1.1                          A bill for an act 
  1.2             relating to human services; modifying provisions in 
  1.3             continuing care services for persons with 
  1.4             disabilities; amending Minnesota Statutes 1998, 
  1.5             section 62D.09, subdivision 8; Minnesota Statutes 1999 
  1.6             Supplement, sections 62Q.73, subdivision 2; 256B.0625, 
  1.7             subdivision 19c; 256B.0627, subdivisions 5, 8, and 11; 
  1.8             256B.501, subdivision 8a; 256B.5011, subdivision 2; 
  1.9             256B.5013, subdivision 1, and by adding subdivisions; 
  1.10            and 256B.77, subdivision 8. 
  1.11  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.12     Section 1.  Minnesota Statutes 1998, section 62D.09, 
  1.13  subdivision 8, is amended to read: 
  1.14     Subd. 8.  Each health maintenance organization shall issue 
  1.15  a membership card to its enrollees.  The membership card must: 
  1.16     (1) identify the health maintenance organization; 
  1.17     (2) include the name, address, and telephone number to call 
  1.18  if the enrollee has a complaint; 
  1.19     (3) include the telephone number to call or the instruction 
  1.20  on how to receive authorization for emergency care; and 
  1.21     (4) include one of the following: 
  1.22     (i) the telephone number to call to appeal to or file a 
  1.23  complaint with the commissioner of health; or 
  1.24     (ii) for persons enrolled under section 256B.69, 256B.77, 
  1.25  256D.03, or 256L.12, the telephone number to call to file a 
  1.26  complaint with the ombudsperson designated by the commissioner 
  1.27  of human services under section 256B.69 or the office of the 
  1.28  ombudsman for mental health and mental retardation under section 
  2.1   256B.77 and the address to appeal to the commissioner of human 
  2.2   services.  The ombudsperson shall annually provide the 
  2.3   commissioner of health with a summary of complaints and actions 
  2.4   taken. 
  2.5      Sec. 2.  Minnesota Statutes 1999 Supplement, section 
  2.6   62Q.73, subdivision 2, is amended to read: 
  2.7      Subd. 2.  [EXCEPTION.] (a) This section does not apply to 
  2.8   governmental programs except as permitted under paragraph (b). 
  2.9   For purposes of this subdivision, "governmental programs" means 
  2.10  the prepaid medical assistance program, the MinnesotaCare 
  2.11  program, the prepaid general assistance medical care 
  2.12  program, the demonstration project for people with disabilities, 
  2.13  and the federal Medicare program. 
  2.14     (b) In the course of a recipient's appeal of a medical 
  2.15  determination to the commissioner of human services under 
  2.16  section 256.045, the recipient may request an expert medical 
  2.17  opinion be arranged by the external review entity under contract 
  2.18  to provide independent external reviews under this section.  If 
  2.19  such a request is made, the cost of the review shall be paid by 
  2.20  the commissioner of human services.  Any medical opinion 
  2.21  obtained under this paragraph shall only be used by a state 
  2.22  human services referee as evidence in the recipient's appeal to 
  2.23  the commissioner of human services under section 256.045.  
  2.24     (c) Nothing in this subdivision shall be construed to limit 
  2.25  or restrict the appeal rights provided in section 256.045 for 
  2.26  governmental program recipients. 
  2.27     Sec. 3.  Minnesota Statutes 1999 Supplement, section 
  2.28  256B.0625, subdivision 19c, is amended to read: 
  2.29     Subd. 19c.  [PERSONAL CARE.] Medical assistance covers 
  2.30  personal care services provided by an individual who is 
  2.31  qualified to provide the services according to subdivision 19a 
  2.32  and section 256B.0627, where the services are prescribed by a 
  2.33  physician in accordance with a plan of treatment and are 
  2.34  supervised by the recipient under the fiscal agent option 
  2.35  according to section 256B.0627, subdivision 10, or a qualified 
  2.36  professional.  "Qualified professional" means a mental health 
  3.1   professional as defined in section 245.462, subdivision 18, or 
  3.2   245.4871, subdivision 26 27; or a registered nurse as defined in 
  3.3   sections 148.171 to 148.285.  As part of the assessment, the 
  3.4   county public health nurse will consult with the recipient or 
  3.5   responsible party and identify the most appropriate person to 
  3.6   provide supervision of the personal care assistant.  The 
  3.7   qualified professional shall perform the duties described in 
  3.8   Minnesota Rules, part 9505.0335, subpart 4.  
  3.9      Sec. 4.  Minnesota Statutes 1999 Supplement, section 
  3.10  256B.0627, subdivision 5, is amended to read: 
  3.11     Subd. 5.  [LIMITATION ON PAYMENTS.] Medical assistance 
  3.12  payments for home care services shall be limited according to 
  3.13  this subdivision.  
  3.14     (a)  [LIMITS ON SERVICES WITHOUT PRIOR AUTHORIZATION.] A 
  3.15  recipient may receive the following home care services during a 
  3.16  calendar year: 
  3.17     (1) up to two face-to-face assessments to determine a 
  3.18  recipient's need for personal care assistant services; 
  3.19     (2) one service update done to determine a recipient's need 
  3.20  for personal care services; and 
  3.21     (3) up to five skilled nurse visits.  
  3.22     (b)  [PRIOR AUTHORIZATION; EXCEPTIONS.] All home care 
  3.23  services above the limits in paragraph (a) must receive the 
  3.24  commissioner's prior authorization, except when: 
  3.25     (1) the home care services were required to treat an 
  3.26  emergency medical condition that if not immediately treated 
  3.27  could cause a recipient serious physical or mental disability, 
  3.28  continuation of severe pain, or death.  The provider must 
  3.29  request retroactive authorization no later than five working 
  3.30  days after giving the initial service.  The provider must be 
  3.31  able to substantiate the emergency by documentation such as 
  3.32  reports, notes, and admission or discharge histories; 
  3.33     (2) the home care services were provided on or after the 
  3.34  date on which the recipient's eligibility began, but before the 
  3.35  date on which the recipient was notified that the case was 
  3.36  opened.  Authorization will be considered if the request is 
  4.1   submitted by the provider within 20 working days of the date the 
  4.2   recipient was notified that the case was opened; 
  4.3      (3) a third-party payor for home care services has denied 
  4.4   or adjusted a payment.  Authorization requests must be submitted 
  4.5   by the provider within 20 working days of the notice of denial 
  4.6   or adjustment.  A copy of the notice must be included with the 
  4.7   request; 
  4.8      (4) the commissioner has determined that a county or state 
  4.9   human services agency has made an error; or 
  4.10     (5) the professional nurse determines an immediate need for 
  4.11  up to 40 skilled nursing or home health aide visits per calendar 
  4.12  year and submits a request for authorization within 20 working 
  4.13  days of the initial service date, and medical assistance is 
  4.14  determined to be the appropriate payer. 
  4.15     (c)  [RETROACTIVE AUTHORIZATION.] A request for retroactive 
  4.16  authorization will be evaluated according to the same criteria 
  4.17  applied to prior authorization requests.  
  4.18     (d)  [ASSESSMENT AND SERVICE PLAN.] Assessments under 
  4.19  section 256B.0627, subdivision 1, paragraph (a), shall be 
  4.20  conducted initially, and at least annually thereafter, in person 
  4.21  with the recipient and result in a completed service plan using 
  4.22  forms specified by the commissioner.  Within 30 days of 
  4.23  recipient or responsible party request for home care services, 
  4.24  the assessment, the service plan, and other information 
  4.25  necessary to determine medical necessity such as diagnostic or 
  4.26  testing information, social or medical histories, and hospital 
  4.27  or facility discharge summaries shall be submitted to the 
  4.28  commissioner.  For personal care services: 
  4.29     (1) The amount and type of service authorized based upon 
  4.30  the assessment and service plan will follow the recipient if the 
  4.31  recipient chooses to change providers.  
  4.32     (2) If the recipient's medical need changes, the 
  4.33  recipient's provider may assess the need for a change in service 
  4.34  authorization and request the change from the county public 
  4.35  health nurse.  Within 30 days of the request, the public health 
  4.36  nurse will determine whether to request the change in services 
  5.1   based upon the provider assessment, or conduct a home visit to 
  5.2   assess the need and determine whether the change is appropriate. 
  5.3      (3) To continue to receive personal care services after the 
  5.4   first year, the recipient or the responsible party, in 
  5.5   conjunction with the public health nurse, may complete a service 
  5.6   update on forms developed by the commissioner according to 
  5.7   criteria and procedures in subdivision 1.  
  5.8      (e)  [PRIOR AUTHORIZATION.] The commissioner, or the 
  5.9   commissioner's designee, shall review the assessment, service 
  5.10  update, request for temporary services, service plan, and any 
  5.11  additional information that is submitted.  The commissioner 
  5.12  shall, within 30 days after receiving a complete request, 
  5.13  assessment, and service plan, authorize home care services as 
  5.14  follows:  
  5.15     (1)  [HOME HEALTH SERVICES.] All home health services 
  5.16  provided by a licensed nurse or a home health aide must be prior 
  5.17  authorized by the commissioner or the commissioner's designee.  
  5.18  Prior authorization must be based on medical necessity and 
  5.19  cost-effectiveness when compared with other care options.  When 
  5.20  home health services are used in combination with personal care 
  5.21  and private duty nursing, the cost of all home care services 
  5.22  shall be considered for cost-effectiveness.  The commissioner 
  5.23  shall limit nurse and home health aide visits to no more than 
  5.24  one visit each per day. 
  5.25     (2)  [PERSONAL CARE SERVICES.] (i) All personal care 
  5.26  services and supervision by a qualified professional must be 
  5.27  prior authorized by the commissioner or the commissioner's 
  5.28  designee except for the assessments established in paragraph 
  5.29  (a).  The amount of personal care services authorized must be 
  5.30  based on the recipient's home care rating.  A child may not be 
  5.31  found to be dependent in an activity of daily living if because 
  5.32  of the child's age an adult would either perform the activity 
  5.33  for the child or assist the child with the activity and the 
  5.34  amount of assistance needed is similar to the assistance 
  5.35  appropriate for a typical child of the same age.  Based on 
  5.36  medical necessity, the commissioner may authorize: 
  6.1      (A) up to two times the average number of direct care hours 
  6.2   provided in nursing facilities for the recipient's comparable 
  6.3   case mix level; or 
  6.4      (B) up to three times the average number of direct care 
  6.5   hours provided in nursing facilities for recipients who have 
  6.6   complex medical needs or are dependent in at least seven 
  6.7   activities of daily living and need physical assistance with 
  6.8   eating or have a neurological diagnosis; or 
  6.9      (C) up to 60 percent of the average reimbursement rate, as 
  6.10  of July 1, 1991, for care provided in a regional treatment 
  6.11  center for recipients who have Level I behavior, plus any 
  6.12  inflation adjustment as provided by the legislature for personal 
  6.13  care service; or 
  6.14     (D) up to the amount the commissioner would pay, as of July 
  6.15  1, 1991, plus any inflation adjustment provided for home care 
  6.16  services, for care provided in a regional treatment center for 
  6.17  recipients referred to the commissioner by a regional treatment 
  6.18  center preadmission evaluation team.  For purposes of this 
  6.19  clause, home care services means all services provided in the 
  6.20  home or community that would be included in the payment to a 
  6.21  regional treatment center; or 
  6.22     (E) up to the amount medical assistance would reimburse for 
  6.23  facility care for recipients referred to the commissioner by a 
  6.24  preadmission screening team established under section 256B.0911 
  6.25  or 256B.092; and 
  6.26     (F) a reasonable amount of time for the provision of 
  6.27  supervision by a qualified professional of personal care 
  6.28  services.  
  6.29     (ii) The number of direct care hours shall be determined 
  6.30  according to the annual cost report submitted to the department 
  6.31  by nursing facilities.  The average number of direct care hours, 
  6.32  as established by May 1, 1992, shall be calculated and 
  6.33  incorporated into the home care limits on July 1, 1992.  These 
  6.34  limits shall be calculated to the nearest quarter hour. 
  6.35     (iii) The home care rating shall be determined by the 
  6.36  commissioner or the commissioner's designee based on information 
  7.1   submitted to the commissioner by the county public health nurse 
  7.2   on forms specified by the commissioner.  The home care rating 
  7.3   shall be a combination of current assessment tools developed 
  7.4   under sections 256B.0911 and 256B.501 with an addition for 
  7.5   seizure activity that will assess the frequency and severity of 
  7.6   seizure activity and with adjustments, additions, and 
  7.7   clarifications that are necessary to reflect the needs and 
  7.8   conditions of recipients who need home care including children 
  7.9   and adults under 65 years of age.  The commissioner shall 
  7.10  establish these forms and protocols under this section and shall 
  7.11  use an advisory group, including representatives of recipients, 
  7.12  providers, and counties, for consultation in establishing and 
  7.13  revising the forms and protocols. 
  7.14     (iv) A recipient shall qualify as having complex medical 
  7.15  needs if the care required is difficult to perform and because 
  7.16  of recipient's medical condition requires more time than 
  7.17  community-based standards allow or requires more skill than 
  7.18  would ordinarily be required and the recipient needs or has one 
  7.19  or more of the following: 
  7.20     (A) daily tube feedings; 
  7.21     (B) daily parenteral therapy; 
  7.22     (C) wound or decubiti care; 
  7.23     (D) postural drainage, percussion, nebulizer treatments, 
  7.24  suctioning, tracheotomy care, oxygen, mechanical ventilation; 
  7.25     (E) catheterization; 
  7.26     (F) ostomy care; 
  7.27     (G) quadriplegia; or 
  7.28     (H) other comparable medical conditions or treatments the 
  7.29  commissioner determines would otherwise require institutional 
  7.30  care.  
  7.31     (v) A recipient shall qualify as having Level I behavior if 
  7.32  there is reasonable supporting evidence that the recipient 
  7.33  exhibits, or that without supervision, observation, or 
  7.34  redirection would exhibit, one or more of the following 
  7.35  behaviors that cause, or have the potential to cause: 
  7.36     (A) injury to the recipient's own body; 
  8.1      (B) physical injury to other people; or 
  8.2      (C) destruction of property. 
  8.3      (vi) Time authorized for personal care relating to Level I 
  8.4   behavior in subclause (v), items (A) to (C), shall be based on 
  8.5   the predictability, frequency, and amount of intervention 
  8.6   required. 
  8.7      (vii) A recipient shall qualify as having Level II behavior 
  8.8   if the recipient exhibits on a daily basis one or more of the 
  8.9   following behaviors that interfere with the completion of 
  8.10  personal care services under subdivision 4, paragraph (a): 
  8.11     (A) unusual or repetitive habits; 
  8.12     (B) withdrawn behavior; or 
  8.13     (C) offensive behavior. 
  8.14     (viii) A recipient with a home care rating of Level II 
  8.15  behavior in subclause (vii), items (A) to (C), shall be rated as 
  8.16  comparable to a recipient with complex medical needs under 
  8.17  subclause (iv).  If a recipient has both complex medical needs 
  8.18  and Level II behavior, the home care rating shall be the next 
  8.19  complex category up to the maximum rating under subclause (i), 
  8.20  item (B). 
  8.21     (3)  [PRIVATE DUTY NURSING SERVICES.] All private duty 
  8.22  nursing services shall be prior authorized by the commissioner 
  8.23  or the commissioner's designee.  Prior authorization for private 
  8.24  duty nursing services shall be based on medical necessity and 
  8.25  cost-effectiveness when compared with alternative care options.  
  8.26  The commissioner may authorize medically necessary private duty 
  8.27  nursing services in quarter-hour units when: 
  8.28     (i) the recipient requires more individual and continuous 
  8.29  care than can be provided during a nurse visit; or 
  8.30     (ii) the cares are outside of the scope of services that 
  8.31  can be provided by a home health aide or personal care assistant.
  8.32     The commissioner may authorize: 
  8.33     (A) up to two times the average amount of direct care hours 
  8.34  provided in nursing facilities statewide for case mix 
  8.35  classification "K" as established by the annual cost report 
  8.36  submitted to the department by nursing facilities in May 1992; 
  9.1      (B) private duty nursing in combination with other home 
  9.2   care services up to the total cost allowed under clause (2); 
  9.3      (C) up to 16 hours per day if the recipient requires more 
  9.4   nursing than the maximum number of direct care hours as 
  9.5   established in item (A) and the recipient meets the hospital 
  9.6   admission criteria established under Minnesota Rules, parts 
  9.7   9505.0500 to 9505.0540.  
  9.8      The commissioner may authorize up to 16 hours per day of 
  9.9   medically necessary private duty nursing services or up to 24 
  9.10  hours per day of medically necessary private duty nursing 
  9.11  services until such time as the commissioner is able to make a 
  9.12  determination of eligibility for recipients who are 
  9.13  cooperatively applying for home care services under the 
  9.14  community alternative care program developed under section 
  9.15  256B.49, or until it is determined by the appropriate regulatory 
  9.16  agency that a health benefit plan is or is not required to pay 
  9.17  for appropriate medically necessary health care services.  
  9.18  Recipients or their representatives must cooperatively assist 
  9.19  the commissioner in obtaining this determination.  Recipients 
  9.20  who are eligible for the community alternative care program may 
  9.21  not receive more hours of nursing under this section than would 
  9.22  otherwise be authorized under section 256B.49. 
  9.23     (4)  [VENTILATOR-DEPENDENT RECIPIENTS.] If the recipient is 
  9.24  ventilator-dependent, the monthly medical assistance 
  9.25  authorization for home care services shall not exceed what the 
  9.26  commissioner would pay for care at the highest cost hospital 
  9.27  designated as a long-term hospital under the Medicare program.  
  9.28  For purposes of this clause, home care services means all 
  9.29  services provided in the home that would be included in the 
  9.30  payment for care at the long-term hospital.  
  9.31  "Ventilator-dependent" means an individual who receives 
  9.32  mechanical ventilation for life support at least six hours per 
  9.33  day and is expected to be or has been dependent for at least 30 
  9.34  consecutive days.  
  9.35     (f)  [PRIOR AUTHORIZATION; TIME LIMITS.] The commissioner 
  9.36  or the commissioner's designee shall determine the time period 
 10.1   for which a prior authorization shall be effective.  If the 
 10.2   recipient continues to require home care services beyond the 
 10.3   duration of the prior authorization, the home care provider must 
 10.4   request a new prior authorization.  Under no circumstances, 
 10.5   other than the exceptions in paragraph (b), shall a prior 
 10.6   authorization be valid prior to the date the commissioner 
 10.7   receives the request or for more than 12 months.  A recipient 
 10.8   who appeals a reduction in previously authorized home care 
 10.9   services may continue previously authorized services, other than 
 10.10  temporary services under paragraph (h), pending an appeal under 
 10.11  section 256.045.  The commissioner must provide a detailed 
 10.12  explanation of why the authorized services are reduced in amount 
 10.13  from those requested by the home care provider.  
 10.14     (g)  [APPROVAL OF HOME CARE SERVICES.] The commissioner or 
 10.15  the commissioner's designee shall determine the medical 
 10.16  necessity of home care services, the level of caregiver 
 10.17  according to subdivision 2, and the institutional comparison 
 10.18  according to this subdivision, the cost-effectiveness of 
 10.19  services, and the amount, scope, and duration of home care 
 10.20  services reimbursable by medical assistance, based on the 
 10.21  assessment, primary payer coverage determination information as 
 10.22  required, the service plan, the recipient's age, the cost of 
 10.23  services, the recipient's medical condition, and diagnosis or 
 10.24  disability.  The commissioner may publish additional criteria 
 10.25  for determining medical necessity according to section 256B.04. 
 10.26     (h)  [PRIOR AUTHORIZATION REQUESTS; TEMPORARY SERVICES.] 
 10.27  The agency nurse, the independently enrolled private duty nurse, 
 10.28  or county public health nurse may request a temporary 
 10.29  authorization for home care services by telephone.  The 
 10.30  commissioner may approve a temporary level of home care services 
 10.31  based on the assessment, and service or care plan information, 
 10.32  and primary payer coverage determination information as required.
 10.33  Authorization for a temporary level of home care services 
 10.34  including nurse supervision is limited to the time specified by 
 10.35  the commissioner, but shall not exceed 45 days, unless extended 
 10.36  because the county public health nurse has not completed the 
 11.1   required assessment and service plan, or the commissioner's 
 11.2   determination has not been made.  The level of services 
 11.3   authorized under this provision shall have no bearing on a 
 11.4   future prior authorization. 
 11.5      (i)  [PRIOR AUTHORIZATION REQUIRED IN FOSTER CARE SETTING.] 
 11.6   Home care services provided in an adult or child foster care 
 11.7   setting must receive prior authorization by the department 
 11.8   according to the limits established in paragraph (a). 
 11.9      The commissioner may not authorize: 
 11.10     (1) home care services that are the responsibility of the 
 11.11  foster care provider under the terms of the foster care 
 11.12  placement agreement and administrative rules.  Requests for home 
 11.13  care services for recipients residing in a foster care setting 
 11.14  must include the foster care placement agreement and 
 11.15  determination of difficulty of care; 
 11.16     (2) personal care services when the foster care license 
 11.17  holder is also the personal care provider or personal care 
 11.18  assistant unless the recipient can direct the recipient's own 
 11.19  care, or case management is provided as required in section 
 11.20  256B.0625, subdivision 19a; 
 11.21     (3) personal care services when the responsible party is an 
 11.22  employee of, or under contract with, or has any direct or 
 11.23  indirect financial relationship with the personal care provider 
 11.24  or personal care assistant, unless case management is provided 
 11.25  as required in section 256B.0625, subdivision 19a; or 
 11.26     (4) home personal care attendant and private duty nursing 
 11.27  services when the number of foster care residents is greater 
 11.28  than four unless the county responsible for the recipient's 
 11.29  foster placement made the placement prior to April 1, 1992, 
 11.30  requests that home personal care attendant and private duty 
 11.31  nursing services be provided, and case management is provided as 
 11.32  required in section 256B.0625, subdivision 19a; or. 
 11.33     (5) home care services when combined with foster care 
 11.34  payments, other than room and board payments that exceed the 
 11.35  total amount that public funds would pay for the recipient's 
 11.36  care in a medical institution. 
 12.1      Sec. 5.  Minnesota Statutes 1999 Supplement, section 
 12.2   256B.0627, subdivision 8, is amended to read: 
 12.3      Subd. 8.  [SHARED PERSONAL CARE ASSISTANT SERVICES.] (a) 
 12.4   Medical assistance payments for shared personal care assistance 
 12.5   services shall be limited according to this subdivision. 
 12.6      (b) Recipients of personal care assistant services may 
 12.7   share staff and the commissioner shall provide a rate system for 
 12.8   shared personal care assistant services.  For two persons 
 12.9   sharing services, the rate paid to a provider shall not exceed 
 12.10  1-1/2 times the rate paid for serving a single individual, and 
 12.11  for three persons sharing services, the rate paid to a provider 
 12.12  shall not exceed twice the rate paid for serving a single 
 12.13  individual.  These rates apply only to situations in which all 
 12.14  recipients were present and received shared services on the date 
 12.15  for which the service is billed.  No more than three persons may 
 12.16  receive shared services from a personal care assistant in a 
 12.17  single setting. 
 12.18     (c) Shared service is the provision of personal care 
 12.19  services by a personal care assistant to two or three recipients 
 12.20  at the same time and in the same setting.  For the purposes of 
 12.21  this subdivision, "setting" means: 
 12.22     (1) the home or foster care home of one of the individual 
 12.23  recipients; or 
 12.24     (2) a child care program in which all recipients served by 
 12.25  one personal care assistant are participating, which is licensed 
 12.26  under chapter 245A or operated by a local school district or 
 12.27  private school.; or 
 12.28     (3) outside the home or foster care home of one of the 
 12.29  recipients when normal life activities take the recipients 
 12.30  outside the home.  
 12.31     The provisions of this subdivision do not apply when a 
 12.32  personal care assistant is caring for multiple recipients in 
 12.33  more than one setting. 
 12.34     (d) The recipient or the recipient's responsible party, in 
 12.35  conjunction with the county public health nurse, shall determine:
 12.36     (1) whether shared personal care assistant services is an 
 13.1   appropriate option based on the individual needs and preferences 
 13.2   of the recipient; and 
 13.3      (2) the amount of shared services allocated as part of the 
 13.4   overall authorization of personal care services. 
 13.5      The recipient or the responsible party, in conjunction with 
 13.6   the supervising qualified professional, shall arrange the 
 13.7   setting and grouping of shared services based on the individual 
 13.8   needs and preferences of the recipients.  Decisions on the 
 13.9   selection of recipients to share services must be based on the 
 13.10  ages of the recipients, compatibility, and coordination of their 
 13.11  care needs. 
 13.12     (e) The following items must be considered by the recipient 
 13.13  or the responsible party and the supervising qualified 
 13.14  professional, and documented in the recipient's health service 
 13.15  record: 
 13.16     (1) the additional qualifications needed by the personal 
 13.17  care assistant to provide care to several recipients in the same 
 13.18  setting; 
 13.19     (2) the additional training and supervision needed by the 
 13.20  personal care assistant to ensure that the needs of the 
 13.21  recipient are met appropriately and safely.  The provider must 
 13.22  provide on-site supervision by a qualified professional within 
 13.23  the first 14 days of shared services, and monthly thereafter; 
 13.24     (3) the setting in which the shared services will be 
 13.25  provided; 
 13.26     (4) the ongoing monitoring and evaluation of the 
 13.27  effectiveness and appropriateness of the service and process 
 13.28  used to make changes in service or setting; and 
 13.29     (5) a contingency plan which accounts for absence of the 
 13.30  recipient in a shared services setting due to illness or other 
 13.31  circumstances and staffing contingencies. 
 13.32     (f) The provider must offer the recipient or the 
 13.33  responsible party the option of shared or one-on-one personal 
 13.34  care assistant services.  The recipient or the responsible party 
 13.35  can withdraw from participating in a shared services arrangement 
 13.36  at any time. 
 14.1      (g) In addition to documentation requirements under 
 14.2   Minnesota Rules, part 9505.2175, a personal care provider must 
 14.3   meet documentation requirements for shared personal care 
 14.4   assistant services and must document the following in the health 
 14.5   service record for each individual recipient sharing services: 
 14.6      (1) permission by the recipient or the recipient's 
 14.7   responsible party, if any, for the maximum number of shared 
 14.8   services hours per week chosen by the recipient; 
 14.9      (2) permission by the recipient or the recipient's 
 14.10  responsible party, if any, for personal care assistant services 
 14.11  provided outside the recipient's residence; 
 14.12     (3) permission by the recipient or the recipient's 
 14.13  responsible party, if any, for others to receive shared services 
 14.14  in the recipient's residence; 
 14.15     (4) revocation by the recipient or the recipient's 
 14.16  responsible party, if any, of the shared service authorization, 
 14.17  or the shared service to be provided to others in the 
 14.18  recipient's residence, or the shared service to be provided 
 14.19  outside the recipient's residence; 
 14.20     (5) supervision of the shared personal care assistant 
 14.21  services by the qualified professional, including the date, time 
 14.22  of day, number of hours spent supervising the provision of 
 14.23  shared services, whether the supervision was face-to-face or 
 14.24  another method of supervision, changes in the recipient's 
 14.25  condition, shared services scheduling issues and 
 14.26  recommendations; 
 14.27     (6) documentation by the qualified professional of 
 14.28  telephone calls or other discussions with the personal care 
 14.29  assistant regarding services being provided to the recipient; 
 14.30  and 
 14.31     (7) daily documentation of the shared services provided by 
 14.32  each identified personal care assistant including: 
 14.33     (i) the names of each recipient receiving shared services 
 14.34  together; 
 14.35     (ii) the setting for the shared services, including the 
 14.36  starting and ending times that the recipient received shared 
 15.1   services; and 
 15.2      (iii) notes by the personal care assistant regarding 
 15.3   changes in the recipient's condition, problems that may arise 
 15.4   from the sharing of services, scheduling issues, care issues, 
 15.5   and other notes as required by the qualified professional. 
 15.6      (h) Unless otherwise provided in this subdivision, all 
 15.7   other statutory and regulatory provisions relating to personal 
 15.8   care services apply to shared services. 
 15.9      Nothing in this subdivision shall be construed to reduce 
 15.10  the total number of hours authorized for an individual recipient.
 15.11     Sec. 6.  Minnesota Statutes 1999 Supplement, section 
 15.12  256B.0627, subdivision 11, is amended to read: 
 15.13     Subd. 11.  [SHARED PRIVATE DUTY NURSING CARE OPTION.] (a) 
 15.14  Medical assistance payments for shared private duty nursing 
 15.15  services by a private duty nurse shall be limited according to 
 15.16  this subdivision.  For the purposes of this section, "private 
 15.17  duty nursing agency" means an agency licensed under chapter 144A 
 15.18  to provide private duty nursing services. 
 15.19     (b) Recipients of private duty nursing services may share 
 15.20  nursing staff and the commissioner shall provide a rate 
 15.21  methodology for shared private duty nursing.  For two persons 
 15.22  sharing nursing care, the rate paid to a provider shall not 
 15.23  exceed 1.5 times the nonwaivered private duty nursing rates paid 
 15.24  for serving a single individual who is not ventilator dependent, 
 15.25  by a registered nurse or licensed practical nurse.  These rates 
 15.26  apply only to situations in which both recipients are present 
 15.27  and receive shared private duty nursing care on the date for 
 15.28  which the service is billed.  No more than two persons may 
 15.29  receive shared private duty nursing services from a private duty 
 15.30  nurse in a single setting. 
 15.31     (c) Shared private duty nursing care is the provision of 
 15.32  nursing services by a private duty nurse to two recipients at 
 15.33  the same time and in the same setting.  For the purposes of this 
 15.34  subdivision, "setting" means: 
 15.35     (1) the home or foster care home of one of the individual 
 15.36  recipients; or 
 16.1      (2) a child care program licensed under chapter 245A or 
 16.2   operated by a local school district or private school; or 
 16.3      (3) an adult day care service licensed under chapter 245A.; 
 16.4   or 
 16.5      (4) outside the home or foster care home of one of the 
 16.6   recipients when normal life activities take the recipients 
 16.7   outside the home.  
 16.8      This subdivision does not apply when a private duty nurse 
 16.9   is caring for multiple recipients in more than one setting. 
 16.10     (d) The recipient or the recipient's legal representative, 
 16.11  and the recipient's physician, in conjunction with the home 
 16.12  health care agency, shall determine: 
 16.13     (1) whether shared private duty nursing care is an 
 16.14  appropriate option based on the individual needs and preferences 
 16.15  of the recipient; and 
 16.16     (2) the amount of shared private duty nursing services 
 16.17  authorized as part of the overall authorization of nursing 
 16.18  services. 
 16.19     (e) The recipient or the recipient's legal representative, 
 16.20  in conjunction with the private duty nursing agency, shall 
 16.21  approve the setting, grouping, and arrangement of shared private 
 16.22  duty nursing care based on the individual needs and preferences 
 16.23  of the recipients.  Decisions on the selection of recipients to 
 16.24  share services must be based on the ages of the recipients, 
 16.25  compatibility, and coordination of their care needs. 
 16.26     (f) The following items must be considered by the recipient 
 16.27  or the recipient's legal representative and the private duty 
 16.28  nursing agency, and documented in the recipient's health service 
 16.29  record: 
 16.30     (1) the additional training needed by the private duty 
 16.31  nurse to provide care to several two recipients in the same 
 16.32  setting and to ensure that the needs of the recipients are met 
 16.33  appropriately and safely; 
 16.34     (2) the setting in which the shared private duty nursing 
 16.35  care will be provided; 
 16.36     (3) the ongoing monitoring and evaluation of the 
 17.1   effectiveness and appropriateness of the service and process 
 17.2   used to make changes in service or setting; 
 17.3      (4) a contingency plan which accounts for absence of the 
 17.4   recipient in a shared private duty nursing setting due to 
 17.5   illness or other circumstances; 
 17.6      (5) staffing backup contingencies in the event of employee 
 17.7   illness or absence; and 
 17.8      (6) arrangements for additional assistance to respond to 
 17.9   urgent or emergency care needs of the recipients. 
 17.10     (g) The provider must offer the recipient or responsible 
 17.11  party the option of shared or one-on-one private duty nursing 
 17.12  services.  The recipient or responsible party can withdraw from 
 17.13  participating in a shared service arrangement at any time. 
 17.14     (h) The private duty nursing agency must document the 
 17.15  following in the health service record for each individual 
 17.16  recipient sharing private duty nursing care: 
 17.17     (1) permission by the recipient or the recipient's legal 
 17.18  representative for the maximum number of shared nursing care 
 17.19  hours per week chosen by the recipient; 
 17.20     (2) permission by the recipient or the recipient's legal 
 17.21  representative for shared private duty nursing services provided 
 17.22  outside the recipient's residence; 
 17.23     (3) permission by the recipient or the recipient's legal 
 17.24  representative for others to receive shared private duty nursing 
 17.25  services in the recipient's residence; 
 17.26     (4) revocation by the recipient or the recipient's legal 
 17.27  representative of the shared private duty nursing care 
 17.28  authorization, or the shared care to be provided to others in 
 17.29  the recipient's residence, or the shared private duty nursing 
 17.30  services to be provided outside the recipient's residence; and 
 17.31     (5) daily documentation of the shared private duty nursing 
 17.32  services provided by each identified private duty nurse, 
 17.33  including: 
 17.34     (i) the names of each recipient receiving shared private 
 17.35  duty nursing services together; 
 17.36     (ii) the setting for the shared services, including the 
 18.1   starting and ending times that the recipient received shared 
 18.2   private duty nursing care; and 
 18.3      (iii) notes by the private duty nurse regarding changes in 
 18.4   the recipient's condition, problems that may arise from the 
 18.5   sharing of private duty nursing services, and scheduling and 
 18.6   care issues. 
 18.7      (i) Unless otherwise provided in this subdivision, all 
 18.8   other statutory and regulatory provisions relating to private 
 18.9   duty nursing services apply to shared private duty nursing 
 18.10  services. 
 18.11     Nothing in this subdivision shall be construed to reduce 
 18.12  the total number of private duty nursing hours authorized for an 
 18.13  individual recipient under subdivision 5. 
 18.14     Sec. 7.  Minnesota Statutes 1999 Supplement, section 
 18.15  256B.501, subdivision 8a, is amended to read: 
 18.16     Subd. 8a.  [PAYMENT FOR PERSONS WITH SPECIAL NEEDS FOR 
 18.17  CRISIS INTERVENTION SERVICES.] Community-based crisis services 
 18.18  authorized by the commissioner or the commissioner's designee 
 18.19  for a resident of an intermediate care facility for persons with 
 18.20  mental retardation (ICF/MR) reimbursed under this section shall 
 18.21  be paid by medical assistance in accordance with the paragraphs 
 18.22  (a) to (g). 
 18.23     (a) "Crisis services" means the specialized services listed 
 18.24  in clauses (1) to (3) provided to prevent the recipient from 
 18.25  requiring placement in a more restrictive institutional setting 
 18.26  such as an inpatient hospital or regional treatment center and 
 18.27  to maintain the recipient in the present community setting. 
 18.28     (1) The crisis services provider shall assess the 
 18.29  recipient's behavior and environment to identify factors 
 18.30  contributing to the crisis. 
 18.31     (2) The crisis services provider shall develop a 
 18.32  recipient-specific intervention plan in coordination with the 
 18.33  service planning team and provide recommendations for revisions 
 18.34  to the individual service plan if necessary to prevent or 
 18.35  minimize the likelihood of future crisis situations.  The 
 18.36  intervention plan shall include a transition plan to aid the 
 19.1   recipient in returning to the community-based ICF/MR if the 
 19.2   recipient is receiving residential crisis services.  
 19.3      (3) The crisis services provider shall consult with and 
 19.4   provide training and ongoing technical assistance to the 
 19.5   recipient's service providers to aid in the implementation of 
 19.6   the intervention plan and revisions to the individual service 
 19.7   plan. 
 19.8      (b) "Residential crisis services" means crisis services 
 19.9   that are provided to a recipient admitted to an alternative, 
 19.10  state-licensed site approved by the commissioner, because the 
 19.11  ICF/MR receiving reimbursement under this section is not able, 
 19.12  as determined by the commissioner, to provide the intervention 
 19.13  and protection of the recipient and others living with the 
 19.14  recipient that is necessary to prevent the recipient from 
 19.15  requiring placement in a more restrictive institutional setting. 
 19.16     (c) Residential crisis services providers must maintain a 
 19.17  license from the commissioner for the residence when providing 
 19.18  crisis services for short-term crisis intervention, and must not 
 19.19  be located in a private residence. 
 19.20     (d) Payment rates shall be established consistent with 
 19.21  county negotiated crisis intervention services.  
 19.22     (e) Payment for residential crisis services is limited to 
 19.23  21 days, unless an additional period is authorized by the 
 19.24  commissioner or part of an approved regional plan.  
 19.25     (f) Payment for crisis services shall be made only for 
 19.26  services provided while the ICF/MR receiving reimbursement under 
 19.27  this section: 
 19.28     (1) has a shared services agreement with the crisis 
 19.29  services provider in effect under section 246.57; and 
 19.30     (2) has executed a cooperative agreement with the crisis 
 19.31  services provider to implement the intervention plan and 
 19.32  revisions to the individual service plan as necessary to prevent 
 19.33  or minimize the likelihood of future crisis situations, to 
 19.34  maintain the recipient in the present community setting, and to 
 19.35  prevent the recipient from requiring a more restrictive 
 19.36  institutional setting. 
 20.1      (g) Payment to the ICF/MR receiving reimbursement under 
 20.2   this section shall be made for up to 18 therapeutic leave days 
 20.3   during which the recipient is receiving residential crisis 
 20.4   services, if the ICF/MR is otherwise eligible to receive payment 
 20.5   for a therapeutic leave day under Minnesota Rules, part 
 20.6   9505.0415.  Payment under this paragraph shall be terminated if 
 20.7   the commissioner determines that the ICF/MR is not meeting the 
 20.8   terms of the shared cooperative service agreement under 
 20.9   paragraph (f) or that the recipient will not return to the 
 20.10  ICF/MR. 
 20.11     Sec. 8.  Minnesota Statutes 1999 Supplement, section 
 20.12  256B.5011, subdivision 2, is amended to read: 
 20.13     Subd. 2.  [CONTRACT PROVISIONS.] (a) The service contract 
 20.14  with each intermediate care facility must include provisions for:
 20.15     (1) modifying payments when significant changes occur in 
 20.16  the needs of the consumers; 
 20.17     (2) the establishment and use of continuous a quality 
 20.18  improvement processes using the results attained through service 
 20.19  quality monitoring plan.  Using criteria and options for 
 20.20  performance measures developed by the commissioner, each 
 20.21  intermediate care facility must identify a minimum of one 
 20.22  performance measure on which to focus its efforts for quality 
 20.23  improvement during the contract period; 
 20.24     (3) appropriate and necessary statistical information 
 20.25  required by the commissioner; 
 20.26     (4) annual aggregate facility financial information; and 
 20.27     (5) additional requirements for intermediate care 
 20.28  facilities not meeting the standards set forth in the service 
 20.29  contract. 
 20.30     (b) The commissioner shall recommend to the legislature by 
 20.31  January 15, 2000, whether the contract should include service 
 20.32  quality monitoring that may utilize performance indicators that 
 20.33  measure consumer and program outcomes.  Performance measurement 
 20.34  shall not increase or duplicate regulatory requirements. 
 20.35     (b) The commissioner of human services and the commissioner 
 20.36  of health, in consultation with representatives from counties, 
 21.1   advocacy organizations, and the provider community, will review 
 21.2   the consolidated standards under chapter 245B and the supervised 
 21.3   living facility rule under Minnesota Rules, chapter 4665, to 
 21.4   determine what provisions in Minnesota Rules, chapter 4665, may 
 21.5   be waived for intermediate care facilities in order to implement 
 21.6   the performance measures in their contract, provide quality 
 21.7   services to residents, and not duplicate or increase the 
 21.8   regulatory requirements.  
 21.9      Sec. 9.  Minnesota Statutes 1999 Supplement, section 
 21.10  256B.5013, subdivision 1, is amended to read: 
 21.11     Subdivision 1.  [VARIABLE RATE ADJUSTMENTS.] For rate years 
 21.12  beginning on or after October 1, 2000, when there is a 
 21.13  documented increase in the resource needs of a current ICF/MR 
 21.14  recipient or recipients, or a person is admitted to a facility 
 21.15  who requires additional resources, the county of financial 
 21.16  responsibility may approve recommend approval of an enhanced a 
 21.17  variable rate for one or more persons in the to enable the 
 21.18  facility to meet the needs based on the recipient's screening.  
 21.19  Resource needs directly attributable to an individual that may 
 21.20  be considered under the variable rate adjustment include 
 21.21  increased direct staff hours and other specialized services, 
 21.22  equipment, and human resources.  The guidelines in paragraphs 
 21.23  (a) to (d) apply for the payment rate adjustments under this 
 21.24  section. 
 21.25     (a) All persons must be screened according to section 
 21.26  256B.092, subdivisions 7 and 8, prior to implementation of the 
 21.27  new payment system, and annually thereafter, and when a variable 
 21.28  rate is being requested due to changes in the needs of the 
 21.29  recipient.  Screening data shall be analyzed to develop broad 
 21.30  profiles of the functional characteristics of recipients.  Three 
 21.31  components shall Criteria to be used to distinguish recipients 
 21.32  based on the following broad develop these profiles shall 
 21.33  include, but not be limited to: 
 21.34     (1) the functional ability of a recipient to care for and 
 21.35  maintain one's the recipient's own basic needs; 
 21.36     (2) the intensity of any aggressive or destructive 
 22.1   behavior; and 
 22.2      (3) any history of obstructive behavior in combination with 
 22.3   a diagnosis of psychosis or neurosis.; 
 22.4      (4) a need for resources due to a change in resident day 
 22.5   program participation because the resident:  (i) has reached the 
 22.6   age of 65 or has a deteriorating health condition that makes it 
 22.7   difficult to participate in day training and habilitation 
 22.8   services over an extended period of time as provided in section 
 22.9   252.41, subdivision 3, clause (3); and (ii) has expressed a 
 22.10  desire for change through the developmental disabilities 
 22.11  screening process; and 
 22.12     (5) a need for additional resources for intensive 
 22.13  short-term training which is necessary prior to a recipient's 
 22.14  discharge to a less restrictive, more integrated setting. 
 22.15     The profile groups recipients' screenings shall be used to 
 22.16  link resource needs to funding.  The resource profile shall 
 22.17  determine the level of funding that may be authorized by the 
 22.18  county.  The county of financial responsibility may approve a 
 22.19  rate adjustment for an individual.  The commissioner shall 
 22.20  recommend to the legislature by January 15, 2000, a methodology 
 22.21  using the profile groups to determine variable rates.  The 
 22.22  variable rate must be applied to expenses related to increased 
 22.23  direct staff hours and other specialized services, equipment, 
 22.24  and human resources.  This variable rate component plus the 
 22.25  facility's current operating payment rate equals the 
 22.26  individual's total operating payment rate. 
 22.27     (b) A recipient must be screened by the county of financial 
 22.28  responsibility using the developmental disabilities screening 
 22.29  document completed immediately prior to approval of a variable 
 22.30  rate by the county.  A comparison of the updated screening and 
 22.31  the previous screening must demonstrate an increase in resource 
 22.32  needs. 
 22.33     (c) Rate adjustments projected to exceed the authorized 
 22.34  funding level associated with the person's profile must be 
 22.35  submitted to the commissioner. 
 22.36     (d) The new rate approved through this process shall not be 
 23.1   averaged across all persons living at a facility but shall be an 
 23.2   individual rate.  The county of financial responsibility must 
 23.3   indicate the projected length of time that the additional 
 23.4   funding may be needed by for the individual.  The need to 
 23.5   continue an individual variable rate must be reviewed at the end 
 23.6   of the anticipated duration of need but at least annually 
 23.7   through the completion of the developmental disabilities 
 23.8   screening document. 
 23.9      Sec. 10.  Minnesota Statutes 1999 Supplement, section 
 23.10  256B.5013, is amended by adding a subdivision to read: 
 23.11     Subd. 5.  [REQUIRED DATA; PAYMENT ADJUSTMENTS.] Facilities 
 23.12  shall maintain and submit monthly bed use data in the form of 
 23.13  resident days and variable rate information.  When a variable 
 23.14  rate is reported by a facility, this information will be used to 
 23.15  track the amount and time span of the rate adjustment.  The 
 23.16  total payments made to a facility can be adjusted based on 
 23.17  concurrent changes in the needs of recipients that are covered 
 23.18  by a variable rate adjustment.  Any adjustment for multiple 
 23.19  resident changes shall not result in a decrease to the facility 
 23.20  base rate. 
 23.21     Sec. 11.  Minnesota Statutes 1999 Supplement, section 
 23.22  256B.5013, is amended by adding a subdivision to read: 
 23.23     Subd. 6.  [COMMISSIONER REVIEW.] During the initial 
 23.24  contracting period, the commissioner shall review the process of 
 23.25  variable rate adjustments to determine if the variable rate 
 23.26  process is being effectively implemented, and whether the 
 23.27  variable rate process minimizes unnecessary detailed 
 23.28  recordkeeping, and meets recipient needs.  
 23.29     Sec. 12.  Minnesota Statutes 1999 Supplement, section 
 23.30  256B.77, subdivision 8, is amended to read: 
 23.31     Subd. 8.  [RESPONSIBILITIES OF THE COUNTY ADMINISTRATIVE 
 23.32  ENTITY.] (a) The county administrative entity shall meet the 
 23.33  requirements of this subdivision, unless the county authority or 
 23.34  the commissioner, with written approval of the county authority, 
 23.35  enters into a service delivery contract with a service delivery 
 23.36  organization for any or all of the requirements contained in 
 24.1   this subdivision. 
 24.2      (b) The county administrative entity shall enroll eligible 
 24.3   individuals regardless of health or disability status. 
 24.4      (c) The county administrative entity shall provide all 
 24.5   enrollees timely access to the medical assistance benefit set.  
 24.6   Alternative services and additional services are available to 
 24.7   enrollees at the option of the county administrative entity and 
 24.8   may be provided if specified in the personal support plan.  
 24.9   County authorities are not required to seek prior authorization 
 24.10  from the department as required by the laws and rules governing 
 24.11  medical assistance. 
 24.12     (d) The county administrative entity shall cover necessary 
 24.13  services as a result of an emergency without prior 
 24.14  authorization, even if the services were rendered outside of the 
 24.15  provider network. 
 24.16     (e) The county administrative entity shall authorize 
 24.17  necessary and appropriate services when needed and requested by 
 24.18  the enrollee or the enrollee's legal representative in response 
 24.19  to an urgent situation.  Enrollees shall have 24-hour access to 
 24.20  urgent care services coordinated by experienced disability 
 24.21  providers who have information about enrollees' needs and 
 24.22  conditions. 
 24.23     (f) The county administrative entity shall accept the 
 24.24  capitation payment from the commissioner in return for the 
 24.25  provision of services for enrollees. 
 24.26     (g) The county administrative entity shall maintain 
 24.27  internal grievance and complaint procedures, including an 
 24.28  expedited informal complaint process in which the county 
 24.29  administrative entity must respond to verbal complaints within 
 24.30  ten calendar days, and a formal grievance process, in which the 
 24.31  county administrative entity must respond to written complaints 
 24.32  within 30 calendar days. 
 24.33     (h) The county administrative entity shall provide a 
 24.34  certificate of coverage, upon enrollment, to each enrollee and 
 24.35  the enrollee's legal representative, if any, which describes the 
 24.36  benefits covered by the county administrative entity, any 
 25.1   limitations on those benefits, and information about providers 
 25.2   and the service delivery network.  This information must also be 
 25.3   made available to prospective enrollees.  This certificate must 
 25.4   be approved by the commissioner. 
 25.5      (i) The county administrative entity shall present evidence 
 25.6   of an expedited process to approve exceptions to benefits, 
 25.7   provider network restrictions, and other plan limitations under 
 25.8   appropriate circumstances. 
 25.9      (j) The county administrative entity shall provide 
 25.10  enrollees or their legal representatives with written notice of 
 25.11  their appeal rights under subdivision 16, and of ombudsman and 
 25.12  advocacy programs under subdivisions 13 and 14, at the following 
 25.13  times:  upon enrollment, upon submission of a written complaint, 
 25.14  when a service is reduced, denied, or terminated, or when 
 25.15  renewal of authorization for ongoing service is refused. 
 25.16     (k) The county administrative entity shall determine 
 25.17  immediate needs, including services, support, and assessments, 
 25.18  within 30 calendar days after enrollment, or within a shorter 
 25.19  time frame if specified in the intergovernmental contract. 
 25.20     (l) The county administrative entity shall assess the need 
 25.21  for services of new enrollees within 60 calendar days after 
 25.22  enrollment, or within a shorter time frame if specified in the 
 25.23  intergovernmental contract, and periodically reassess the need 
 25.24  for services for all enrollees. 
 25.25     (m) The county administrative entity shall ensure the 
 25.26  development of a personal support plan for each person within 60 
 25.27  calendar days of enrollment, or within a shorter time frame if 
 25.28  specified in the intergovernmental contract, unless otherwise 
 25.29  agreed to by the enrollee and the enrollee's legal 
 25.30  representative, if any.  Until a personal support plan is 
 25.31  developed and agreed to by the enrollee, enrollees must have 
 25.32  access to the same amount, type, setting, duration, and 
 25.33  frequency of covered services that they had at the time of 
 25.34  enrollment unless other covered services are needed.  For an 
 25.35  enrollee who is not receiving covered services at the time of 
 25.36  enrollment and for enrollees whose personal support plan is 
 26.1   being revised, access to the medical assistance benefit set must 
 26.2   be assured until a personal support plan is developed or 
 26.3   revised.  If an enrollee chooses not to develop a personal 
 26.4   support plan, the enrollee will be subject to the network and 
 26.5   prior authorization requirements of the county administrative 
 26.6   entity or service delivery organization 60 days after 
 26.7   enrollment.  An enrollee can choose to have a personal support 
 26.8   plan developed at any time.  The personal support plan must be 
 26.9   based on choices, preferences, and assessed needs and strengths 
 26.10  of the enrollee.  The service coordinator shall develop the 
 26.11  personal support plan, in consultation with the enrollee or the 
 26.12  enrollee's legal representative and other individuals requested 
 26.13  by the enrollee.  The personal support plan must be updated as 
 26.14  needed or as requested by the enrollee.  Enrollees may choose 
 26.15  not to have a personal support plan. 
 26.16     (n) The county administrative entity shall ensure timely 
 26.17  authorization, arrangement, and continuity of needed and covered 
 26.18  supports and services. 
 26.19     (o) The county administrative entity shall offer service 
 26.20  coordination that fulfills the responsibilities under 
 26.21  subdivision 12 and is appropriate to the enrollee's needs, 
 26.22  choices, and preferences, including a choice of service 
 26.23  coordinator. 
 26.24     (p) The county administrative entity shall contract with 
 26.25  schools and other agencies as appropriate to provide otherwise 
 26.26  covered medically necessary medical assistance services as 
 26.27  described in an enrollee's individual family support plan, as 
 26.28  described in sections 125A.26 to 125A.48, or individual 
 26.29  education plan, as described in chapter 125A. 
 26.30     (q) The county administrative entity shall develop and 
 26.31  implement strategies, based on consultation with affected 
 26.32  groups, to respect diversity and ensure culturally competent 
 26.33  service delivery in a manner that promotes the physical, social, 
 26.34  psychological, and spiritual well-being of enrollees and 
 26.35  preserves the dignity of individuals, families, and their 
 26.36  communities. 
 27.1      (r) When an enrollee changes county authorities, county 
 27.2   administrative entities shall ensure coordination with the 
 27.3   entity that is assuming responsibility for administering the 
 27.4   medical assistance benefit set to ensure continuity of supports 
 27.5   and services for the enrollee. 
 27.6      (s) The county administrative entity shall comply with 
 27.7   additional requirements as specified in the intergovernmental 
 27.8   contract.  
 27.9      (t) To the extent that alternatives are approved under 
 27.10  subdivision 17, county administrative entities must provide for 
 27.11  the health and safety of enrollees and protect the rights to 
 27.12  privacy and to provide informed consent. 
 27.13     (u) Prepaid health plans serving counties with a nonprofit 
 27.14  community clinic or community health services agency must 
 27.15  contract with the clinic or agency to provide services to 
 27.16  clients who choose to receive services from the clinic or 
 27.17  agency, if the clinic or agency agrees to payment rates that are 
 27.18  competitive with rates paid to other health plan providers for 
 27.19  the same or similar services. 
 27.20     (v) For purposes of the subdivision, "nonprofit community 
 27.21  clinic" includes, but is not limited to, a community mental 
 27.22  health center as defined in sections 245.62 and 256B.0625, 
 27.23  subdivision 5.