1.1 	A bill for an act
1.2 	relating to human services; delaying implementation of certain personal care 
1.3 	assistant documentation and reporting requirements;amending Minnesota 
1.4 	Statutes 2005 Supplement, section 256B.0655, subdivision 2.
1.5 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.6 	Section 1. Minnesota Statutes 2005 Supplement, section 256B.0655, subdivision 2, 
1.7 	is amended to read:
1.8 		Subd. 2.Personal care assistant services. (a) The personal care assistant services 
1.9 	that are eligible for payment are services and supports furnished to an individual, as 
1.10 	needed, to assist in accomplishing activities of daily living; instrumental activities of daily 
1.11 	living; health-related functions through hands-on assistance, supervision, and cuing; and 
1.12 	redirection and intervention for behavior including observation and monitoring.
1.13 	(b) Payment for services will be made within the limits approved using the 
1.14 	prior authorized process established in subdivisions 3 and 4, and sections 256B.0651, 
1.15 	subdivisions 4 to 12, and 256B.0654, subdivision 2.
1.16 	(c) The amount and type of services authorized shall be based on an assessment of 
1.17 	the recipient's needs in these areas:
1.18 	(1) bowel and bladder care;
1.19 	(2) skin care to maintain the health of the skin;
1.20 	(3) repetitive maintenance range of motion, muscle strengthening exercises, and 
1.21 	other tasks specific to maintaining a recipient's optimal level of function;
1.22 	(4) respiratory assistance;
1.23 	(5) transfers and ambulation;
1.24 	(6) bathing, grooming, and hairwashing necessary for personal hygiene;
2.1 	(7) turning and positioning;
2.2 	(8) assistance with furnishing medication that is self-administered;
2.3 	(9) application and maintenance of prosthetics and orthotics;
2.4 	(10) cleaning medical equipment;
2.5 	(11) dressing or undressing;
2.6 	(12) assistance with eating and meal preparation and necessary grocery shopping;
2.7 	(13) accompanying a recipient to obtain medical diagnosis or treatment;
2.8 	(14) assisting, monitoring, or prompting the recipient to complete the services in 
2.9 	clauses (1) to (13);
2.10 	(15) redirection, monitoring, and observation that are medically necessary and an 
2.11 	integral part of completing the personal care assistant services described in clauses (1) to 
2.12 	(14);
2.13 	(16) redirection and intervention for behavior, including observation and monitoring;
2.14 	(17) interventions for seizure disorders, including monitoring and observation if the 
2.15 	recipient has had a seizure that requires intervention within the past three months;
2.16 	(18) tracheostomy suctioning using a clean procedure if the procedure is properly 
2.17 	delegated by a registered nurse. Before this procedure can be delegated to a personal 
2.18 	care assistant, a registered nurse must determine that the tracheostomy suctioning can be 
2.19 	accomplished utilizing a clean rather than a sterile procedure and must ensure that the 
2.20 	personal care assistant has been taught the proper procedure; and
2.21 	(19) incidental household services that are an integral part of a personal care service 
2.22 	described in clauses (1) to (18).
2.23 	For purposes of this subdivision, monitoring and observation means watching for outward 
2.24 	visible signs that are likely to occur and for which there is a covered personal care service 
2.25 	or an appropriate personal care intervention. For purposes of this subdivision, a clean 
2.26 	procedure refers to a procedure that reduces the numbers of microorganisms or prevents or 
2.27 	reduces the transmission of microorganisms from one person or place to another. A clean 
2.28 	procedure may be used beginning 14 days after insertion.
2.29 	(d) The personal care assistant services that are not eligible for payment are the 
2.30 	following:
2.31 	(1) services provided without a physician's statement of need as required by section 
2.32 	256B.0625, subdivision 19c, and included in the personal care provider agency's file for 
2.33 	the recipient;
2.34 	(2) assessments by personal care assistant provider organizations or by independently 
2.35 	enrolled registered nurses;
2.36 	(3) services that are not in the service plan;
3.1 	(4) services provided by the recipient's spouse, legal guardian for an adult or child 
3.2 	recipient, or parent of a recipient under age 18;
3.3 	(5) services provided by a foster care provider of a recipient who cannot direct the 
3.4 	recipient's own care, unless monitored by a county or state case manager under section 
3.5 	256B.0625, subdivision 19a;
3.6 	(6) services provided by the residential or program license holder in a residence for 
3.7 	more than four persons;
3.8 	(7) services that are the responsibility of a residential or program license holder 
3.9 	under the terms of a service agreement and administrative rules;
3.10 	(8) sterile procedures;
3.11 	(9) injections of fluids into veins, muscles, or skin;
3.12 	(10) homemaker services that are not an integral part of a personal care assistant 
3.13 	services;
3.14 	(11) home maintenance or chore services;
3.15 	(12) services not specified under paragraph (a); and
3.16 	(13) services not authorized by the commissioner or the commissioner's designee.
3.17 	(e) The recipient or responsible party may choose to supervise the personal care 
3.18 	assistant or to have a qualified professional, as defined in section 256B.0625, subdivision 
3.19 	19c, provide the supervision. As required under section 256B.0625, subdivision 19c, 
3.20 	the county public health nurse, as a part of the assessment, will assist the recipient or 
3.21 	responsible party to identify the most appropriate person to provide supervision of the 
3.22 	personal care assistant. Health-related delegated tasks performed by the personal care 
3.23 	assistant will be under the supervision of a qualified professional or the direction of the 
3.24 	recipient's physician. If the recipient has a qualified professional, Minnesota Rules, part 
3.25 	9505.0335, subpart 4, applies.
3.26 	(f) In order to be paid for personal care assistant services, personal care provider 
3.27 	organizations, and personal care assistant choice providers are required:
3.28 	(1) to maintain a recipient file for each recipient for whom services are being billed 
3.29 	that contains:
3.30 	(i) the current physician's statement of need as required by section 256B.0625, 
3.31 	subdivision 19c;
3.32 	(ii) the service plan, including the monthly authorized hours, or flexible use plan;
3.33 	(iii) the care plan, signed by the recipient and the qualified professional, if required 
3.34 	or designated, detailing the personal care assistant services to be provided;
3.35 	(iv) documentation, on a form approved by the commissioner and signed by the 
3.36 	personal care assistant, specifying the day, month, year, arrival, and departure times, with 
4.1 	AM and PM notation, for all services provided to the recipient. The form must include a 
4.2 	notice that it is a federal crime to provide false information on personal care service 
4.3 	billings for medical assistance payment; and
4.4 	(v) all notices to the recipient regarding personal care service use exceeding 
4.5 	authorized hours; and
4.6 	(2) to communicate, by telephone if available, and in writing, with the recipient or 
4.7 	the responsible party about the schedule for use of authorized hours and to notify the 
4.8 	recipient and the county public health nurse in advance and as soon as possible, on a form 
4.9 	approved by the commissioner, if the monthly number of hours authorized is likely to be 
4.10 	exceeded for the month.
4.11 	(g) The commissioner shall establish an ongoing audit process for potential fraud 
4.12 	and abuse for personal care assistant services. The audit process must include, at a 
4.13 	minimum, a requirement that the documentation of hours of care provided be on a form 
4.14 	approved by the commissioner and include the personal care assistant's signature attesting 
4.15 	that the hours shown on each bill were provided by the personal care assistant on the dates 
4.16 	and the times specified.
4.17 	(h) The commissioner shall not implement until July 1, 2007, the documentation 
4.18 	and reporting requirements in paragraph (f), clause (1), items (iv) and (v), and clause (2), and 
4.19 	paragraph (g), for providers that employ personal care assistants using pooled or shared 
4.20 	hours in corporate foster care or other settings or for providers serving recipients who 
4.21 	choose to pool personal care assistant hours in order to have staff available 24 hours per 
4.22 	day. This paragraph applies to all personal care assistants employed by providers that use 
4.23 	shared or pooled hours. The commissioner shall work with providers covered by this 
4.24 	paragraph to develop reasonable and appropriate documentation requirements or options 
4.25 	for alternative services for affected recipients and report the results of that effort to the 
4.26 	legislature by January 15, 2007.

4.27 	EFFECTIVE DATE. This section is effective retroactive to March 1, 2006.