1.1                          A bill for an act 
  1.2             relating to human services; establishing pilot 
  1.3             projects for mental health services; expanding the 
  1.4             definition of "related condition"; establishing a 
  1.5             consumer support grant program; providing assessment 
  1.6             and prior authorization for recipients of home care 
  1.7             and waivered services; allowing persons with mental 
  1.8             retardation receiving home and community-based 
  1.9             services to live in their own homes without licensure; 
  1.10            amending Minnesota Statutes 1994, sections 252.27, 
  1.11            subdivision 1a; 252.275, subdivisions 3, 4, and 8; 
  1.12            254B.02, subdivision 1; 254B.05, subdivision 1; 
  1.13            256B.0628, by adding a subdivision; and 256B.092, by 
  1.14            adding a subdivision; proposing coding for new law in 
  1.15            Minnesota Statutes, chapters 252; and 256; repealing 
  1.16            Minnesota Statutes 1994, section 252.275, subdivisions 
  1.17            4a and 10. 
  1.18  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.19     Section 1.  [PILOT PROJECTS TO TEST ALTERNATIVES TO 
  1.20  DELIVERY OF MENTAL HEALTH SERVICES.] 
  1.21     Subdivision 1.  [AUTHORIZATION FOR PILOT PROJECTS.] The 
  1.22  commissioner of human services may approve up to six pilot 
  1.23  projects to test alternatives to the delivery of mental health 
  1.24  services required under the Minnesota comprehensive adult mental 
  1.25  health act, Minnesota Statutes, section 245.461 to 245.486. 
  1.26     Subd. 2.  [PROGRAM DESIGN AND IMPLEMENTATION.] (a) The 
  1.27  pilot projects shall be established to design and plan an 
  1.28  improved mental health services delivery system for adults with 
  1.29  serious and persistent mental illness that would: 
  1.30     (1) provide an expanded array of services from which 
  1.31  clients can choose services appropriate to their needs; 
  2.1      (2) be based on purchasing strategies that improve access 
  2.2   and coordinate services without cost shifting; 
  2.3      (3) incorporate existing state facilities and resources 
  2.4   into the community mental health infrastructure through creative 
  2.5   partnerships with local vendors; and 
  2.6      (4) utilize existing categorical funding streams and 
  2.7   reimbursement sources in combined and creative ways. 
  2.8      (b) All projects must complete their planning phase and be 
  2.9   operational by June 30, 1997. 
  2.10     Subd. 3.  [PROGRAM EVALUATION.] Evaluation of each project 
  2.11  will be based on outcome evaluation criteria negotiated with 
  2.12  each project prior to implementation. 
  2.13     Subd. 4.  [NOTICE OF PROJECT DISCONTINUATION.] Each project 
  2.14  may be discontinued for any reason by the project's managing 
  2.15  entity or the commissioner of human services, after 90 days' 
  2.16  written notice to the other party. 
  2.17     Subd. 5.  [PLANNING FOR PILOT PROJECTS.] Each local plan 
  2.18  for a pilot project must be developed under the direction of the 
  2.19  county board, or multiple county boards acting jointly, as the 
  2.20  local mental health authority.  The planning process for each 
  2.21  pilot shall include, but not be limited to, mental health 
  2.22  consumers, advocates, local and state providers, and the 
  2.23  department of human services.  As part of the planning process, 
  2.24  the county board or boards shall designate a managing entity 
  2.25  responsible for receipt of funds and management of the pilot 
  2.26  project. 
  2.27     Subd. 6.  [DUTIES OF COMMISSIONER.] (a) For purposes of the 
  2.28  pilot projects, the commissioner shall facilitate integration of 
  2.29  funds or other resources as needed and requested by each 
  2.30  project.  These resources may include: 
  2.31     (1) residential services funds administered under Minnesota 
  2.32  Rules, parts 9535.2000 to 9535.3000, in an amount to be 
  2.33  determined by mutual agreement between the project's managing 
  2.34  entity and the commissioner of human services after an 
  2.35  examination of the county's historical utilization of facilities 
  2.36  located both within and outside of the county and licensed under 
  3.1   Minnesota Rules, parts 9520.0500 to 9520.0690; 
  3.2      (2) community support services funds administered under 
  3.3   Minnesota Rules, parts 9535.1700 to 9535.1760; 
  3.4      (3) other mental health special project funds; 
  3.5      (4) medical assistance, general assistance medical care, 
  3.6   MinnesotaCare and Minnesota supplemental aid if requested by the 
  3.7   project's managing entity, and if the commissioner determines 
  3.8   this would be consistent with the state's overall health care 
  3.9   reform efforts; and 
  3.10     (5) regional treatment center resources to the extent 
  3.11  agreed to by the project's managing entity and the regional 
  3.12  treatment center. 
  3.13     (b) The commissioner shall consider the following criteria 
  3.14  in awarding start-up and implementation grants for the pilot 
  3.15  projects: 
  3.16     (1) the ability of the proposed projects to accomplish the 
  3.17  objectives described in subdivision 2; 
  3.18     (2) the size of the target population to be served; and 
  3.19     (3) geographical distribution. 
  3.20     (c) The commissioner shall review overall status of the 
  3.21  projects at least every two years and recommend any legislative 
  3.22  changes needed by January 15 of each odd-numbered year. 
  3.23     (d) The commissioner may waive administrative rule 
  3.24  requirements which are incompatible with the implementation of 
  3.25  the pilot project. 
  3.26     (e) The commissioner may exempt the participating counties 
  3.27  from fiscal sanctions for noncompliance with requirements in 
  3.28  laws and rules which are incompatible with the implementation of 
  3.29  the pilot project. 
  3.30     (f) The commissioner may award grants to an entity 
  3.31  designated by a county board or group of county boards to pay 
  3.32  for start-up and implementation costs of the pilot project. 
  3.33     Subd. 7.  [DUTIES OF COUNTY BOARD.] The county board, or 
  3.34  other entity which is approved to administer a pilot project, 
  3.35  shall: 
  3.36     (1) administer the project in a manner which is consistent 
  4.1   with the objectives described in subdivision 2 and the planning 
  4.2   process described in subdivision 5; 
  4.3      (2) assure that no one is denied services for which they 
  4.4   would otherwise be eligible; and 
  4.5      (3) provide the commissioner of human services with timely 
  4.6   and pertinent information through the following methods: 
  4.7      (i) submission of community social services act plans and 
  4.8   plan amendments; 
  4.9      (ii) submission of social services expenditure and grant 
  4.10  reconciliation reports, based on a coding format to be 
  4.11  determined by mutual agreement between the project's managing 
  4.12  entity and the commissioner; and 
  4.13     (iii) submission of data and participation in an evaluation 
  4.14  of the pilot projects, to be designed cooperatively by the 
  4.15  commissioner and the projects. 
  4.16     Sec. 2.  Minnesota Statutes 1994, section 252.27, 
  4.17  subdivision 1a, is amended to read: 
  4.18     Subd. 1a.  [DEFINITIONS.] A ~~person has a~~ "related 
  4.19  condition" ~~if that person has~~ is a condition that: (a) is severe 
  4.20  ~~,~~ and chronic ~~disability that meets all of the following~~ 
  4.21  ~~conditions:  (a)~~; and (b) is attributable to any condition found 
  4.22  to be closely related to mental retardation, including, but not 
  4.23  limited to, cerebral palsy, epilepsy, autism, and Prader-Willi 
  4.24  syndrome~~, or any other condition, other than mental illness as~~ 
  4.25  ~~defined under section 245.462, subdivision 20, or an emotional~~ 
  4.26  ~~disturbance, as defined under section 245.4871, subdivision 15,~~ 
  4.27  ~~found to be closely related to mental retardation because the~~ 
  4.28  ~~condition~~; and (c) results in impairment of general intellectual 
  4.29  functioning or adaptive behavior similar to that of persons with 
  4.30  mental retardation; and (d) requires treatment or services 
  4.31  similar to those required for persons with mental 
  4.32  retardation; ~~(b)~~ and (e) is manifested before the person reaches 
  4.33  22 years of age; ~~(c)~~ and (f) is likely to continue indefinitely; 
  4.34  and ~~(d)~~ (g) results in substantial functional limitations in 
  4.35  three or more of the following areas of major life activity:  
  4.36  (1) self-care, (2) understanding and use of language, (3) 
  5.1   learning, (4) mobility, (5) self-direction, (6) capacity for 
  5.2   independent living; and (h) is not attributable to mental 
  5.3   illness as defined in section 245.462, subdivision 20, or an 
  5.4   emotional disturbance as defined in section 245.4871, 
  5.5   subdivision 15.  For purposes of this section, notwithstanding 
  5.6   section 245.462, subdivision 20, or 245.4871, subdivision 15, 
  5.7   "mental illness" does not include autism. 
  5.8      Sec. 3.  Minnesota Statutes 1994, section 252.275, 
  5.9   subdivision 3, is amended to read: 
  5.10     Subd. 3.  [REIMBURSEMENT.] Counties shall be reimbursed for 
  5.11  all expenditures made pursuant to subdivision 1 at a rate of 70 
  5.12  percent, up to the allocation determined pursuant to 
  5.13  subdivisions 4~~, 4a,~~ and 4b.  However, the commissioner shall not 
  5.14  reimburse costs of services for any person if the costs exceed 
  5.15  the state share of the average medical assistance costs for 
  5.16  services provided by intermediate care facilities for a person 
  5.17  with mental retardation or a related condition for the same 
  5.18  fiscal year, and shall not reimburse costs of a one-time living 
  5.19  allowance for any person if the costs exceed $1,500 in a state 
  5.20  fiscal year.  ~~For the biennium ending June 30, 1993, the~~ 
  5.21  ~~commissioner shall not reimburse costs in excess of the 85th~~ 
  5.22  ~~percentile of hourly service costs based upon the cost~~ 
  5.23  ~~information supplied to the legislature in the proposed budget~~ 
  5.24  ~~for the biennium.~~  The commissioner may make payments to each 
  5.25  county in quarterly installments.  The commissioner may certify 
  5.26  an advance of up to 25 percent of the allocation.  Subsequent 
  5.27  payments shall be made on a reimbursement basis for reported 
  5.28  expenditures and may be adjusted for anticipated spending 
  5.29  patterns.  
  5.30     Sec. 4.  Minnesota Statutes 1994, section 252.275, 
  5.31  subdivision 4, is amended to read: 
  5.32     Subd. 4.  [FORMULA.] ~~Effective January 1, 1992,~~ The 
  5.33  commissioner shall allocate funds on a calendar year basis.  ~~For~~ 
  5.34  ~~calendar year 1992, funds shall be allocated based on each~~ 
  5.35  ~~county's portion of the statewide reimbursement received under~~ 
  5.36  ~~this section for state fiscal year 1991.  For subsequent~~ 
  6.1   ~~calendar years, funds shall be~~ Beginning with the calendar year 
  6.2   in the 1996 grant period, funds shall be allocated first in 
  6.3   amounts equal to each county's guaranteed floor according to 
  6.4   subdivision 4b, with any remaining available funds allocated 
  6.5   based on each county's portion of the statewide expenditures 
  6.6   eligible for reimbursement under this section during the 12 
  6.7   months ending on June 30 of the preceding calendar year. 
  6.8      If the legislature appropriates funds for special purposes, 
  6.9   the commissioner may allocate the funds based on proposals 
  6.10  submitted by the counties to the commissioner in a format 
  6.11  prescribed by the commissioner.  Nothing in this section 
  6.12  prevents a county from using other funds to pay for additional 
  6.13  costs of semi-independent living services. 
  6.14     Sec. 5.  Minnesota Statutes 1994, section 252.275, 
  6.15  subdivision 8, is amended to read: 
  6.16     Subd. 8.  [USE OF FEDERAL FUNDS AND TRANSFER OF FUNDS TO 
  6.17  MEDICAL ASSISTANCE.] (a) The commissioner shall make every 
  6.18  reasonable effort to maximize the use of federal funds for 
  6.19  semi-independent living services. 
  6.20     (b) The commissioner shall reduce the payments to be made 
  6.21  under this section to each county from January 1, 1994 to June 
  6.22  30, 1996, by the amount of the state share of medical assistance 
  6.23  reimbursement for services other than residential services 
  6.24  provided under the home and community-based waiver program under 
  6.25  section 256B.092 from January 1, 1994 to June 30, 1996, for 
  6.26  clients for whom the county is financially responsible and who 
  6.27  have been transferred by the county from the semi-independent 
  6.28  living services program to the home and community-based waiver 
  6.29  program.  Unless otherwise specified, all reduced amounts shall 
  6.30  be transferred to the medical assistance state account. 
  6.31     (c) For fiscal year 1997, the base appropriation available 
  6.32  under this section shall be reduced by the amount of the state 
  6.33  share of medical assistance reimbursement for services other 
  6.34  than residential services provided under the home and 
  6.35  community-based waiver program authorized in section 256B.092 
  6.36  from January 1, 1995 to December 31, 1995, for persons who have 
  7.1   been transferred from the semi-independent living services 
  7.2   program to the home and community-based waiver program.  The 
  7.3   base appropriation for the medical assistance state account 
  7.4   shall be increased by the same amount. 
  7.5      (d) For purposes of calculating the guaranteed floor under 
  7.6   subdivision 4b and to establish the calendar year 1996 
  7.7   allocations, each county's original allocation for calendar year 
  7.8   1995 shall be reduced by the amount transferred to the state 
  7.9   medical assistance account under paragraph (b) during the six 
  7.10  months ending on June 30, 1995.  For purposes of calculating the 
  7.11  guaranteed floor under subdivision 4b and to establish the 
  7.12  calendar year 1997 allocations, each county's original 
  7.13  allocation for calendar year 1996 shall be reduced by the amount 
  7.14  transferred to the state medical assistance account under 
  7.15  paragraph (b) during the six months ending on ~~June 30, 1996~~ 
  7.16  December 31, 1995. 
  7.17     Sec. 6.  [252.60] [LOCALLY MANAGED INTEGRATED FUND 
  7.18  DEMONSTRATION PILOT PROJECT.] 
  7.19     Subdivision 1.  [PURPOSE.] In order to demonstrate 
  7.20  substantial change in the management and delivery of services to 
  7.21  persons with mental retardation or related conditions, the 
  7.22  commissioner of human services may cooperatively establish pilot 
  7.23  projects with county agencies that are proposed and designed by 
  7.24  local planning groups that include county and provider agencies, 
  7.25  consumers, and advocacy agencies.  The pilot projects are to 
  7.26  determine whether a locally managed integrated funding model 
  7.27  covering services for persons with mental retardation or related 
  7.28  conditions is an effective mechanism to achieve the outcomes 
  7.29  prescribed in Laws 1993, First Special Session chapter 1, 
  7.30  article 4, section 12, regarding:  (1) comprehensive reform; (2) 
  7.31  service access and coordination; and (3) regulatory standards 
  7.32  and quality assurance.  These pilot projects shall result in a 
  7.33  locally managed service system characterized by increased 
  7.34  consumer choice, flexibility in the types and delivery methods 
  7.35  of services, improved access to and coordination and continuity 
  7.36  of services, streamlined and unified regulations and controls, 
  8.1   and enhanced cost controls.  For purposes of this project, 
  8.2   waiver of certain statutory provisions is necessary in 
  8.3   accordance with this section. 
  8.4      Subd. 2.  [DEFINITIONS.] (a) "Eligible persons" means 
  8.5   individuals who reside within the geographic area designated 
  8.6   under subdivision 3 and who are otherwise eligible as defined in 
  8.7   section 256B.092.  Other persons with a developmental disability 
  8.8   as defined in United States Code, title 42, section 6001, may be 
  8.9   determined eligible by the local managing entity to participate 
  8.10  in these pilots. 
  8.11     (b) "Local managing entity" means the agency or alliance of 
  8.12  agencies under contract with the Minnesota department of human 
  8.13  services and participating in each local demonstration project 
  8.14  that manages the resources and the delivery of services to 
  8.15  eligible individuals. 
  8.16     Subd. 3.  [GEOGRAPHIC AREA.] The commissioner shall 
  8.17  designate the geographic areas in which eligible individuals and 
  8.18  organizations will be included in the project. 
  8.19     Subd. 4.  [PAYMENT.] The commissioner shall establish the 
  8.20  method and amount of payments and prepayments for the management 
  8.21  and delivery of services.  The managing entity may integrate 
  8.22  these funds with local resources appropriated for services to 
  8.23  persons with mental retardation or related conditions and may 
  8.24  require transfer of resources from other county agencies for 
  8.25  eligible persons who reside within the geographic area and who 
  8.26  are the financial responsibility of another county.  The 
  8.27  commissioner shall contract with the local managing entity and 
  8.28  the contract shall be consistent with these established methods 
  8.29  and amounts for payment. 
  8.30     Subd. 5.  [SERVICE DELIVERY.] Each managing entity shall be 
  8.31  responsible for management and delivery of services for eligible 
  8.32  individuals within their geographic area.  Managing entities: 
  8.33     (1) shall accept the prospective, per capita payment from 
  8.34  the commissioner in return for the provision of comprehensive 
  8.35  and coordinated services for eligible individuals enrolled in 
  8.36  the project; 
  9.1      (2) may contract with health care, long-term care, and 
  9.2   other providers to serve eligible persons enrolled in the 
  9.3   project; and 
  9.4      (3) may integrate state, federal, and county resources into 
  9.5   an account and draw funding from this single source to purchase 
  9.6   or provide services for eligible persons. 
  9.7      Subd. 6.  [REPORTING.] Each participating local managing 
  9.8   entity shall submit information as required by the commissioner, 
  9.9   including data required for assessing client satisfaction, 
  9.10  quality of care, cost, and utilization of services for purposes 
  9.11  of project evaluation. 
  9.12     Subd. 7.  [ALTERNATIVE METHODS.] Upon federal waiver 
  9.13  approval to proceed with these pilots, the commissioner may 
  9.14  approve alternative methods to meet the intent of existing rules 
  9.15  and statutes relating to services for eligible persons.  The 
  9.16  commissioner shall ensure that in no case are the rights and 
  9.17  protections afforded under these rules and statutes abridged. 
  9.18     Subd. 8.  [NUMBER OF GRANTS.] For the biennium ending June 
  9.19  30, 1997, up to three pilot projects may be operational, and the 
  9.20  commissioner may provide planning grants for up to three 
  9.21  additional local planning groups to expand the projects in the 
  9.22  next biennium. 
  9.23     Sec. 7.  Minnesota Statutes 1994, section 254B.02, 
  9.24  subdivision 1, is amended to read: 
  9.25     Subdivision 1.  [CHEMICAL DEPENDENCY TREATMENT ALLOCATION.] 
  9.26  The chemical dependency funds appropriated for allocation shall 
  9.27  be placed in a special revenue account.  For the fiscal year 
  9.28  beginning July 1, 1987, funds shall be transferred to operate 
  9.29  the vendor payment, invoice processing, and collections system 
  9.30  for one year.  The commissioner shall annually transfer funds 
  9.31  from the chemical dependency fund to pay for operation of the 
  9.32  drug and alcohol abuse normative evaluation system and to pay 
  9.33  for all costs incurred by adding two positions for licensing of 
  9.34  chemical dependency treatment and rehabilitation programs 
  9.35  located in hospitals for which funds are not otherwise 
  9.36  appropriated.  The commissioner shall annually divide the money 
 10.1   available in the chemical dependency fund that is not held in 
 10.2   reserve by counties from a previous allocation.  Twelve percent 
 10.3   of the remaining money must be reserved for treatment of 
 10.4   American Indians by eligible vendors under section 254B.05.  The 
 10.5   remainder of the money must be allocated among the counties 
 10.6   according to the following formula, using state demographer data 
 10.7   and other data sources determined by the commissioner: 
 10.8      ~~(a) The county non-Indian and over age 14 per capita-months~~ 
 10.9   ~~of eligibility for aid to families with dependent children,~~ 
 10.10  ~~general assistance, and medical assistance is divided by the~~ 
 10.11  ~~total state non-Indian and over age 14 per capita-months of~~ 
 10.12  ~~eligibility to determine the caseload factor for each county.~~ 
 10.13     ~~(b) The average median married couple income for the~~ 
 10.14  ~~previous three years for the state is divided by the average~~ 
 10.15  ~~median married couple income for the previous three years for~~ 
 10.16  ~~each county to determine the income factor.~~  
 10.17     ~~(c) The non-Indian and over age 14 population of the county~~ 
 10.18  ~~is multiplied by the sum of the income factor and the caseload~~ 
 10.19  ~~factor to determine the adjusted population.~~  
 10.20     (a) For purposes of this formula, American Indians and 
 10.21  children under age 14 are subtracted from the population of each 
 10.22  county to determine the restricted population. 
 10.23     (b) The amount of chemical dependency fund expenditures for 
 10.24  entitled persons for services not covered by prepaid plans 
 10.25  governed by section 256B.69 in the previous year is divided by 
 10.26  the amount of chemical dependency fund expenditures for entitled 
 10.27  persons for all services to determine the proportion of exempt 
 10.28  service expenditures for each county. 
 10.29     (c) The prepaid plan months of eligibility is multiplied by 
 10.30  the proportion of exempt service expenditures to determine the 
 10.31  adjusted prepaid plan months of eligibility for each county. 
 10.32     (d) The adjusted prepaid plan months of eligibility is 
 10.33  added to the number of restricted population fee for service 
 10.34  months of eligibility for aid to families with dependent 
 10.35  children, general assistance, and medical assistance and divided 
 10.36  by the county restricted population to determine county per 
 11.1   capita months of covered service eligibility. 
 11.2      (e) The number of adjusted prepaid plan months of 
 11.3   eligibility for the state is added to the number of fee for 
 11.4   service months of eligibility for aid to families with dependent 
 11.5   children, general assistance, and medical assistance for the 
 11.6   state restricted population and divided by the state restricted 
 11.7   population to determine state per capita months of covered 
 11.8   service eligibility. 
 11.9      (f) The county per capita months of covered service 
 11.10  eligibility is divided by the state per capita months of covered 
 11.11  service eligibility to determine the county welfare caseload 
 11.12  factor. 
 11.13     (g) The median married couple income for the most recent 
 11.14  three-year period available for the state is divided by the 
 11.15  median married couple income for the same period for each county 
 11.16  to determine the income factor for each county. 
 11.17     (h) The county restricted population is multiplied by the 
 11.18  sum of the county welfare caseload factor and the county income 
 11.19  factor to determine the adjusted population. 
 11.20     ~~(d)~~ (i) $15,000 shall be allocated to each county.  
 11.21     ~~(e)~~ (j) The remaining funds shall be allocated proportional 
 11.22  to the county adjusted population. 
 11.23     Sec. 8.  Minnesota Statutes 1994, section 254B.05, 
 11.24  subdivision 1, is amended to read: 
 11.25     Subdivision 1.  [LICENSURE REQUIRED.] Programs licensed by 
 11.26  the commissioner are eligible vendors.  Hospitals may apply for 
 11.27  and receive licenses to be eligible vendors, notwithstanding the 
 11.28  provisions of section 245A.03.  American Indian programs located 
 11.29  on federally recognized tribal lands that provide chemical 
 11.30  dependency primary treatment, extended care, transitional 
 11.31  residence, or outpatient treatment services, and are licensed by 
 11.32  tribal government are eligible vendors.  Detoxification programs 
 11.33  are not eligible vendors.  Programs that are not licensed as a 
 11.34  chemical dependency residential or nonresidential treatment 
 11.35  program by the commissioner or by tribal government are not 
 11.36  eligible vendors.  To be eligible for payment under the 
 12.1   Consolidated Chemical Dependency Treatment Fund, a vendor must 
 12.2   participate in the Drug and Alcohol Abuse Normative Evaluation 
 12.3   System and the treatment accountability plan. 
 12.4      Sec. 9.  [256.476] [CONSUMER SUPPORT PROGRAM.] 
 12.5      Subdivision 1.  [PURPOSE AND GOALS.] The commissioner of 
 12.6   human services shall establish a consumer support grant program 
 12.7   to assist individuals with functional limitations and their 
 12.8   families in purchasing and securing supports which the 
 12.9   individuals need to live as independently and productively in 
 12.10  the community as possible.  The program shall: 
 12.11     (1) make support grants available to individuals or 
 12.12  families as an effective alternative to existing programs and 
 12.13  services, such as the developmental disability family support 
 12.14  program, the alternative care program, personal care attendant 
 12.15  services, home health aide services, and nursing facility 
 12.16  services; 
 12.17     (2) provide consumers more control, flexibility, and 
 12.18  responsibility over the needed supports; 
 12.19     (3) promote local program management and decision-making; 
 12.20  and 
 12.21     (4) encourage the use of informal and typical community 
 12.22  supports. 
 12.23     Subd. 2.  [DEFINITIONS.] For purposes of this section, the 
 12.24  following terms have the meanings given them: 
 12.25     (a) "County board" means the county board of commissioners 
 12.26  for the county of financial responsibility as defined in section 
 12.27  256G.02, subdivision 4, or its designated representative.  When 
 12.28  a human services board has been established under sections 
 12.29  402.01 to 402.10, it shall be considered the county board for 
 12.30  the purposes of this section. 
 12.31     (b) "Family" means the person's birth parents, adoptive 
 12.32  parents or stepparents, siblings or stepsiblings, children or 
 12.33  stepchildren, grandparents, grandchildren, niece, nephew, aunt, 
 12.34  uncle, or spouse.  For the purposes of this section, a family 
 12.35  member is at least 18 years of age. 
 12.36     (c) "Functional limitations" means the long-term inability 
 13.1   to perform an activity or task in one or more areas of major 
 13.2   life activity, including self-care, understanding and use of 
 13.3   language, learning, mobility, self-direction, and capacity for 
 13.4   independent living.  For the purpose of this section, the 
 13.5   inability to significantly perform an activity or task results 
 13.6   from a mental, emotional, psychological, sensory, or physical 
 13.7   disability, condition, or illness. 
 13.8      (d) "Informed choice" means a voluntary decision made by 
 13.9   the person or the person's legal representative, after becoming 
 13.10  familiarized with the alternatives to: 
 13.11     (1) select a preferred alternative from a number of 
 13.12  feasible alternatives; 
 13.13     (2) select an alternative which may be developed in the 
 13.14  future; and 
 13.15     (3) refuse any or all alternatives. 
 13.16     (e) "Local agency" means the local agency authorized by the 
 13.17  county board to carry out the provisions of this section. 
 13.18     (f) "Person" or "persons" means a person or persons meeting 
 13.19  the eligibility criteria in subdivision 3. 
 13.20     (g) "Responsible individual" means an individual designated 
 13.21  by the person or their legal representative to act on their 
 13.22  behalf.  This individual may be a family member, guardian, 
 13.23  representative payee, or other individual designated by the 
 13.24  person or their legal representative, if any, to assist in 
 13.25  purchasing and arranging for supports.  For the purposes of this 
 13.26  section, a responsible individual is at least 18 years of age. 
 13.27     (h) "Screening" means the screening of a person's service 
 13.28  needs under sections 256B.0911 and 256B.092. 
 13.29     (i) "Supports" means services, care, aids, home 
 13.30  modifications, or assistance purchased by the person or the 
 13.31  person's family.  Examples of supports include respite care, 
 13.32  assistance with daily living, and adaptive aids.  For the 
 13.33  purpose of this section, notwithstanding the provisions of 
 13.34  section 144A.43, supports purchased under the consumer support 
 13.35  program are not considered home care services. 
 13.36     Subd. 3.  [ELIGIBILITY FOR GRANTS.] (a) A person is 
 14.1   eligible to receive a consumer support grant if the person meets 
 14.2   all of the following criteria: 
 14.3      (1) the person is eligible for medical assistance as 
 14.4   determined under sections 256B.055 and 256B.056 or the person is 
 14.5   eligible for alternative care services as determined under 
 14.6   section 256B.0913; 
 14.7      (2) the person is able to direct and purchase their own 
 14.8   care and supports, or the person has a family member, legal 
 14.9   representative, or other responsible individual who can purchase 
 14.10  and arrange supports on the person's behalf; 
 14.11     (3) the person has functional limitations, requires ongoing 
 14.12  supports to live in the community, and is at risk of or would 
 14.13  continue institutionalization without such supports; and 
 14.14     (4) the person lives in a home.  For the purpose of this 
 14.15  section, "home" means the person's own home or home of a 
 14.16  person's family member.  These homes are natural home settings 
 14.17  and are not licensed by the department of health or human 
 14.18  services. 
 14.19     (b) Persons may not concurrently receive a consumer support 
 14.20  grant if they are: 
 14.21     (1) receiving home and community-based services under 
 14.22  United States Code, title 42, section 1396h(c); personal care 
 14.23  attendant and home health aide services under section 256B.0625; 
 14.24  a developmentally disabled family support grant; or alternative 
 14.25  care services under section 256B.0913; or 
 14.26     (2) residing in an institutional or congregate care setting.
 14.27     (c) A person or person's family receiving a consumer 
 14.28  support grant shall not be charged a fee or premium by a local 
 14.29  agency for participating in the program.  A person or person's 
 14.30  family is not eligible for a consumer support grant if their 
 14.31  income is at a level where they are required to pay a parental 
 14.32  fee under sections 252.27, 256B.055, subdivision 12, and 256B.14 
 14.33  and rules adopted under those sections for medical assistance 
 14.34  services to a disabled child living with at least one parent. 
 14.35     Subd. 4.  [SUPPORT GRANTS; CRITERIA AND LIMITATIONS.] (a) 
 14.36  The local agency shall establish written procedures and criteria 
 15.1   to determine the amount and use of support grants.  These 
 15.2   procedures must include, at least, the availability of respite 
 15.3   care, assistance with daily living, and adaptive aids.  The 
 15.4   local agency may establish monthly or annual maximum amounts for 
 15.5   grants and procedures where exceptional resources may be 
 15.6   required to meet the health and safety needs of the person on a 
 15.7   time-limited basis. 
 15.8      (b) Support grants to a person or a person's family may be 
 15.9   provided through a monthly subsidy or lump sum payment basis and 
 15.10  be in the form of cash, voucher, or direct county payment to 
 15.11  vendor.  Support grant amounts must be determined by the local 
 15.12  agency.  Each service and item purchased with a support grant 
 15.13  must meet all of the following criteria:  
 15.14     (1) it must be over and above the normal cost of caring for 
 15.15  the person if the person did not have functional limitations; 
 15.16     (2) it must be directly attributable to the person's 
 15.17  functional limitations; 
 15.18     (3) it must enable a person or the person's family to delay 
 15.19  or prevent out-of-home placement of the person; and 
 15.20     (4) it must be consistent with the needs identified in the 
 15.21  service plan, when applicable. 
 15.22     (c) Items and services purchased with support grants must 
 15.23  be those for which there are no other public or private funds 
 15.24  available to the person or the person's family.  Fees assessed 
 15.25  to the person or the person's family for health and human 
 15.26  services are not reimbursable through the grant. 
 15.27     (d) In approving or denying applications, the local agency 
 15.28  shall consider the following factors:  
 15.29     (1) the extent and areas of the person's functional 
 15.30  limitations; 
 15.31     (2) the degree of need in the home environment for 
 15.32  additional support; and 
 15.33     (3) the potential effectiveness of the grant to maintain 
 15.34  and support the person in the family environment or the person's 
 15.35  own home. 
 15.36     (e) At the time of application to the program or screening 
 16.1   for other services, the person or the person's family shall be 
 16.2   provided sufficient information to ensure an informed choice of 
 16.3   alternatives by the person, the person's legal representative, 
 16.4   if any, or the person's family.  The application shall be made 
 16.5   to the local agency and shall specify the needs of the person 
 16.6   and family, the form and amount of grant requested, the items 
 16.7   and services to be reimbursed, and evidence of eligibility for 
 16.8   medical assistance or alternative care program. 
 16.9      (f) Upon approval of an application by the local agency and 
 16.10  agreement on a support plan for the person or person's family, 
 16.11  the local agency shall make grants to the person or the person's 
 16.12  family.  The grant shall be in an amount for the direct costs of 
 16.13  the services or supports outlined in the service agreement.  
 16.14     (g) Reimbursable costs shall not include costs for 
 16.15  resources already available, such as special education classes, 
 16.16  day training and habilitation, case management, other services 
 16.17  to which the person is entitled, medical costs covered by 
 16.18  insurance or other health programs, or other resources usually 
 16.19  available at no cost to the person or the person's family. 
 16.20     Subd. 5.  [REIMBURSEMENT, ALLOCATIONS, AND REPORTING.] (a) 
 16.21  For the purpose of transferring persons to the consumer support 
 16.22  grant program from specific programs or services, such as the 
 16.23  developmental disability family support program and alternative 
 16.24  care program, personal care attendant, home health aide, or 
 16.25  nursing facility services, the amount of funds transferred by 
 16.26  the commissioner between the developmental disability family 
 16.27  support program account, the alternative care account, the 
 16.28  medical assistance account, or the consumer support grant 
 16.29  account shall be based on each county's participation in 
 16.30  transferring persons to the consumer support grant program from 
 16.31  those programs and services. 
 16.32     (b) At the beginning of each fiscal year, county 
 16.33  allocations for consumer support grants shall be based on: 
 16.34     (1) the number of persons to whom the county board expects 
 16.35  to provide consumer supports grants; 
 16.36     (2) their eligibility for current program and services; 
 17.1      (3) the amount of nonfederal dollars expended on those 
 17.2   individuals for those programs and services; and 
 17.3      (4) projected dates when persons will start receiving 
 17.4   grants.  County allocations shall be adjusted periodically by 
 17.5   the commissioner based on the actual transfer of persons or 
 17.6   service openings, and the nonfederal dollars associated with 
 17.7   those persons or service openings, to the consumer support grant 
 17.8   program. 
 17.9      (c) The commissioner shall use up to five percent of each 
 17.10  county's allocation, as adjusted, for payments to that county 
 17.11  for administrative expenses, to be paid as a proportionate 
 17.12  addition to reported direct service expenditures. 
 17.13     (d) The commissioner may recover, suspend, or withhold 
 17.14  payments if the county board, local agency, or grantee does not 
 17.15  comply with the requirements of this section. 
 17.16     Subd. 6.  [RIGHT TO APPEAL.] Notice, appeal, and hearing 
 17.17  procedures shall be conducted in accordance with section 
 17.18  256.045.  The denial, suspension, or termination of services 
 17.19  under this program may be appealed by a recipient or applicant 
 17.20  under section 256.045, subdivision 3.  It is an absolute defense 
 17.21  to an appeal under this section, if the county board proves that 
 17.22  it followed the established written procedures and criteria and 
 17.23  determined that the grant could not be provided within the 
 17.24  county board's allocation of money for consumer support grants. 
 17.25     Subd. 7.  [FEDERAL FUNDS.] The commissioner and the 
 17.26  counties shall make reasonable efforts to maximize the use of 
 17.27  federal funds.  If federal funds are made available to the 
 17.28  consumer support grant program, the money shall be allocated to 
 17.29  the responsible county agency's consumer support grant fund. 
 17.30     Subd. 8.  [COMMISSIONER RESPONSIBILITIES.] The commissioner 
 17.31  shall: 
 17.32     (1) transfer and allocate funds pursuant to this section; 
 17.33     (2) determine allocations based on projected and actual 
 17.34  local agency use; 
 17.35     (3) monitor and oversee overall program spending; 
 17.36     (4) evaluate the effectiveness of the program; 
 18.1      (5) provide training and technical assistance for local 
 18.2   agencies and consumers to help identify potential applicants to 
 18.3   the program; and 
 18.4      (6) develop guidelines for local agency program 
 18.5   administration and consumer information. 
 18.6      Subd. 9.  [COUNTY BOARD RESPONSIBILITIES.] County boards 
 18.7   receiving funds under this section shall: 
 18.8      (1) determine the needs of persons and families for 
 18.9   services and supports; 
 18.10     (2) determine the eligibility for persons proposed for 
 18.11  program participation; 
 18.12     (3) approve items and services to be reimbursed and inform 
 18.13  families of their determination; 
 18.14     (4) issue support grants directly to or on behalf of 
 18.15  persons; 
 18.16     (5) submit quarterly financial reports and an annual 
 18.17  program report to the commissioner; 
 18.18     (6) coordinate services and supports with other programs 
 18.19  offered or made available to persons or their families; and 
 18.20     (7) provide assistance to persons or their families in 
 18.21  securing or maintaining supports, as needed. 
 18.22     Subd. 10.  [CONSUMER RESPONSIBILITIES.] Persons receiving 
 18.23  grants under this section shall: 
 18.24     (1) spend the grant money in a manner consistent with their 
 18.25  agreement with the local agency; 
 18.26     (2) notify the local agency of any necessary changes in the 
 18.27  grant or the items on which it is spent; 
 18.28     (3) notify the local agency of any decision made by the 
 18.29  person, the person's legal representative, or the person's 
 18.30  family that would change their eligibility for consumer support 
 18.31  grants; 
 18.32     (4) arrange and pay for supports; and 
 18.33     (5) inform the local agency of areas where they have 
 18.34  experienced difficulty securing or maintaining supports. 
 18.35     Sec. 10.  [256.973] [HOUSING FOR ELDERLY PERSONS WITH 
 18.36  PHYSICAL OR DEVELOPMENTAL DISABILITIES AND SINGLE-PARENT 
 19.1   FAMILIES.] 
 19.2      Subdivision 1.  [HOME SHARING.] The home-sharing grant 
 19.3   program authorized by section 462A.05, subdivision 24, is 
 19.4   transferred from the Minnesota housing finance agency to the 
 19.5   department of human services.  The housing finance agency shall 
 19.6   administer the current grants that terminate on August 30, 
 19.7   1995.  The department of human services shall administer grants 
 19.8   funded after August 30, 1995.  The department of human services 
 19.9   may engage in housing programs, as defined by the agency, to 
 19.10  provide grants to housing sponsors who will provide a 
 19.11  home-sharing program for low- and moderate-income elderly, 
 19.12  persons with physical or developmental disabilities, or 
 19.13  single-parent families in urban and rural areas. 
 19.14     Subd. 2.  [MATCHING OWNERS AND TENANTS.] Housing sponsors 
 19.15  of home sharing programs, as defined by the agency, shall match 
 19.16  existing homeowners with prospective tenants who will contribute 
 19.17  either rent or services to the homeowner, where either the 
 19.18  homeowner or the prospective tenant is elderly, a person with 
 19.19  physical or developmental disabilities, or the head of a 
 19.20  single-parent family.  Home-sharing projects will coordinate 
 19.21  efforts with appropriate public and private agencies and 
 19.22  organizations in their area. 
 19.23     Subd. 3.  [INFORMATION FOR PARTICIPANTS.] Housing sponsors 
 19.24  who receive funding through these programs shall provide 
 19.25  homeowners and tenants participating in a home-sharing program 
 19.26  with information regarding their rights and obligations as they 
 19.27  relate to federal and state tax law including, but not limited 
 19.28  to, taxable rental income, homestead credit under chapter 273, 
 19.29  and the property tax refund act under chapter 290A. 
 19.30     Subd. 4.  [TECHNICAL ASSISTANCE.] The department of human 
 19.31  services may provide technical assistance to sponsors of 
 19.32  home-sharing programs or may contract or delegate the provision 
 19.33  of technical assistance. 
 19.34     Subd. 5.  [USING OUTSIDE AGENCIES.] The department of human 
 19.35  services may delegate, use, or employ any federal, state, 
 19.36  regional, or local public or private agency or organization, 
 20.1   including organizations of physically handicapped persons, upon 
 20.2   terms it deems necessary or desirable, to assist in the exercise 
 20.3   of any of the powers granted in this section. 
 20.4      Sec. 11.  Minnesota Statutes 1994, section 256B.0628, is 
 20.5   amended by adding a subdivision to read: 
 20.6      Subd. 3.  [ASSESSMENT AND PRIOR AUTHORIZATION PROCESS FOR 
 20.7   RECIPIENTS OF BOTH HOME CARE AND WAIVERED SERVICES FOR PERSONS 
 20.8   WITH MENTAL RETARDATION OR RELATED CONDITIONS.] Effective 
 20.9   January 1, 1996, for purposes of providing informed choice, 
 20.10  coordination of local planning decisions, and streamlining 
 20.11  administrative requirements, the assessment and prior 
 20.12  authorization process for persons receiving both home care and 
 20.13  waivered services for persons with mental retardation or related 
 20.14  conditions shall meet the requirements of this section and 
 20.15  section 256B.0627 with the following exceptions: 
 20.16     (a) Upon request for home care services and subsequent 
 20.17  assessment by the public health nurse under section 256B.0627, 
 20.18  the public health nurse shall participate in the screening 
 20.19  process, as appropriate, and, if home care services are 
 20.20  determined to be necessary, participate in the development of a 
 20.21  service plan coordinating the need for home care and waivered 
 20.22  services with the assigned county case manager, the recipient of 
 20.23  services, and the recipient's legal representative, if any. 
 20.24     (b) The public health nurse shall give prior authorization 
 20.25  for home care services to the extent that home care services are:
 20.26     (1) medically necessary; 
 20.27     (2) chosen by the recipient and their legal representative, 
 20.28  if any, from the array of home care and waivered services 
 20.29  available; 
 20.30     (3) coordinated with other services to be received by the 
 20.31  recipient as described in the service plan; and 
 20.32     (4) provided within the county's reimbursement limits for 
 20.33  home care and waivered services. 
 20.34     (c) If the public health agency is or may be the provider 
 20.35  of home care services to the recipient, the public health agency 
 20.36  shall provide the commissioner with a written plan that 
 21.1   specifies how the assessment and prior authorization process 
 21.2   will be held separate and distinct from the provision of 
 21.3   services. 
 21.4      Sec. 12.  Minnesota Statutes 1994, section 256B.092, is 
 21.5   amended by adding a subdivision to read: 
 21.6      Subd. 4c.  [LIVING ARRANGEMENTS BASED ON A 24-HOUR PLAN OF 
 21.7   CARE.] (a) Notwithstanding the requirements for licensure under 
 21.8   Minnesota Rules, part 9525.1860, subpart 6, item D, and upon 
 21.9   federal approval of an amendment to the home and community-based 
 21.10  services waiver for persons with mental retardation or related 
 21.11  conditions, a person receiving home and community-based services 
 21.12  may choose to live in their own home without requiring that the 
 21.13  living arrangement be licensed under Minnesota Rules, parts 
 21.14  9555.5050 to 9555.6265, provided the following conditions are 
 21.15  met: 
 21.16     (1) the person receiving home and community-based services 
 21.17  chooses to live in their own home; 
 21.18     (2) home and community-based services are provided by a 
 21.19  qualified vendor who meets the provider standards as approved in 
 21.20  the Minnesota home and community-based services waiver plan for 
 21.21  persons with mental retardation or related conditions; 
 21.22     (3) the person, or their legal representative, individually 
 21.23  or with others has purchased or rents the home and the person's 
 21.24  service provider has no financial interest in the home; and 
 21.25     (4) the service planning team, as defined in Minnesota 
 21.26  Rules, part 9525.0004, subpart 24, has determined that the 
 21.27  planned services, the 24-hour plan of care, and the housing 
 21.28  arrangement are appropriate to address the health, safety, and 
 21.29  welfare of the person. 
 21.30     (b) The county agency may require safety inspections of the 
 21.31  selected housing as part of their determination of the adequacy 
 21.32  of the living arrangement. 
 21.33     Sec. 13.  [REPEALER.] 
 21.34     Minnesota Statutes 1994, section 252.275, subdivisions 4a 
 21.35  and 10, are repealed. 
 21.36     Sec. 14.  [EFFECTIVE DATE.] 
 22.1      Section 6 (252.60) is effective January 1, 1996.  Section 9 
 22.2   (256.476) is effective July 1, 1996.