the individual service and individual habilitation plans 
13.11 	required under Minnesota Rules, parts 9525.0015 to 9525.0165, to help an adult reach 
13.12 	and maintain the highest possible level of independence, productivity, and integration 
13.13 	into the community; and
13.14 	(2) are provided ~~under contract with the county where the services are delivered~~
13.15 	by a vendor licensed under sections 245A.01 to 245A.16 and 252.28, subdivision 2, to 
13.16 	provide day training and habilitation services.
13.17 	Day training and habilitation services reimbursable under this section do not include 
13.18 	special education and related services as defined in the Education of the Individuals with 
13.19 	Disabilities Act, United States Code, title 20, chapter 33, section 1401, clauses (6) and 
13.20 	(17), or vocational services funded under section 110 of the Rehabilitation Act of 1973, 
13.21 	United States Code, title 29, section 720, as amended.

13.22 	EFFECTIVE DATE. This section is effective January 1, 2013, or on the date the 
13.23 	commissioner adopts rules for the administration of home and community-based services 
13.24 	waivers under section 256B.4912, subdivision 4, whichever is sooner.

13.25 	Sec. 7. Minnesota Statutes 2010, section 252.42, is amended to read:
13.26 	252.42 SERVICE PRINCIPLES.
13.27 	The design and delivery of services eligible for reimbursement ~~under the rates~~ 
13.28 	~~established in section 252.46~~ should reflect the following principles:
13.29 	(1) services must suit a person's chronological age and be provided in the least 
13.30 	restrictive environment possible, consistent with the needs identified in the person's 
13.31 	individual service and individual habilitation plans under Minnesota Rules, parts 
13.32 	9525.0015 to 9525.0165;
14.1 	(2) a person with a developmental disability whose individual service and individual 
14.2 	habilitation plans authorize employment or employment-related activities shall be given 
14.3 	the opportunity to participate in employment and employment-related activities in which 
14.4 	nondisabled persons participate;
14.5 	(3) a person with a developmental disability participating in work shall be paid 
14.6 	wages commensurate with the rate for comparable work and productivity except as 
14.7 	regional centers are governed by section 246.151;
14.8 	(4) a person with a developmental disability shall receive services which include 
14.9 	services offered in settings used by the general public and designed to increase the person's 
14.10 	active participation in ordinary community activities;
14.11 	(5) a person with a developmental disability shall participate in the patterns, 
14.12 	conditions, and rhythms of everyday living and working that are consistent with the norms 
14.13 	of the mainstream of society.

14.14 	EFFECTIVE DATE. This section is effective January 1, 2013, or on the date the 
14.15 	commissioner adopts rules for the administration of home and community-based services 
14.16 	waivers under section 256B.4912, subdivision 4, whichever is sooner.

14.17 	Sec. 8. Minnesota Statutes 2010, section 252.43, is amended to read:
14.18 	252.43 COMMISSIONER'S DUTIES.
14.19 	The commissioner shall supervise county boards' provision of day training and 
14.20 	habilitation services to adults with developmental disabilities. The commissioner shall:
14.21 	(1) determine the need for day training and habilitation services under section 252.28;
14.22 	(2) ~~approve~~ establish payment rates ~~established by a county under section 252.46,~~ 
14.23 	~~subdivision 1~~ under section 256B.4912;
14.24 	(3) adopt rules for the administration and provision of day training and habilitation 
14.25 	services under sections ~~252.40~~ 252.41 to 252.46 and sections 245A.01 to 245A.16 and 
14.26 	252.28, subdivision 2;
14.27 	(4) enter into interagency agreements necessary to ensure effective coordination and 
14.28 	provision of day training and habilitation services;
14.29 	(5) monitor and evaluate the costs and effectiveness of day training and habilitation 
14.30 	services; and
14.31 	(6) provide information and technical help to county boards and vendors in their 
14.32 	administration and provision of day training and habilitation services.

15.1 	EFFECTIVE DATE. This section is effective January 1, 2013, or on the date the 
15.2 	commissioner adopts rules for the administration of home and community-based services 
15.3 	waivers under section 256B.4912, subdivision 4, whichever is sooner.

15.4 	Sec. 9. Minnesota Statutes 2010, section 252.44, is amended to read:
15.5 	252.44 COUNTY BOARD RESPONSIBILITIES.
15.6 	~~(a)~~ When the need for day training and habilitation services in a county has been 
15.7 	determined under section 252.28, the board of commissioners for that county shall: 
15.8 	(1) authorize the delivery of services according to the individual service and 
15.9 	habilitation plans required as part of the county's provision of case management services 
15.10 	under Minnesota Rules, parts 9525.0015 to 9525.0165~~. For calendar years for which~~ 
15.11 	~~section 252.46, subdivisions 2 to 10, apply, the county board shall not authorize a change~~ 
15.12 	~~in service days from the number of days authorized for the previous calendar year unless~~ 
15.13 	~~there is documentation for the change in the individual service plan. An increase in service~~ 
15.14 	~~days must also be supported by documentation that the goals and objectives assigned to the~~ 
15.15 	~~vendor cannot be met more economically and effectively by other available community~~ 
15.16 	~~services and that without the additional days of service the individual service plan could~~ 
15.17 	~~not be implemented in a manner consistent with the service principles in section 252.42;~~
15.18 	~~(2) contract with licensed vendors, as specified in paragraph (b), under sections~~ 
15.19 	~~256E.12 and 256B.092 and rules adopted under those sections~~;
15.20 	~~(3)~~(2) ensure that transportation is provided or arranged by the vendor in the most 
15.21 	efficient and reasonable way possible; and
15.22 	~~(4) set payment rates under section 252.46;~~ 
15.23 	~~(5)~~ (3) monitor and evaluate ~~the cost and effectiveness of~~ that the services~~; and~~
15.24 	being paid for are being provided.
15.25 	~~(6) reimburse vendors for the provision of authorized services according to the rates,~~ 
15.26 	~~procedures, and regulations governing reimbursement.~~
15.27 	~~(b) With all vendors except regional centers, the contract must include the approved~~ 
15.28 	~~payment rates, the projected budget for the contract period, and any actual expenditures~~ 
15.29 	~~of previous and current contract periods. With all vendors, including regional centers,~~ 
15.30 	~~the contract must also include the amount, availability, and components of day training~~ 
15.31 	~~and habilitation services to be provided, the performance standards governing service~~ 
15.32 	~~provision and evaluation, and the time period in which the contract is effective.~~

16.1 	EFFECTIVE DATE. This section is effective January 1, 2013, or on the date the 
16.2 	commissioner adopts rules for the administration of home and community-based services 
16.3 	waivers under section 256B.4912, subdivision 4, whichever is sooner.

16.4 	Sec. 10. Minnesota Statutes 2010, section 252.45, is amended to read:
16.5 	252.45 VENDOR'S DUTIES.
16.6 	A ~~vendor's responsibility~~ vendor enrolled through the process established by the 
16.7 	commissioner is responsible under clauses (1)~~, (2), and (3)~~to (4). This responsibility 
16.8 	extends only to the provision of services that are reimbursable under state and federal 
16.9 	law. A vendor ~~under contract with a county board to provide~~providing day training and 
16.10 	habilitation services shall:
16.11 	(1) provide the amount and type of services authorized in the individual service plan 
16.12 	under Minnesota Rules, parts 9525.0015 to 9525.0165;
16.13 	(2) design the services to achieve the outcomes assigned to the vendor in the 
16.14 	individual service plan;
16.15 	(3) provide or arrange for transportation of persons receiving services to and from 
16.16 	service sites; and
16.17 	(4) enter into agreements with community-based intermediate care facilities for 
16.18 	persons with developmental disabilities to ensure compliance with applicable federal 
16.19 	regulations~~; and~~.
16.20 	~~(5) comply with state and federal law.~~

16.21 	EFFECTIVE DATE. This section is effective January 1, 2013, or on the date the 
16.22 	commissioner adopts rules for the administration of home and community-based services 
16.23 	waivers under section 256B.4912, subdivision 4, whichever is sooner.

16.24 	Sec. 11. Minnesota Statutes 2010, section 252.451, subdivision 2, is amended to read:
16.25 		Subd. 2.Vendor participation and reimbursement. Notwithstanding requirements 
16.26 	in chapter 245A, and sections 252.28, ~~252.40~~ 252.41 to 252.46, and 256B.501, vendors of 
16.27 	day training and habilitation services may enter into written agreements with qualified 
16.28 	businesses to provide additional training and supervision needed by individuals to 
16.29 	maintain their employment.

16.30 	EFFECTIVE DATE. This section is effective January 1, 2013, or on the date the 
16.31 	commissioner adopts rules for the administration of home and community-based services 
16.32 	waivers under section 256B.4912, subdivision 4, whichever is sooner.

17.1 	Sec. 12. Minnesota Statutes 2010, section 252.451, subdivision 5, is amended to read:
17.2 		Subd. 5.Vendor payment. (a) For purposes of this section, ~~the vendor shall bill and~~ 
17.3 	~~the commissioner shall reimburse the vendor for full-day or partial-day services to a client~~ 
17.4 	~~that would otherwise have been paid to the vendor for providing direct services, provided~~ 
17.5 	~~that both of the following criteria are met:~~
17.6 	~~(1) the vendor provides services and payments to the qualified business that enable~~ 
17.7 	~~the business to perform support and supervision services for the client that the vendor~~ 
17.8 	~~would otherwise need to perform; and~~
17.9 	~~(2) the client for whom a rate will be billed will receive full-day or partial-day~~ 
17.10 	~~services from the vendor and the rate to be paid the vendor will allow the client to work~~ 
17.11 	~~with this support and supervision at the qualified business instead of receiving these~~ 
17.12 	~~services from the vendor.~~ vendors of day training and habilitation services that enter 
17.13 	into written agreements with qualified businesses shall reimburse the qualified business 
17.14 	according to the terms of their written agreement as defined in section 252.45, subdivision 
17.15 	3, clause (5), items (i) and (ii).
17.16 	(b) Medical assistance reimbursement of services provided to persons receiving 
17.17 	day training and habilitation services under this section is subject to the limitations on 
17.18 	reimbursement for vocational services under federal law and regulation.

17.19 	EFFECTIVE DATE. This section is effective January 1, 2013, or on the date the 
17.20 	commissioner adopts rules for the administration of home and community-based services 
17.21 	waivers under section 256B.4912, subdivision 4, whichever is sooner.

17.22 	Sec. 13. Minnesota Statutes 2010, section 252.46, subdivision 1a, is amended to read:
17.23 		Subd. 1a.Day training and habilitation rates. The commissioner shall establish a 
17.24 	statewide rate-setting methodology for all day training and habilitation services as defined 
17.25 	in section 256B.4912. The rate-setting methodology must abide by the principles of 
17.26 	transparency and equitability across the state. The methodology must involve a uniform 
17.27 	process of structuring rates for each service and must promote quality and participant 
17.28 	choice under section 256B.4912.

17.29 	EFFECTIVE DATE. This section is effective January 1, 2013, or on the date the 
17.30 	commissioner adopts rules for the administration of home and community-based services 
17.31 	waivers under section 256B.4912, subdivision 4, whichever is sooner.

17.32 	Sec. 14. Minnesota Statutes 2010, section 252A.21, subdivision 2, is amended to read:
18.1 		Subd. 2.Rules. The commissioner shall adopt rules to implement this chapter. 
18.2 	The rules must include standards for performance of guardianship or conservatorship 
18.3 	duties including, but not limited to: twice a year visits with the ward; ~~quarterly reviews~~ 
18.4 	~~of records from day, residential, and support services;~~ a requirement that the duties of 
18.5 	guardianship or conservatorship and case management not be performed by the same 
18.6 	person; specific standards for action on "do not resuscitate" orders, sterilization requests, 
18.7 	and the use of psychotropic medication and aversive procedures.

18.8 	Sec. 15. Minnesota Statutes 2010, section 256.476, subdivision 11, is amended to read:
18.9 		Subd. 11.Consumer support grant program after July 1, 2001.  Effective 
18.10 	July 1, 2001, the commissioner shall allocate consumer support grant resources to 
18.11 	serve additional individuals based on a review of Medicaid authorization and payment 
18.12 	information of persons eligible for a consumer support grant from the most recent fiscal 
18.13 	year. The commissioner shall use the following methodology to calculate maximum 
18.14 	allowable monthly consumer support grant levels:
18.15 	(1) For individuals whose program of origination is medical assistance home care 
18.16 	under sections 256B.0651 and 256B.0653 to 256B.0656, the maximum allowable monthly 
18.17 	grant levels are calculated by:
18.18 	(i) determining ~~50 percent of the average~~the service authorization for each 
18.19 	individual based on the individual's home care ~~rating~~ assessment;
18.20 	(ii) calculating the overall ratio of actual payments to service authorizations by 
18.21 	program;
18.22 	(iii) applying the overall ratio to ~~the average~~50 percent of the service authorization 
18.23 	level of each home care rating; and
18.24 	(iv) adjusting the result for any authorized rate ~~increases~~changes provided by the 
18.25 	legislature~~; and~~.
18.26 	~~(v) adjusting the result for the average monthly utilization per recipient.~~
18.27 	(2) The commissioner ~~may review and evaluate~~shall ensure the methodology ~~to~~ 
18.28 	~~reflect changes in~~is consistent with the home care programs.

18.29 	Sec. 16. Minnesota Statutes 2010, section 256B.0625, subdivision 19c, is amended to 
18.30 	read:
18.31 		Subd. 19c.Personal care. Medical assistance covers personal care assistance 
18.32 	services provided by an individual who is qualified to provide the services according to 
18.33 	subdivision 19a and sections 256B.0651 to 256B.0656, provided in accordance with a 
18.34 	plan, and supervised by a qualified professional.
19.1 	"Qualified professional" means a mental health professional as defined in section 
19.2 	245.462, subdivision 18, clauses (1) to (6), or 245.4871, subdivision 27, clauses (1) to (6); 
19.3 	or a registered nurse as defined in sections 148.171 to 148.285, a licensed social worker 
19.4 	as defined in sections 148D.010 and 148D.055, or a qualified developmental disabilities 
19.5 	specialist under section 245B.07, subdivision 4. The qualified professional shall perform 
19.6 	the duties required in section 256B.0659.

19.7 	Sec. 17. Minnesota Statutes 2010, section 256B.0659, subdivision 1, is amended to 
19.8 	read:
19.9 		Subdivision 1.Definitions. (a) For the purposes of this section, the terms defined in 
19.10 	paragraphs (b) to (r) have the meanings given unless otherwise provided in text.
19.11 	(b) "Activities of daily living" means grooming, dressing, bathing, transferring, 
19.12 	mobility, positioning, eating, and toileting.
19.13 	(c) "Behavior," effective January 1, 2010, means a category to determine the home 
19.14 	care rating and is based on the criteria found in this section. "Level I behavior" means 
19.15 	physical aggression towards self, others, or destruction of property that requires the 
19.16 	immediate response of another person.
19.17 	(d) "Complex health-related needs," effective January 1, 2010, means a category to 
19.18 	determine the home care rating and is based on the criteria found in this section.
19.19 	(e) "Critical activities of daily living," effective January 1, 2010, means transferring, 
19.20 	mobility, eating, and toileting.
19.21 	(f) "Dependency in activities of daily living" means a person requires assistance to 
19.22 	begin and complete one or more of the activities of daily living.
19.23 	(g) "Extended personal care assistance service" means personal care assistance 
19.24 	services included in a service plan under one of the home and community-based services 
19.25 	waivers authorized under sections 256B.0915, 256B.092, subdivision 5, and 256B.49, 
19.26 	which exceed the amount, duration, and frequency of the state plan personal care 
19.27 	assistance services for participants who:
19.28 	(1) need assistance provided periodically during a week, but less than daily will not 
19.29 	be able to remain in their homes without the assistance, and other replacement services 
19.30 	are more expensive or are not available when personal care assistance services are to 
19.31 	be ~~terminated~~ reduced; or
19.32 	(2) need additional personal care assistance services beyond the amount authorized 
19.33 	by the state plan personal care assistance assessment in order to ensure that their safety, 
19.34 	health, and welfare are provided for in their homes.
20.1 	(h) "Health-related procedures and tasks" means procedures and tasks that can 
20.2 	be delegated or assigned by a licensed health care professional under state law to be 
20.3 	performed by a personal care assistant.
20.4 	(i) "Instrumental activities of daily living" means activities to include meal planning 
20.5 	and preparation; basic assistance with paying bills; shopping for food, clothing, and other 
20.6 	essential items; performing household tasks integral to the personal care assistance 
20.7 	services; communication by telephone and other media; and traveling, including to 
20.8 	medical appointments and to participate in the community.
20.9 	(j) "Managing employee" has the same definition as Code of Federal Regulations, 
20.10 	title 42, section 455.
20.11 	(k) "Qualified professional" means a professional providing supervision of personal 
20.12 	care assistance services and staff as defined in section 256B.0625, subdivision 19c.
20.13 	(l) "Personal care assistance provider agency" means a medical assistance enrolled 
20.14 	provider that provides or assists with providing personal care assistance services and 
20.15 	includes a personal care assistance provider organization, personal care assistance choice 
20.16 	agency, class A licensed nursing agency, and Medicare-certified home health agency.
20.17 	(m) "Personal care assistant" or "PCA" means an individual employed by a personal 
20.18 	care assistance agency who provides personal care assistance services.
20.19 	(n) "Personal care assistance care plan" means a written description of personal 
20.20 	care assistance services developed by the personal care assistance provider according 
20.21 	to the service plan.
20.22 	(o) "Responsible party" means an individual who is capable of providing the support 
20.23 	necessary to assist the recipient to live in the community.
20.24 	(p) "Self-administered medication" means medication taken orally, by injection or 
20.25 	insertion, or applied topically without the need for assistance.
20.26 	(q) "Service plan" means a written summary of the assessment and description of the 
20.27 	services needed by the recipient.
20.28 	(r) "Wages and benefits" means wages and salaries, the employer's share of FICA 
20.29 	taxes, Medicare taxes, state and federal unemployment taxes, workers' compensation, 
20.30 	mileage reimbursement, health and dental insurance, life insurance, disability insurance, 
20.31 	long-term care insurance, uniform allowance, and contributions to employee retirement 
20.32 	accounts.

20.33 	Sec. 18. Minnesota Statutes 2010, section 256B.0659, subdivision 3, is amended to 
20.34 	read:
21.1 		Subd. 3.Noncovered personal care assistance services. (a) Personal care 
21.2 	assistance services are not eligible for medical assistance payment under this section 
21.3 	when provided:
21.4 	(1) by the recipient's spouse, parent of a recipient under the age of 18, paid legal 
21.5 	guardian, licensed foster provider, except as allowed under section 256B.0652, subdivision 
21.6 	10, or responsible party;
21.7 	(2) in ~~lieu of other staffing options~~ order to meet staffing or license requirements in a 
21.8 	residential or child care setting;
21.9 	(3) solely as a child care or babysitting service; or
21.10 	(4) without authorization by the commissioner or the commissioner's designee.
21.11 	(b) The following personal care services are not eligible for medical assistance 
21.12 	payment under this section when provided in residential settings:
21.13 	(1) ~~effective January 1, 2010,~~ when the provider of home care services who is not 
21.14 	related by blood, marriage, or adoption owns or otherwise controls the living arrangement, 
21.15 	including licensed or unlicensed services; or
21.16 	(2) when personal care assistance services are the responsibility of a residential or 
21.17 	program license holder under the terms of a service agreement and administrative rules.
21.18 	(c) Other specific tasks not covered under paragraph (a) or (b) that are not eligible 
21.19 	for medical assistance reimbursement for personal care assistance services under this 
21.20 	section include:
21.21 	(1) sterile procedures;
21.22 	(2) injections of fluids and medications into veins, muscles, or skin;
21.23 	(3) home maintenance or chore services;
21.24 	(4) homemaker services not an integral part of assessed personal care assistance 
21.25 	services needed by a recipient;
21.26 	(5) application of restraints or implementation of procedures under section 245.825;
21.27 	(6) instrumental activities of daily living for children under the age of 18, except 
21.28 	when immediate attention is needed for health or hygiene reasons integral to the personal 
21.29 	care services and the need is listed in the service plan by the assessor; and
21.30 	(7) assessments for personal care assistance services by personal care assistance 
21.31 	provider agencies or by independently enrolled registered nurses.

21.32 	Sec. 19. Minnesota Statutes 2010, section 256B.0659, subdivision 9, is amended to 
21.33 	read:
22.1 		Subd. 9.Responsible party; generally. (a) "Responsible party" means an 
22.2 	individual who is capable of providing the support necessary to assist the recipient to live 
22.3 	in the community.
22.4 	(b) A responsible party must be 18 years of age, actively participate in planning and 
22.5 	directing of personal care assistance services, and attend all assessments for the recipient.
22.6 	(c) A responsible party must not be the:
22.7 	(1) personal care assistant;
22.8 	(2) qualified professional;
22.9 	(3) home care provider agency owner or ~~staff~~ manager; ~~or~~
22.10 	(4) home care provider agency staff unless staff who are not listed in clauses (1) to 
22.11 	(3) are related to the recipient by blood, marriage, or adoption; or
22.12 	~~(3)~~ (5) county staff acting as part of employment.
22.13 	(d) A licensed family foster parent who lives with the recipient may be the 
22.14 	responsible party as long as the family foster parent meets the other responsible party 
22.15 	requirements.
22.16 	(e) A responsible party is required when:
22.17 	(1) the person is a minor according to section 524.5-102, subdivision 10;
22.18 	(2) the person is an incapacitated adult according to section 524.5-102, subdivision 
22.19 	6, resulting in a court-appointed guardian; or
22.20 	(3) the assessment according to subdivision 3a determines that the recipient is in 
22.21 	need of a responsible party to direct the recipient's care.
22.22 	(f) There may be two persons designated as the responsible party for reasons such 
22.23 	as divided households and court-ordered custodies. Each person named as responsible 
22.24 	party must meet the program criteria and responsibilities.
22.25 	(g) The recipient or the recipient's legal representative shall appoint a responsible 
22.26 	party if necessary to direct and supervise the care provided to the recipient. The 
22.27 	responsible party must be identified at the time of assessment and listed on the recipient's 
22.28 	service agreement and personal care assistance care plan.

22.29 	Sec. 20. Minnesota Statutes 2010, section 256B.0659, subdivision 11, is amended to 
22.30 	read:
22.31 		Subd. 11.Personal care assistant; requirements. (a) A personal care assistant 
22.32 	must meet the following requirements:
22.33 	(1) be at least 18 years of age with the exception of persons who are 16 or 17 years 
22.34 	of age with these additional requirements:
22.35 	(i) supervision by a qualified professional every 60 days; and
23.1 	(ii) employment by only one personal care assistance provider agency responsible 
23.2 	for compliance with current labor laws;
23.3 	(2) be employed by a personal care assistance provider agency;
23.4 	(3) enroll with the department as a personal care assistant after clearing a background 
23.5 	study. Except as provided in subdivision 11a, before a personal care assistant provides 
23.6 	services, the personal care assistance provider agency must initiate a background study on 
23.7 	the personal care assistant under chapter 245C, and the personal care assistance provider 
23.8 	agency must have received a notice from the commissioner that the personal care assistant 
23.9 	is:
23.10 	(i) not disqualified under section 245C.14; or
23.11 	(ii) is disqualified, but the personal care assistant has received a set aside of the 
23.12 	disqualification under section 245C.22;
23.13 	(4) be able to effectively communicate with the recipient and personal care 
23.14 	assistance provider agency;
23.15 	(5) be able to provide covered personal care assistance services according to the 
23.16 	recipient's personal care assistance care plan, respond appropriately to recipient needs, 
23.17 	and report changes in the recipient's condition to the supervising qualified professional 
23.18 	or physician;
23.19 	(6) not be a consumer of personal care assistance services;
23.20 	(7) maintain daily written records including, but not limited to, time sheets under 
23.21 	subdivision 12;
23.22 	(8) effective January 1, 2010, complete standardized training as determined 
23.23 	by the commissioner before completing enrollment. The training must be available 
23.24 	in languages other than English and to those who need accommodations due to 
23.25 	disabilities. Personal care assistant training must include successful completion of the 
23.26 	following training components: basic first aid, vulnerable adult, child maltreatment, 
23.27 	OSHA universal precautions, basic roles and responsibilities of personal care assistants 
23.28 	including information about assistance with lifting and transfers for recipients, emergency 
23.29 	preparedness, orientation to positive behavioral practices, fraud issues, and completion of 
23.30 	time sheets. Upon completion of the training components, the personal care assistant must 
23.31 	demonstrate the competency to provide assistance to recipients;
23.32 	(9) complete training and orientation on the needs of the recipient within the first 
23.33 	seven days after the services begin. This training shall occur where services are provided 
23.34 	with the recipient present; and
23.35 	(10) be limited to providing and being paid for up to 275 hours per month~~, except~~ 
23.36 	~~that this limit shall be 275 hours per month for the period July 1, 2009, through June 30,~~ 
24.1 	~~2011,~~ of personal care assistance services regardless of the number of recipients being 
24.2 	served or the number of personal care assistance provider agencies enrolled with. The 
24.3 	number of hours worked per day shall not be disallowed by the department unless in 
24.4 	violation of the law.
24.5 	(b) A legal guardian may be a personal care assistant if the guardian is not being paid 
24.6 	for the guardian services and meets the criteria for personal care assistants in paragraph (a).
24.7 	(c) ~~Effective January 1, 2010,~~ Persons who do not qualify as a personal care 
24.8 	assistant include parents, legal guardians, and stepparents of minors~~,~~; spouses~~,~~; paid legal 
24.9 	guardians~~,~~ of adults; family foster care providers, except as otherwise allowed in section 
24.10 	256B.0625, subdivision 19a~~, or~~; and staff of a residential setting.

24.11 	Sec. 21. Minnesota Statutes 2010, section 256B.0659, subdivision 13, is amended to 
24.12 	read:
24.13 		Subd. 13.Qualified professional; qualifications. (a) The qualified professional 
24.14 	must work for a personal care assistance provider agency and meet the definition under 
24.15 	section 256B.0625, subdivision 19c. Before a qualified professional provides services, the 
24.16 	personal care assistance provider agency must initiate a background study on the qualified 
24.17 	professional under chapter 245C, and the personal care assistance provider agency must 
24.18 	have received a notice from the commissioner that the qualified professional:
24.19 	(1) is not disqualified under section 245C.14; or
24.20 	(2) is disqualified, but the qualified professional has received a set aside of the 
24.21 	disqualification under section 245C.22.
24.22 	(b) The qualified professional shall perform the duties of training, supervision, and 
24.23 	evaluation of the personal care assistance staff and evaluation of the effectiveness of 
24.24 	personal care assistance services. The qualified professional shall:
24.25 	(1) develop and monitor with the recipient a personal care assistance care plan based 
24.26 	on the service plan and individualized needs of the recipient;
24.27 	(2) develop and monitor with the recipient a monthly plan for the use of personal 
24.28 	care assistance services;
24.29 	(3) review documentation of personal care assistance services provided;
24.30 	(4) provide training and ensure competency for the personal care assistant in the 
24.31 	individual needs of the recipient; and
24.32 	(5) document all training, communication, evaluations, and needed actions to 
24.33 	improve performance of the personal care assistants.
24.34 	(c) Effective July 1, ~~2010~~ 2011, the qualified professional shall complete the provider 
24.35 	training with basic information about the personal care assistance program approved by 
25.1 	the commissioner. Newly hired qualified professionals must complete the training within 
25.2 	six months of the date hired by a personal care assistance provider agency. Qualified 
25.3 	professionals who have completed the required training as a worker from a personal care 
25.4 	assistance provider agency do not need to repeat the required training if they are hired 
25.5 	by another agency, if they have completed the training within the last three years. The 
25.6 	required training ~~shall~~ must be available ~~in languages other than English and to those who~~ 
25.7 	~~need accommodations due to disabilities,~~with meaningful access according to title VI of 
25.8 	the Civil Rights Act and federal regulations adopted under that law or any guidance from 
25.9 	the United States Health and Human Services Department. The required training must 
25.10 	be available online~~,~~ or by electronic remote connection~~, and~~. The required training must
25.11 	provide for competency testing to demonstrate an understanding of the content without 
25.12 	attending in-person training. A qualified professional is allowed to be employed and is not 
25.13 	subject to the training requirement until the training is offered online or through remote 
25.14 	electronic connection. A qualified professional employed by a personal care assistance 
25.15 	provider agency certified for participation in Medicare as a home health agency is exempt 
25.16 	from the training required in this subdivision. When available, the qualified professional 
25.17 	working for a Medicare-certified home health agency must successfully complete the 
25.18 	competency test. The commissioner shall ensure there is a mechanism in place to verify 
25.19 	the identity of persons completing the competency testing electronically.

25.20 	Sec. 22. Minnesota Statutes 2010, section 256B.0659, subdivision 14, is amended to 
25.21 	read:
25.22 		Subd. 14.Qualified professional; duties. (a) Effective January 1, 2010, all personal 
25.23 	care assistants must be supervised by a qualified professional.
25.24 	(b) Through direct training, observation, return demonstrations, and consultation 
25.25 	with the staff and the recipient, the qualified professional must ensure and document 
25.26 	that the personal care assistant is:
25.27 	(1) capable of providing the required personal care assistance services;
25.28 	(2) knowledgeable about the plan of personal care assistance services before services 
25.29 	are performed; and
25.30 	(3) able to identify conditions that should be immediately brought to the attention of 
25.31 	the qualified professional.
25.32 	(c) The qualified professional shall evaluate the personal care assistant within the first 
25.33 	14 days of starting to provide regularly scheduled services for a recipient except for the 
25.34 	personal care assistance choice option under subdivision 19, paragraph (a), clause (4). For 
25.35 	the initial evaluation, the qualified professional shall evaluate the personal care assistance 
26.1 	services for a recipient through direct observation of a personal care assistant's work. 
26.2 	Subsequent visits to evaluate the personal care assistance services provided to a recipient 
26.3 	do not require direct observation of each personal care assistant's work and shall occur:
26.4 	(1) at least every 90 days thereafter for the first year of a recipient's services;
26.5 	(2) every 120 days after the first year of a recipient's service or whenever needed for 
26.6 	response to a recipient's request for increased supervision of the personal care assistance 
26.7 	staff; and
26.8 	(3) after the first 180 days of a recipient's service, supervisory visits may alternate 
26.9 	between unscheduled phone or Internet technology and in-person visits, unless the 
26.10 	in-person visits are needed according to the care plan.
26.11 	(d) Communication with the recipient is a part of the evaluation process of the 
26.12 	personal care assistance staff.
26.13 	(e) At each supervisory visit, the qualified professional shall evaluate personal care 
26.14 	assistance services including the following information:
26.15 	(1) satisfaction level of the recipient with personal care assistance services;
26.16 	(2) review of the month-to-month plan for use of personal care assistance services;
26.17 	(3) review of documentation of personal care assistance services provided;
26.18 	(4) whether the personal care assistance services are meeting the goals of the service 
26.19 	as stated in the personal care assistance care plan and service plan;
26.20 	(5) a written record of the results of the evaluation and actions taken to correct any 
26.21 	deficiencies in the work of a personal care assistant; and
26.22 	(6) revision of the personal care assistance care plan as necessary in consultation 
26.23 	with the recipient or responsible party, to meet the needs of the recipient.
26.24 	(f) The qualified professional shall complete the required documentation in the 
26.25 	agency recipient and employee files and the recipient's home, including the following 
26.26 	documentation:
26.27 	(1) the personal care assistance care plan based on the service plan and individualized 
26.28 	needs of the recipient;
26.29 	(2) a month-to-month plan for use of personal care assistance services;
26.30 	(3) changes in need of the recipient requiring a change to the level of service and the 
26.31 	personal care assistance care plan;
26.32 	(4) evaluation results of supervision visits and identified issues with personal care 
26.33 	assistance staff with actions taken;
26.34 	(5) all communication with the recipient and personal care assistance staff; and
26.35 	(6) hands-on training or individualized training for the care of the recipient.
26.36 	(g) The documentation in paragraph (f) must be done on agency ~~forms~~ templates.
27.1 	(h) The services that are not eligible for payment as qualified professional services 
27.2 	include:
27.3 	(1) direct professional nursing tasks that could be assessed and authorized as skilled 
27.4 	nursing tasks;
27.5 	~~(2) supervision of personal care assistance completed by telephone;~~
27.6 	~~(3)~~ (2) agency administrative activities;
27.7 	~~(4)~~ (3) training other than the individualized training required to provide care for a 
27.8 	recipient; and
27.9 	~~(5)~~ (4) any other activity that is not described in this section.

27.10 	Sec. 23. Minnesota Statutes 2010, section 256B.0659, subdivision 19, is amended to 
27.11 	read:
27.12 		Subd. 19.Personal care assistance choice option; qualifications; duties. (a) 
27.13 	Under personal care assistance choice, the recipient or responsible party shall:
27.14 	(1) recruit, hire, schedule, and terminate personal care assistants according to the 
27.15 	terms of the written agreement required under subdivision 20, paragraph (a);
27.16 	(2) develop a personal care assistance care plan based on the assessed needs 
27.17 	and addressing the health and safety of the recipient with the assistance of a qualified 
27.18 	professional as needed;
27.19 	(3) orient and train the personal care assistant with assistance as needed from the 
27.20 	qualified professional;
27.21 	(4) effective January 1, 2010, supervise and evaluate the personal care assistant with 
27.22 	the qualified professional, who is required to visit the recipient at least every 180 days;
27.23 	(5) monitor and verify in writing and report to the personal care assistance choice 
27.24 	agency the number of hours worked by the personal care assistant and the qualified 
27.25 	professional;
27.26 	(6) engage in an annual face-to-face reassessment to determine continuing eligibility 
27.27 	and service authorization; and
27.28 	(7) use the same personal care assistance choice provider agency if shared personal 
27.29 	assistance care is being used.
27.30 	(b) The personal care assistance choice provider agency shall:
27.31 	(1) meet all personal care assistance provider agency standards;
27.32 	(2) enter into a written agreement with the recipient, responsible party, and personal 
27.33 	care assistants;
27.34 	(3) not be related as a parent, child, sibling, or spouse to the recipient~~, qualified~~ 
27.35 	~~professional,~~ or the personal care assistant; and
28.1 	(4) ensure arm's-length transactions without undue influence or coercion with the 
28.2 	recipient and personal care assistant.
28.3 	(c) The duties of the personal care assistance choice provider agency are to:
28.4 	(1) be the employer of the personal care assistant and the qualified professional for 
28.5 	employment law and related regulations including, but not limited to, purchasing and 
28.6 	maintaining workers' compensation, unemployment insurance, surety and fidelity bonds, 
28.7 	and liability insurance, and submit any or all necessary documentation including, but not 
28.8 	limited to, workers' compensation and unemployment insurance;
28.9 	(2) bill the medical assistance program for personal care assistance services and 
28.10 	qualified professional services;
28.11 	(3) request and complete background studies that comply with the requirements for 
28.12 	personal care assistants and qualified professionals;
28.13 	(4) pay the personal care assistant and qualified professional based on actual hours 
28.14 	of services provided;
28.15 	(5) withhold and pay all applicable federal and state taxes;
28.16 	(6) verify and keep records of hours worked by the personal care assistant and 
28.17 	qualified professional;
28.18 	(7) make the arrangements and pay taxes and other benefits, if any, and comply with 
28.19 	any legal requirements for a Minnesota employer;
28.20 	(8) enroll in the medical assistance program as a personal care assistance choice 
28.21 	agency; and
28.22 	(9) enter into a written agreement as specified in subdivision 20 before services 
28.23 	are provided.

28.24 	Sec. 24. Minnesota Statutes 2010, section 256B.0659, subdivision 21, is amended to 
28.25 	read:
28.26 		Subd. 21.Requirements for initial enrollment of personal care assistance 
28.27 	provider agencies. (a) All personal care assistance provider agencies must provide, at the 
28.28 	time of enrollment as a personal care assistance provider agency in a format determined 
28.29 	by the commissioner, information and documentation that includes, but is not limited to, 
28.30 	the following:
28.31 	(1) the personal care assistance provider agency's current contact information 
28.32 	including address, telephone number, and e-mail address;
28.33 	(2) proof of surety bond coverage in the amount of $50,000 or ten percent of the 
28.34 	provider's payments from Medicaid in the previous year, whichever is less;
28.35 	(3) proof of fidelity bond coverage in the amount of $20,000;
29.1 	(4) proof of workers' compensation insurance coverage;
29.2 	(5) proof of liability insurance;
29.3 	(6) a description of the personal care assistance provider agency's organization 
29.4 	identifying the names of all owners, managing employees, staff, board of directors, and 
29.5 	the affiliations of the directors, owners, or staff to other service providers;
29.6 	(7) a copy of the personal care assistance provider agency's written policies and 
29.7 	procedures including: hiring of employees; training requirements; service delivery; 
29.8 	and employee and consumer safety including process for notification and resolution 
29.9 	of consumer grievances, identification and prevention of communicable diseases, and 
29.10 	employee misconduct;
29.11 	(8) copies of all other forms the personal care assistance provider agency uses in 
29.12 	the course of daily business including, but not limited to:
29.13 	(i) a copy of the personal care assistance provider agency's time sheet if the time 
29.14 	sheet varies from the standard time sheet for personal care assistance services approved 
29.15 	by the commissioner, and a letter requesting approval of the personal care assistance 
29.16 	provider agency's nonstandard time sheet;
29.17 	(ii) the personal care assistance provider agency's template for the personal care 
29.18 	assistance care plan; and
29.19 	(iii) the personal care assistance provider agency's template for the written 
29.20 	agreement in subdivision 20 for recipients using the personal care assistance choice 
29.21 	option, if applicable;
29.22 	(9) a list of all training and classes that the personal care assistance provider agency 
29.23 	requires of its staff providing personal care assistance services;
29.24 	(10) documentation that the personal care assistance provider agency and staff have 
29.25 	successfully completed all the training required by this section;
29.26 	(11) documentation of the agency's marketing practices;
29.27 	(12) disclosure of ownership, leasing, or management of all residential properties 
29.28 	that is used or could be used for providing home care services;
29.29 	(13) documentation that the agency will use the following percentages of revenue 
29.30 	generated from the medical assistance rate paid for personal care assistance services 
29.31 	for employee personal care assistant wages and benefits: 72.5 percent of revenue in the 
29.32 	personal care assistance choice option and 72.5 percent of revenue from other personal 
29.33 	care assistance providers; and
29.34 	(14) effective May 15, 2010, documentation that the agency does not burden 
29.35 	recipients' free exercise of their right to choose service providers by requiring personal 
29.36 	care assistants to sign an agreement not to work with any particular personal care 
30.1 	assistance recipient or for another personal care assistance provider agency after leaving 
30.2 	the agency and that the agency is not taking action on any such agreements or requirements 
30.3 	regardless of the date signed.
30.4 	(b) Personal care assistance provider agencies shall provide the information specified 
30.5 	in paragraph (a) to the commissioner at the time the personal care assistance provider 
30.6 	agency enrolls as a vendor or upon request from the commissioner. The commissioner 
30.7 	shall collect the information specified in paragraph (a) from all personal care assistance 
30.8 	providers beginning July 1, 2009.
30.9 	(c) All personal care assistance provider agencies shall require all employees in 
30.10 	management and supervisory positions and owners of the agency who are active in the 
30.11 	day-to-day management and operations of the agency to complete mandatory training 
30.12 	as determined by the commissioner before enrollment of the agency as a provider. 
30.13 	Employees in management and supervisory positions and owners who are active in 
30.14 	the day-to-day operations of an agency who have completed the required training as 
30.15 	an employee with a personal care assistance provider agency do not need to repeat 
30.16 	the required training if they are hired by another agency, if they have completed the 
30.17 	training within the past three years. By September 1, 2010, the required training must be 
30.18 	available ~~in languages other than English and to those who need accommodations due~~ 
30.19 	~~to disabilities,~~with meaningful access according to title VI of the Civil Rights Act and 
30.20 	federal regulations adopted under that law or any guidance from the United States Health 
30.21 	and Human Services Department. The required training must be available online~~,~~ or by 
30.22 	electronic remote connection~~, and~~. The required training must provide for competency 
30.23 	testing. Personal care assistance provider agency billing staff shall complete training about 
30.24 	personal care assistance program financial management. This training is effective July 1, 
30.25 	2009. Any personal care assistance provider agency enrolled before that date shall, if it 
30.26 	has not already, complete the provider training within 18 months of July 1, 2009. Any new 
30.27 	owners or employees in management and supervisory positions involved in the day-to-day 
30.28 	operations are required to complete mandatory training as a requisite of working for the 
30.29 	agency. Personal care assistance provider agencies certified for participation in Medicare 
30.30 	as home health agencies are exempt from the training required in this subdivision. When 
30.31 	available, Medicare-certified home health agency owners, supervisors, or managers must 
30.32 	successfully complete the competency test.

30.33 	Sec. 25. Minnesota Statutes 2010, section 256B.0659, subdivision 30, is amended to 
30.34 	read:
30.35 		Subd. 30.Notice of service changes to recipients. The commissioner must provide:
31.1 	(1) by October 31, 2009, information to recipients likely to be affected that (i) 
31.2 	describes the changes to the personal care assistance program that may result in the 
31.3 	loss of access to personal care assistance services, and (ii) includes resources to obtain 
31.4 	further information;
31.5 	(2) effective through January 1, 2012, notice of changes in medical assistance 
31.6 	personal care assistance services to each affected recipient at least 30 days before the 
31.7 	effective date of the change.
31.8 	The notice shall include how to get further information on the changes, how to get help to 
31.9 	obtain other services, a list of community resources, and appeal rights. Notwithstanding 
31.10 	section 256.045, a recipient may request continued services pending appeal within the 
31.11 	time period allowed to request an appeal; and
31.12 	(3) a service agreement authorizing personal care assistance hours of service at 
31.13 	the previously authorized level, throughout the appeal process period, when a recipient 
31.14 	requests services pending an appeal.

31.15 	Sec. 26. Minnesota Statutes 2010, section 256B.0916, subdivision 7, is amended to 
31.16 	read:
31.17 		Subd. 7.Annual report by commissioner. (a) Beginning November 1, 2001, and 
31.18 	each November 1 thereafter, the commissioner shall issue an annual report on county and 
31.19 	state use of available resources for the home and community-based waiver for persons with 
31.20 	developmental disabilities. For each county or county partnership, the report shall include:
31.21 	(1) the amount of funds allocated but not used;
31.22 	(2) the county specific allowed reserve amount approved and used;
31.23 	(3) the number, ages, and living situations of individuals screened and waiting for 
31.24 	services;
31.25 	(4) the urgency of need for services to begin within one, two, or more than two 
31.26 	years for each individual;
31.27 	(5) the services needed;
31.28 	(6) the number of additional persons served by approval of increased capacity within 
31.29 	existing allocations;
31.30 	(7) results of action by the commissioner to streamline administrative requirements 
31.31 	and improve county resource management; and
31.32 	(8) additional action that would decrease the number of those eligible and waiting 
31.33 	for waivered services.
31.34 	The commissioner shall specify intended outcomes for the program and the degree to 
31.35 	which these specified outcomes are attained.
32.1 	(b) This subdivision expires January 1, 2012.

32.2 	Sec. 27. Minnesota Statutes 2010, section 256B.092, subdivision 1b, is amended to 
32.3 	read:
32.4 		Subd. 1b.Individual service plan. The individual service plan must:
32.5 	(1) include the results of the assessment information on the person's need for service, 
32.6 	including identification of service needs that will be or that are met by the person's 
32.7 	relatives, friends, and others, as well as community services used by the general public;
32.8 	(2) identify the person's preferences for services as stated by the person, the person's 
32.9 	legal guardian or conservator, or the parent if the person is a minor;
32.10 	(3) identify long- and short-range goals for the person;
32.11 	(4) identify specific services and the amount and frequency of the services to be 
32.12 	provided to the person based on assessed needs, preferences, and available resources. 
32.13 	The individual service plan shall also specify other services the person needs that are 
32.14 	not available;
32.15 	(5) identify the need for an individual program plan to be developed by the provider 
32.16 	according to the respective state and federal licensing and certification standards, and 
32.17 	additional assessments to be completed or arranged by the provider after service initiation;
32.18 	(6) identify provider responsibilities to implement and make recommendations for 
32.19 	modification to the individual service plan;
32.20 	(7) include notice of the right to request a conciliation conference or a hearing 
32.21 	under section 256.045;
32.22 	(8) be agreed upon and signed by the person, the person's legal guardian 
32.23 	or conservator, or the parent if the person is a minor, and the authorized county 
32.24 	representative; ~~and~~
32.25 	(9) be reviewed by a health professional if the person has overriding medical needs 
32.26 	that impact the delivery of services~~.~~; and
32.27 	(10) provide a notice at least annually of the amount of funds authorized for services.
32.28 	Service planning formats developed for interagency planning such as transition, 
32.29 	vocational, and individual family service plans may be substituted for service planning 
32.30 	formats developed by county agencies.

32.31 	Sec. 28. Minnesota Statutes 2010, section 256B.092, subdivision 11, is amended to 
32.32 	read:
32.33 		Subd. 11.Residential support services. (a) Upon federal approval, there is 
32.34 	established a new service called residential support that is available on the community 
33.1 	alternative care, community alternatives for disabled individuals, developmental 
33.2 	disabilities, and traumatic brain injury waivers. Existing waiver service descriptions 
33.3 	must be modified to the extent necessary to ensure there is no duplication between 
33.4 	other services. Residential support services must be provided by vendors licensed as a 
33.5 	community residential setting as defined in section 245A.11, subdivision 8.
33.6 	(b) Residential support services must meet the following criteria:
33.7 	(1) providers of residential support services must own or control the residential site;
33.8 	(2) the residential site must not be the primary residence of the license holder;
33.9 	(3) the residential site must have a designated program supervisor responsible for 
33.10 	program oversight, development, and implementation of policies and procedures;
33.11 	(4) the provider of residential support services must provide supervision, training, 
33.12 	and assistance as described in the person's community support plan; and
33.13 	(5) the provider of residential support services must meet the requirements of 
33.14 	licensure and additional requirements of the person's community support plan.
33.15 	(c) Providers of residential support services that meet the definition in paragraph 
33.16 	(a) must be registered using a process determined by the commissioner beginning July 
33.17 	1, 2009. Providers licensed to provide child foster care under Minnesota Rules, parts 
33.18 	2960.3000 to 2960.3340, or adult foster care licensed under Minnesota Rules, parts 
33.19 	9555.5105 to 9555.6265, and that meet the requirements in section 245A.03, subdivision 
33.20 	7, paragraph (e), are considered registered under this section.

33.21 	Sec. 29. Minnesota Statutes 2010, section 256B.096, subdivision 5, is amended to read:
33.22 		Subd. 5.Biennial report. (a) The commissioner shall provide a biennial report to 
33.23 	the chairs of the legislative committees with jurisdiction over health and human services 
33.24 	policy and funding beginning January 15, 2009, on the development and activities of the 
33.25 	quality management, assurance, and improvement system designed to meet the federal 
33.26 	requirements under the home and community-based services waiver programs for persons 
33.27 	with disabilities. By January 15, 2008, the commissioner shall provide a preliminary 
33.28 	report on priorities for meeting the federal requirements, progress on development and 
33.29 	field testing of the annual survey, appropriations necessary to implement an annual survey 
33.30 	of service recipients once field testing is completed, recommendations for improvements 
33.31 	in the incident reporting system, and a plan for incorporating quality assurance efforts 
33.32 	under section 256B.095 and other regional efforts into the statewide system.
33.33 	(b) This subdivision expires January 1, 2012.

33.34 	Sec. 30. Minnesota Statutes 2010, section 256B.49, subdivision 15, is amended to read:
34.1 		Subd. 15.Individualized service plan. (a) Each recipient of home and 
34.2 	community-based waivered services shall be provided a copy of the written service plan 
34.3 	which:
34.4 	(1) is developed and signed by the recipient within ten working days of the 
34.5 	completion of the assessment;
34.6 	(2) meets the assessed needs of the recipient;
34.7 	(3) reasonably ensures the health and safety of the recipient;
34.8 	(4) promotes independence;
34.9 	(5) allows for services to be provided in the most integrated settings; ~~and~~
34.10 	(6) provides for an informed choice, as defined in section 256B.77, subdivision 2, 
34.11 	paragraph ~~(p)~~ (o), of service and support providers~~.~~; and
34.12 	(7) provides a notice at least annually of the amount of funds authorized for services.
34.13 	(b) When a county is evaluating denials, reductions, or terminations of home and 
34.14 	community-based services under section 256B.49 for an individual, the case manager 
34.15 	shall offer to meet with the individual or the individual's guardian in order to discuss the 
34.16 	prioritization of service needs within the individualized service plan. The reduction in 
34.17 	the authorized services for an individual due to changes in funding for waivered services 
34.18 	may not exceed the amount needed to ensure medically necessary services to meet the 
34.19 	individual's health, safety, and welfare.

34.20 	Sec. 31. Minnesota Statutes 2010, section 256B.49, subdivision 21, is amended to read:
34.21 		Subd. 21.Report. (a) The commissioner shall expand on the annual report required 
34.22 	under section 256B.0916, subdivision 7, to include information on the county of residence 
34.23 	and financial responsibility, age, and major diagnoses for persons eligible for the home 
34.24 	and community-based waivers authorized under subdivision 11 who are:
34.25 	(1) receiving those services;
34.26 	(2) screened and waiting for waiver services; and
34.27 	(3) residing in nursing facilities and are under age 65.
34.28 	(b) This subdivision expires January 1, 2012.

34.29 	Sec. 32. Minnesota Statutes 2010, section 256B.4912, is amended to read:
34.30 	256B.4912 HOME AND COMMUNITY-BASED WAIVERS; PROVIDERS 
34.31 	AND PAYMENT.
34.32 		Subdivision 1.Provider qualifications. (a) For the home and community-based 
34.33 	waivers providing services to seniors and individuals with disabilities, the commissioner 
34.34 	shall establish:
35.1 	(1) agreements with enrolled waiver service providers to ensure providers meet 
35.2 	~~qualifications defined in the waiver plans~~ Minnesota health care program requirements;
35.3 	(2) regular reviews of provider qualifications, and including requests of proof of 
35.4 	documentation; and
35.5 	(3) processes to gather the necessary information to determine provider 
35.6 	qualifications.
35.7 	~~By July 2010,~~Beginning July 2011, staff that provide direct contact~~, as defined~~ 
35.8 	~~in section 245C.02, subdivision 11, that are employees of waiver service providers~~ for 
35.9 	services specified in the federally approved waiver plans must meet the requirements 
35.10 	of chapter 245C prior to providing waiver services and as part of ongoing enrollment. 
35.11 	Upon federal approval, this requirement must also apply to consumer-directed community 
35.12 	supports.
35.13 	(b) By January 1, 2013, or on the date the state adopts rules under subdivision 4, 
35.14 	whichever is sooner, providers of waiver services must re-enroll with the state. County 
35.15 	and tribal agency contracts existing prior to January 1, 2013, are not effective beginning 
35.16 	January 1, 2013.
35.17 		Subd. 1a.Definitions. For the purposes of this section, the following definitions 
35.18 	apply.
35.19 	(a) "Home and community-based service providers" means approved vendors who 
35.20 	provide community services and long-term supports under medical assistance programs 
35.21 	that include waiver programs as defined in sections 245B.092, 256B.0915, and 256B.49, 
35.22 	and state plan home care services as defined in section 256B.0651.
35.23 	(b) "Home and community-based service administrators" means counties and tribes 
35.24 	that, individually or collaboratively, administer home and community-based waiver 
35.25 	services delivery in a consistent manner under a state agency directive.
35.26 		Subd. 2.Rate-setting methodologies. (a) The commissioner shall establish 
35.27 	statewide rate-setting methodologies that meet federal waiver requirements for home 
35.28 	and community-based waiver services for individuals with disabilities. The rate-setting 
35.29 	methodologies must abide by the principles of transparency and equitability across the 
35.30 	state. The methodologies must involve a uniform process of structuring rates for each 
35.31 	service and must promote quality and participant choice.
35.32 	(b) No later than January 1, 2012, the commissioner shall authorize the final 
35.33 	determination of rates for waiver and day services. Rates must be determined utilizing 
35.34 	individualized payment structures and methodologies established by the commissioner.
35.35 		Subd. 3.Payment rate criteria. (a) The payment structures and methodologies 
35.36 	under this section shall reflect the payment rate criteria in paragraphs (b) and (c).
36.1 	(b) Payment rates must be based on reasonable costs that are ordinary, necessary, 
36.2 	and related to delivery of authorized client services.
36.3 	(c) The commissioner must not reimburse:
36.4 	(1) unauthorized service delivery;
36.5 	(2) services provided under a receipt of a special grant;
36.6 	(3) services provided under contract to a local school district;
36.7 	(4) extended employment services under Minnesota Rules, parts 3300.2005 to 
36.8 	3300.3100, or vocational rehabilitation services provided under the federal Rehabilitation 
36.9 	Act, as amended, Title I, section 110, or Title VI-C, and not through use of medical 
36.10 	assistance or county social service funds; or
36.11 	(5) services provided to a client by a licensed medical, therapeutic, or rehabilitation 
36.12 	practitioner or any other vendor of medical care which are billed separately on a 
36.13 	fee-for-service basis.
36.14 		Subd. 4.Rate exception process. The payment structures and methodologies 
36.15 	under this section must include procedures to seek authorization from the commissioner 
36.16 	for exceptions for very dependent persons with special needs to the rates in excess of the 
36.17 	amounts as determined utilizing individualized payment structures and methodologies 
36.18 	established by the commissioner under subdivision 2.
36.19 		Subd. 5.Shared service limits. The commissioner retains authority to limit the 
36.20 	number of people that share waiver and day services. Individualized payment structures 
36.21 	and methodologies established by the commissioner under subdivision 2 must reflect the 
36.22 	option to share services within the limits established by the commissioner.
36.23 		Subd. 6.Home and community-based service administrator roles and 
36.24 	responsibilities. The commissioner shall define roles and responsibilities of home and 
36.25 	community-based service administrators to include:
36.26 	(1) certification functions to include monitoring and review of waiver home and 
36.27 	community-based service providers in compliance with federal requirements; and
36.28 	(2) assessment of home and community-based waiver service capacity and 
36.29 	development to address identified service gaps.
36.30 		Subd. 7.Authority to enter into expedited rulemaking. The commissioner is 
36.31 	authorized to adopt rules using the expedited rulemaking process as defined in section 
36.32 	14.389. Rules adopted under the expedited rulemaking process are in effect until 
36.33 	operational structures under subdivisions 1 to 6 are developed, evaluated, and approved 
36.34 	and rules are adopted through the rulemaking process in sections 14.131 to 14.28 and 
36.35 	pursuant to the authority in sections 256B.04, subdivision 2, and 256B.092, subdivision 6.

37.1 	Sec. 33. Minnesota Statutes 2010, section 256B.501, subdivision 4b, is amended to 
37.2 	read:
37.3 		Subd. 4b.Waiver rates and group residential housing rates. (a) The average 
37.4 	daily reimbursement rates established by the commissioner for waivered services shall 
37.5 	be adjusted to include the additional costs of services eligible for waiver funding under 
37.6 	title XIX of the Social Security Act and for which there is no group residential housing 
37.7 	payment available as a result of the payment limitations set forth in section 256I.05, 
37.8 	subdivision 10. The adjustment to the waiver rates shall be based on county reports of 
37.9 	service costs that are no longer eligible for group residential housing payments. No 
37.10 	adjustment shall be made for any amount of reported payments that prior to July 1, 1992, 
37.11 	exceeded the group residential housing rate limits established in section 256I.05 and were 
37.12 	reimbursed through county funds.
37.13 	(b) This subdivision expires January 1, 2013, or on the date the commissioner adopts 
37.14 	rules for the administration of home and community-based services waivers under section 
37.15 	256B.4912, subdivision 4, whichever is sooner.

37.16 	Sec. 34. Laws 2009, chapter 79, article 8, section 81, as amended by Laws 2010, 
37.17 	chapter 352, article 1, section 24, is amended to read:
37.18 	Sec. 81. ESTABLISHING A SINGLE SET OF STANDARDS.
 37.19 	(a) The commissioner of human services shall consult with disability service 
37.20 	providers, advocates, counties, and consumer families to develop a single set of standards, 
37.21 	to be referred to as "quality outcome standards," governing services for people with 
37.22 	disabilities receiving services under the home and community-based waiver services 
37.23 	program, with the exception of customized living services because the service license 
37.24 	is under the jurisdiction of the Department of Health, to replace all or portions of 
37.25 	existing laws and rules including, but not limited to, data practices, licensure of facilities 
37.26 	and providers, background studies, reporting of maltreatment of minors, reporting of 
37.27 	maltreatment of vulnerable adults, and the psychotropic medication checklist. The 
37.28 	standards must:
37.29 	(1) enable optimum consumer choice;
37.30 	(2) be consumer driven;
37.31 	(3) link services to individual needs and life goals;
37.32 	(4) be based on quality assurance and individual outcomes; 
37.33 	(5) utilize the people closest to the recipient, who may include family, friends, and 
37.34 	health and service providers, in conjunction with the recipient's risk management plan to 
38.1 	assist the recipient or the recipient's guardian in making decisions that meet the recipient's 
38.2 	needs in a cost-effective manner and assure the recipient's health and safety;
38.3 	(6) utilize person-centered planning; and
38.4 	(7) maximize federal financial participation.
38.5 	(b) The commissioner may consult with existing stakeholder groups convened under 
38.6 	the commissioner's authority, including the home and community-based expert services 
38.7 	panel established by the commissioner in 2008, to meet all or some of the requirements 
38.8 	of this section.
38.9 	(c) The commissioner shall provide the reports and plans required by this section to 
38.10 	the legislative committees and budget divisions with jurisdiction over health and human 
38.11 	services policy and finance by January 15, 2012.

38.12 	Sec. 35. STREAMLINE CONSUMER-DIRECTED SERVICES.
 38.13 	The commissioner of human services shall prepare and provide recommendations 
38.14 	for streamlining administrative oversight, financial management, and payment protocols 
38.15 	for consumer-directed services administered through the commissioner, including 
38.16 	consumer-directed community supports, under Minnesota Statutes, sections 256B.49, 
38.17 	subdivision 16, and 256B.0916, subdivision 6a; consumer support grants, under Minnesota 
38.18 	Statutes, section 256.476; family support grants, under Minnesota Statutes, section 252.32; 
38.19 	and any other consumer directed service options identified by the commissioner. The 
38.20 	commissioner shall report to the legislature by January 15, 2012, with recommendations 
38.21 	prepared under this section.

38.22 	Sec. 36.  REPEALER.
 38.23 	Minnesota Statutes 2010, sections 252.46, subdivisions 1, 2, 3, 4, 5, 6, 7, 8, 9, 
38.24 	10, 11, 16, 17, 18, 19, 20, and 21; 256.0112, subdivision 6; 256B.092, subdivision 8a; 
38.25 	256B.49, subdivision 16a; and 256B.501, subdivision 8, are repealed effective January 1, 
38.26 	2013, or on the date the commissioner adopts rules for the administration of home and 
38.27 	community-based services waivers under section 256B.4912, subdivision 4, whichever 
38.28 	is sooner.

38.29 	ARTICLE 3
38.30 	COMPREHENSIVE ASSESSMENT AND CASE MANAGEMENT REFORM

38.31 	Section 1. Minnesota Statutes 2010, section 256B.0659, subdivision 1, is amended to 
38.32 	read:
39.1 		Subdivision 1.Definitions. (a) For the purposes of this section, the terms defined in 
39.2 	paragraphs (b) to (r) have the meanings given unless otherwise provided in text.
39.3 	(b) "Activities of daily living" means grooming, dressing, bathing, transferring, 
39.4 	mobility, positioning, eating, and toileting.
39.5 	(c) "Level I behavior~~,~~" ~~effective January 1, 2010,~~ means a category to determine 
39.6 	the home care rating ~~and is based on the criteria found in this section. "Level I behavior"~~ 
39.7 	~~means~~ and is defined as physical aggression towards self, others, or destruction of property 
39.8 	that requires the immediate response of another person and either:
39.9 	(1) has occurred within 30 days prior to the assessment; or
39.10 	(2) there is objective evidence that, without intervention, it would have occurred 
39.11 	30 days prior to the assessment. Objective evidence includes logs of intervention kept 
39.12 	by the family or provider.
39.13 	(d) "Complex health-related needs," effective January 1, 2010, means a category to 
39.14 	determine the home care rating and is based on the criteria found in this section.
39.15 	(e) "Critical activities of daily living," effective January 1, 2010, means transferring, 
39.16 	mobility, eating, and toileting.
39.17 	(f) "Dependency in activities of daily living" means a person requires physical 
39.18 	assistance to begin and complete one or more of the activities of daily living~~.~~ or 
39.19 	constant oversight, cueing, and monitoring throughout the activity. Dependency does not 
39.20 	mean oversight, cueing, monitoring, and redirection related to behaviors, as defined in 
39.21 	subdivision 4, paragraph (d). The need must be present on a daily basis or on the days 
39.22 	that the activity is performed. For the purposes of this section, a person is not considered 
39.23 	dependent in an activity of daily living if the person needs assistance only to begin or 
39.24 	set up the activity.
39.25 	(g) "Extended personal care assistance service" means personal care assistance 
39.26 	services included in a service plan under one of the home and community-based services 
39.27 	waivers authorized under sections 256B.0915, 256B.092, subdivision 5, and 256B.49, 
39.28 	which exceed the amount, duration, and frequency of the state plan personal care 
39.29 	assistance services for participants who:
39.30 	(1) need assistance provided periodically during a week, but less than daily will not 
39.31 	be able to remain in their homes without the assistance, and other replacement services 
39.32 	are more expensive or are not available when personal care assistance services are to be 
39.33 	terminated; or
39.34 	(2) need additional personal care assistance services beyond the amount authorized 
39.35 	by the state plan personal care assistance assessment in order to ensure that their safety, 
39.36 	health, and welfare are provided for in their homes.
40.1 	(h) "Health-related procedures and tasks" means procedures and tasks that can 
40.2 	be delegated or assigned by a licensed health care professional under state law to be 
40.3 	performed by a personal care assistant.
40.4 	(i) "Instrumental activities of daily living" means activities to include meal planning 
40.5 	and preparation; basic assistance with paying bills; shopping for food, clothing, and other 
40.6 	essential items; performing household tasks integral to the personal care assistance 
40.7 	services; communication by telephone and other media; and traveling, including to 
40.8 	medical appointments and to participate in the community.
40.9 	(j) "Managing employee" has the same definition as Code of Federal Regulations, 
40.10 	title 42, section 455.
40.11 	(k) "Qualified professional" means a professional providing supervision of personal 
40.12 	care assistance services and staff as defined in section 256B.0625, subdivision 19c.
40.13 	(l) "Personal care assistance provider agency" means a medical assistance enrolled 
40.14 	provider that provides or assists with providing personal care assistance services and 
40.15 	includes a personal care assistance provider organization, personal care assistance choice 
40.16 	agency, class A licensed nursing agency, and Medicare-certified home health agency.
40.17 	(m) "Personal care assistant" or "PCA" means an individual employed by a personal 
40.18 	care assistance agency who provides personal care assistance services.
40.19 	(n) "Personal care assistance care plan" means a written description of personal 
40.20 	care assistance services developed by the personal care assistance provider according 
40.21 	to the service plan.
40.22 	(o) "Responsible party" means an individual who is capable of providing the support 
40.23 	necessary to assist the recipient to live in the community.
40.24 	(p) "Self-administered medication" means medication taken orally, by injection or 
40.25 	insertion, or applied topically without the need for assistance.
40.26 	(q) "Service plan" means a written summary of the assessment and description of the 
40.27 	services needed by the recipient.
40.28 	(r) "Wages and benefits" means wages and salaries, the employer's share of FICA 
40.29 	taxes, Medicare taxes, state and federal unemployment taxes, workers' compensation, 
40.30 	mileage reimbursement, health and dental insurance, life insurance, disability insurance, 
40.31 	long-term care insurance, uniform allowance, and contributions to employee retirement 
40.32 	accounts.

40.33 	Sec. 2. Minnesota Statutes 2010, section 256B.0659, subdivision 2, is amended to read:
41.1 		Subd. 2.Personal care assistance services; covered services. (a) The personal 
41.2 	care assistance services eligible for payment include services and supports furnished 
41.3 	to an individual, as needed, to assist in:
41.4 	(1) activities of daily living;
41.5 	(2) health-related procedures and tasks;
41.6 	(3) observation and redirection of behaviors; and
41.7 	(4) instrumental activities of daily living.
41.8 	(b) Activities of daily living include the following covered services:
41.9 	(1) dressing, including assistance with choosing, application, and changing of 
41.10 	clothing and application of special appliances, wraps, or clothing;
41.11 	(2) grooming, including assistance with basic hair care, washing hands, oral care, 
41.12 	shaving, applying cosmetics and deodorant, feminine hygiene, and care of eyeglasses and 
41.13 	hearing aids. Nail care is included, except for recipients who are diabetic or have poor 
41.14 	circulation;
41.15 	(3) bathing, ~~including~~ assistance with basic personal hygiene, and inspection of the 
41.16 	skin and skin care;
41.17 	(4) eating~~, including~~ and assistance with ~~hand washing and~~ application of orthotics 
41.18 	required for eating~~, transfers,~~ and feeding;
41.19 	(5) transfers, including hands-on assistance with transferring the recipient from one 
41.20 	seating or reclining area to another, and transfers for activities of daily living;
41.21 	(6) mobility, including hands-on assistance with ~~ambulation~~ locomotion, ~~including~~
41.22 	or with the use of a wheelchair or other device inside or outside of the home. Mobility 
41.23 	does not include providing transportation for a recipient or redirection and monitoring;
41.24 	(7) positioning, ~~including~~ defined as hands-on assistance with positioning or turning 
41.25 	a recipient for necessary care and comfort; and
41.26 	(8) toileting, including assistance with helping recipient with bowel or bladder 
41.27 	elimination and care ~~including transfers, mobility, positioning, feminine hygiene~~, use of 
41.28 	toileting equipment or supplies, cleansing the perineal area, ~~inspection of the skin,~~ and 
41.29 	adjusting clothing.
41.30 	(c) Health-related procedures and tasks include the following covered services:
41.31 	(1) range of motion and passive exercise to maintain a recipient's strength and 
41.32 	muscle functioning;
41.33 	(2) assistance with self-administered medication as defined by this section~~, including~~. 
41.34 	The personal care assistant must not determine the medication dose or time for the 
41.35 	medication. Assistance with medications includes reminders to take medication, bringing 
42.1 	medication to the recipient, and assistance with opening medication under the direction of 
42.2 	the recipient or responsible party, including medications given through a nebulizer;
42.3 	(3) interventions for seizure disorders, including monitoring and observation; and
42.4 	(4) other activities considered within the scope of the personal care service and 
42.5 	meeting the definition of health-related procedures and tasks under this section.
42.6 	(d) A personal care assistant may provide health-related procedures and tasks 
42.7 	associated with the complex health-related needs of a recipient if the procedures and 
42.8 	tasks meet the definition of health-related procedures and tasks under this section and the 
42.9 	personal care assistant is trained by a qualified professional and demonstrates competency 
42.10 	to safely complete the procedures and tasks. Delegation of health-related procedures and 
42.11 	tasks and all training must be documented in the personal care assistance care plan and the 
42.12 	recipient's and personal care assistant's files.
42.13 	(e) Effective January 1, 2010, for a personal care assistant to provide the 
42.14 	health-related procedures and tasks of tracheostomy suctioning and services to recipients 
42.15 	on ventilator support there must be:
42.16 	(1) delegation and training by a registered nurse, certified or licensed respiratory 
42.17 	therapist, or a physician;
42.18 	(2) utilization of clean rather than sterile procedure;
42.19 	(3) specialized training about the health-related procedures and tasks and equipment, 
42.20 	including ventilator operation and maintenance;
42.21 	(4) individualized training regarding the needs of the recipient; and
42.22 	(5) supervision by a qualified professional who is a registered nurse.
42.23 	(f) Effective January 1, 2010, a personal care assistant may observe and redirect the 
42.24 	recipient for episodes where there is a need for redirection due to behaviors. Training of 
42.25 	the personal care assistant must occur based on the needs of the recipient, the personal 
42.26 	care assistance care plan, and any other support services provided.
42.27 	(g) Instrumental activities of daily living under subdivision 1, paragraph (i).

42.28 	Sec. 3. Minnesota Statutes 2010, section 256B.0659, subdivision 3a, is amended to 
42.29 	read:
42.30 		Subd. 3a.Assessment; defined. This subdivision is effective until January 1, 2012, 
42.31 	or until a new form and process have been developed by the commissioner, whichever 
42.32 	is later. "Assessment" means a review and evaluation of a recipient's need for ~~home~~
42.33 	personal care assistance services conducted in person. Assessments for personal care 
42.34 	assistance services shall be conducted by the county public health nurse or a certified 
42.35 	public health nurse under contract with the county except when a long-term care 
43.1 	consultation is being conducted for the purposes of determining a person's eligibility for 
43.2 	home and community-based waiver services according to section 256B.0911 and the 
43.3 	support plan may include personal care assistance services. An in-person assessment 
43.4 	must include: documentation of health status, determination of need, evaluation of 
43.5 	service effectiveness, identification of appropriate services, service plan development 
43.6 	or modification, coordination of services, referrals and follow-up to appropriate payers 
43.7 	and community resources, completion of required reports, recommendation of service 
43.8 	authorization, and consumer education. Once the need for personal care assistance 
43.9 	services is determined under this section or sections 256B.0651, 256B.0653, 256B.0654, 
43.10 	and 256B.0656, the county public health nurse or certified public health nurse under 
43.11 	contract with the county is responsible for communicating this recommendation to the 
43.12 	commissioner and the recipient. An in-person assessment must occur at least annually or 
43.13 	when there is a significant change in the recipient's condition or when there is a change 
43.14 	in the need for personal care assistance services. A service update may substitute for 
43.15 	the annual face-to-face assessment when there is not a significant change in recipient 
43.16 	condition or a change in the need for personal care assistance service. A service update 
43.17 	may be completed by telephone, used when there is no need for an increase in personal 
43.18 	care assistance services, and used for two consecutive assessments if followed by a 
43.19 	face-to-face assessment. A service update must be completed on a form approved by the 
43.20 	commissioner. A service update or review for temporary increase includes a review of 
43.21 	initial baseline data, evaluation of service effectiveness, redetermination of service need, 
43.22 	modification of service plan and appropriate referrals, update of initial forms, obtaining 
43.23 	service authorization, and on going consumer education. Assessments or reassessments 
43.24 	must be completed on forms provided by the commissioner within ~~30~~ 20 days of a request 
43.25 	for home care services by a recipient or responsible party ~~or personal care provider agency~~.

43.26 	Sec. 4. Minnesota Statutes 2010, section 256B.0659, subdivision 4, is amended to read:
43.27 		Subd. 4.Assessment for personal care assistance services; limitations. (a) An 
43.28 	assessment as defined in subdivision 3a must be completed for personal care assistance 
43.29 	services.
43.30 	(b) The following limitations apply to the assessment:
43.31 	(1) a person must be assessed as dependent in an activity of daily living ~~based on the~~ 
43.32 	~~person's daily need or need on the days during the week the activity is completed for:~~
43.33 	~~(i) cuing and constant supervision to complete the task; or~~
44.1 	~~(ii) hands-on assistance to complete the task; and~~ if the need for assistance meets 
44.2 	the definition of dependency defined in subdivision 1, paragraph (e), except as noted in 
44.3 	subdivision 2; and
44.4 	(2) a child may not be found to be dependent in an activity of daily living if because 
44.5 	of the child's age an adult would either perform the activity for the child or assist the child 
44.6 	with the activity. Assistance needed is the assistance appropriate for a typical child of 
44.7 	the same age.
44.8 	(c) Assessment for complex health-related needs must meet the criteria in this 
44.9 	paragraph. During the assessment process, a recipient qualifies as having complex 
44.10 	health-related needs if the recipient has one or more of the interventions that are ordered by 
44.11 	a physician, specified in a personal care assistance care plan, and found in the following:
44.12 	(1) tube feedings requiring:
44.13 	(i) a gastrojejunostomy tube; or
44.14 	(ii) continuous tube feeding lasting longer than 12 hours per day;
44.15 	(2) wounds described as:
44.16 	(i) stage III or stage IV;
44.17 	(ii) multiple wounds;
44.18 	(iii) requiring sterile or clean dressing changes or a wound vac; or
44.19 	(iv) open lesions such as burns, fistulas, tube sites, or ostomy sites that require 
44.20 	specialized care;
44.21 	(3) parenteral therapy described as:
44.22 	(i) IV therapy more than two times per week lasting longer than four hours for 
44.23 	each treatment; or
44.24 	(ii) total parenteral nutrition (TPN) daily;
44.25 	(4) respiratory interventions, including:
44.26 	(i) oxygen required more than eight hours per day;
44.27 	(ii) respiratory vest more than one time per day;
44.28 	(iii) bronchial drainage treatments more than two times per day;
44.29 	(iv) sterile or clean suctioning more than six times per day;
44.30 	(v) dependence on another to apply respiratory ventilation augmentation devices 
44.31 	such as BiPAP and CPAP; and
44.32 	(vi) ventilator dependence under section 256B.0652;
44.33 	(5) insertion and maintenance of catheter, including:
44.34 	(i) sterile catheter changes more than one time per month;
44.35 	(ii) clean intermittent catheterization, and including self-catheterization more than 
44.36 	six times per day; or
45.1 	(iii) bladder irrigations;
45.2 	(6) bowel program more than two times per week requiring more than 30 minutes to 
45.3 	perform each time;
45.4 	(7) neurological intervention, including:
45.5 	(i) seizures more than two times per week affecting daily functioning and requiring 
45.6 	significant physical assistance to maintain safety; or
45.7 	(ii) swallowing disorders diagnosed by a physician and requiring specialized 
45.8 	assistance from another on a daily basis; and
45.9 	(8) other congenital or acquired diseases creating a need for significantly increased 
45.10 	direct hands-on assistance and interventions in six to eight activities of daily living.
45.11 	(d) An assessment of behaviors must meet the criteria in this paragraph. A recipient 
45.12 	qualifies as having a need for assistance due to behaviors if the recipient's behavior requires 
45.13 	assistance at least four times per week and shows one or more of the following behaviors:
45.14 	(1) physical aggression towards self or others, or destruction of property that requires 
45.15 	the immediate response of another person;
45.16 	(2) increased vulnerability due to cognitive deficits or socially inappropriate 
45.17 	behavior; or
45.18 	(3) increased need for assistance for recipients who are verbally aggressive ~~and~~ or 
45.19 	 resistive to care such that the time needed to perform activities of daily living is increased.

45.20 	Sec. 5. Minnesota Statutes 2010, section 256B.0911, subdivision 1, is amended to read:
45.21 		Subdivision 1.Purpose and goal. (a) The purpose of long-term care consultation 
45.22 	services is to assist persons with long-term or chronic care needs in making ~~long-term~~ care 
45.23 	decisions and selecting support and service options that meet their needs and reflect their 
45.24 	preferences. The availability of, and access to, information and other types of assistance, 
45.25 	including assessment and support planning, is also intended to prevent or delay ~~certified~~ 
45.26 	~~nursing facility~~ institutional placements and to provide access to transition assistance 
45.27 	after admission. Further, the goal of these services is to contain costs associated with 
45.28 	unnecessary ~~certified nursing facility~~ institutional admissions. Long-term consultation 
45.29 	services must be available to any person regardless of public program eligibility. The 
45.30 	commissioner of human services shall seek to maximize use of available federal and state 
45.31 	funds and establish the broadest program possible within the funding available.
45.32 	(b) These services must be coordinated with long-term care options counseling 
45.33 	provided under section 256.975, subdivision 7, and section 256.01, subdivision 24~~, for~~ 
45.34 	~~telephone assistance and follow up and to offer a variety of cost-effective alternatives~~ 
45.35 	~~to persons with disabilities and elderly persons~~. The ~~county or tribal~~ lead agency ~~or~~ 
46.1 	~~managed care plan~~ providing long-term care consultation services shall encourage the use 
46.2 	of volunteers from families, religious organizations, social clubs, and similar civic and 
46.3 	service organizations to provide community-based services.

46.4 	Sec. 6. Minnesota Statutes 2010, section 256B.0911, subdivision 1a, is amended to 
46.5 	read:
46.6 		Subd. 1a.Definitions. For purposes of this section, the following definitions apply:
46.7 	(a) "Long-term care consultation services" means:
46.8 	(1) intake for and access to assistance in identifying services needed to maintain an 
46.9 	individual in the most inclusive environment;
46.10 	(2) providing recommendations ~~on~~ for and referrals to cost-effective community 
46.11 	services that are available to the individual;
46.12 	(3) development of an individual's person-centered community support plan;
46.13 	(4) providing information regarding eligibility for Minnesota health care programs;
46.14 	(5) face-to-face long-term care consultation assessments, which may be completed 
46.15 	in a hospital, nursing facility, intermediate care facility for persons with developmental 
46.16 	disabilities (ICF/DDs), regional treatment centers, or the person's current or planned 
46.17 	residence;
46.18 	(6) federally mandated preadmission screening ~~to determine the need for an~~ 
46.19 	~~institutional level of care~~ activities described under ~~subdivision~~ subdivisions 4a and 4b;
46.20 	(7) determination of home and community-based waiver and other service eligibility
46.21 	as required under sections 256B.0913, 256B.0915, 256B.092, and 256B.49, including 
46.22 	level of care determination for individuals who need an institutional level of care as 
46.23 	defined under section 144.0724, subdivision 11, or 256B.092, ~~service eligibility including~~ 
46.24 	~~state plan home care services identified in sections 256B.0625, subdivisions 6, 7, and 19,~~ 
46.25 	~~paragraphs (a) and (c), and 256B.0657,~~ based on assessment and community support 
46.26 	plan development ~~with~~, appropriate referrals to obtain necessary diagnostic information, 
46.27 	and including ~~the option~~ an eligibility determination for consumer-directed community 
46.28 	supports;
46.29 	(8) service eligibility determination for state plan home care services identified in:
46.30 	(i) section 256B.0625, subdivisions 7, 19a, and 19c;
46.31 	(ii) section 256B.0657; or
46.32 	(iii) consumer support grants under section 256.476;
46.33 	(9) notwithstanding provisions in Minnesota Rules, parts 9525.0004 to 9525.0024, 
46.34 	determination of eligibility for case management services available under sections 
47.1 	256B.0621, subdivision 2, paragraph (4), and 256B.0924 and Minnesota Rules, part 
47.2 	9525.0016, and also includes obtaining necessary diagnostic information;
47.3 	(10) determination of eligibility for family support grants under section 252.32 and 
47.4 	semi-independent living services under section 252.275 and day training and habilitation 
47.5 	services under section 256B.092;
47.6 	~~(8)~~ (11) providing recommendations for ~~nursing facility~~institutional placement 
47.7 	when there are no cost-effective community services available; and
47.8 	~~(9)~~ (12) providing access to assistance to transition people back to community 
47.9 	settings after ~~facility~~ institutional admission.
47.10 	(b) "Long-term care options counseling" means the services provided by the linkage 
47.11 	lines as mandated by sections 256.01 and 256.975, subdivision 7, and also includes 
47.12 	telephone assistance and follow up once a long-term care consultation assessment has 
47.13 	been completed.
47.14 	(c) "Minnesota health care programs" means the medical assistance program under 
47.15 	chapter 256B and the alternative care program under section 256B.0913.
47.16 	(d) "Lead agencies" means counties or a collaboration of counties, tribes, and health 
47.17 	plans administering long-term care consultation assessment and support planning services.

47.18 	Sec. 7. Minnesota Statutes 2010, section 256B.0911, subdivision 2b, is amended to 
47.19 	read:
47.20 		Subd. 2b.Certified assessors. (a) Beginning January 1, ~~2011~~ 2012, each lead 
47.21 	agency shall use certified assessors who have completed training and the certification 
47.22 	processes determined by the commissioner in subdivision 2c. Certified assessors shall 
47.23 	demonstrate best practices in assessment and support planning including person-centered 
47.24 	planning principals and have a common set of skills that must ensure consistency and 
47.25 	equitable access to services statewide. ~~Assessors must be part of a multidisciplinary team~~ 
47.26 	~~of professionals that includes public health nurses, social workers, and other professionals~~ 
47.27 	~~as defined in paragraph (b). For persons with complex health care needs, a public health~~ 
47.28 	~~nurse or registered nurse from a multidisciplinary team must be consulted.~~ A lead agency 
47.29 	may choose, according to departmental policies, to contract with a qualified, certified 
47.30 	assessor to conduct assessments and reassessments on behalf of the lead agency.
47.31 	(b) Certified assessors are persons with a minimum of a bachelor's degree in social 
47.32 	work, nursing with a public health nursing certificate, or other closely related field with at 
47.33 	least one year of home and community-based experience or a two-year registered nursing 
47.34 	degree with at least three years of home and community-based experience that have 
48.1 	received training and certification specific to assessment and consultation for long-term 
48.2 	care services in the state.

48.3 	Sec. 8. Minnesota Statutes 2010, section 256B.0911, subdivision 2c, is amended to 
48.4 	read:
48.5 		Subd. 2c.Assessor training and certification. The commissioner shall develop a 
48.6 	curriculum and an assessor certification process ~~to begin no later than January 1, 2010~~. All 
48.7 	existing lead agency staff designated to provide the services defined in subdivision 1a must 
48.8 	be certified by ~~December 30, 2010~~ January 1, 2012. Each lead agency is required to ensure 
48.9 	that they have sufficient numbers of certified assessors to provide long-term consultation 
48.10 	assessment and support planning within the timelines and parameters of the service ~~by~~ 
48.11 	~~January 1, 2011~~. Certified assessors are required to be recertified every three years.

48.12 	Sec. 9. Minnesota Statutes 2010, section 256B.0911, subdivision 3, is amended to read:
48.13 		Subd. 3.Long-term care consultation team. (a) Until January 1, 2011, a long-term 
48.14 	care consultation team shall be established by the county board of commissioners. Each 
48.15 	local consultation team shall consist of at least one social worker and at least one public 
48.16 	health nurse from their respective county agencies. The board may designate public 
48.17 	health or social services as the lead agency for long-term care consultation services. If a 
48.18 	county does not have a public health nurse available, it may request approval from the 
48.19 	commissioner to assign a county registered nurse with at least one year experience in 
48.20 	home care to participate on the team. Two or more counties may collaborate to establish 
48.21 	a joint local consultation team or teams.
48.22 	(b) Certified assessors must be part of a multidisciplinary team of professionals 
48.23 	that includes public health nurses, social workers, and other professionals as defined in 
48.24 	subdivision 2b, paragraph (b). The team is responsible for providing long-term care 
48.25 	consultation services to all persons located in the county who request the services, 
48.26 	regardless of eligibility for Minnesota health care programs.
48.27 	(c) The commissioner shall allow arrangements and make recommendations that 
48.28 	encourage counties and tribes to collaborate to establish joint local long-term care 
48.29 	consultation teams to ensure that long-term care consultations are done within the 
48.30 	timelines and parameters of the service. This includes integrated service models as 
48.31 	required in subdivision 1, paragraph (b).

48.32 	Sec. 10. Minnesota Statutes 2010, section 256B.0911, subdivision 3a, is amended to 
48.33 	read:
49.1 		Subd. 3a.Assessment and support planning. (a) Persons requesting assessment, 
49.2 	services planning, or other assistance intended to support community-based living, 
49.3 	including persons who need assessment in order to determine waiver or alternative care 
49.4 	program eligibility, must be visited by a long-term care consultation team within ~~15~~ 20
49.5 	calendar days after the date on which an assessment was requested or recommended. 
49.6 	After January 1, ~~2011~~ 2012, ~~these requirements~~ this requirement also ~~apply~~ applies
49.7 	to assessment of persons requesting personal care assistance services, and private duty 
49.8 	nursing~~, and home health agency services, on timelines established in subdivision 5~~. 
49.9 	Face-to-face assessments must be conducted according to paragraphs (b) to (i).
49.10 	(b) The county may utilize a team of either the social worker or public health 
49.11 	nurse, or both. After January 1, ~~2011~~ 2012, lead agencies shall use certified assessors to 
49.12 	conduct the ~~assessment in a face-to-face interview~~ assessments. The consultation team 
49.13 	members must confer regarding the most appropriate care for each individual screened 
49.14 	or assessed. For persons with complex health care needs, a public health or registered 
49.15 	nurse from the team must be consulted.
49.16 	(c) The assessment must be comprehensive and include a person-centered assessment 
49.17 	of the health, psychological, functional, environmental, and social needs of referred 
49.18 	individuals and provide information necessary to develop a community support plan that 
49.19 	meets the consumers needs, using an assessment form provided by the commissioner.
49.20 	(d) The assessment must be conducted in a face-to-face interview with the person 
49.21 	being assessed and the person's legal representative~~, as required by legally executed~~ 
49.22 	~~documents~~, and other individuals as requested by the person, who can provide information 
49.23 	on the needs, strengths, and preferences of the person necessary to develop a community 
49.24 	support plan that ensures the person's health and safety, but who is not a provider of 
49.25 	service or has any financial interest in the provision of services.
49.26 	~~(e) The person, or the person's legal representative, must be provided with written~~ 
49.27 	~~recommendations for community-based services, including consumer-directed options,~~ 
49.28 	~~or institutional care that include documentation that the most cost-effective alternatives~~ 
49.29 	~~available were offered to the individual. For purposes of this requirement, "cost-effective~~ 
49.30 	~~alternatives" means community services and living arrangements that cost the same as or~~ 
49.31 	~~less than institutional care.~~
49.32 	~~(f)~~ (e) If the person chooses to use community-based services, the person or the 
49.33 	person's legal representative must be provided with a written community support plan
49.34 	within 40 calendar days of the assessment visit, regardless of whether the individual 
49.35 	is eligible for Minnesota health care programs. The written community support plan 
49.36 	must include:
50.1 	(1) a summary of assessed needs as defined in paragraphs (c) and (d);
50.2 	(2) the individual's options and choices to meet identified needs, including all 
50.3 	available options for case management services and providers;
50.4 	(3) identification of health and safety risks and how those risks will be addressed, 
50.5 	including personal risk management strategies;
50.6 	(4) referral information; and
50.7 	(5) informal caregiver supports, if applicable.
50.8 	For persons determined eligible for services defined under subdivision 1a, paragraph 
50.9 	(a), clauses (7) to (10), the community support plan must also include the estimated annual 
50.10 	and monthly budget amount for those services. In addition, for persons determined 
50.11 	eligible for state plan home care under subdivision 1a, paragraph (a), clause (8), the 
50.12 	person or person's representative must also receive a copy of the home care service plan 
50.13 	developed by the certified assessor.
50.14 	(f) A person may request assistance in identifying community supports without 
50.15 	participating in a complete assessment. Upon a request for assistance identifying 
50.16 	community support, the person must be transferred or referred to ~~the~~ long-term care 
50.17 	options counseling services available under sections 256.975, subdivision 7, and 256.01, 
50.18 	subdivision 24, for telephone assistance and follow up.
50.19 	(g) The person has the right to make the final decision between institutional 
50.20 	placement and community placement after the recommendations have been provided, 
50.21 	except as provided in subdivision 4a, paragraph (c).
50.22 	(h) The ~~team~~ lead agency must give the person receiving assessment or support 
50.23 	planning, or the person's legal representative, materials, and forms supplied by the 
50.24 	commissioner containing the following information:
50.25 	(1) written recommendations for community-based services and consumer-directed 
50.26 	options;
50.27 	(2) documentation that the most cost-effective alternatives available were offered to 
50.28 	the individual. For purposes of this clause, "cost-effective" means community services 
50.29 	and living arrangements that cost the same as or less than institutional care;
50.30 	(3) the need for and purpose of preadmission screening if the person selects nursing 
50.31 	facility placement;
50.32 	~~(2)~~ (4) the role of ~~the~~ long-term care consultation assessment and support planning 
50.33 	in ~~waiver and alternative care program~~ eligibility determination for waiver and alternative 
50.34 	care programs, and state plan home care and case management services as defined in 
50.35 	subdivision 1a, paragraph (a), clauses (7) to (10);
50.36 	~~(3)~~ (5) information about Minnesota health care programs;
51.1 	~~(4)~~ (6) the person's freedom to accept or reject the recommendations of the team;
51.2 	~~(5)~~ (7) the person's right to confidentiality under the Minnesota Government Data 
51.3 	Practices Act, chapter 13;
51.4 	~~(6)~~ (8) the ~~long-term care consultant's~~ certified assessor's decision regarding the 
51.5 	person's need for institutional level of care as determined under criteria established 
51.6 	in section 144.0724, subdivision 11, or 256B.092 and the certified assessor's decision 
51.7 	regarding eligibility for all services and programs as defined in subdivision 1a, paragraph 
51.8 	(a), clauses (7) to (10); and
51.9 	~~(7)~~ (9) the person's right to appeal any certified assessor's decision regarding 
51.10 	eligibility for all services and programs as defined in subdivision 1a, paragraph (a), 
51.11 	clauses (7) to (10), and incorporating the decision regarding the need for ~~nursing facility~~
51.12 	institutional level of care or the ~~county's~~ lead agency's final decisions regarding public 
51.13 	programs eligibility according to section 256.045, subdivision 3.
51.14 	(i) Face-to-face assessment completed as part of eligibility determination for 
51.15 	the alternative care, elderly waiver, community alternatives for disabled individuals, 
51.16 	community alternative care, and traumatic brain injury waiver programs under sections 
51.17 	256B.0913, 256B.0915, ~~256B.0917,~~ and 256B.49 is valid to establish service eligibility 
51.18 	for no more than 60 calendar days after the date of assessment. The effective eligibility 
51.19 	start date for these programs can never be prior to the date of assessment. If an assessment 
51.20 	was completed more than 60 days before the effective waiver or alternative care program 
51.21 	eligibility start date, assessment and support plan information must be updated in a 
51.22 	face-to-face visit and documented in the department's Medicaid Management Information 
51.23 	System (MMIS). The effective date of program eligibility in this case cannot be prior to 
51.24 	the date the updated assessment is completed.

51.25 	Sec. 11. Minnesota Statutes 2010, section 256B.0911, subdivision 3b, is amended to 
51.26 	read:
51.27 		Subd. 3b.Transition assistance. (a) ~~A long-term care consultation team~~ Lead 
51.28 	agency certified assessors shall provide assistance to persons residing in a nursing 
51.29 	facility, hospital, regional treatment center, or intermediate care facility for persons with 
51.30 	developmental disabilities who request or are referred for assistance. Transition assistance 
51.31 	must include assessment, community support plan development, referrals to long-term 
51.32 	care options counseling under section ~~256B.975~~ 256.975, subdivision ~~10~~ 7, for community 
51.33 	support plan implementation and to Minnesota health care programs, including home and 
51.34 	community-based waiver services and consumer-directed options through the waivers, 
51.35 	and referrals to programs that provide assistance with housing. Transition assistance 
52.1 	must also include information about the Centers for Independent Living ~~and the Senior~~ 
52.2 	~~LinkAge Line~~, Disability Linkage Line, and about other organizations that can provide 
52.3 	assistance with relocation efforts, and information about contacting these organizations to 
52.4 	obtain their assistance and support.
52.5 	(b) The ~~county~~ lead agency shall ~~develop transition processes with institutional~~ 
52.6 	~~social workers and discharge planners to~~ ensure that:
52.7 	(1) referrals for in-person assessments are taken from long-term care options 
52.8 	counselors as provided for in section 256.975, subdivision 7, paragraph (b), clause (11);
52.9 	(2) persons ~~admitted to facilities~~assessed in institutions receive information about 
52.10 	transition assistance that is available;
52.11 	~~(2)~~ (3) the assessment is completed for persons within ~~ten working~~ 20 calendar days 
52.12 	of the date of request or recommendation for assessment; ~~and~~
52.13 	~~(3)~~ (4) there is a plan for transition and follow-up for the individual's return to the 
52.14 	community~~. The plan must require~~, including notification of other local agencies when a 
52.15 	person ~~who~~ may require assistance ~~is screened by one county for admission to a facility~~
52.16 	from agencies located in another county~~.~~; and
52.17 	(5) relocation targeted case management as defined in section 256B.0621, 
52.18 	subdivision 2, clause (4), is authorized for an eligible medical assistance recipient.
52.19 	~~(c) If a person who is eligible for a Minnesota health care program is admitted to a~~ 
52.20 	~~nursing facility, the nursing facility must include a consultation team member or the case~~ 
52.21 	~~manager in the discharge planning process.~~

52.22 	Sec. 12. Minnesota Statutes 2010, section 256B.0911, subdivision 3c, is amended to 
52.23 	read:
52.24 		Subd. 3c.Transition to housing with services. (a) Housing with services 
52.25 	establishments offering or providing assisted living under chapter 144G shall inform 
52.26 	all prospective residents of the availability of and contact information for transitional 
52.27 	consultation services under this subdivision prior to executing a lease or contract with the 
52.28 	prospective resident. The purpose of transitional long-term care consultation is to support 
52.29 	persons with current or anticipated long-term care needs in making informed choices 
52.30 	among options that include the most cost-effective and least restrictive settings, and to 
52.31 	delay spenddown to eligibility for publicly funded programs by connecting people to 
52.32 	alternative services in their homes before transition to housing with services. Regardless 
52.33 	of the consultation, prospective residents maintain the right to choose housing with 
52.34 	services or assisted living if that option is their preference.
53.1 	(b) Transitional consultation services are provided as determined by the 
53.2 	commissioner of human services in partnership with ~~county~~ long-term care consultation 
53.3 	units, and the Area Agencies on Aging, and are a combination of telephone-based 
53.4 	and in-person assistance provided under models developed by the commissioner. The 
53.5 	consultation shall be performed in a manner that provides objective and complete 
53.6 	information. Transitional consultation must be provided within five working days of the 
53.7 	request of the prospective resident as follows:
53.8 	(1) the consultation must be provided by a qualified professional as determined by 
53.9 	the commissioner;
53.10 	(2) the consultation must include a review of the prospective resident's reasons for 
53.11 	considering assisted living, the prospective resident's personal goals, a discussion of the 
53.12 	prospective resident's immediate and projected long-term care needs, and alternative 
53.13 	community services or assisted living settings that may meet the prospective resident's 
53.14 	needs; and
53.15 	(3) the prospective resident shall be informed of the availability of long-term care 
53.16 	consultation services described in subdivision 3a that are available at no charge to the 
53.17 	prospective resident to assist the prospective resident in assessment and planning to meet 
53.18 	the prospective resident's long-term care needs. The Senior LinkAge Line and long-term 
53.19 	care consultation team shall give the highest priority to referrals of individuals who are at 
53.20 	highest risk of nursing facility placement or as needed for determining eligibility.

53.21 	Sec. 13. Minnesota Statutes 2010, section 256B.0911, subdivision 4a, is amended to 
53.22 	read:
53.23 		Subd. 4a.Preadmission screening activities related to nursing facility 
53.24 	admissions. (a) All applicants to Medicaid certified nursing facilities, including certified 
53.25 	boarding care facilities, must be screened prior to admission regardless of income, assets, 
53.26 	or funding sources for nursing facility care, except as described in subdivision 4b. The 
53.27 	purpose of the screening is to determine the need for nursing facility level of care as 
53.28 	described in paragraph (d) and to complete activities required under federal law related to 
53.29 	mental illness and developmental disability as outlined in paragraph (b).
53.30 	(b) A person who has a diagnosis or possible diagnosis of mental illness or 
53.31 	developmental disability must receive a preadmission screening before admission 
53.32 	regardless of the exemptions outlined in subdivision 4b, paragraph (b), to identify the need 
53.33 	for further evaluation and specialized services, unless the admission prior to screening is 
53.34 	authorized by the local mental health authority or the local developmental disabilities case 
53.35 	manager, or unless authorized by the county agency according to Public Law 101-508.
54.1 	The following criteria apply to the preadmission screening:
54.2 	(1) the ~~county~~ lead agency must use forms and criteria developed by the 
54.3 	commissioner to identify persons who require referral for further evaluation and 
54.4 	determination of the need for specialized services; and
54.5 	(2) the evaluation and determination of the need for specialized services must be 
54.6 	done by:
54.7 	(i) a qualified independent mental health professional, for persons with a primary or 
54.8 	secondary diagnosis of a serious mental illness; or
54.9 	(ii) a qualified developmental disability professional, for persons with a primary or 
54.10 	secondary diagnosis of developmental disability. For purposes of this requirement, a 
54.11 	qualified developmental disability professional must meet the standards for a qualified 
54.12 	developmental disability professional under Code of Federal Regulations, title 42, section 
54.13 	483.430.
54.14 	(c) The local county mental health authority or the state developmental disability 
54.15 	authority under Public Law Numbers 100-203 and 101-508 may prohibit admission to a 
54.16 	nursing facility if the individual does not meet the nursing facility level of care criteria or 
54.17 	needs specialized services as defined in Public Law Numbers 100-203 and 101-508. For 
54.18 	purposes of this section, "specialized services" for a person with developmental disability 
54.19 	means active treatment as that term is defined under Code of Federal Regulations, title 
54.20 	42, section 483.440 (a)(1).
54.21 	(d) The determination of the need for nursing facility level of care must be made 
54.22 	according to criteria established in section 144.0724, subdivision 11, and 256B.092, 
54.23 	using forms developed by the commissioner. In assessing a person's needs, consultation 
54.24 	team members shall have a physician available for consultation and shall consider the 
54.25 	assessment of the individual's attending physician, if any. The individual's physician must 
54.26 	be included if the physician chooses to participate. Other personnel may be included on 
54.27 	the team as deemed appropriate by the ~~county~~ lead agency.

54.28 	Sec. 14. Minnesota Statutes 2010, section 256B.0911, subdivision 4c, is amended to 
54.29 	read:
54.30 		Subd. 4c.Screening requirements. (a) A person may be screened for nursing 
54.31 	facility admission by telephone or in a face-to-face screening interview. ~~Consultation team~~ 
54.32 	~~members~~ Certified assessors shall identify each individual's needs using the following 
54.33 	categories:
55.1 	(1) the person needs no face-to-face screening interview to determine the need 
55.2 	for nursing facility level of care based on information obtained from other health care 
55.3 	professionals;
55.4 	(2) the person needs an immediate face-to-face screening interview to determine the 
55.5 	need for nursing facility level of care and complete activities required under subdivision 
55.6 	4a; or
55.7 	(3) the person may be exempt from screening requirements as outlined in subdivision 
55.8 	4b, but will need transitional assistance after admission or in-person follow-along after 
55.9 	a return home.
55.10 	(b) Persons admitted on a nonemergency basis to a Medicaid-certified nursing 
55.11 	facility must be screened prior to admission.
55.12 	(c) The ~~county~~ lead agency screening or intake activity must include processes to 
55.13 	identify persons who may require transition assistance as described in subdivision 3b.

55.14 	Sec. 15. Minnesota Statutes 2010, section 256B.0911, subdivision 6, is amended to 
55.15 	read:
55.16 		Subd. 6.Payment for long-term care consultation services. (a) The total payment 
55.17 	for each county must be paid monthly by certified nursing facilities in the county. The 
55.18 	monthly amount to be paid by each nursing facility for each fiscal year must be determined 
55.19 	by dividing the county's annual allocation for long-term care consultation services by 12 
55.20 	to determine the monthly payment and allocating the monthly payment to each nursing 
55.21 	facility based on the number of licensed beds in the nursing facility. Payments to counties 
55.22 	in which there is no certified nursing facility must be made by increasing the payment 
55.23 	rate of the two facilities located nearest to the county seat.
55.24 	(b) The commissioner shall include the total annual payment determined under 
55.25 	paragraph (a) for each nursing facility reimbursed under section 256B.431~~or~~,256B.434, 
55.26 	or 256B.441, according to section 256B.431, subdivision 2b, paragraph (g).
55.27 	(c) In the event of the layaway, delicensure and decertification, or removal from 
55.28 	layaway of 25 percent or more of the beds in a facility, the commissioner may adjust 
55.29 	the per diem payment amount in paragraph (b) and may adjust the monthly payment 
55.30 	amount in paragraph (a). The effective date of an adjustment made under this paragraph 
55.31 	shall be on or after the first day of the month following the effective date of the layaway, 
55.32 	delicensure and decertification, or removal from layaway.
55.33 	(d) Payments for long-term care consultation services are available to the county 
55.34 	or counties to cover staff salaries and expenses to provide the services described in 
55.35 	subdivision 1a. The county shall employ, or contract with other agencies to employ, within 
56.1 	the limits of available funding, sufficient personnel to provide long-term care consultation 
56.2 	services while meeting the state's long-term care outcomes and objectives as defined in 
56.3 	~~section 256B.0917,~~ subdivision 1. The county shall be accountable for meeting local 
56.4 	objectives as approved by the commissioner in the biennial home and community-based 
56.5 	services quality assurance plan on a form provided by the commissioner.
56.6 	(e) Notwithstanding section 256B.0641, overpayments attributable to payment of the 
56.7 	screening costs under the medical assistance program may not be recovered from a facility.
56.8 	(f) The commissioner of human services shall amend the Minnesota medical 
56.9 	assistance plan to include reimbursement for the local consultation teams.
56.10 	(g) Until the alternative payment methodology in paragraph (h) is implemented, 
56.11 	the county may bill, as case management services, assessments, support planning, and 
56.12 	follow-along provided to persons determined to be eligible for case management under 
56.13 	Minnesota health care programs. No individual or family member shall be charged for an 
56.14 	initial assessment or initial support plan development provided under subdivision 3a or 3b.
56.15 	(h) The commissioner shall develop an alternative payment methodology for 
56.16 	long-term care consultation services that includes the funding available under this 
56.17 	subdivision, and sections 256B.092 and 256B.0659. In developing the new payment 
56.18 	methodology, the commissioner shall consider the maximization of other funding sources, 
56.19 	including federal funding, for ~~this~~ all long-term care consultation and preadmission 
56.20 	screening activity.

56.21 	Sec. 16. Minnesota Statutes 2010, section 256B.0913, subdivision 7, is amended to 
56.22 	read:
56.23 		Subd. 7.Case management. (a) The provision of case management under the 
56.24 	alternative care program is governed by requirements in section 256B.0915, subdivisions 
56.25 	1a and 1b.
56.26 	(b) The case manager must not approve alternative care funding for a client in any 
56.27 	setting in which the case manager cannot reasonably ensure the client's health and safety. 
56.28 	(c) The case manager is responsible for the cost-effectiveness of the alternative care 
56.29 	individual ~~care~~ coordinated services and support plan and must not approve any ~~care~~ plan 
56.30 	in which the cost of services funded by alternative care and client contributions exceeds 
56.31 	the limit specified in section 256B.0915, subdivision 3, paragraph (b).
56.32 	(d) Case manager responsibilities include those in section 256B.0915, subdivision 
56.33 	1a, paragraph (g).

57.1 	Sec. 17. Minnesota Statutes 2010, section 256B.0913, subdivision 8, is amended to 
57.2 	read:
57.3 		Subd. 8.Requirements for individual ~~care~~ coordinated services and support
57.4 	plan. (a) The case manager shall implement the coordinated services and support plan ~~of~~ 
57.5 	~~care~~ for each alternative care client and ensure that a client's service needs and eligibility 
57.6 	are reassessed at least every 12 months. The  coordinated services and support plan must 
57.7 	meet the requirements in section 256B.0915, subdivision 6. The plan shall include any 
57.8 	services prescribed by the individual's attending physician as necessary to allow the 
57.9 	individual to remain in a community setting. In developing the individual's care plan, the 
57.10 	case manager should include the use of volunteers from families and neighbors, religious 
57.11 	organizations, social clubs, and civic and service organizations to support the formal home 
57.12 	care services. The lead agency shall be held harmless for damages or injuries sustained 
57.13 	through the use of volunteers under this subdivision including workers' compensation 
57.14 	liability. The case manager shall provide documentation in each individual's plan ~~of care~~
57.15 	and, if requested, to the commissioner that the most cost-effective alternatives available 
57.16 	have been offered to the individual and that the individual was free to choose among 
57.17 	available qualified providers, both public and private, including qualified case management 
57.18 	or service coordination providers other than those employed by any county; however, the 
57.19 	county or tribe maintains responsibility for prior authorizing services in accordance with 
57.20 	statutory and administrative requirements. The case manager must give the individual a 
57.21 	ten-day written notice of any denial, termination, or reduction of alternative care services.
57.22 	(b) The county of service or tribe must provide access to and arrange for case 
57.23 	management services, including assuring implementation of the coordinated services 
57.24 	and support plan. "County of service" has the meaning given it in Minnesota Rules, 
57.25 	part 9505.0015, subpart 11. The county of service must notify the county of financial 
57.26 	responsibility of the approved care plan and the amount of encumbered funds.

57.27 	Sec. 18. Minnesota Statutes 2010, section 256B.0915, subdivision 1a, is amended to 
57.28 	read:
57.29 		Subd. 1a.Elderly waiver case management services. (a) Elderly case management 
57.30 	services under the home and community-based services waiver for elderly individuals are 
57.31 	available from providers meeting qualification requirements and the standards specified 
57.32 	in subdivision 1b. Eligible recipients may choose any qualified provider of elderly case 
57.33 	management services.
57.34 	(b) Case management services assist individuals who receive waiver services in 
57.35 	gaining access to needed waiver and other state plan services~~,~~ and assist individuals in 
58.1 	appeals under section 256.045, as well as needed medical, social, educational, and other 
58.2 	services regardless of the funding source for the services to which access is gained. Case 
58.3 	managers shall collaborate with consumers, families, legal representatives, and relevant 
58.4 	medical experts and service providers in the development and periodic review of the 
58.5 	coordinated services and support plan.
58.6 	(c) A case aide shall provide assistance to the case manager in carrying out 
58.7 	administrative activities of the case management function. The case aide may not assume 
58.8 	responsibilities that require professional judgment including assessments, reassessments, 
58.9 	and care plan development. The case manager is responsible for providing oversight of 
58.10 	the case aide.
58.11 	(d) Case managers shall be responsible for ongoing monitoring of the provision of 
58.12 	services included in the individual's plan of care. Case managers shall initiate ~~and oversee~~
58.13 	the process of ~~assessment and~~ reassessment of the individual's ~~care~~ coordinated services 
58.14 	and support plan as defined in subdivision 6 and review the plan ~~of care~~ at intervals 
58.15 	specified in the federally approved waiver plan.
58.16 	(e) The county of service or tribe must provide access to and arrange for case 
58.17 	management services. County of service has the meaning given it in Minnesota Rules, 
58.18 	part 9505.0015, subpart 11.
58.19 	(f) Case management services must be provided by a public or private agency that is 
58.20 	enrolled as a medical assistance provider determined by the commissioner to meet all of 
58.21 	the requirements in subdivision 1b. Case management services must not be provided to 
58.22 	a recipient by a private agency that has a financial interest in the provision of any other 
58.23 	services included in the recipient's coordinated service and support plan. For purposes 
58.24 	of this section, "private agency" means any agency that is not identified as a lead agency 
58.25 	under section 256B.0911, subdivision 1a, paragraph (d).
58.26 	(g) Case management service activities provided to or arranged for a person include:
58.27 	(1) development of the coordinated services and support plan under subdivision 6;
58.28 	(2) informing the individual or the individual's legal guardian or conservator of 
58.29 	service options, and options for case management services and providers;
58.30 	(3) consulting with relevant medical experts or service providers;
58.31 	(4) assisting the person in the identification of potential providers;
58.32 	(5) assisting the person to access services;
58.33 	(6) coordination of services; and
58.34 	(7) evaluation and monitoring of the services identified in the plan, including at least 
58.35 	one annual face-to-face visit by the case manager with each person.

59.1 	Sec. 19. Minnesota Statutes 2010, section 256B.0915, subdivision 1b, is amended to 
59.2 	read:
59.3 		Subd. 1b.Provider qualifications and standards. The commissioner must 
59.4 	enroll qualified providers of elderly case management services under the home 
59.5 	and community-based waiver for the elderly under section 1915(c) of the Social 
59.6 	Security Act. The enrollment process shall ensure the provider's ability to meet the 
59.7 	qualification requirements and standards in this subdivision and other federal and state 
59.8 	requirements of this service. An elderly case management provider is an enrolled medical 
59.9 	assistance provider who is determined by the commissioner to have all of the following 
59.10 	characteristics:
59.11 	(1) the demonstrated capacity and experience to provide the components of 
59.12 	case management to coordinate and link community resources needed by the eligible 
59.13 	population;
59.14 	(2) administrative capacity and experience in serving the target population for 
59.15 	whom it will provide services and in ensuring quality of services under state and federal 
59.16 	requirements;
59.17 	(3) a financial management system that provides accurate documentation of services 
59.18 	and costs under state and federal requirements;
59.19 	(4) the capacity to document and maintain individual case records under state and 
59.20 	federal requirements; and
59.21 	(5) the lead agency may allow a case manager employed by the lead agency to 
59.22 	delegate certain aspects of the case management activity to another individual employed 
59.23 	by the lead agency provided there is oversight of the individual by the case manager. 
59.24 	The case manager may not delegate those aspects which require professional judgment 
59.25 	including assessments, reassessments, and ~~care~~ coordinated services and support plan 
59.26 	development. Lead agencies include counties, health plans, and federally recognized 
59.27 	tribes who authorize services under this section.

59.28 	Sec. 20. Minnesota Statutes 2010, section 256B.0915, subdivision 3c, is amended to 
59.29 	read:
59.30 		Subd. 3c.Service approval and contracting provisions. (a) Medical assistance 
59.31 	funding for skilled nursing services, private duty nursing, home health aide, and personal 
59.32 	care services for waiver recipients must be approved by the case manager and included in 
59.33 	the ~~individual care~~ coordinated services and support plan.
59.34 	(b) A lead agency is not required to contract with a provider of supplies and 
59.35 	equipment if the monthly cost of the supplies and equipment is less than $250.

60.1 	Sec. 21. Minnesota Statutes 2010, section 256B.0915, subdivision 6, is amended to 
60.2 	read:
60.3 		Subd. 6.Implementation of ~~care~~ coordinated services and support plan. (a) 
60.4 	Each elderly waiver client shall be provided a copy of a written ~~care~~ coordinated services 
60.5 	and support plan ~~that meets the requirements outlined in section 256B.0913, subdivision 8.~~ 
60.6 	~~The care plan must be implemented by the county of service when it is different than the~~ 
60.7 	~~county of financial responsibility. The county of service administering waivered services~~ 
60.8 	~~must notify the county of financial responsibility of the approved care plan.~~ that:
60.9 	(1) is developed and signed by the recipient within ten working days after the case 
60.10 	manager receives the community support plan from the certified assessor;
60.11 	(2) includes the results of the assessment information on the person's need for 
60.12 	service and identification of service needs that will be or that are met by the person's 
60.13 	relatives, friends, and others, as well as community services used by the general public;
60.14 	(3) reasonably ensures the health and safety of the recipient;
60.15 	(4) identifies the person's preferences for services as stated by the person or the 
60.16 	person's legal guardian or conservator;
60.17 	(5) reflects the person's informed choice between institutional and community-based 
60.18 	services, as well as choice of services, supports, and providers, including available case 
60.19 	manager providers;
60.20 	(6) identifies long and short-range goals for the person;
60.21 	(7) identifies specific services and the amount, frequency, duration, and cost of the 
60.22 	services to be provided to the person based on assessed needs, preferences, and available 
60.23 	resources; and
60.24 	(8) includes information about the right to appeal decisions under section 256.045;
60.25 	(b) In developing the coordinated services and support plan, the case manager should 
60.26 	also include the use of volunteers, religious organizations, social clubs, and civic and 
60.27 	service organizations to support the individual in the community. The lead agency must be 
60.28 	held harmless for damages or injuries sustained through the use of volunteers and agencies 
60.29 	under this paragraph, including workers' compensation liability.

60.30 	Sec. 22. Minnesota Statutes 2010, section 256B.092, subdivision 1, is amended to read:
60.31 		Subdivision 1.County of financial responsibility; duties. Before any services 
60.32 	shall be rendered to persons with developmental disabilities who are in need of social 
60.33 	service and medical assistance, the county of financial responsibility shall conduct or 
60.34 	arrange for a diagnostic evaluation in order to determine whether the person has or may 
60.35 	have a developmental disability or has or may have a related condition. If the county 
61.1 	of financial responsibility determines that the person has a developmental disability, 
61.2 	the county shall inform the person of case management services available under this 
61.3 	section. Except as provided in subdivision 1g or 4b, if a person is diagnosed as having a 
61.4 	developmental disability, the county of financial responsibility shall conduct or arrange for 
61.5 	a needs assessment by a certified assessor, and develop ~~or arrange for an individual service~~
61.6 	a community support plan according to section 256B.0911, ~~provide or arrange for ongoing~~ 
61.7 	~~case management services at the level identified in the individual service plan, provide~~ 
61.8 	~~or arrange for case management administration,~~ and authorize services identified in the 
61.9 	person's ~~individual service~~ coordinated services and support plan developed according to 
61.10 	subdivision 1b. Diagnostic information, obtained by other providers or agencies, may be 
61.11 	used by the county agency in determining eligibility for case management. Nothing in this 
61.12 	section shall be construed as requiring: (1) assessment in areas agreed to as unnecessary 
61.13 	by ~~the case manager~~ a certified assessor and the person, or the person's legal guardian or 
61.14 	conservator, or the parent if the person is a minor, or (2) assessments in areas where there 
61.15 	has been a functional assessment completed in the previous 12 months for which the 
61.16 	~~case manager~~ certified assessor and the person or person's guardian or conservator, or the 
61.17 	parent if the person is a minor, agree that further assessment is not necessary. For persons 
61.18 	under state guardianship, the ~~case manager~~ certified assessor shall seek authorization from 
61.19 	the public guardianship office for waiving any assessment requirements. Assessments 
61.20 	related to health, safety, and protection of the person for the purpose of identifying service 
61.21 	type, amount, and frequency or assessments required to authorize services may not be 
61.22 	waived. To the extent possible, for wards of the commissioner the county shall consider 
61.23 	the opinions of the parent of the person with a developmental disability when developing 
61.24 	the person's ~~individual service~~ community support plan and coordinated services and 
61.25 	support plan.

61.26 	Sec. 23. Minnesota Statutes 2010, section 256B.092, subdivision 1a, is amended to 
61.27 	read:
61.28 		Subd. 1a.Case management ~~administration and~~ services. (a) ~~The administrative~~ 
61.29 	~~functions of case management provided to or arranged for a person include:~~ Each recipient 
61.30 	of a home and community-based waiver shall be provided case management services by 
61.31 	qualified vendors as described in the federally approved waiver application.
61.32 	~~(1) review of eligibility for services;~~
61.33 	~~(2) screening;~~
61.34 	~~(3) intake;~~
61.35 	~~(4) diagnosis;~~
62.1 	~~(5) the review and authorization of services based upon an individualized service~~ 
62.2 	~~plan; and~~
62.3 	~~(6) responding to requests for conciliation conferences and appeals according to~~ 
62.4 	~~section 256.045 made by the person, the person's legal guardian or conservator, or the~~ 
62.5 	~~parent if the person is a minor.~~
62.6 	(b) Case management service activities provided to or arranged for a person include:
62.7 	(1) development of the ~~individual service~~ coordinated services and support plan
62.8 	under subdivision 1b;
62.9 	(2) informing the individual or the individual's legal guardian or conservator, or 
62.10 	parent if the person is a minor, of service options;
62.11 	(3) consulting with relevant medical experts or service providers;
62.12 	(4) assisting the person in the identification of potential providers;
62.13 	(5) assisting the person to access services and assisting in appeals under section 
62.14 	256.045;
62.15 	(6) coordination of services, if coordination is not provided by another service 
62.16 	provider;
62.17 	(7) evaluation and monitoring of the services identified in the coordinated services 
62.18 	and support plan, which must incorporate at least one annual face-to-face visit by the case 
62.19 	manager with each person; and
62.20 	(8) ~~annual reviews of service plans and services provided~~ review and provide the 
62.21 	lead agency with recommendations for service authorization based upon the individual's 
62.22 	needs identified in the coordinated services and support plan.
62.23 	(c) Case management ~~administration and~~ service activities that are provided to the 
62.24 	person with a developmental disability shall be provided directly by county agencies or 
62.25 	under contract. Case management services must be provided by a public or private agency 
62.26 	that is enrolled as a medical assistance provider determined by the commissioner to meet 
62.27 	all of the requirements in the approved federal waiver plans. Case management services 
62.28 	must not be provided to a recipient by a private agency that has a financial interest in the 
62.29 	provision of any other services included in the recipient's coordinated services and support 
62.30 	plan. For purposes of this section, "private agency" means any agency that is not identified 
62.31 	as a lead agency under section 256B.0911, subdivision 1a, paragraph (d).
62.32 	(d) Case managers are responsible for ~~the administrative duties and~~ service 
62.33 	provisions listed in paragraphs (a) and (b). Case managers shall collaborate with 
62.34 	consumers, families, legal representatives, and relevant medical experts and service 
62.35 	providers in the development and annual review of the ~~individualized service~~ coordinated 
62.36 	services and support plan and habilitation ~~plans~~ plan.
63.1 	(e) The Department of Human Services shall offer ongoing education in case 
63.2 	management to case managers. Case managers shall receive no less than ten hours of case 
63.3 	management education and disability-related training each year.
63.4 	(f) For persons eligible for home and community-based waiver services under this 
63.5 	section, case management service must be provided and paid for under the terms of the 
63.6 	approved federal waiver plans and must not be billed as targeted case management.

63.7 	Sec. 24. Minnesota Statutes 2010, section 256B.092, subdivision 1b, is amended to 
63.8 	read:
63.9 		Subd. 1b.~~Individual~~ Coordinated service and support plan. ~~The individual~~ 
63.10 	~~service plan must~~ (a) Each recipient of home and community-based waivered services 
63.11 	shall be provided a copy of the written coordinated service and support plan which:
63.12 	(1) is developed and signed by the recipient within ten working days after the case 
63.13 	manager receives the community support plan from the certified assessor;
63.14 	~~(1) include~~ (2) includes the results of the assessment information on the person's 
63.15 	need for service, including identification of service needs that will be or that are met 
63.16 	by the person's relatives, friends, and others, as well as community services used by 
63.17 	the general public;
63.18 	(3) reasonably ensures the health and safety of the recipient;
63.19 	~~(2) identify~~ (4) identifies the person's preferences for services as stated by the person, 
63.20 	the person's legal guardian or conservator, or the parent if the person is a minor;
63.21 	(5) provides for an informed choice, as defined in section 256B.77, subdivision 2, 
63.22 	paragraph (o), of service and support providers, and identifies all available options for 
63.23 	case management services and providers;
63.24 	~~(3) identify~~ (6) identifies long- and short-range goals for the person;
63.25 	~~(4) identify~~ (7) identifies specific services and the amount and frequency of the 
63.26 	services to be provided to the person based on assessed needs, preferences, and available 
63.27 	resources. The ~~individual service~~ coordinated service and support plan shall also specify 
63.28 	other services the person needs that are not available;
63.29 	~~(5) identify~~ (8) identifies the need for an individual program plan to be developed 
63.30 	by the provider according to the respective state and federal licensing and certification 
63.31 	standards, and additional assessments to be completed or arranged by the provider after 
63.32 	service initiation;
63.33 	~~(6) identify~~ (9) identifies provider responsibilities to implement and make 
63.34 	recommendations for modification to the ~~individual service~~ coordinated service and 
63.35 	support plan;
64.1 	~~(7) include~~ (10) includes notice of the right to request a conciliation conference or a 
64.2 	hearing under section 256.045;
64.3 	~~(8) be~~ (11) is agreed upon and signed by the person, the person's legal guardian 
64.4 	or conservator, or the parent if the person is a minor, and the authorized county 
64.5 	representative; and
64.6 	~~(9) be~~ (12) is reviewed by a health professional if the person has overriding medical 
64.7 	needs that impact the delivery of services.
64.8 	~~Service planning formats developed for interagency planning such as transition,~~ 
64.9 	~~vocational, and individual family service plans may be substituted for service planning~~ 
64.10 	~~formats developed by county agencies.~~
64.11 	(b) In developing the coordinated services and support plan, the case manager is 
64.12 	encouraged to include the use of volunteers, religious organizations, social clubs, and civic 
64.13 	and service organizations to support the individual in the community. The lead agency 
64.14 	must be held harmless for damages or injuries sustained through the use of volunteers and 
64.15 	agencies under this paragraph, including workers' compensation liability.

64.16 	Sec. 25. Minnesota Statutes 2010, section 256B.092, subdivision 1e, is amended to 
64.17 	read:
64.18 		Subd. 1e.Coordination, evaluation, and monitoring of services. (a) If the 
64.19 	~~individual service~~ coordinated service and support plan identifies the need for individual 
64.20 	program plans for authorized services, the case manager shall assure that individual 
64.21 	program plans are developed by the providers according to clauses (2) to (5). The 
64.22 	providers shall assure that the individual program plans:
64.23 	(1) are developed according to the respective state and federal licensing and 
64.24 	certification requirements;
64.25 	(2) are designed to achieve the goals of the ~~individual service~~ coordinated service 
64.26 	and support plan;
64.27 	(3) are consistent with other aspects of the ~~individual service~~ coordinated service 
64.28 	and support plan;
64.29 	(4) assure the health and safety of the person; and
64.30 	(5) are developed with consistent and coordinated approaches to services among the 
64.31 	various service providers.
64.32 	(b) The case manager shall monitor the provision of services:
64.33 	(1) to assure that the ~~individual service~~ coordinated service and support plan is 
64.34 	being followed according to paragraph (a);
65.1 	(2) to identify any changes or modifications that might be needed in the ~~individual~~ 
65.2 	~~service~~ coordinated service and support plan, including changes resulting from 
65.3 	recommendations of current service providers;
65.4 	(3) to determine if the person's legal rights are protected, and if not, notify the 
65.5 	person's legal guardian or conservator, or the parent if the person is a minor, protection 
65.6 	services, or licensing agencies as appropriate; and
65.7 	(4) to determine if the person, the person's legal guardian or conservator, or the 
65.8 	parent if the person is a minor, is satisfied with the services provided.
65.9 	(c) If the provider fails to develop or carry out the individual program plan according 
65.10 	to paragraph (a), the case manager shall notify the person's legal guardian or conservator, 
65.11 	or the parent if the person is a minor, the provider, the respective licensing and certification 
65.12 	agencies, and the county board where the services are being provided. In addition, the 
65.13 	case manager shall identify other steps needed to assure the person receives the services 
65.14 	identified in the ~~individual service~~ coordinated service and support plan.

65.15 	Sec. 26. Minnesota Statutes 2010, section 256B.092, subdivision 1g, is amended to 
65.16 	read:
65.17 		Subd. 1g.Conditions not requiring development of ~~individual service~~
65.18 	coordinated service and support plan. Unless otherwise required by federal law, the 
65.19 	county agency is not required to complete ~~an individual service~~ a coordinated service and 
65.20 	support plan as defined in subdivision 1b for:
65.21 	(1) persons whose families are requesting respite care for their family member who 
65.22 	resides with them, or whose families are requesting a family support grant and are not 
65.23 	requesting purchase or arrangement of habilitative services; and
65.24 	(2) persons with developmental disabilities, living independently without authorized 
65.25 	services or receiving funding for services at a rehabilitation facility as defined in section 
65.26 	268A.01, subdivision 6, and not in need of or requesting additional services.

65.27 	Sec. 27. Minnesota Statutes 2010, section 256B.092, subdivision 2, is amended to read:
65.28 		Subd. 2.Medical assistance. To assure quality case management to those persons 
65.29 	who are eligible for medical assistance, the commissioner shall, upon request:
65.30 	(1) provide consultation on the case management process;
65.31 	(2) assist county agencies in the ~~screening and~~ annual reviews of clients review 
65.32 	process to assure that appropriate levels of service are provided to persons;
65.33 	(3) provide consultation on service planning and development of services with 
65.34 	appropriate options;
66.1 	(4) provide training and technical assistance to county case managers; and
66.2 	(5) authorize payment for medical assistance services according to this chapter 
66.3 	and rules implementing it.

66.4 	Sec. 28. Minnesota Statutes 2010, section 256B.092, subdivision 3, is amended to read:
66.5 		Subd. 3.Authorization and termination of services. County agency case 
66.6 	managers, under rules of the commissioner, shall authorize and terminate services of 
66.7 	community and regional treatment center providers according to ~~individual service~~
66.8 	support plans. Services provided to persons with developmental disabilities may only be 
66.9 	authorized and terminated by case managers or certified assessors according to (1) rules of 
66.10 	the commissioner and (2) the ~~individual service~~ support plan as defined in subdivision 
66.11 	1b and section 256B.0911. Medical assistance services not needed shall not be authorized 
66.12 	by county agencies or funded by the commissioner. When purchasing or arranging for 
66.13 	unlicensed respite care services for persons with overriding health needs, the county 
66.14 	agency shall seek the advice of a health care professional in assessing provider staff 
66.15 	training needs and skills necessary to meet the medical needs of the person.

66.16 	Sec. 29. Minnesota Statutes 2010, section 256B.092, subdivision 5, is amended to read:
66.17 		Subd. 5.Federal waivers. (a) The commissioner shall apply for any federal 
66.18 	waivers necessary to secure, to the extent allowed by law, federal financial participation 
66.19 	under United States Code, title 42, sections 1396 et seq., as amended, for the provision 
66.20 	of services to persons who, in the absence of the services, would need the level of care 
66.21 	provided in a regional treatment center or a community intermediate care facility for 
66.22 	persons with developmental disabilities. The commissioner may seek amendments to the 
66.23 	waivers or apply for additional waivers under United States Code, title 42, sections 1396 
66.24 	et seq., as amended, to contain costs. The commissioner shall ensure that payment for 
66.25 	the cost of providing home and community-based alternative services under the federal 
66.26 	waiver plan shall not exceed the cost of intermediate care services including day training 
66.27 	and habilitation services that would have been provided without the waivered services.
66.28 	The commissioner shall seek an amendment to the 1915c home and 
66.29 	community-based waiver to allow properly licensed adult foster care homes to provide 
66.30 	residential services to up to five individuals with developmental disabilities. If the 
66.31 	amendment to the waiver is approved, adult foster care providers that can accommodate 
66.32 	five individuals shall increase their capacity to five beds, provided the providers continue 
66.33 	to meet all applicable licensing requirements.
67.1 	(b) The commissioner, in administering home and community-based waivers for 
67.2 	persons with developmental disabilities, shall ensure that day services for eligible persons 
67.3 	are not provided by the person's residential service provider, unless the person or the 
67.4 	person's legal representative is offered a choice of providers and agrees in writing to 
67.5 	provision of day services by the residential service provider. The ~~individual service~~
67.6 	coordinated service and support plan for individuals who choose to have their residential 
67.7 	service provider provide their day services must describe how health, safety, protection, 
67.8 	and habilitation needs will be met, including how frequent and regular contact with 
67.9 	persons other than the residential service provider will occur. The ~~individualized service~~
67.10 	coordinated service and support plan must address the provision of services during the 
67.11 	day outside the residence on weekdays.
67.12 	(c) When a ~~county~~ lead agency is evaluating denials, reductions, or terminations 
67.13 	of home and community-based services under section 256B.0916 for an individual, the 
67.14 	~~case manager~~ lead agency shall offer to meet with the individual or the individual's 
67.15 	guardian in order to discuss the prioritization of service needs within the ~~individualized~~ 
67.16 	~~service~~ coordinated service and support plan. The reduction in the authorized services 
67.17 	for an individual due to changes in funding for waivered services may not exceed the 
67.18 	amount needed to ensure medically necessary services to meet the individual's health, 
67.19 	safety, and welfare.

67.20 	Sec. 30. Minnesota Statutes 2010, section 256B.092, subdivision 7, is amended to read:
67.21 		Subd. 7.~~Screening teams~~ Assessments. (a) Assessments and reassessments shall 
67.22 	be conducted by certified assessors according to section 256B.0911, and must incorporate 
67.23 	appropriate referrals to determine eligibility for case management under subdivision 1a.
67.24 	(b) For persons with developmental disabilities, ~~screening teams shall be established~~ 
67.25 	~~which~~ a certified assessor shall evaluate the need for the level of care provided by 
67.26 	residential-based habilitation services, residential services, training and habilitation 
67.27 	services, and nursing facility services. The ~~evaluation~~ assessment shall address whether 
67.28 	home and community-based services are appropriate for persons who are at risk of 
67.29 	placement in an intermediate care facility for persons with developmental disabilities, or 
67.30 	for whom there is reasonable indication that they might require this level of care. The 
67.31 	~~screening team~~ certified assessor shall make an evaluation of need ~~within 60 working~~ 
67.32 	~~days of a request for service by a person with a developmental disability, and~~ within 
67.33 	five working days of an emergency admission of a person to an intermediate care 
67.34 	facility for persons with developmental disabilities. ~~The screening team shall consist of~~ 
67.35 	~~the case manager for persons with developmental disabilities, the person, the person's~~ 
68.1 	~~legal guardian or conservator, or the parent if the person is a minor, and a qualified~~ 
68.2 	~~developmental disability professional, as defined in the Code of Federal Regulations,~~ 
68.3 	~~title 42, section 483.430, as amended through June 3, 1988. The case manager may also~~ 
68.4 	~~act as the qualified developmental disability professional if the case manager meets~~ 
68.5 	~~the federal definition. County social service agencies may contract with a public or~~ 
68.6 	~~private agency or individual who is not a service provider for the person for the public~~ 
68.7 	~~guardianship representation required by the screening or individual service planning~~ 
68.8 	~~process. The contract shall be limited to public guardianship representation for the~~ 
68.9 	~~screening and individual service planning activities. The contract shall require compliance~~ 
68.10 	~~with the commissioner's instructions and may be for paid or voluntary services. For~~ 
68.11 	~~persons determined to have overriding health care needs and are seeking admission to a~~ 
68.12 	~~nursing facility or an ICF/MR, or seeking access to home and community-based waivered~~ 
68.13 	~~services, a registered nurse must be designated as either the case manager or the qualified~~ 
68.14 	~~developmental disability professional. For persons under the jurisdiction of a correctional~~ 
68.15 	~~agency, the case manager must consult with the corrections administrator regarding~~ 
68.16 	~~additional health, safety, and supervision needs. The case manager, with the concurrence~~ 
68.17 	~~of the person, the person's legal guardian or conservator, or the parent if the person is a~~ 
68.18 	~~minor, may invite other individuals to attend meetings of the screening team. No member~~ 
68.19 	~~of the screening team shall have any direct or indirect service provider interest in the case.~~ 
68.20 	~~Nothing in this section shall be construed as requiring the screening team meeting to be~~ 
68.21 	~~separate from the service planning meeting.~~

68.22 	Sec. 31. Minnesota Statutes 2010, section 256B.092, subdivision 8, is amended to read:
68.23 		Subd. 8.~~Screening team~~ Additional certified assessor duties. In addition to the 
68.24 	responsibilities of certified assessors described in section 256B.0911, for persons with 
68.25 	developmental disabilities, the ~~screening team~~ certified assessor shall:
68.26 	~~(1) review diagnostic data;~~
68.27 	~~(2) review health, social, and developmental assessment data using a uniform~~ 
68.28 	~~screening tool specified by the commissioner;~~
68.29 	~~(3) identify the level of services appropriate to maintain the person in the most~~ 
68.30 	~~normal and least restrictive setting that is consistent with the person's treatment needs;~~
68.31 	~~(4)~~ (1) identify other noninstitutional public assistance or social service that may 
68.32 	prevent or delay long-term residential placement;
68.33 	~~(5)~~ (2) assess whether a person is in need of long-term residential care;
68.34 	~~(6)~~ (3) make recommendations regarding placement and payment for: (i) social 
68.35 	service or public assistance support, or both, to maintain a person in the person's own home 
69.1 	or other place of residence; (ii) training and habilitation service, vocational rehabilitation, 
69.2 	and employment training activities; (iii) community residential placement; (iv) regional 
69.3 	treatment center placement; or (v) a home and community-based service alternative to 
69.4 	community residential placement or regional treatment center placement;
69.5 	~~(7)~~ (4) evaluate the availability, location, and quality of the services listed in clause 
69.6 	~~(6)~~ (3), including the impact of placement alternatives on the person's ability to maintain 
69.7 	or improve existing patterns of contact and involvement with parents and other family 
69.8 	members;
69.9 	~~(8)~~ (5) identify the cost implications of recommendations in clause ~~(6)~~ (3); and
69.10 	~~(9)~~ (6) make recommendations to a court as may be needed to assist the court in 
69.11 	making decisions regarding commitment of persons with developmental disabilities~~; and~~
69.12 	~~(10) inform the person and the person's legal guardian or conservator, or the parent if~~ 
69.13 	~~the person is a minor, that appeal may be made to the commissioner pursuant to section~~ 
69.14 	~~256.045~~.

69.15 	Sec. 32. Minnesota Statutes 2010, section 256B.092, subdivision 8a, is amended to 
69.16 	read:
69.17 		Subd. 8a.County ~~concurrence~~ notification. (a) If the county of financial 
69.18 	responsibility wishes to place a person in another county for services, the county of 
69.19 	financial responsibility shall ~~seek concurrence from~~ notify the proposed county of service 
69.20 	and the placement shall be made cooperatively between the two counties. Arrangements 
69.21 	shall be made between the two counties for ongoing social service, including annual 
69.22 	reviews of the person's ~~individual service~~ coordinated service and support plan. The county 
69.23 	where services are provided may not make changes in the person's ~~service~~ coordinated 
69.24 	service and support plan without approval by the county of financial responsibility.
69.25 	(b) ~~When a person has been screened and authorized for services in an intermediate~~ 
69.26 	~~care facility for persons with developmental disabilities or for home and community-based~~ 
69.27 	~~services for persons with developmental disabilities, the case manager shall assist that~~ 
69.28 	~~person in identifying a service provider who is able to meet the needs of the person~~ 
69.29 	~~according to the person's individual service plan. If the identified service is to be provided~~ 
69.30 	~~in a county other than the county of financial responsibility, the county of financial~~ 
69.31 	~~responsibility shall request concurrence of the county where the person is requesting to~~ 
69.32 	~~receive the identified services.~~ The county of service ~~may refuse to concur~~ shall notify 
69.33 	the county of financial responsibility if~~:~~
69.34 	~~(1) it can demonstrate that the provider is unable to provide the services identified in~~ 
69.35 	~~the person's individual service plan as services that are needed and are to be provided; or~~
70.1 	~~(2)~~, in the case of an intermediate care facility for persons with developmental 
70.2 	disabilities, there has been no authorization for admission by the admission review team 
70.3 	as required in section 256B.0926.
70.4 	(c) The county of service shall notify the county of financial responsibility of 
70.5 	~~concurrence or refusal to concur~~ any concerns about the chosen provider's capacity to 
70.6 	meet the needs of the person seeking to move to residential services in another county no 
70.7 	later than 20 working days following receipt of the written ~~request~~ notification. Unless 
70.8 	other mutually acceptable arrangements are made by the involved county agencies, the 
70.9 	county of financial responsibility is responsible for costs of social services and the costs 
70.10 	associated with the development and maintenance of the placement. The county of 
70.11 	service may request that the county of financial responsibility purchase case management 
70.12 	services from the county of service or from a contracted provider of case management 
70.13 	when the county of financial responsibility is not providing case management as defined 
70.14 	in this section and rules adopted under this section, unless other mutually acceptable 
70.15 	arrangements are made by the involved county agencies. Standards for payment limits 
70.16 	under this section may be established by the commissioner. Financial disputes between 
70.17 	counties shall be resolved as provided in section 256G.09. This subdivision also applies to 
70.18 	home and community-based waiver services provided under section 256B.49.

70.19 	Sec. 33. Minnesota Statutes 2010, section 256B.092, subdivision 9, is amended to read:
70.20 		Subd. 9.Reimbursement. Payment for services shall not be provided to a 
70.21 	service provider for any person placed in an intermediate care facility for persons with 
70.22 	developmental disabilities prior to the person ~~being screened by the screening team~~
70.23 	receiving an assessment by a certified assessor. The commissioner shall not deny 
70.24 	reimbursement for: (1) a person admitted to an intermediate care facility for persons 
70.25 	with developmental disabilities who is assessed to need long-term supportive services, 
70.26 	if long-term supportive services other than intermediate care are not available in that 
70.27 	community; (2) any person admitted to an intermediate care facility for persons with 
70.28 	developmental disabilities under emergency circumstances; (3) any eligible person placed 
70.29 	in the intermediate care facility for persons with developmental disabilities pending an 
70.30 	appeal of the ~~screening team's~~ certified assessor's decision; or (4) any medical assistance 
70.31 	recipient when, after full discussion of all appropriate alternatives including those that 
70.32 	are expected to be less costly than intermediate care for persons with developmental 
70.33 	disabilities, the person or the person's legal guardian or conservator, or the parent if the 
70.34 	person is a minor, insists on intermediate care placement. The ~~screening team~~ certified 
71.1 	assessor shall provide documentation that the most cost-effective alternatives available 
71.2 	were offered to this individual or the individual's legal guardian or conservator.

71.3 	Sec. 34. Minnesota Statutes 2010, section 256B.092, subdivision 11, is amended to 
71.4 	read:
71.5 		Subd. 11.Residential support services. (a) Upon federal approval, there is 
71.6 	established a new service called residential support that is available on the community 
71.7 	alternative care, community alternatives for disabled individuals, developmental 
71.8 	disabilities, and traumatic brain injury waivers. Existing waiver service descriptions 
71.9 	must be modified to the extent necessary to ensure there is no duplication between 
71.10 	other services. Residential support services must be provided by vendors licensed as a 
71.11 	community residential setting as defined in section 245A.11, subdivision 8.
71.12 	(b) Residential support services must meet the following criteria:
71.13 	(1) providers of residential support services must own or control the residential site;
71.14 	(2) the residential site must not be the primary residence of the license holder;
71.15 	(3) the residential site must have a designated program supervisor responsible for 
71.16 	program oversight, development, and implementation of policies and procedures;
71.17 	(4) the provider of residential support services must provide supervision, training, 
71.18 	and assistance as described in the person's ~~community~~ coordinated services and support 
71.19 	plan; and
71.20 	(5) the provider of residential support services must meet the requirements of 
71.21 	licensure and additional requirements of the person's ~~community~~ coordinated services and
71.22 	support plan.
71.23 	(c) Providers of residential support services that meet the definition in paragraph 
71.24 	(a) must be registered using a process determined by the commissioner beginning July 
71.25 	1, 2009.

71.26 	Sec. 35. Minnesota Statutes 2010, section 256B.49, subdivision 13, is amended to read:
71.27 		Subd. 13.Case management. (a) Each recipient of a home and community-based 
71.28 	waiver shall be provided case management services by qualified vendors as described 
71.29 	in the federally approved waiver application. The case management service activities 
71.30 	provided ~~will~~ must include:
71.31 	~~(1) assessing the needs of the individual within 20 working days of a recipient's~~ 
71.32 	~~request;~~
72.1 	~~(2) developing~~ (1) finalizing the written ~~individual service~~ coordinated service and 
72.2 	support plan within ten working days after the ~~assessment is completed~~ case manager 
72.3 	receives the plan from the certified assessor;
72.4 	~~(3)~~ (2) informing the recipient or the recipient's legal guardian or conservator 
72.5 	of service options;
72.6 	~~(4)~~ (3) assisting the recipient in the identification of potential service providers and 
72.7 	available options for case management service and providers;
72.8 	~~(5)~~ (4) assisting the recipient to access services and assisting with appeals under 
72.9 	section 256.045; and
72.10 	~~(6)~~ (5) coordinating, evaluating, and monitoring of the services identified in the 
72.11 	service plan~~;~~.
72.12 	~~(7) completing the annual reviews of the service plan; and~~
72.13 	~~(8) informing the recipient or legal representative of the right to have assessments~~ 
72.14 	~~completed and service plans developed within specified time periods, and to appeal county~~ 
72.15 	~~action or inaction under section 256.045, subdivision 3, including the determination of~~ 
72.16 	~~nursing facility level of care.~~
72.17 	(b) The case manager may delegate certain aspects of the case management service 
72.18 	activities to another individual provided there is oversight by the case manager. The case 
72.19 	manager may not delegate those aspects which require professional judgment including 
72.20 	~~assessments, reassessments, and care plan development.~~:
72.21 	(1) finalizing the coordinated service and support plan;
72.22 	(2) ongoing assessment and monitoring of the person's needs and adequacy of the 
72.23 	approved coordinated service and support plan; and
72.24 	(3) adjustments to the coordinated service and support plan.
72.25 	(c) Case management services must be provided by a public or private agency that 
72.26 	is enrolled as a medical assistance provider determined by the commissioner to meet all 
72.27 	of the requirements in the approved federal waiver plans. Case management services 
72.28 	must not be provided to a recipient by a private agency that has any financial interest in 
72.29 	the provision of any other services included in the recipient's coordinated services and 
72.30 	support plan. For purposes of this section, "private agency" means any agency that is not 
72.31 	identified as a lead agency under section 256B.0911, subdivision 1a, paragraph (d).
72.32 	(d) For persons eligible for home and community-based waiver services under this 
72.33 	section, case management service must be provided and paid for under the terms of the 
72.34 	approved federal waiver plans and must not be billed as targeted case management.

72.35 	Sec. 36. Minnesota Statutes 2010, section 256B.49, subdivision 14, is amended to read:
73.1 		Subd. 14.Assessment and reassessment. (a) Assessments ~~of each recipient's~~ 
73.2 	~~strengths, informal support systems, and need for services shall be completed within~~ 
73.3 	~~20 working days of the recipient's request. Reassessment of each recipient's strengths,~~ 
73.4 	~~support systems, and need for services shall be conducted at least every 12 months and at~~ 
73.5 	~~other times when there has been a significant change in the recipient's functioning~~ and 
73.6 	reassessments shall be conducted by certified assessors according to section 256B.0911, 
73.7 	subdivision 2b.
73.8 	(b) There must be a determination that the client requires a hospital level of care or a 
73.9 	nursing facility level of care as defined in section 144.0724, subdivision 11, at initial and 
73.10 	subsequent assessments to initiate and maintain participation in the waiver program.
73.11 	(c) Regardless of other assessments identified in section 144.0724, subdivision 4, as 
73.12 	appropriate to determine nursing facility level of care for purposes of medical assistance 
73.13 	payment for nursing facility services, only face-to-face assessments conducted according 
73.14 	to section 256B.0911, subdivisions 3a, 3b, and 4d, that result in a hospital level of care 
73.15 	determination or a nursing facility level of care determination must be accepted for 
73.16 	purposes of initial and ongoing access to waiver services payment.
73.17 	~~(d) Persons with developmental disabilities who apply for services under the nursing~~ 
73.18 	~~facility level waiver programs shall be screened for the appropriate level of care according~~ 
73.19 	~~to section 256B.092.~~
73.20 	~~(e)~~ (d) Recipients who are found eligible for home and community-based services 
73.21 	under this section before their 65th birthday may remain eligible for these services after 
73.22 	their 65th birthday if they continue to meet all other eligibility factors.

73.23 	Sec. 37. Minnesota Statutes 2010, section 256B.49, subdivision 15, is amended to read:
73.24 		Subd. 15.~~Individualized~~Coordinated service and support plan. (a) Each 
73.25 	recipient of home and community-based waivered services shall be provided a copy of the 
73.26 	written ~~service~~coordinated service and support plan which~~:~~
73.27 	~~(1) is developed and signed by the recipient within ten working days of the~~ 
73.28 	~~completion of the assessment;~~
73.29 	~~(2) meets the assessed needs of the recipient;~~
73.30 	~~(3) reasonably ensures the health and safety of the recipient;~~
73.31 	~~(4) promotes independence;~~
73.32 	~~(5) allows for services to be provided in the most integrated settings; and~~
73.33 	~~(6) provides for an informed choice, as defined in section 256B.77, subdivision~~ 
73.34 	~~2, paragraph (p), of service and support providers~~ meets the requirements in section 
73.35 	256B.092, subdivision 1b.
74.1 	(b) When a county is evaluating denials, reductions, or terminations of home and 
74.2 	community-based services under section 256B.49 for an individual, the case manager 
74.3 	shall offer to meet with the individual or the individual's guardian in order to discuss the 
74.4 	prioritization of service needs within the ~~individualized service~~ coordinated services and 
74.5 	support plan. The reduction in the authorized services for an individual due to changes 
74.6 	in funding for waivered services may not exceed the amount needed to ensure medically 
74.7 	necessary services to meet the individual's health, safety, and welfare.

74.8 	Sec. 38. Minnesota Statutes 2010, section 256G.02, subdivision 6, is amended to read:
74.9 		Subd. 6.Excluded time. "Excluded time" means:
74.10 	~~(a)~~ (1) any period an applicant spends in a hospital, sanitarium, nursing home, 
74.11 	shelter other than an emergency shelter, halfway house, foster home, semi-independent 
74.12 	living domicile or services program, residential facility offering care, board and lodging 
74.13 	facility or other institution for the hospitalization or care of human beings, as defined in 
74.14 	section 144.50, 144A.01, or 245A.02, subdivision 14; maternity home, battered women's 
74.15 	shelter, or correctional facility; or any facility based on an emergency hold under sections 
74.16 	253B.05, subdivisions 1 and 2, and 253B.07, subdivision 6;
74.17 	~~(b)~~ (2) any period an applicant spends on a placement basis in a training and 
74.18 	habilitation program, including: a rehabilitation facility or work or employment program 
74.19 	as defined in section 268A.01; ~~or receiving personal care assistance services pursuant to~~ 
74.20 	~~section 256B.0659;~~ semi-independent living services provided under section 252.275, and 
74.21 	Minnesota Rules, parts 9525.0500 to 9525.0660; or day training and habilitation programs 
74.22 	and assisted living services; and
74.23 	~~(c)~~ (3) any placement for a person with an indeterminate commitment, including 
74.24 	independent living.

74.25 	Sec. 39. RECOMMENDATIONS FOR FURTHER CASE MANAGEMENT 
74.26 	REDESIGN.
 74.27 	By February 1, 2012, the commissioner of human services shall develop a legislative 
74.28 	report with specific recommendations and language for proposed legislation to be effective 
74.29 	July 1, 2012, for the following:
74.30 	(a) definitions of service and consolidation of standards and rates to the extent 
74.31 	appropriate for all types of medical assistance case management service services, including 
74.32 	targeted case management under Minnesota Statutes, sections 256B.0621, 256B.0924, and 
74.33 	256B.094, and all types of home and community-based waiver case management and case 
75.1 	management under Minnesota Rules, parts 9525.0004 to 9525.0036. This work must be 
75.2 	completed in collaboration with efforts under Minnesota Statutes, section 256B.4912;
75.3 	(b) recommendations on county of financial responsibility requirements and quality 
75.4 	assurance measures for case management; and
75.5 	(c) identification of county administrative functions that may remain entwined in 
75.6 	case management service delivery models.

75.7 	ARTICLE 4
75.8 	NURSING FACILITIES

75.9 	Section 1. Minnesota Statutes 2010, section 144A.071, subdivision 3, is amended to 
75.10 	read:
75.11 		Subd. 3.Exceptions authorizing increase in beds; hardship areas. (a) The 
75.12 	commissioner of health, in coordination with the commissioner of human services, may 
75.13 	approve the addition of ~~a~~ new ~~certified bed or the addition of a new~~ licensed and Medicare 
75.14 	and Medicaid-certified nursing home ~~bed~~ beds, ~~under~~ using the ~~following conditions:~~
75.15 	criteria and process in this subdivision.
75.16 	~~(a) to license or certify a new bed in place of one decertified after July 1, 1993, as~~ 
75.17 	~~long as the number of certified plus newly certified or recertified beds does not exceed the~~ 
75.18 	~~number of beds licensed or certified on July 1, 1993, or to address an extreme hardship~~ 
75.19 	~~situation, in a particular county that, together with all contiguous Minnesota counties, has~~ 
75.20 	~~fewer nursing home beds per 1,000 elderly than the number that is ten percent higher than~~ 
75.21 	~~the national average of nursing home beds per 1,000 elderly individuals. For the purposes~~ 
75.22 	~~of this section, the national average of nursing home beds shall be the most recent figure~~ 
75.23 	~~that can be supplied by the federal Centers for Medicare and Medicaid Services and the~~ 
75.24 	~~number of elderly in the county or the nation shall be determined by the most recent~~ 
75.25 	~~federal census or the most recent estimate of the state demographer as of July 1, of each~~ 
75.26 	~~year of persons age 65 and older, whichever is the most recent at the time of the request for~~ 
75.27 	~~replacement. An extreme hardship situation can only be found after the county documents~~ 
75.28 	~~the existence of unmet medical needs that cannot be addressed by any other alternatives;~~
75.29 	(b) The commissioner, in cooperation with the commissioner of human services, 
75.30 	shall consider the following criteria when determining that an area of the state is a 
75.31 	hardship area with regard to access to nursing facility services:
75.32 	(1) a low number of beds per thousand in a specified area using as a standard 
75.33 	an amount lower than the beds per thousand of the county at the 20th percentile, as 
75.34 	determined by the commissioner of human services;
76.1 	(2) a high level of outmigration associated with a described area from the county or 
76.2 	counties of residence to other Minnesota counties, as determined by the commissioner 
76.3 	of human services, using as a standard an amount greater than the outmigration of the 
76.4 	county ranked at the 50th percentile;
76.5 	(3) an adequate level of availability of noninstitutional services as determined by 
76.6 	the commissioner of human services using as a standard an amount greater than the 50th 
76.7 	percentile of counties;
76.8 	(4) there must be a declaration of hardship by local county agencies and area 
76.9 	agencies on aging; and
76.10 	(5) other factors that may demonstrate the need to add new nursing facility beds.
76.11 	(c) On August 15 of odd-numbered years, the commissioner, in cooperation with 
76.12 	the commissioner of human services, may publish in the State Register a request for 
76.13 	information in which interested parties, using the data provided under section 144A.351, 
76.14 	along with any other relevant data, demonstrate that a specified area is a hardship area 
76.15 	with regard to access to nursing facility services. For a response to be considered, the 
76.16 	commissioner must receive it by November 15. The commissioner shall make responses 
76.17 	to the request for information available to the public and shall allow 30 days for comment. 
76.18 	The commissioner shall review responses and comments and determine if any areas of 
76.19 	the state are to be declared hardship areas. 
76.20 	(d) For each designated hardship area determined in paragraph (c), the commissioner 
76.21 	shall publish a request for proposals in accordance with section 144A.073 and Minnesota 
76.22 	Rules, parts 4655.1070 to 4655.1098. The request for proposals must be published in the 
76.23 	State Register by March 15 following receipt of responses to the request for information. 
76.24 	The request for proposals must specify the number of new beds which may be added 
76.25 	in the designated hardship area, which must not exceed the number which, if added to 
76.26 	the existing number of beds in the area, including beds in layaway status, would have 
76.27 	prevented it from being determined to be a hardship area under paragraph (b), clause 
76.28 	(1). Beginning July 1, 2011, the number of new beds approved must not exceed 200 
76.29 	beds statewide per biennium. After June 30, 2019, the number of new beds that may be 
76.30 	approved in a biennium must not exceed 300 statewide. For a proposal to be considered, 
76.31 	the commissioner must receive it within six months of the publication of the request for 
76.32 	proposals. The commissioner shall review responses to the request for proposals and 
76.33 	shall approve or disapprove each proposal by the following July 15, in accordance with 
76.34 	section 144A.073 and Minnesota Rules, parts 4655.1070 to 4655.1098. The commissioner 
76.35 	shall base approvals or disapprovals on a comparison and ranking of proposals using 
76.36 	only the criteria in subdivision 4a. Approval of a proposal expires after 18 months 
77.1 	unless the facility has added the new beds using existing space, subject to approval 
77.2 	by the commissioner, or has commenced construction as defined in section 144A.071, 
77.3 	subdivision 1a, paragraph (d). If fewer than 50 percent of the beds in a facility are newly 
77.4 	licensed, after the beds have been added, the operating payment rates previously in effect 
77.5 	shall remain. If 50 percent or more of the beds in a facility are newly licensed after the 
77.6 	approved beds have been added, then determination of operating payment rates shall 
77.7 	be done according to Minnesota Rules, part 9549.0057, using limits determined under 
77.8 	section 256B.441. Determination of external fixed payment rates must be done according 
77.9 	to section 256B.441, subdivision 53. Determinations of property payment rates for 
77.10 	facilities with beds added under this subdivision must be done in the same manner as rate 
77.11 	determinations resulting from projects approved and completed under section 144A.073. 
77.12 	~~(b) to~~ (e) The commissioner may:
77.13 	(1) certify or license new beds in a new facility that is to be operated by the 
77.14 	commissioner of veterans affairs or when the costs of constructing and operating the new 
77.15 	beds are to be reimbursed by the commissioner of veterans affairs or the United States 
77.16 	Veterans Administration; and
77.17 	~~(c) to~~ (2) license or certify beds in a facility that has been involuntarily delicensed or 
77.18 	decertified for participation in the medical assistance program, provided that an application 
77.19 	for relicensure or recertification is submitted to the commissioner by an organization that 
77.20 	is not a related organization as defined in section 256B.441, subdivision 34, to the prior 
77.21 	licensee within 120 days after delicensure or decertification~~;~~.
77.22 	~~(d) to certify two existing beds in a facility with 66 licensed beds on January 1, 1994,~~ 
77.23 	~~that had an average occupancy rate of 98 percent or higher in both calendar years 1992 and~~ 
77.24 	~~1993, and which began construction of four attached assisted living units in April 1993; or~~
77.25 	~~(e) to certify four existing beds in a facility in Winona with 139 beds, of which 129~~ 
77.26 	~~beds are certified.~~

77.27 	Sec. 2. Minnesota Statutes 2010, section 144A.073, subdivision 3c, is amended to read:
77.28 		Subd. 3c.Cost neutral relocation projects. (a) Notwithstanding subdivision 3, the 
77.29 	commissioner may at any time accept proposals, or amendments to proposals previously 
77.30 	approved under this section, for relocations that are cost neutral with respect to state costs 
77.31 	as defined in section 144A.071, subdivision 5a. The commissioner, in consultation with 
77.32 	the commissioner of human services, shall evaluate proposals according to subdivision 
77.33 	~~4~~ 4a, clauses (1), ~~(2), (3), and (9)~~ (4), (5), (6), and (8), and other criteria established in 
77.34 	rule~~.~~or law. The commissioner of human services shall determine the allowable payment 
77.35 	rates of the facility receiving the beds in accordance with section 256B.441, subdivision 
78.1 	60. The commissioner shall approve or disapprove a project within 90 days. ~~Proposals~~ 
78.2 	~~and amendments approved under this subdivision are not subject to the six-mile limit~~ 
78.3 	~~in subdivision 5, paragraph (e).~~
78.4 	(b) For the purposes of paragraph (a), cost neutrality shall be measured over the first 
78.5 	three 12-month periods of operation after completion of the project.

78.6 	Sec. 3. Minnesota Statutes 2010, section 144A.073, is amended by adding a 
78.7 	subdivision to read:
78.8 		Subd. 4a.Criteria for review. In reviewing the application materials and submitted 
78.9 	costs by an applicant to the moratorium process, the review panel shall consider the 
78.10 	following criteria in recommending proposals:
78.11 	(1) the extent to which the proposed nursing home project is integrated with other 
78.12 	health and long-term care services for older adults;
78.13 	(2) the extent to which the project provides for the complete replacement of an 
78.14 	outdated physical plant;
78.15 	(3) the extent to which the project results in a reduction of nursing facility beds in an 
78.16 	area that has a relatively high number of beds per thousand occupied by persons age 85 
78.17 	and over;
78.18 	(4) the extent to which the project produces improvements in health, safety 
78.19 	(including life safety code corrections), quality of life, and privacy of residents;
78.20 	(5) the extent to which, under the current facility ownership and management, the 
78.21 	provider has shown the ability to provide good quality of care based on health-related 
78.22 	findings on certification surveys, quality indicator scores, and quality-of-life scores, 
78.23 	including those from the Minnesota nursing home report card;
78.24 	(6) the extent to which the project integrates the latest technology and design 
78.25 	features in a way that improves the resident experience and improves the working 
78.26 	environment for employees;
78.27 	(7) the extent to which the sustainability of the nursing facility can be demonstrated 
78.28 	based on the need for services in the area and the proposed financing of the project; and
78.29 	(8) the extent to which the project provides or maintains access to nursing facility 
78.30 	services needed in the community.

78.31 	Sec. 4. Minnesota Statutes 2010, section 144D.03, subdivision 2, is amended to read:
78.32 		Subd. 2.Registration information. The establishment shall provide the following 
78.33 	information to the commissioner in order to be registered:
78.34 	(1) the business name, street address, and mailing address of the establishment;
79.1 	(2) the name and mailing address of the owner or owners of the establishment and, if 
79.2 	the owner or owners are not natural persons, identification of the type of business entity 
79.3 	of the owner or owners, and the names and addresses of the officers and members of the 
79.4 	governing body, or comparable persons for partnerships, limited liability corporations, or 
79.5 	other types of business organizations of the owner or owners;
79.6 	(3) the name and mailing address of the managing agent, whether through 
79.7 	management agreement or lease agreement, of the establishment, if different from the 
79.8 	owner or owners, and the name of the on-site manager, if any;
79.9 	(4) verification that the establishment has entered into a housing with services 
79.10 	contract, as required in section 144D.04, with each resident or resident's representative;
79.11 	(5) verification that the establishment is complying with the requirements of section 
79.12 	325F.72, if applicable;
79.13 	(6) the name and address of at least one natural person who shall be responsible 
79.14 	for dealing with the commissioner on all matters provided for in sections 144D.01 to 
79.15 	144D.06, and on whom personal service of all notices and orders shall be made, and who 
79.16 	shall be authorized to accept service on behalf of the owner or owners and the managing 
79.17 	agent, if any;
79.18 	(7) the signature of the authorized representative of the owner or owners or, if 
79.19 	the owner or owners are not natural persons, signatures of at least two authorized 
79.20 	representatives of each owner, one of which shall be an officer of the owner; ~~and~~
79.21 	(8) ~~whether~~ which services, as defined in section 144D.01, subdivisions 5 and 6, 
79.22 	or any other services, are included ~~in the base rate to be paid by the resident.~~ with the 
79.23 	rent in a base rate. "Base rate" means the payment required when services are included 
79.24 	with rent. "Rent" means the payment for occupancy of a property and may only include 
79.25 	the following when specified in a lease:
79.26 	(i) utilities, such as heat, electricity, telephone, garbage, recycling, water, sewer, 
79.27 	cable or satellite television service, and Internet service;
79.28 	(ii) access to common areas and amenities;
79.29 	(iii) vehicle parking;
79.30 	(iv) building maintenance; and
79.31 	(v) front desk service; and
79.32 	(9) whether the establishment requires as a condition of tenancy the purchase 
79.33 	of services with the rent.
79.34 	Personal service on the person identified under clause (6) by the owner or owners in 
79.35 	the registration shall be considered service on the owner or owners, and it shall not be a 
79.36 	defense to any action that personal service was not made on each individual or entity. The 
80.1 	designation of one or more individuals under this subdivision shall not affect the legal 
80.2 	responsibility of the owner or owners under sections 144D.01 to 144D.06.

80.3 	EFFECTIVE DATE. This section is effective March 1, 2012. 

80.4 	Sec. 5. Minnesota Statutes 2010, section 144D.04, subdivision 2, is amended to read:
80.5 		Subd. 2.Contents of contract.  A housing with services contract, which need not be 
80.6 	entitled as such to comply with this section, shall include at least the following elements 
80.7 	in itself or through supporting documents or attachments:
80.8 	(1) the name, street address, and mailing address of the establishment;
80.9 	(2) the name and mailing address of the owner or owners of the establishment and, if 
80.10 	the owner or owners is not a natural person, identification of the type of business entity 
80.11 	of the owner or owners;
80.12 	(3) the name and mailing address of the managing agent, through management 
80.13 	agreement or lease agreement, of the establishment, if different from the owner or owners;
80.14 	(4) the name and address of at least one natural person who is authorized to accept 
80.15 	service of process on behalf of the owner or owners and managing agent;
80.16 	(5) a statement describing the registration and licensure status of the establishment 
80.17 	and any provider providing health-related or supportive services under an arrangement 
80.18 	with the establishment;
80.19 	(6) the term of the contract;
80.20 	(7) ~~a description of the services to be provided to the resident in the~~ effective March 
80.21 	1, 2012, the amount and charge for each of the services defined in section 144D.01, 
80.22 	subdivision 5 or 6, or any other services included with rent in a base rate to be paid by 
80.23 	resident, including a delineation of the ~~portion~~ percentage of the base rate that constitutes 
80.24 	rent and ~~a delineation of charges for each service included in the base rate~~ services;
80.25 	(8) a description of any additional services, including home care services, available 
80.26 	for an additional fee from the establishment directly or through arrangements with the 
80.27 	establishment, and a schedule of fees charged for these services;
80.28 	(9) a description of the process through which the contract may be modified, 
80.29 	amended, or terminated;
80.30 	(10) a description of the establishment's complaint resolution process available 
80.31 	to residents including the toll-free complaint line for the Office of Ombudsman for 
80.32 	Long-Term Care;
80.33 	(11) the resident's designated representative, if any;
80.34 	(12) the establishment's referral procedures if the contract is terminated;
81.1 	(13) requirements of residency used by the establishment to determine who may 
81.2 	reside or continue to reside in the housing with services establishment;
81.3 	(14) billing and payment procedures and requirements;
81.4 	(15) a statement regarding the ability of residents to receive services from service 
81.5 	providers with whom the establishment does not have an arrangement;
81.6 	(16) a statement regarding the availability of public funds for payment for residence 
81.7 	or services in the establishment; and
81.8 	(17) a statement regarding the availability of and contact information for 
81.9 	long-term care consultation services under section 256B.0911 in the county in which the 
81.10 	establishment is located.

81.11 	Sec. 6. Minnesota Statutes 2010, section 256B.19, subdivision 1e, is amended to read:
81.12 		Subd. 1e.Additional local share of certain nursing facility costs. Beginning on 
81.13 	the latter of January 1, 2011, or the first day of the month beginning no less than 45 days 
81.14 	following federal approval, local government entities that own the physical plant or are 
81.15 	the license holders of nursing facilities receiving rate adjustments under section 256B.441, 
81.16 	subdivision 55a, shall be responsible for paying the portion of nonfederal costs calculated 
81.17 	under section 256B.441, subdivision 55a, paragraph (d). This responsibility remains in 
81.18 	effect through the day before the phase-in under section 256B.441, subdivision 55, is 
81.19 	complete. Beginning the day when the phase-in under section 256B.441, subdivision 55, 
81.20 	is complete, local government entities that own the physical plant or are the license holders 
81.21 	of nursing facilities receiving rate adjustments under section 256B.441, subdivision 55a, 
81.22 	shall be responsible for paying the portion of nonfederal costs calculated under section 
81.23 	256B.441, subdivision 55a, paragraph (e). Payments of the nonfederal share shall be 
81.24 	made monthly to the commissioner in amounts determined in accordance with section 
81.25 	256B.441, subdivision 55a, paragraph ~~(d)~~ (e). Payments for each month beginning ~~in~~ 
81.26 	~~January 2011 through September 2015~~ on the effective date of the rate adjustment  shall be 
81.27 	due by the 15th day of the following month. If any provider obligated to pay an amount 
81.28 	under this subdivision is more than ~~two months~~ 30 days delinquent in the timely payment 
81.29 	of the monthly installment, the commissioner may ~~withhold payments, penalties, and~~ 
81.30 	~~interest in accordance with the methods outlined in section 256.9657, subdivision 7a~~
81.31 	revoke participation under this subdivision and end payments determined under section 
81.32 	256B.441, subdivision 55a, to the participating nursing facility effective on the first day of 
81.33 	the month for which payment was due and not received. Any amounts paid by private 
81.34 	residents for days of service after the effective date of revocation must be refunded.

82.1 	Sec. 7. Minnesota Statutes 2010, section 256B.431, subdivision 2t, is amended to read:
82.2 		Subd. 2t.Payment limitation. For services rendered on or after July 1, 2003, 
82.3 	for facilities reimbursed under this ~~section or section 256B.434~~ chapter, the Medicaid 
82.4 	program shall only pay a co-payment during a Medicare-covered skilled nursing facility 
82.5 	stay if the Medicare rate less the resident's co-payment responsibility is less than the 
82.6 	Medicaid RUG-III case-mix payment rate, or, beginning January 1, 2012, the Medicaid 
82.7 	RUG-IV case-mix payment rate. The amount that shall be paid by the Medicaid program 
82.8 	is equal to the amount by which the Medicaid RUG-III or RUG-IV case-mix payment 
82.9 	rate exceeds the Medicare rate less the co-payment responsibility. Health plans paying 
82.10 	for nursing home services under section 256B.69, subdivision 6a, may limit payments as 
82.11 	allowed under this subdivision.

82.12 	Sec. 8. Minnesota Statutes 2010, section 256B.438, subdivision 1, is amended to read:
82.13 		Subdivision 1.Scope. This section establishes the method and criteria used to 
82.14 	determine resident reimbursement classifications based upon the assessments of residents 
82.15 	of nursing homes and boarding care homes whose payment rates are established under 
82.16 	section 256B.431, 256B.434, or ~~256B.435~~256B.441 or any other section. Resident 
82.17 	reimbursement classifications shall be established according to the 34 group, resource 
82.18 	utilization groups, version III or RUG-III model as described in section 144.0724. 
82.19 	Reimbursement classifications established under this section shall be implemented 
82.20 	after June 30, 2002, but no later than January 1, 2003. Reimbursement classifications 
82.21 	established under this section shall be implemented no earlier than six weeks after the 
82.22 	commissioner mails notices of payment rates to the facilities. Effective January 1, 2012, 
82.23 	resident reimbursement classifications shall be established according to the 48 group, 
82.24 	resource utilization groups, RUG-IV model under section 144.0724.

82.25 	Sec. 9. Minnesota Statutes 2010, section 256B.438, subdivision 3, is amended to read:
82.26 		Subd. 3.Case mix indices. (a) The commissioner of human services shall assign a 
82.27 	case mix index to each resident class based on the Centers for Medicare and Medicaid 
82.28 	Services staff time measurement study and adjusted for Minnesota-specific wage indices. 
82.29 	The case mix indices assigned to each resident class shall be published in the Minnesota 
82.30 	State Register at least 120 days prior to the implementation of the 34 group, RUG-III 
82.31 	resident classification system.
82.32 	(b) An index maximization approach shall be used to classify residents.
82.33 	(c) After implementation of the revised case mix system, the commissioner of 
82.34 	human services may annually rebase case mix indices and base rates using more current 
83.1 	data on average wage rates and staff time measurement studies. This rebasing shall be 
83.2 	calculated under subdivision 7, paragraph (b). The commissioner shall publish in the 
83.3 	Minnesota State Register adjusted case mix indices at least 45 days prior to the effective 
83.4 	date of the adjusted case mix indices.
83.5 	(d) Upon implementation of the 48-group RUG-IV resident classification system, the 
83.6 	commissioner of human services shall assign a case mix index to each resident class based 
83.7 	on the Centers for Medicare and Medicaid Services staff time measurement study. The 
83.8 	case mix indices assigned to each resident class shall be published in the State Register at 
83.9 	least 120 days prior to the implementation of the RUG-IV resident classification system.

83.10 	Sec. 10. Minnesota Statutes 2010, section 256B.438, subdivision 4, is amended to read:
83.11 		Subd. 4.Resident assessment schedule. (a) Nursing facilities shall conduct and 
83.12 	submit case mix assessments according to the schedule established by the commissioner 
83.13 	of health under section 144.0724, subdivisions 4 and 5.
83.14 	(b) The resident reimbursement classifications established under section 144.0724, 
83.15 	subdivision 3, shall be effective the day of admission for new admission assessments. 
83.16 	The effective date for significant change assessments shall be the assessment reference 
83.17 	date. The effective date for annual and quarterly assessments shall be the first day of the 
83.18 	month following assessment reference date.
83.19 	(c) Effective October 1, 2006, the commissioner shall rebase payment rates 
83.20 	to account for the change in the resident assessment schedule in section 144.0724, 
83.21 	subdivision 4, paragraph (b), clause (4), in a facility specific budget neutral manner, 
83.22 	according to subdivision 7, paragraph (b).
83.23 	(d) Effective January 1, 2012, the commissioner shall determine payment rates 
83.24 	to account for the transition to RUG-IV, in a facility-specific, revenue-neutral manner, 
83.25 	according to subdivision 8, paragraph (b).

83.26 	Sec. 11. Minnesota Statutes 2010, section 256B.438, is amended by adding a 
83.27 	subdivision to read:
83.28 		Subd. 8.Rate determination upon transition to RUG-IV payment rates. (a) The 
83.29 	commissioner of human services shall determine payment rates at the time of transition 
83.30 	to the RUG-IV-based payment model in a facility-specific, revenue-neutral manner. To 
83.31 	transition from the current calculation methodology to the RUG-IV-based methodology, 
83.32 	nursing facilities shall report to the commissioner of human services the private pay 
83.33 	and Medicaid resident days classified according to the categories defined in subdivision 
83.34 	3, paragraphs (a) and (d), for the six-month reporting period ending June 30, 2011. This 
84.1 	report must be submitted to the commissioner, in a form prescribed by the commissioner, 
84.2 	by August 15, 2011. The commissioner of human services shall use this data to compute 
84.3 	the standardized days for the RUG-III and RUG-IV classification systems.
84.4 	(b) The commissioner of human services shall determine the case mix adjusted 
84.5 	component for the January 1, 2012, rate as follows:
84.6 	(1) using the September 30, 2010, cost report, determine the case mix portion of the 
84.7 	operating cost for each facility;
84.8 	(2) multiply the 36 operating payment rates in effect on December 31, 2011, by the 
84.9 	number of private pay and Medicaid resident days assigned to each group for the reporting 
84.10 	period ending June 30, 2011, and compute the total;
84.11 	(3) compute the product of the amounts in clauses (1) and (2);
84.12 	(4) determine the private pay and Medicaid RUG standardized days for the reporting 
84.13 	period ending June 30, 2011, using the new indices calculated under subdivision 3, 
84.14 	paragraph (d);
84.15 	(5) divide the amount determined in clause (3) by the amount in clause (4), which 
84.16 	shall be the default rate (DDF) unadjusted case mix component of the rate under the 
84.17 	RUG-IV method; and
84.18 	(6) determine the case mix adjusted component of each operating rate by multiplying 
84.19 	the default rate (DDF) unadjusted case mix component by the case mix weight in 
84.20 	subdivision 3, paragraph (d), for each RUG-IV group.
84.21 	(c) The noncase mix components will be allocated to each RUG group as a constant 
84.22 	amount to determine the operating payment rate.

84.23 	Sec. 12. Minnesota Statutes 2010, section 256B.441, subdivision 55a, is amended to 
84.24 	read:
84.25 		Subd. 55a.Alternative to phase-in for publicly owned nursing facilities. (a) For 
84.26 	operating payment rates implemented between ~~January 1, 2011, and September 30, 2015,~~
84.27 	 the first day of the month beginning no less than 45 days following federal approval, 
84.28 	and the day before the phase-in under subdivision 55 is complete, the commissioner 
84.29 	shall allow nursing facilities whose physical plant is owned or whose license is held by a 
84.30 	city, county, or hospital district to apply for a higher payment rate under this section if 
84.31 	the local government entity agrees to pay a specified portion of the nonfederal share 
84.32 	of medical assistance costs. Nursing facilities that apply shall be eligible to select an 
84.33 	operating payment rate, with a weight of 1.00, up to the rate calculated in subdivision 54, 
84.34 	without application of the phase-in under subdivision 55. The rates for the other ~~RUG's~~ 
84.35 	~~levels~~ RUGS shall be computed as provided under subdivision 54.
85.1 	(b) For operating payment rates implemented beginning the day when the phase-in 
85.2 	under subdivision 55 is complete, the commissioner shall allow nursing facilities whose 
85.3 	physical plant is owned or whose license is held by a city, county, or hospital district to 
85.4 	apply for a higher payment rate under this section if the local government entity agrees 
85.5 	to pay a specified portion of the nonfederal share of medical assistance costs. Nursing 
85.6 	facilities that apply are eligible to select an operating payment rate, with a weight of 1.00, 
85.7 	up to an amount determined by the commissioner to be allowable under the Medicare upper 
85.8 	payment limit test. The rates for the other RUGS shall be computed under subdivision 54.
85.9 	~~(b)~~ (c) Rates determined under this subdivision shall take effect beginning on the 
85.10 	latter of January 1, 2011, or the first day of the month beginning no less than 45 days 
85.11 	following federal approval, based on cost reports for the rate year ending September 30, 
85.12 	2009, and in future rate years, rates determined for nursing facilities participating under 
85.13 	this subdivision shall take effect on October 1 of each year, based on the most recent 
85.14 	available cost report.
85.15 	~~(c)~~ (d) Eligible nursing facilities that wish to participate under this subdivision shall 
85.16 	make an application to the commissioner by September 30, 2010, or by June 30 of any 
85.17 	subsequent year. ~~Participation under this subdivision is irrevocable. If paragraph (a) does~~ 
85.18 	~~not result in a rate greater than what would have been provided without application of this~~ 
85.19 	~~subdivision, a facility's rates shall be calculated as otherwise provided and no payment by~~ 
85.20 	~~the local government entity shall be required under paragraph (d).~~
85.21 	~~(d)~~(e) For each participating nursing facility, the public entity that owns the physical 
85.22 	plant or is the license holder of the nursing facility shall pay to the state the entire 
85.23 	nonfederal share of medical assistance payments received as a result of the difference 
85.24 	between the nursing facility's payment rate under ~~subdivision 54,~~ paragraph (a) or (b), 
85.25 	and the rates that the nursing facility would otherwise be paid without application of this 
85.26 	subdivision under subdivision 54 or 55 as determined by the commissioner.
85.27 	~~(e)~~(f) The commissioner may, at any time, reduce the payments under this 
85.28 	subdivision based on the commissioner's determination that the payments shall cause 
85.29 	nursing facility rates to exceed the state's Medicare upper payment limit or any other 
85.30 	federal limitation. If the commissioner determines a reduction is necessary, the 
85.31 	commissioner shall reduce all payment rates for participating nursing facilities by a 
85.32 	percentage applied to the amount of increase they would otherwise receive under this 
85.33 	subdivision and shall notify participating facilities of the reductions. If payments to a 
85.34 	nursing facility are reduced, payments under section 256B.19, subdivision 1e, shall be 
85.35 	reduced accordingly.

86.1 	Sec. 13. Minnesota Statutes 2010, section 256B.441, is amended by adding a 
86.2 	subdivision to read:
86.3 		Subd. 60.Method for determining budget-neutral nursing facility rates for 
86.4 	relocated beds. (a) Nursing facility rates for bed relocations must be calculated by 
86.5 	comparing the estimated medical assistance costs prior to and after the proposed bed 
86.6 	relocation using the calculations in this subdivision. All payment rates are based on a 1.0 
86.7 	case mix level, with other case mix rates determined accordingly. Nursing facility beds 
86.8 	on layaway status that are being moved must be included in the calculation for both the 
86.9 	originating and receiving facility and treated as though they were in active status with the 
86.10 	occupancy characteristics of the active beds of the originating facility.
86.11 	(b) Medical assistance costs of the beds in the originating nursing facilities must 
86.12 	be calculated as follows:
86.13 	(1) multiply each originating facility's total payment rate for a RUGS weight of 1.0 
86.14 	by the facility's percentage of medical assistance days on its most recent available cost 
86.15 	report;
86.16 	(2) take the products in clause (1) and multiply by each facility's average case mix 
86.17 	score for medical assistance residents on its most recent available cost report;
86.18 	(3) take the products in clause (2) and multiply by the number of beds being 
86.19 	relocated, times 365; and
86.20 	(4) calculate the sum of the amounts determined in clause (3).
86.21 	(c) Medical assistance costs in the receiving facility, prior to the bed relocation, must 
86.22 	be calculated as follows:
86.23 	(1) multiply the facility's total payment rate for a RUGS weight of 1.0 by the medical 
86.24 	assistance days on the most recent cost report; and
86.25 	(2) multiply the product in clause (1) by the average case mix weight of medical 
86.26 	assistance residents on the most recent cost report.
86.27 	(d) The commissioner shall determine the medical assistance costs prior to the bed 
86.28 	relocation which must be the sum of the amounts determined in paragraphs (b) and (c).
86.29 	(e) The commissioner shall estimate the medical assistance costs after the bed 
86.30 	relocation as follows:
86.31 	(1) estimate the medical assistance days in the receiving facility after the bed 
86.32 	relocation. The commissioner may use the current medical assistance portion, or if data 
86.33 	does not exist, may use the statewide average, or may use the provider's estimate of the 
86.34 	medical assistance utilization of the relocated beds;
86.35 	(2) estimate the average case mix weight of medical assistance residents in the 
86.36 	receiving facility after the bed relocation. The commissioner may use current average 
87.1 	case mix weight or, if data does not exist, may use the statewide average, or may use the 
87.2 	provider's estimate of the average case mix weight; and
87.3 	(3) multiply the amount determined in clause (1) by the amount determined in 
87.4 	clause (2) by the total payment rate for a RUGS weight of 1.0 that is the highest rate of 
87.5 	the facilities from which the relocated beds either originate or to which they are being 
87.6 	relocated so long as that rate is associated with ten percent or more of the total number of 
87.7 	beds to be in the receiving facility after the bed relocation.
87.8 	(f) If the amount determined in paragraph (e) is less than or equal to the amount 
87.9 	determined in paragraph (d), the commissioner shall allow a total payment rate equal to 
87.10 	the amount used in paragraph (e), clause (3).
87.11 	(g) If the amount determined in paragraph (e) is greater than the amount determined 
87.12 	in paragraph (d), the commissioner shall allow a rate with a RUGS weight of 1.0 that 
87.13 	when used in paragraph (e), clause (3), results in the amount determined in paragraph (e) 
87.14 	being equal to the amount determined in paragraph (d).
87.15 	(h) If the commissioner relies upon provider estimates in paragraph (e), clause (1) 
87.16 	or (2), then annually, for three years after the rates determined in this subdivision take 
87.17 	effect, the commissioner shall determine the accuracy of the alternative factors of medical 
87.18 	assistance case load and RUGS weight used in this subdivision and shall reduce the total 
87.19 	payment rate for a RUGS weight of 1.0 if the factors used result in medical assistance 
87.20 	costs exceeding the amount in paragraph (d). If the actual medical assistance costs exceed 
87.21 	the estimates by more than five percent, the commissioner shall also recover the difference 
87.22 	between the estimated costs in paragraph (e) and the actual costs according to section 
87.23 	256B.0641. The commissioner may require submission of data from the receiving facility 
87.24 	needed to implement this paragraph.
87.25 	(i) When beds approved for relocation are put into active service at the destination 
87.26 	facility, rates determined in this subdivision must be adjusted by any adjustment amounts 
87.27 	that were implemented after the date of the letter of approval.

87.28 	Sec. 14.  REPEALER.
 87.29 	Minnesota Statutes 2010, section 144A.073, subdivisions 4 and 5, are repealed.

87.30 	ARTICLE 5
87.31 	TECHNICAL

87.32 	Section 1. Minnesota Statutes 2010, section 144A.071, subdivision 4a, is amended to 
87.33 	read:
88.1 		Subd. 4a.Exceptions for replacement beds.  It is in the best interest of the state 
88.2 	to ensure that nursing homes and boarding care homes continue to meet the physical 
88.3 	plant licensing and certification requirements by permitting certain construction projects. 
88.4 	Facilities should be maintained in condition to satisfy the physical and emotional needs 
88.5 	of residents while allowing the state to maintain control over nursing home expenditure 
88.6 	growth.
88.7 	The commissioner of health in coordination with the commissioner of human 
88.8 	services, may approve the renovation, replacement, upgrading, or relocation of a nursing 
88.9 	home or boarding care home, under the following conditions:
88.10 	(a) to license or certify beds in a new facility constructed to replace a facility or to 
88.11 	make repairs in an existing facility that was destroyed or damaged after June 30, 1987, by 
88.12 	fire, lightning, or other hazard provided:
88.13 	(i) destruction was not caused by the intentional act of or at the direction of a 
88.14 	controlling person of the facility;
88.15 	(ii) at the time the facility was destroyed or damaged the controlling persons of the 
88.16 	facility maintained insurance coverage for the type of hazard that occurred in an amount 
88.17 	that a reasonable person would conclude was adequate;
88.18 	(iii) the net proceeds from an insurance settlement for the damages caused by the 
88.19 	hazard are applied to the cost of the new facility or repairs;
88.20 	~~(iv) the new facility is constructed on the same site as the destroyed facility or on~~ 
88.21 	~~another site subject to the restrictions in section 144A.073, subdivision 5;~~
88.22 	~~(v)~~ (iv) the number of licensed and certified beds in the new facility does not exceed 
88.23 	the number of licensed and certified beds in the destroyed facility; and
88.24 	~~(vi)~~ (v) the commissioner determines that the replacement beds are needed to 
88.25 	prevent an inadequate supply of beds.
88.26 	Project construction costs incurred for repairs authorized under this clause shall not be 
88.27 	considered in the dollar threshold amount defined in subdivision 2;
88.28 	(b) to license or certify beds that are moved from one location to another within a 
88.29 	nursing home facility, provided the total costs of remodeling performed in conjunction 
88.30 	with the relocation of beds does not exceed $1,000,000;
88.31 	(c) to license or certify beds in a project recommended for approval under section 
88.32 	144A.073;
88.33 	(d) to license or certify beds that are moved from an existing state nursing home to 
88.34 	a different state facility, provided there is no net increase in the number of state nursing 
88.35 	home beds;
89.1 	(e) to certify and license as nursing home beds boarding care beds in a certified 
89.2 	boarding care facility if the beds meet the standards for nursing home licensure, or in a 
89.3 	facility that was granted an exception to the moratorium under section 144A.073, and if 
89.4 	the cost of any remodeling of the facility does not exceed $1,000,000. If boarding care 
89.5 	beds are licensed as nursing home beds, the number of boarding care beds in the facility 
89.6 	must not increase beyond the number remaining at the time of the upgrade in licensure. 
89.7 	The provisions contained in section 144A.073 regarding the upgrading of the facilities 
89.8 	do not apply to facilities that satisfy these requirements;
89.9 	(f) to license and certify up to 40 beds transferred from an existing facility owned and 
89.10 	operated by the Amherst H. Wilder Foundation in the city of St. Paul to a new unit at the 
89.11 	same location as the existing facility that will serve persons with Alzheimer's disease and 
89.12 	other related disorders. The transfer of beds may occur gradually or in stages, provided 
89.13 	the total number of beds transferred does not exceed 40. At the time of licensure and 
89.14 	certification of a bed or beds in the new unit, the commissioner of health shall delicense 
89.15 	and decertify the same number of beds in the existing facility. As a condition of receiving 
89.16 	a license or certification under this clause, the facility must make a written commitment 
89.17 	to the commissioner of human services that it will not seek to receive an increase in its 
89.18 	property-related payment rate as a result of the transfers allowed under this paragraph;
89.19 	(g) to license and certify nursing home beds to replace currently licensed and certified 
89.20 	boarding care beds which may be located either in a remodeled or renovated boarding care 
89.21 	or nursing home facility or in a remodeled, renovated, newly constructed, or replacement 
89.22 	nursing home facility within the identifiable complex of health care facilities in which the 
89.23 	currently licensed boarding care beds are presently located, provided that the number of 
89.24 	boarding care beds in the facility or complex are decreased by the number to be licensed 
89.25 	as nursing home beds and further provided that, if the total costs of new construction, 
89.26 	replacement, remodeling, or renovation exceed ten percent of the appraised value of 
89.27 	the facility or $200,000, whichever is less, the facility makes a written commitment to 
89.28 	the commissioner of human services that it will not seek to receive an increase in its 
89.29 	property-related payment rate by reason of the new construction, replacement, remodeling, 
89.30 	or renovation. The provisions contained in section 144A.073 regarding the upgrading of 
89.31 	facilities do not apply to facilities that satisfy these requirements;
89.32 	(h) to license as a nursing home and certify as a nursing facility a facility that is 
89.33 	licensed as a boarding care facility but not certified under the medical assistance program, 
89.34 	but only if the commissioner of human services certifies to the commissioner of health that 
89.35 	licensing the facility as a nursing home and certifying the facility as a nursing facility will 
89.36 	result in a net annual savings to the state general fund of $200,000 or more;
90.1 	(i) to certify, after September 30, 1992, and prior to July 1, 1993, existing nursing 
90.2 	home beds in a facility that was licensed and in operation prior to January 1, 1992;
90.3 	(j) to license and certify new nursing home beds to replace beds in a facility acquired 
90.4 	by the Minneapolis Community Development Agency as part of redevelopment activities 
90.5 	in a city of the first class, provided the new facility is located within three miles of the site 
90.6 	of the old facility. Operating and property costs for the new facility must be determined 
90.7 	and allowed under section 256B.431 or 256B.434;
90.8 	(k) to license and certify up to 20 new nursing home beds in a community-operated 
90.9 	hospital and attached convalescent and nursing care facility with 40 beds on April 21, 
90.10 	1991, that suspended operation of the hospital in April 1986. The commissioner of human 
90.11 	services shall provide the facility with the same per diem property-related payment rate 
90.12 	for each additional licensed and certified bed as it will receive for its existing 40 beds;
90.13 	(l) to license or certify beds in renovation, replacement, or upgrading projects as 
90.14 	defined in section 144A.073, subdivision 1, so long as the cumulative total costs of the 
90.15 	facility's remodeling projects do not exceed $1,000,000;
90.16 	(m) to license and certify beds that are moved from one location to another for the 
90.17 	purposes of converting up to five four-bed wards to single or double occupancy rooms 
90.18 	in a nursing home that, as of January 1, 1993, was county-owned and had a licensed 
90.19 	capacity of 115 beds;
90.20 	(n) to allow a facility that on April 16, 1993, was a 106-bed licensed and certified 
90.21 	nursing facility located in Minneapolis to layaway all of its licensed and certified nursing 
90.22 	home beds. These beds may be relicensed and recertified in a newly constructed teaching 
90.23 	nursing home facility affiliated with a teaching hospital upon approval by the legislature. 
90.24 	The proposal must be developed in consultation with the interagency committee on 
90.25 	long-term care planning. The beds on layaway status shall have the same status as 
90.26 	voluntarily delicensed and decertified beds, except that beds on layaway status remain 
90.27 	subject to the surcharge in section 256.9657. This layaway provision expires July 1, 1998;
90.28 	(o) to allow a project which will be completed in conjunction with an approved 
90.29 	moratorium exception project for a nursing home in southern Cass County and which is 
90.30 	directly related to that portion of the facility that must be repaired, renovated, or replaced, 
90.31 	to correct an emergency plumbing problem for which a state correction order has been 
90.32 	issued and which must be corrected by August 31, 1993;
90.33 	(p) to allow a facility that on April 16, 1993, was a 368-bed licensed and certified 
90.34 	nursing facility located in Minneapolis to layaway, upon 30 days prior written notice to 
90.35 	the commissioner, up to 30 of the facility's licensed and certified beds by converting 
90.36 	three-bed wards to single or double occupancy. Beds on layaway status shall have the 
91.1 	same status as voluntarily delicensed and decertified beds except that beds on layaway 
91.2 	status remain subject to the surcharge in section 256.9657, remain subject to the license 
91.3 	application and renewal fees under section 144A.07 and shall be subject to a $100 per bed 
91.4 	reactivation fee. In addition, at any time within three years of the effective date of the 
91.5 	layaway, the beds on layaway status may be:
91.6 	(1) relicensed and recertified upon relocation and reactivation of some or all of 
91.7 	the beds to an existing licensed and certified facility or facilities located in Pine River, 
91.8 	Brainerd, or International Falls; provided that the total project construction costs related to 
91.9 	the relocation of beds from layaway status for any facility receiving relocated beds may 
91.10 	not exceed the dollar threshold provided in subdivision 2 unless the construction project 
91.11 	has been approved through the moratorium exception process under section 144A.073;
91.12 	(2) relicensed and recertified, upon reactivation of some or all of the beds within the 
91.13 	facility which placed the beds in layaway status, if the commissioner has determined a 
91.14 	need for the reactivation of the beds on layaway status.
91.15 	The property-related payment rate of a facility placing beds on layaway status 
91.16 	must be adjusted by the incremental change in its rental per diem after recalculating the 
91.17 	rental per diem as provided in section 256B.431, subdivision 3a, paragraph (c). The 
91.18 	property-related payment rate for a facility relicensing and recertifying beds from layaway 
91.19 	status must be adjusted by the incremental change in its rental per diem after recalculating 
91.20 	its rental per diem using the number of beds after the relicensing to establish the facility's 
91.21 	capacity day divisor, which shall be effective the first day of the month following the 
91.22 	month in which the relicensing and recertification became effective. Any beds remaining 
91.23 	on layaway status more than three years after the date the layaway status became effective 
91.24 	must be removed from layaway status and immediately delicensed and decertified;
91.25 	(q) to license and certify beds in a renovation and remodeling project to convert 12 
91.26 	four-bed wards into 24 two-bed rooms, expand space, and add improvements in a nursing 
91.27 	home that, as of January 1, 1994, met the following conditions: the nursing home was 
91.28 	located in Ramsey County; had a licensed capacity of 154 beds; and had been ranked 
91.29 	among the top 15 applicants by the 1993 moratorium exceptions advisory review panel. 
91.30 	The total project construction cost estimate for this project must not exceed the cost 
91.31 	estimate submitted in connection with the 1993 moratorium exception process;
91.32 	(r) to license and certify up to 117 beds that are relocated from a licensed and 
91.33 	certified 138-bed nursing facility located in St. Paul to a hospital with 130 licensed 
91.34 	hospital beds located in South St. Paul, provided that the nursing facility and hospital are 
91.35 	owned by the same or a related organization and that prior to the date the relocation is 
91.36 	completed the hospital ceases operation of its inpatient hospital services at that hospital. 
92.1 	After relocation, the nursing facility's status under section 256B.431, subdivision 2j, shall 
92.2 	be the same as it was prior to relocation. The nursing facility's property-related payment 
92.3 	rate resulting from the project authorized in this paragraph shall become effective no 
92.4 	earlier than April 1, 1996. For purposes of calculating the incremental change in the 
92.5 	facility's rental per diem resulting from this project, the allowable appraised value of 
92.6 	the nursing facility portion of the existing health care facility physical plant prior to the 
92.7 	renovation and relocation may not exceed $2,490,000;
92.8 	(s) to license and certify two beds in a facility to replace beds that were voluntarily 
92.9 	delicensed and decertified on June 28, 1991;
92.10 	(t) to allow 16 licensed and certified beds located on July 1, 1994, in a 142-bed 
92.11 	nursing home and 21-bed boarding care home facility in Minneapolis, notwithstanding 
92.12 	the licensure and certification after July 1, 1995, of the Minneapolis facility as a 147-bed 
92.13 	nursing home facility after completion of a construction project approved in 1993 under 
92.14 	section 144A.073, to be laid away upon 30 days' prior written notice to the commissioner. 
92.15 	Beds on layaway status shall have the same status as voluntarily delicensed or decertified 
92.16 	beds except that they shall remain subject to the surcharge in section 256.9657. The 
92.17 	16 beds on layaway status may be relicensed as nursing home beds and recertified at 
92.18 	any time within five years of the effective date of the layaway upon relocation of some 
92.19 	or all of the beds to a licensed and certified facility located in Watertown, provided that 
92.20 	the total project construction costs related to the relocation of beds from layaway status 
92.21 	for the Watertown facility may not exceed the dollar threshold provided in subdivision 
92.22 	2 unless the construction project has been approved through the moratorium exception 
92.23 	process under section 144A.073.
92.24 	The property-related payment rate of the facility placing beds on layaway status 
92.25 	must be adjusted by the incremental change in its rental per diem after recalculating the 
92.26 	rental per diem as provided in section 256B.431, subdivision 3a, paragraph (c). The 
92.27 	property-related payment rate for the facility relicensing and recertifying beds from 
92.28 	layaway status must be adjusted by the incremental change in its rental per diem after 
92.29 	recalculating its rental per diem using the number of beds after the relicensing to establish 
92.30 	the facility's capacity day divisor, which shall be effective the first day of the month 
92.31 	following the month in which the relicensing and recertification became effective. Any 
92.32 	beds remaining on layaway status more than five years after the date the layaway status 
92.33 	became effective must be removed from layaway status and immediately delicensed 
92.34 	and decertified;
92.35 	(u) to license and certify beds that are moved within an existing area of a facility or 
92.36 	to a newly constructed addition which is built for the purpose of eliminating three- and 
93.1 	four-bed rooms and adding space for dining, lounge areas, bathing rooms, and ancillary 
93.2 	service areas in a nursing home that, as of January 1, 1995, was located in Fridley and had 
93.3 	a licensed capacity of 129 beds;
93.4 	(v) to relocate 36 beds in Crow Wing County and four beds from Hennepin County 
93.5 	to a 160-bed facility in Crow Wing County, provided all the affected beds are under 
93.6 	common ownership;
93.7 	(w) to license and certify a total replacement project of up to 49 beds located in 
93.8 	Norman County that are relocated from a nursing home destroyed by flood and whose 
93.9 	residents were relocated to other nursing homes. The operating cost payment rates for 
93.10 	the new nursing facility shall be determined based on the interim and settle-up payment 
93.11 	provisions of Minnesota Rules, part 9549.0057, and the reimbursement provisions of 
93.12 	section 256B.431, except that subdivision 26, paragraphs (a) and (b), shall not apply until 
93.13 	the second rate year after the settle-up cost report is filed. Property-related reimbursement 
93.14 	rates shall be determined under section 256B.431, taking into account any federal or state 
93.15 	flood-related loans or grants provided to the facility;
93.16 	(x) to license and certify a total replacement project of up to 129 beds located 
93.17 	in Polk County that are relocated from a nursing home destroyed by flood and whose 
93.18 	residents were relocated to other nursing homes. The operating cost payment rates for 
93.19 	the new nursing facility shall be determined based on the interim and settle-up payment 
93.20 	provisions of Minnesota Rules, part 9549.0057, and the reimbursement provisions of 
93.21 	section 256B.431, except that subdivision 26, paragraphs (a) and (b), shall not apply until 
93.22 	the second rate year after the settle-up cost report is filed. Property-related reimbursement 
93.23 	rates shall be determined under section 256B.431, taking into account any federal or state 
93.24 	flood-related loans or grants provided to the facility;
93.25 	(y) to license and certify beds in a renovation and remodeling project to convert 13 
93.26 	three-bed wards into 13 two-bed rooms and 13 single-bed rooms, expand space, and 
93.27 	add improvements in a nursing home that, as of January 1, 1994, met the following 
93.28 	conditions: the nursing home was located in Ramsey County, was not owned by a hospital 
93.29 	corporation, had a licensed capacity of 64 beds, and had been ranked among the top 15 
93.30 	applicants by the 1993 moratorium exceptions advisory review panel. The total project 
93.31 	construction cost estimate for this project must not exceed the cost estimate submitted in 
93.32 	connection with the 1993 moratorium exception process;
93.33 	(z) to license and certify up to 150 nursing home beds to replace an existing 285 
93.34 	bed nursing facility located in St. Paul. The replacement project shall include both the 
93.35 	renovation of existing buildings and the construction of new facilities at the existing 
93.36 	site. The reduction in the licensed capacity of the existing facility shall occur during the 
94.1 	construction project as beds are taken out of service due to the construction process. Prior 
94.2 	to the start of the construction process, the facility shall provide written information to the 
94.3 	commissioner of health describing the process for bed reduction, plans for the relocation 
94.4 	of residents, and the estimated construction schedule. The relocation of residents shall be 
94.5 	in accordance with the provisions of law and rule;
94.6 	(aa) to allow the commissioner of human services to license an additional 36 beds 
94.7 	to provide residential services for the physically disabled under Minnesota Rules, parts 
94.8 	9570.2000 to 9570.3400, in a 198-bed nursing home located in Red Wing, provided that 
94.9 	the total number of licensed and certified beds at the facility does not increase;
94.10 	(bb) to license and certify a new facility in St. Louis County with 44 beds 
94.11 	constructed to replace an existing facility in St. Louis County with 31 beds, which has 
94.12 	resident rooms on two separate floors and an antiquated elevator that creates safety 
94.13 	concerns for residents and prevents nonambulatory residents from residing on the second 
94.14 	floor. The project shall include the elimination of three- and four-bed rooms;
94.15 	(cc) to license and certify four beds in a 16-bed certified boarding care home in 
94.16 	Minneapolis to replace beds that were voluntarily delicensed and decertified on or 
94.17 	before March 31, 1992. The licensure and certification is conditional upon the facility 
94.18 	periodically assessing and adjusting its resident mix and other factors which may 
94.19 	contribute to a potential institution for mental disease declaration. The commissioner of 
94.20 	human services shall retain the authority to audit the facility at any time and shall require 
94.21 	the facility to comply with any requirements necessary to prevent an institution for mental 
94.22 	disease declaration, including delicensure and decertification of beds, if necessary;
94.23 	(dd) to license and certify 72 beds in an existing facility in Mille Lacs County with 
94.24 	80 beds as part of a renovation project. The renovation must include construction of 
94.25 	an addition to accommodate ten residents with beginning and midstage dementia in a 
94.26 	self-contained living unit; creation of three resident households where dining, activities, 
94.27 	and support spaces are located near resident living quarters; designation of four beds 
94.28 	for rehabilitation in a self-contained area; designation of 30 private rooms; and other 
94.29 	improvements;
94.30 	(ee) to license and certify beds in a facility that has undergone replacement or 
94.31 	remodeling as part of a planned closure under section 256B.437;
94.32 	(ff) to license and certify a total replacement project of up to 124 beds located 
94.33 	in Wilkin County that are in need of relocation from a nursing home significantly 
94.34 	damaged by flood. The operating cost payment rates for the new nursing facility shall 
94.35 	be determined based on the interim and settle-up payment provisions of Minnesota 
94.36 	Rules, part 9549.0057, and the reimbursement provisions of section 256B.431, except 
95.1 	that section 256B.431, subdivision 26, paragraphs (a) and (b), shall not apply until the 
95.2 	second rate year after the settle-up cost report is filed. Property-related reimbursement 
95.3 	rates shall be determined under section 256B.431, taking into account any federal or state 
95.4 	flood-related loans or grants provided to the facility;
95.5 	(gg) to allow the commissioner of human services to license an additional nine beds 
95.6 	to provide residential services for the physically disabled under Minnesota Rules, parts 
95.7 	9570.2000 to 9570.3400, in a 240-bed nursing home located in Duluth, provided that the 
95.8 	total number of licensed and certified beds at the facility does not increase;
95.9 	(hh) to license and certify up to 120 new nursing facility beds to replace beds in a 
95.10 	facility in Anoka County, which was licensed for 98 beds as of July 1, 2000, provided the 
95.11 	new facility is located within four miles of the existing facility and is in Anoka County. 
95.12 	Operating and property rates shall be determined and allowed under section 256B.431 and 
95.13 	Minnesota Rules, parts 9549.0010 to 9549.0080, or section 256B.434 or 256B.435. The 
95.14 	provisions of section 256B.431, subdivision 26, paragraphs (a) and (b), do not apply until 
95.15 	the second rate year following settle-up; or
95.16 	(ii) to transfer up to 98 beds of a 129-licensed bed facility located in Anoka County 
95.17 	that, as of March 25, 2001, is in the active process of closing, to a 122-licensed bed 
95.18 	nonprofit nursing facility located in the city of Columbia Heights or its affiliate. The 
95.19 	transfer is effective when the receiving facility notifies the commissioner in writing of the 
95.20 	number of beds accepted. The commissioner shall place all transferred beds on layaway 
95.21 	status held in the name of the receiving facility. The layaway adjustment provisions of 
95.22 	section 256B.431, subdivision 30, do not apply to this layaway. The receiving facility 
95.23 	may only remove the beds from layaway for recertification and relicensure at the receiving 
95.24 	facility's current site, or at a newly constructed facility located in Anoka County. The 
95.25 	receiving facility must receive statutory authorization before removing these beds from 
95.26 	layaway status, or may remove these beds from layaway status if removal from layaway 
95.27 	status is part of a moratorium exception project approved by the commissioner under 
95.28 	section 144A.073.

95.29 	Sec. 2. Minnesota Statutes 2010, section 144A.071, subdivision 5a, is amended to read:
95.30 		Subd. 5a.Cost estimate of a moratorium exception project. (a) For the 
95.31 	purposes of this section and section 144A.073, the cost estimate of a moratorium 
95.32 	exception project shall include the effects of the proposed project on the costs of the state 
95.33 	subsidy for community-based services, nursing services, and housing in institutional 
95.34 	and noninstitutional settings. The commissioner of health, in cooperation with the 
95.35 	commissioner of human services, shall define the method for estimating these costs in the 
96.1 	permanent rule implementing section 144A.073. The commissioner of human services 
96.2 	shall prepare an estimate of the total state annual long-term costs of each moratorium 
96.3 	exception proposal.
96.4 	(b) The interest rate to be used for estimating the cost of each moratorium exception 
96.5 	project proposal shall be the lesser of either the prime rate plus two percentage points, or 
96.6 	the posted yield for standard conventional fixed rate mortgages of the Federal Home Loan 
96.7 	Mortgage Corporation plus two percentage points as published in the Wall Street Journal 
96.8 	and in effect 56 days prior to the application deadline. If the applicant's proposal uses this 
96.9 	interest rate, the commissioner of human services, in determining the facility's actual 
96.10 	property-related payment rate to be established upon completion of the project must use 
96.11 	the actual interest rate obtained by the facility for the project's permanent financing up to 
96.12 	the maximum permitted under ~~subdivision 6~~ Minnesota Rules, part 9549.0060, subpart 6.
96.13 	The applicant may choose an alternate interest rate for estimating the project's cost. 
96.14 	If the applicant makes this election, the commissioner of human services, in determining 
96.15 	the facility's actual property-related payment rate to be established upon completion of the 
96.16 	project, must use the lesser of the actual interest rate obtained for the project's permanent 
96.17 	financing or the interest rate which was used to estimate the proposal's project cost. For 
96.18 	succeeding rate years, the applicant is at risk for financing costs in excess of the interest 
96.19 	rate selected.

96.20 	Sec. 3. Minnesota Statutes 2010, section 245B.02, subdivision 20, is amended to read:
96.21 		Subd. 20.Residential-based habilitation. "Residential-based habilitation" means 
96.22 	care, supervision, and training provided primarily in the consumer's own home or place 
96.23 	of residence but also including community-integrated activities following the individual 
96.24 	service plan. Residential habilitation services are provided in coordination with the 
96.25 	provision of day training and habilitation services for those persons receiving day training 
96.26 	and habilitation services under sections ~~252.40~~ 252.41 to 252.46.

96.27 	EFFECTIVE DATE. This section is effective January 1, 2013, or on the date the 
96.28 	commissioner adopts rules for the administration of home and community-based services 
96.29 	waivers under section 256B.4912, subdivision 4, whichever is sooner.

96.30 	Sec. 4. Minnesota Statutes 2010, section 245B.06, subdivision 7, is amended to read:
96.31 		Subd. 7.Staffing requirements. The license holder must provide supervision 
96.32 	to ensure the health, safety, and protection of rights of each consumer and to be able 
96.33 	to implement each consumer's individual service plan. Day training and habilitation 
97.1 	programs must meet the minimum staffing requirements as specified in sections ~~252.40~~
97.2 	252.41 to 252.46 and rules promulgated under those sections. 

97.3 	EFFECTIVE DATE. This section is effective January 1, 2013, or on the date the 
97.4 	commissioner adopts rules for the administration of home and community-based services 
97.5 	waivers under section 256B.4912, subdivision 4, whichever is sooner.

97.6 	Sec. 5. Minnesota Statutes 2010, section 252.41, subdivision 1, is amended to read:
97.7 		Subdivision 1.Scope. The definitions in this section apply to sections ~~252.40~~ 252.41
97.8 	to 252.46.

97.9 	EFFECTIVE DATE. This section is effective January 1, 2013, or on the date the 
97.10 	commissioner adopts rules for the administration of home and community-based services 
97.11 	waivers under section 256B.4912, subdivision 4, whichever is sooner.

97.12 	Sec. 6. Minnesota Statutes 2010, section 252.451, subdivision 2, is amended to read:
97.13 		Subd. 2.Vendor participation and reimbursement. Notwithstanding requirements 
97.14 	in chapter 245A, and sections 252.28, ~~252.40~~ 252.41 to 252.46, and 256B.501, vendors of 
97.15 	day training and habilitation services may enter into written agreements with qualified 
97.16 	businesses to provide additional training and supervision needed by individuals to 
97.17 	maintain their employment.

97.18 	EFFECTIVE DATE. This section is effective January 1, 2013, or on the date the 
97.19 	commissioner adopts rules for the administration of home and community-based services 
97.20 	waivers under section 256B.4912, subdivision 4, whichever is sooner.

97.21 	Sec. 7. Minnesota Statutes 2010, section 256B.431, subdivision 26, is amended to read:
97.22 		Subd. 26.Changes to nursing facility reimbursement beginning July 1, 1997.
 97.23 	The nursing facility reimbursement changes in paragraphs (a) to (e) shall apply in the 
97.24 	sequence specified in Minnesota Rules, parts 9549.0010 to 9549.0080, and this section, 
97.25 	beginning July 1, 1997.
97.26 	(a) For rate years beginning on or after July 1, 1997, the commissioner shall limit a 
97.27 	nursing facility's allowable operating per diem for each case mix category for each rate 
97.28 	year. The commissioner shall group nursing facilities into two groups, freestanding and 
97.29 	nonfreestanding, within each geographic group, using their operating cost per diem for 
97.30 	the case mix A classification. A nonfreestanding nursing facility is a nursing facility 
97.31 	whose other operating cost per diem is subject to the hospital attached, short length of 
97.32 	stay, or the rule 80 limits. All other nursing facilities shall be considered freestanding 
98.1 	nursing facilities. The commissioner shall then array all nursing facilities in each grouping 
98.2 	by their allowable case mix A operating cost per diem. In calculating a nursing facility's 
98.3 	operating cost per diem for this purpose, the commissioner shall exclude the raw food 
98.4 	cost per diem related to providing special diets that are based on religious beliefs, as 
98.5 	determined in subdivision 2b, paragraph (h). For those nursing facilities in each grouping 
98.6 	whose case mix A operating cost per diem:
98.7 	(1) is at or below the median of the array, the commissioner shall limit the nursing 
98.8 	facility's allowable operating cost per diem for each case mix category to the lesser of 
98.9 	the prior reporting year's allowable operating cost per diem as specified in Laws 1996, 
98.10 	chapter 451, article 3, section 11, paragraph (h), plus the inflation factor as established 
98.11 	in paragraph (d), clause (2), increased by two percentage points, or the current reporting 
98.12 	year's corresponding allowable operating cost per diem; or
98.13 	(2) is above the median of the array, the commissioner shall limit the nursing 
98.14 	facility's allowable operating cost per diem for each case mix category to the lesser of 
98.15 	the prior reporting year's allowable operating cost per diem as specified in Laws 1996, 
98.16 	chapter 451, article 3, section 11, paragraph (h), plus the inflation factor as established 
98.17 	in paragraph (d), clause (2), increased by one percentage point, or the current reporting 
98.18 	year's corresponding allowable operating cost per diem.
98.19 	For purposes of paragraph (a), if a nursing facility reports on its cost report a 
98.20 	reduction in cost due to a refund or credit for a rate year beginning on or after July 1, 1998, 
98.21 	the commissioner shall increase that facility's spend-up limit for the rate year following 
98.22 	the current rate year by the amount of the cost reduction divided by its resident days for 
98.23 	the reporting year preceding the rate year in which the adjustment is to be made.
98.24 	(b) For rate years beginning on or after July 1, 1997, the commissioner shall limit the 
98.25 	allowable operating cost per diem for high cost nursing facilities. After application of the 
98.26 	limits in paragraph (a) to each nursing facility's operating cost per diem, the commissioner 
98.27 	shall group nursing facilities into two groups, freestanding or nonfreestanding, within each 
98.28 	geographic group. A nonfreestanding nursing facility is a nursing facility whose other 
98.29 	operating cost per diem are subject to hospital attached, short length of stay, or rule 80 
98.30 	limits. All other nursing facilities shall be considered freestanding nursing facilities. The 
98.31 	commissioner shall then array all nursing facilities within each grouping by their allowable 
98.32 	case mix A operating cost per diem. In calculating a nursing facility's operating cost per 
98.33 	diem for this purpose, the commissioner shall exclude the raw food cost per diem related to 
98.34 	providing special diets that are based on religious beliefs, as determined in subdivision 2b, 
98.35 	paragraph (h). For those nursing facilities in each grouping whose case mix A operating 
98.36 	cost per diem exceeds 1.0 standard deviation above the median, the commissioner shall 
99.1 	reduce their allowable operating cost per diem by three percent. For those nursing 
99.2 	facilities in each grouping whose case mix A operating cost per diem exceeds 0.5 standard 
99.3 	deviation above the median but is less than or equal to 1.0 standard deviation above the 
99.4 	median, the commissioner shall reduce their allowable operating cost per diem by two 
99.5 	percent. However, in no case shall a nursing facility's operating cost per diem be reduced 
99.6 	below its grouping's limit established at 0.5 standard deviations above the median.
99.7 	(c) For rate years beginning on or after July 1, 1997, the commissioner shall 
99.8 	determine a nursing facility's efficiency incentive by first computing the allowable 
99.9 	difference, which is the lesser of $4.50 or the amount by which the facility's other 
99.10 	operating cost limit exceeds its nonadjusted other operating cost per diem for that rate 
99.11 	year. The commissioner shall compute the efficiency incentive by:
99.12 	(1) subtracting the allowable difference from $4.50 and dividing the result by $4.50;
99.13 	(2) multiplying 0.20 by the ratio resulting from clause (1), and then;
99.14 	(3) adding 0.50 to the result from clause (2); and
99.15 	(4) multiplying the result from clause (3) times the allowable difference.
99.16 	The nursing facility's efficiency incentive payment shall be the lesser of $2.25 or the 
99.17 	product obtained in clause (4).
99.18 	(d) For rate years beginning on or after July 1, 1997, the forecasted price index for 
99.19 	a nursing facility's allowable operating cost per diem shall be determined under clauses 
99.20 	(1) and (2) using the change in the Consumer Price Index-All Items (United States city 
99.21 	average) (CPI-U) as forecasted by Data Resources, Inc. The commissioner shall use the 
99.22 	indices as forecasted in the fourth quarter of the calendar year preceding the rate year, 
99.23 	subject to subdivision 2l, paragraph (c).
99.24 	(1) The CPI-U forecasted index for allowable operating cost per diem shall be based 
99.25 	on the 21-month period from the midpoint of the nursing facility's reporting year to the 
99.26 	midpoint of the rate year following the reporting year.
99.27 	(2) For rate years beginning on or after July 1, 1997, the forecasted index for 
99.28 	operating cost limits referred to in subdivision 21, paragraph (b), shall be based on 
99.29 	the CPI-U for the 12-month period between the midpoints of the two reporting years 
99.30 	preceding the rate year.
99.31 	(e) After applying these provisions for the respective rate years, the commissioner 
99.32 	shall index these allowable operating cost per diem by the inflation factor provided for in 
99.33 	paragraph (d), clause (1), and add the nursing facility's efficiency incentive as computed in 
99.34 	paragraph (c).
99.35 	(f) For the rate years beginning on July 1, 1997, July 1, 1998, and July 1, 1999, a 
99.36 	nursing facility licensed for 40 beds effective May 1, 1992, with a subsequent increase of 
100.1 	20 Medicare/Medicaid certified beds, effective January 26, 1993, in accordance with an 
100.2 	increase in licensure is exempt from paragraphs (a) and (b).
100.3 	~~(g) For a nursing facility whose construction project was authorized according to~~ 
100.4 	~~section 144A.073, subdivision 5, paragraph (g), the operating cost payment rates for~~ 
100.5 	~~the new location shall be determined based on Minnesota Rules, part 9549.0057. The~~ 
100.6 	~~relocation allowed under section 144A.073, subdivision 5, paragraph (g), and the rate~~ 
100.7 	~~determination allowed under this paragraph must meet the cost neutrality requirements~~ 
100.8 	~~of section 144A.073, subdivision 3c. Paragraphs (a) and (b) shall not apply until the~~ 
100.9 	~~second rate year after the settle-up cost report is filed. Notwithstanding subdivision 2b,~~ 
100.10 	~~paragraph (g), real estate taxes and special assessments payable by the new location, a~~ 
100.11 	~~501(c)(3) nonprofit corporation, shall be included in the payment rates determined under~~ 
100.12 	~~this subdivision for all subsequent rate years.~~
100.13 	~~(h)~~(g) For the rate year beginning July 1, 1997, the commissioner shall compute 
100.14 	the payment rate for a nursing facility licensed for 94 beds on September 30, 1996, 
100.15 	that applied in October 1993 for approval of a total replacement under the moratorium 
100.16 	exception process in section 144A.073, and completed the approved replacement in June 
100.17 	1995, with other operating cost spend-up limit under paragraph (a), increased by $3.98, 
100.18 	and after computing the facility's payment rate according to this section, the commissioner 
100.19 	shall make a one-year positive rate adjustment of $3.19 for operating costs related to the 
100.20 	newly constructed total replacement, without application of paragraphs (a) and (b). The 
100.21 	facility's per diem, before the $3.19 adjustment, shall be used as the prior reporting year's 
100.22 	allowable operating cost per diem for payment rate calculation for the rate year beginning 
100.23 	July 1, 1998. A facility described in this paragraph is exempt from paragraph (b) for the 
100.24 	rate years beginning July 1, 1997, and July 1, 1998.
100.25 	~~(i)~~ (h) For the purpose of applying the limit stated in paragraph (a), a nursing facility 
100.26 	in Kandiyohi County licensed for 86 beds that was granted hospital-attached status on 
100.27 	December 1, 1994, shall have the prior year's allowable care-related per diem increased 
100.28 	by $3.207 and the prior year's other operating cost per diem increased by $4.777 before 
100.29 	adding the inflation in paragraph (d), clause (2), for the rate year beginning on July 1, 1997.
100.30 	~~(j)~~ (i) For the purpose of applying the limit stated in paragraph (a), a 117 bed nursing 
100.31 	facility located in Pine County shall have the prior year's allowable other operating cost 
100.32 	per diem increased by $1.50 before adding the inflation in paragraph (d), clause (2), for 
100.33 	the rate year beginning on July 1, 1997.
100.34 	~~(k)~~ (j) For the purpose of applying the limit under paragraph (a), a nursing facility in 
100.35 	Hibbing licensed for 192 beds shall have the prior year's allowable other operating cost 
101.1 	per diem increased by $2.67 before adding the inflation in paragraph (d), clause (2), 
101.2 	for the rate year beginning July 1, 1997.

101.3 	Sec. 8. Minnesota Statutes 2010, section 256B.5013, subdivision 1, is amended to read:
101.4 		Subdivision 1.Variable rate adjustments. (a) For rate years beginning on or after 
101.5 	October 1, 2000, when there is a documented increase in the needs of a current ICF/MR 
101.6 	recipient, the county of financial responsibility may recommend a variable rate to enable 
101.7 	the facility to meet the individual's increased needs. Variable rate adjustments made under 
101.8 	this subdivision replace ~~payments for persons with special needs under section 256B.501,~~ 
101.9 	~~subdivision 8, and~~ payments for persons with special needs for crisis intervention services 
101.10 	under section 256B.501, subdivision 8a. Effective July 1, 2003, facilities with a base rate 
101.11 	above the 50th percentile of the statewide average reimbursement rate for a Class A 
101.12 	facility or Class B facility, whichever matches the facility licensure, are not eligible for a 
101.13 	variable rate adjustment. Variable rate adjustments may not exceed a 12-month period, 
101.14 	except when approved for purposes established in paragraph (b), clause (1). Variable rate 
101.15 	adjustments approved solely on the basis of changes on a developmental disabilities 
101.16 	screening document will end June 30, 2002.
101.17 	(b) A variable rate may be recommended by the county of financial responsibility 
101.18 	for increased needs in the following situations:
101.19 	(1) a need for resources due to an individual's full or partial retirement from 
101.20 	participation in a day training and habilitation service when the individual: (i) has reached 
101.21 	the age of 65 or has a change in health condition that makes it difficult for the person 
101.22 	to participate in day training and habilitation services over an extended period of time 
101.23 	because it is medically contraindicated; and (ii) has expressed a desire for change through 
101.24 	the developmental disability screening process under section 256B.092;
101.25 	(2) a need for additional resources for intensive short-term programming which is 
101.26 	necessary prior to an individual's discharge to a less restrictive, more integrated setting;
101.27 	(3) a demonstrated medical need that significantly impacts the type or amount of 
101.28 	services needed by the individual; or
101.29 	(4) a demonstrated behavioral need that significantly impacts the type or amount of 
101.30 	services needed by the individual.
101.31 	(c) The county of financial responsibility must justify the purpose, the projected 
101.32 	length of time, and the additional funding needed for the facility to meet the needs of 
101.33 	the individual.
101.34 	(d) The facility shall provide an annual report to the county case manager on 
101.35 	the use of the variable rate funds and the status of the individual on whose behalf the 
102.1 	funds were approved. The county case manager will forward the facility's report with a 
102.2 	recommendation to the commissioner to approve or disapprove a continuation of the 
102.3 	variable rate.
102.4 	(e) Funds made available through the variable rate process that are not used by 
102.5 	the facility to meet the needs of the individual for whom they were approved shall be 
102.6 	returned to the state.

102.7 	EFFECTIVE DATE. This section is effective January 1, 2013, or on the date the 
102.8 	commissioner adopts rules for the administration of home and community-based services 
102.9 	waivers under section 256B.4912, subdivision 4, whichever is sooner.

102.10 	Sec. 9. Minnesota Statutes 2010, section 256B.5015, subdivision 1, is amended to read:
102.11 		Subdivision 1.Day training and habilitation services. Day training and 
102.12 	habilitation services costs shall be paid as a pass-through payment at the lowest rate paid 
102.13 	for the comparable services at that site under sections ~~252.40~~ 252.41 to 252.46. The 
102.14 	pass-through payments for training and habilitation services shall be paid separately by 
102.15 	the commissioner and shall not be included in the computation of the ICF/MR facility 
102.16 	total payment rate. 

102.17 	EFFECTIVE DATE. This section is effective January 1, 2013, or on the date the 
102.18 	commissioner adopts rules for the administration of home and community-based services 
102.19 	waivers under section 256B.4912, subdivision 4, whichever is sooner.

102.20 	Sec. 10. Minnesota Statutes 2010, section 256B.765, is amended to read:
102.21 	256B.765 PROVIDER RATE INCREASES.
102.22 	(a) Effective July 1, 2001, within the limits of appropriations specifically for this 
102.23 	purpose, the commissioner shall provide an annual inflation adjustment for the providers 
102.24 	listed in paragraph (c). The index for the inflation adjustment must be based on the 
102.25 	change in the Employment Cost Index for Private Industry Workers - Total Compensation 
102.26 	forecasted by Data Resources, Inc., as forecasted in the fourth quarter of the calendar year 
102.27 	preceding the fiscal year. The commissioner shall increase reimbursement or allocation 
102.28 	rates by the percentage of this adjustment, and county boards shall adjust provider 
102.29 	contracts as needed.
102.30 	(b) The commissioner of management and budget shall include an annual 
102.31 	inflationary adjustment in reimbursement rates for the providers listed in paragraph (c) 
102.32 	using the inflation factor specified in paragraph (a) as a budget change request in each 
102.33 	biennial detailed expenditure budget submitted to the legislature under section 16A.11.
103.1 	(c) The annual adjustment under paragraph (a) shall be provided for home and 
103.2 	community-based waiver services for persons with developmental disabilities under 
103.3 	section 256B.501; home and community-based waiver services for the elderly under 
103.4 	section 256B.0915; waivered services under community alternatives for disabled 
103.5 	individuals under section 256B.49; community alternative care waivered services under 
103.6 	section 256B.49; traumatic brain injury waivered services under section 256B.49; nursing 
103.7 	services and home health services under section 256B.0625, subdivision 6a; personal care 
103.8 	services and nursing supervision of personal care services under section 256B.0625, 
103.9 	subdivision 19a; private duty nursing services under section 256B.0625, subdivision 7; 
103.10 	day training and habilitation services for adults with developmental disabilities under 
103.11 	sections ~~252.40~~ 252.41 to 252.46; physical therapy services under sections 256B.0625, 
103.12 	subdivision 8, and 256D.03, subdivision 4; occupational therapy services under sections 
103.13 	256B.0625, subdivision 8a, and 256D.03, subdivision 4; speech-language therapy services 
103.14 	under section 256D.03, subdivision 4, and Minnesota Rules, part 9505.0390; respiratory 
103.15 	therapy services under section 256D.03, subdivision 4, and Minnesota Rules, part 
103.16 	9505.0295; alternative care services under section 256B.0913; adult residential program 
103.17 	grants under Minnesota Rules, parts 9535.2000 to 9535.3000; adult and family community 
103.18 	support grants under Minnesota Rules, parts 9535.1700 to 9535.1760; semi-independent 
103.19 	living services under section 252.275 including SILS funding under county social services 
103.20 	grants formerly funded under chapter 256I; and community support services for deaf 
103.21 	and hard-of-hearing adults with mental illness who use or wish to use sign language as 
103.22 	their primary means of communication.

103.23 	EFFECTIVE DATE. This section is effective January 1, 2013, or on the date the 
103.24 	commissioner adopts rules for the administration of home and community-based services 
103.25 	waivers under section 256B.4912, subdivision 4, whichever is sooner.