1.1 	A bill for an act
1.2 	relating to human services; implementing the
1.3 	recommendations of the tripartisan Long-Term Care Task
1.4 	Force; reducing excess capacity of nursing facility
1.5 	beds; allocating resultant savings to home and
1.6 	community-based services for elderly persons and
1.7 	family caregivers; expanding home and community-based
1.8 	services for elderly persons and family caregivers;
1.9 	establishing a demonstration project.
1.10 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.11 	Section 1. PURPOSE.
 1.12 	Minnesota's long-term care system serving older Minnesotans
1.13 	supports self-determination, provides services that meet
1.14 	consumers' needs and preferences, provides high quality care,
1.15 	and ensures efficiency and affordability.

1.16 	Sec. 2. LONG-TERM CARE SERVICE OPTIONS.
 1.17 	To ensure the availability of long-term care service
1.18 	options for older persons, the commissioner shall develop
1.19 	service options that meet the following objectives:
1.20 	(1) choice to ensure a range of options including nursing
1.21 	facilities, housing with services establishments, and home and
1.22 	community-based services and support that include, but are not
1.23 	limited to, home health care, living at home block nurse
1.24 	programs, home-delivered meals, congregate dining, chore
1.25 	assistance, transportation, homemaker assistance, assisted
1.26 	living programs, senior companionship, respite and other
1.27 	caregiver support services, adult day health services,
2.1 	technology, and care coordination;
2.2 	(2) cost-effectiveness methodologies that ensure incentives
2.3 	for lower cost quality options, fair compensation for services
2.4 	delivered, appropriate use of trained community volunteers, and
2.5 	flexible funding streams such as the alternative care, elderly
2.6 	waiver, and aging grants programs;
2.7 	(3) high quality and good outcomes with assurances that
2.8 	services are provided by sufficient, trained, and competent
2.9 	staff that meet industry standards;
2.10 	(4) least restrictive alternatives to minimize disruption
2.11 	to an older person's life while still meeting the person's
2.12 	assistance needs;
2.13 	(5) avoidance of premature use of nursing facilities and
2.14 	diversion from nursing facilities to community supports when
2.15 	feasible;
2.16 	(6) elder-friendly communities with family, government,
2.17 	faith communities, businesses, and other sectors working
2.18 	together to support vital aging and long-term care at home; and 
2.19 	(7) strengthening informal care systems that include
2.20 	family, friends, volunteers, and existing community resources.

2.21 	Sec. 3. ALLOCATION OF STATE AND FEDERAL FUNDS.
 2.22 	By 2010, at least 60 percent of state and federal funds for
2.23 	long-term care for elderly persons shall be allocated to home
2.24 	and community-based services developed according to section 2,
2.25 	through the alternative care, elderly waiver, medical assistance
2.26 	home care, and aging grants programs, and other relevant
2.27 	programs and demonstration projects.  The commissioner of human
2.28 	services shall establish a baseline for fiscal year 2005 and
2.29 	shall measure progress each fiscal year thereafter and report on
2.30 	the status of achieving the allocation of funds under this
2.31 	section to the legislature by January 31 of each year.

2.32 	Sec. 4. BED CLOSURES AND REALLOCATION OF FUNDS.
 2.33 	The commissioner of human services, in consultation with
2.34 	nursing facilities, shall establish and implement a program by
2.35 	December 31, 2005, to close at least 3,000 nursing facility beds
2.36 	in fiscal years 2006 and 2007 and at least 3,000 additional beds
3.1 	in fiscal years 2008 and 2009 through incentives or other
3.2 	measures determined by the commissioner.  All of the cost
3.3 	savings shall be tracked by the commissioner and used to fund
3.4 	home and community-based services in section 2, the
3.5 	demonstration project in section 6, and the regional planning
3.6 	process in section 5, subdivision 2.

3.7 	Sec. 5. EXPANSION OF HOME AND COMMUNITY-BASED SERVICES.
 3.8 		Subdivision 1.Expansion of services. The commissioner
3.9 	shall expand services to elderly persons and caregivers and
3.10 	provide ongoing funding for home and community-based services in
3.11 	section 2 through the alternative care, elderly waiver, medical
3.12 	assistance home care, and aging grant programs.  Additional
3.13 	categories of services, such as transportation, may be developed
3.14 	and funded under the aging grant programs if determined
3.15 	necessary through the regional planning process under section 5,
3.16 	subdivision 2, and with the agreement of the commissioner.
3.17 		Subd. 2.Expansion priorities. Service expansion
3.18 	priorities shall be determined by December 31, 2005, through a
3.19 	coordinated regional planning process conducted jointly by area
3.20 	agencies on aging, counties, health plans that hold contracts as
3.21 	MSHO or elderly waiver administrators, and nursing facilities.
3.22 		Subd. 3.Caregiver support. The commissioner, in
3.23 	partnership with the Minnesota Board on Aging, shall develop and
3.24 	implement access to caregiver support using the Internet to
3.25 	provide family caregivers information and tools to support the
3.26 	caregiver's ability to provide care longer and to identify and
3.27 	engage service providers such as respite workers, caregiver
3.28 	consultants, and adult day health services.  Respite, caregiver
3.29 	consultation, adult day health, and other services shall be
3.30 	expanded in underserved areas according to subdivisions 1 and 2.

3.31 	Sec. 6. TARGETED CASE MANAGEMENT RELOCATION DEMONSTRATION
3.32 	PROJECT.
 3.33 		Subdivision 1.Case management. The commissioner shall
3.34 	develop and implement, through a request for proposal process, a
3.35 	relocation demonstration project by July 1, 2006, of case
3.36 	management targeted at elderly persons currently residing in
4.1 	nursing facilities with care needs that could be met in the
4.2 	community.  The priority focus shall be on elderly persons
4.3 	during their first 60 days of residence in a nursing facility.
4.4 		Subd. 2.Persons served. The demonstration project shall
4.5 	serve 500 persons by June 30, 2007, and shall be implemented in
4.6 	at least one urban market area and one rural market area.
4.7 	Elderly persons are eligible for targeted relocation if enrolled
4.8 	in medical assistance or will spend down to medical assistance
4.9 	eligibility within 180 days.
4.10 		Subd. 3.Providers. Providers eligible for the targeted
4.11 	case management demonstration project are county health and
4.12 	human service agencies, area agencies on aging, or other
4.13 	nonprofit or for profit entities that do not have a conflict of
4.14 	interest and meet medical assistance or other federal and state
4.15 	requirements.  Counties in the demonstration area have the first
4.16 	right of refusal.  Targeted case management providers must have:
4.17 	(1) the legal authority to provide case management
4.18 	services;
4.19 	(2) the demonstrated capacity and experience to provide the
4.20 	components of case management to coordinate and link community
4.21 	resources needed by elderly persons;
4.22 	(3) a financial management system that provides accurate
4.23 	documentation of and billing for services and costs; and 
4.24 	(4) the capacity to document and maintain individual case
4.25 	records.
4.26 		Subd. 4.Covered services and activities. Targeted case
4.27 	management services eligible for reimbursement of state funds
4.28 	and federal funds under the demonstration for a nine-month
4.29 	period are:
4.30 	(1) in-person assessments;
4.31 	(2) written individual service plan development,
4.32 	completion, and regular review that is based on the older
4.33 	person's needs and preferences, and which ensures access to
4.34 	community-based long-term care services, medical care, and other
4.35 	related services and supports;
4.36 	(3) routine contact and support for the elderly person, the
5.1 	person's family, and any primary caregiver, and routine
5.2 	communication with service providers or other persons necessary
5.3 	to develop and implement the goals of the individual service
5.4 	plan;
5.5 	(4) coordination and monitoring of overall service delivery
5.6 	to ensure quality of services, appropriateness, and continued
5.7 	need;
5.8 	(5) maintenance of records and documentation that supports
5.9 	and verifies the activities in this subdivision;
5.10 	(6) travel necessary to conduct one or more visits with the
5.11 	elderly person to develop or implement the goals of the
5.12 	individual service plan;
5.13 	(7) coordination with the nursing facility discharge
5.14 	planner; and 
5.15 	(8) performance of the administrative activities of the
5.16 	demonstration project.

5.17 	Sec. 7. TRANSITIONAL SUPPORT GRANT.
 5.18 	A cash grant of up to $3,000 shall be available to elderly
5.19 	persons participating in the demonstration project who are
5.20 	moving from a nursing facility to a community setting with a
5.21 	onetime payment to cover the costs, not covered by other
5.22 	sources, associated with moving into a community setting.
5.23 	Covered costs include, but are not limited to:
5.24 	(1) lease or rent deposits;
5.25 	(2) security deposits;
5.26 	(3) utility setup costs, including telephone;
5.27 	(4) essential furnishings and supplies; and 
5.28 	(5) personal supports and transports needed to locate and
5.29 	transition to community settings.

5.30 	Sec. 8. APPROPRIATIONS.
 5.31 	Subdivision 1.  $....... is appropriated for the biennium
5.32 	ending June 30, 2007, from the general fund to the commissioner
5.33 	of human services to fund the expansion of home and
5.34 	community-based services under section 5.
5.35 	Subd. 2.  $....... is appropriated for the biennium ending
5.36 	June 30, 2007, from the general fund to the commissioner of
6.1 	human services to fund the targeted case management relocation
6.2 	demonstration project under section 6.
6.3 	Subd. 3.  $....... is appropriated for the biennium ending
6.4 	June 30, 2007, from the general fund to the commissioner of
6.5 	human services to fund comparable cost-of-living increases for
6.6 	state-funded home and community-based service providers not
6.7 	covered under the cost-of-living provisions granted to nursing
6.8 	facility providers.