1.1                          A bill for an act 
  1.2             relating to health; modifying requirements relating to 
  1.3             elderly housing with services establishments; 
  1.4             permitting medical assistance reimbursement to certain 
  1.5             home care providers in elderly housing with services 
  1.6             establishments; including an elderly housing with 
  1.7             services establishment as a permitted single family 
  1.8             residential use of property for zoning purposes; 
  1.9             amending Minnesota Statutes 1996, sections 144A.45, by 
  1.10            adding a subdivision; 144D.01, subdivisions 4, 5, 6, 
  1.11            and by adding a subdivision; 144D.03, subdivision 1; 
  1.12            144D.06; 157.17, subdivisions 5 and 7; 256B.0913, 
  1.13            subdivision 5; 256B.0915, subdivision 3; 256I.04, 
  1.14            subdivision 2a; and 462.357, subdivision 7.  
  1.15  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.16     Section 1.  Minnesota Statutes 1996, section 144A.45, is 
  1.17  amended by adding a subdivision to read: 
  1.18     Subd. 4.  [MEDICAID REIMBURSEMENT.] Notwithstanding state 
  1.19  plan requirements to the contrary, and according to federal law, 
  1.20  a home care provider licensed under sections 144A.43 to 144A.49 
  1.21  is eligible to receive Medicaid reimbursement for services 
  1.22  provided to clients living in an elderly housing with services 
  1.23  establishment registered under chapter 144D. 
  1.24     Sec. 2.  Minnesota Statutes 1996, section 144D.01, 
  1.25  subdivision 4, is amended to read: 
  1.26     Subd. 4.  [ELDERLY HOUSING WITH SERVICES ESTABLISHMENT OR 
  1.27  ESTABLISHMENT.] "Elderly housing with services establishment" or 
  1.28  "establishment" means an establishment providing sleeping 
  1.29  accommodations to one or more adult residents, at least 80 
  1.30  percent of which are 55 years of age or older, and offering or 
  2.1   providing, for a fee, one or more regularly scheduled 
  2.2   health-related services or two or more regularly scheduled 
  2.3   supportive service services, whether offered or provided 
  2.4   directly by the establishment or by another entity arranged for 
  2.5   by the establishment. 
  2.6      Elderly housing with services establishment does not 
  2.7   include: 
  2.8      (1) a nursing home licensed under chapter 144A; 
  2.9      (2) a hospital, boarding care home, or supervised living 
  2.10  facility licensed under sections 144.50 to 144.56; 
  2.11     (3) a board and lodging establishment licensed under 
  2.12  chapter 157 and Minnesota Rules, parts 9520.0500 to 9520.0670, 
  2.13  9525.0215 to 9525.0355, 9525.0500 to 9525.0660, or 9530.4100 to 
  2.14  9530.4450; 
  2.15     (4) a board and lodging establishment which serves as a 
  2.16  shelter for battered women or other similar purpose; 
  2.17     (5) a family adult foster care home licensed under 
  2.18  Minnesota Rules, parts 9543.0010 to 9543.0150 by the department 
  2.19  of human services; or 
  2.20     (6) private homes in which the residents are related by 
  2.21  kinship, law, or affinity with the providers of services; 
  2.22     (7) a home-sharing arrangement such as when an elderly or 
  2.23  disabled person or single-parent family makes lodging in a 
  2.24  private residence available to another person in exchange for 
  2.25  services or rent, or both; 
  2.26     (8) a duly organized condominium, cooperative, common 
  2.27  interest community, or owners' association of the foregoing 
  2.28  where at least 80 percent of the units that comprise the 
  2.29  condominium, cooperative, or common interest community are 
  2.30  occupied by individuals who are the owners, members, or 
  2.31  shareholders of the units; or 
  2.32     (9) services for persons with developmental disabilities 
  2.33  that are provided under a license according to Minnesota Rules, 
  2.34  parts 9525.2100 to 9525.2140. 
  2.35     Sec. 3.  Minnesota Statutes 1996, section 144D.01, 
  2.36  subdivision 5, is amended to read: 
  3.1      Subd. 5.  [SUPPORTIVE SERVICES.] "Supportive services" 
  3.2   means arranging for medical services, health-related services, 
  3.3   social services, transportation, help with personal laundry, or 
  3.4   handling or assisting with personal funds of residents, or 
  3.5   arranging for medical services, health-related services, social 
  3.6   services, or transportation to medical or social services 
  3.7   appointments.  Arranging for services does not include making 
  3.8   referrals, assisting a resident in contacting a service provider 
  3.9   of the resident's choice, or contacting a service provider in an 
  3.10  emergency. 
  3.11     Sec. 4.  Minnesota Statutes 1996, section 144D.01, 
  3.12  subdivision 6, is amended to read: 
  3.13     Subd. 6.  [HEALTH-RELATED SERVICES.] "Health-related 
  3.14  services" include professional nursing services, home health 
  3.15  aide tasks, and home care aide tasks identified in Minnesota 
  3.16  Rules, parts 4668.0100, subparts 1 and 2;, and 4668.0110, 
  3.17  subpart 1,; or the central storage of medication for residents 
  3.18  under section 144A.485, subdivision 2, clause (6). 
  3.19     Sec. 5.  Minnesota Statutes 1996, section 144D.01, is 
  3.20  amended by adding a subdivision to read: 
  3.21     Subd. 7.  [FAMILY ADULT FOSTER CARE HOME.] "Family adult 
  3.22  foster care home" means an adult foster home that is licensed by 
  3.23  the department of human services, that is the primary residence 
  3.24  of the license holder, and in which the license holder is the 
  3.25  primary caregiver. 
  3.26     Sec. 6.  Minnesota Statutes 1996, section 144D.03, 
  3.27  subdivision 1, is amended to read: 
  3.28     Subdivision 1.  [REGISTRATION PROCEDURES.] The commissioner 
  3.29  shall establish forms and procedures for annual registration of 
  3.30  elderly housing with services establishments.  The commissioner 
  3.31  shall charge an annual registration fee of $35.  No fee shall be 
  3.32  refunded.  A registered establishment shall notify the 
  3.33  commissioner within 30 days of the date it is no longer required 
  3.34  to be registered under this chapter or of any change in the 
  3.35  business name or address of the establishment, the name or 
  3.36  mailing address of the owner or owners, or the name or mailing 
  4.1   address of the managing agent.  There shall be no fee for 
  4.2   submission of the notice. 
  4.3      Sec. 7.  Minnesota Statutes 1996, section 144D.06, is 
  4.4   amended to read: 
  4.5      144D.06 [OTHER LAWS.] 
  4.6      An elderly housing with services establishment shall obtain 
  4.7   and maintain all other licenses, permits, registrations, or 
  4.8   other governmental approvals required of it in addition to 
  4.9   registration under this chapter, except that an establishment 
  4.10  registered under this chapter is exempt, at its option, from the 
  4.11  requirement of obtaining and maintaining an adult foster care 
  4.12  license under Minnesota Rules, parts 9543.0010 to 9543.0150, or 
  4.13  a lodging license under chapter 157.  An elderly housing with 
  4.14  services establishment is subject to the provisions of sections 
  4.15  504.01 to 504.28 and 566.01 to 566.175.  An elderly housing with 
  4.16  services establishment which is also described in section 157.17 
  4.17  is exempt from the requirements of that section while it is 
  4.18  registered under this chapter. 
  4.19     Sec. 8.  Minnesota Statutes 1996, section 157.17, 
  4.20  subdivision 5, is amended to read: 
  4.21     Subd. 5.  [SERVICES THAT MAY NOT BE PROVIDED IN A BOARDING 
  4.22  AND LODGING ESTABLISHMENT OR LODGING ESTABLISHMENT.] Except 
  4.23  those facilities registered under chapter 144D, a boarding and 
  4.24  lodging establishment or lodging establishment may not admit or 
  4.25  retain individuals who: 
  4.26     (1) would require assistance from establishment staff 
  4.27  because of the following needs:  bowel incontinence, catheter 
  4.28  care, use of injectable or parenteral medications, wound care, 
  4.29  or dressing changes or irrigations of any kind; or 
  4.30     (2) require a level of care and supervision beyond 
  4.31  supportive services or health supervision services. 
  4.32     Sec. 9.  Minnesota Statutes 1996, section 157.17, 
  4.33  subdivision 7, is amended to read: 
  4.34     Subd. 7.  [EXEMPTION FOR ESTABLISHMENTS WITH A HUMAN 
  4.35  SERVICES LICENSE AND FOR REGISTERED ELDERLY HOUSING WITH 
  4.36  SERVICES ESTABLISHMENTS.] This section does not apply to a 
  5.1   boarding and lodging establishment or lodging establishment that 
  5.2   is licensed by the commissioner of human services under chapter 
  5.3   245A.  Elderly housing with services establishments that are 
  5.4   registered under chapter 144D shall be considered registered 
  5.5   under this section for all purposes except that: 
  5.6      (1) the establishments shall operate under the requirements 
  5.7   of chapter 144D; and 
  5.8      (2) the criminal background check requirements of sections 
  5.9   299C.66 to 299C.71 apply.  The criminal background check 
  5.10  requirements of section 144.057 apply only to personnel 
  5.11  providing home care services under sections 144A.43 to 144A.48. 
  5.12     Sec. 10.  Minnesota Statutes 1996, section 256B.0913, 
  5.13  subdivision 5, is amended to read: 
  5.14     Subd. 5.  [SERVICES COVERED UNDER ALTERNATIVE CARE.] (a) 
  5.15  Alternative care funding may be used for payment of costs of: 
  5.16     (1) adult foster care; 
  5.17     (2) adult day care; 
  5.18     (3) home health aide; 
  5.19     (4) homemaker services; 
  5.20     (5) personal care; 
  5.21     (6) case management; 
  5.22     (7) respite care; 
  5.23     (8) assisted living; 
  5.24     (9) residential care services; 
  5.25     (10) care-related supplies and equipment; 
  5.26     (11) meals delivered to the home; 
  5.27     (12) transportation; 
  5.28     (13) skilled nursing; 
  5.29     (14) chore services; 
  5.30     (15) companion services; 
  5.31     (16) nutrition services; 
  5.32     (17) training for direct informal caregivers; and 
  5.33     (18) telemedicine devices to monitor recipients in their 
  5.34  own homes as an alternative to hospital care, nursing home care, 
  5.35  or home visits. 
  5.36     (b) The county agency must ensure that the funds are used 
  6.1   only to supplement and not supplant services available through 
  6.2   other public assistance or services programs. 
  6.3      (c) Unless specified in statute, the service standards for 
  6.4   alternative care services shall be the same as the service 
  6.5   standards defined in the elderly waiver.  Persons or agencies 
  6.6   must be employed by or under a contract with the county agency 
  6.7   or the public health nursing agency of the local board of health 
  6.8   in order to receive funding under the alternative care program. 
  6.9      (d) The adult foster care rate shall be considered a 
  6.10  difficulty of care payment and shall not include room and 
  6.11  board.  The adult foster care daily rate shall be negotiated 
  6.12  between the county agency and the foster care provider.  The 
  6.13  rate established under this section shall not exceed 75 percent 
  6.14  of the state average monthly nursing home payment for the case 
  6.15  mix classification to which the individual receiving foster care 
  6.16  is assigned, and it must allow for other alternative care 
  6.17  services to be authorized by the case manager. 
  6.18     (e) Personal care services may be provided by a personal 
  6.19  care provider organization.  A county agency may contract with a 
  6.20  relative of the client to provide personal care services, but 
  6.21  must ensure nursing supervision.  Covered personal care services 
  6.22  defined in section 256B.0627, subdivision 4, must meet 
  6.23  applicable standards in Minnesota Rules, part 9505.0335. 
  6.24     (f) A county may use alternative care funds to purchase 
  6.25  medical supplies and equipment without prior approval from the 
  6.26  commissioner when:  (1) there is no other funding source; (2) 
  6.27  the supplies and equipment are specified in the individual's 
  6.28  care plan as medically necessary to enable the individual to 
  6.29  remain in the community according to the criteria in Minnesota 
  6.30  Rules, part 9505.0210, item A; and (3) the supplies and 
  6.31  equipment represent an effective and appropriate use of 
  6.32  alternative care funds.  A county may use alternative care funds 
  6.33  to purchase supplies and equipment from a non-Medicaid certified 
  6.34  vendor if the cost for the items is less than that of a Medicaid 
  6.35  vendor.  A county is not required to contract with a provider of 
  6.36  supplies and equipment if the monthly cost of the supplies and 
  7.1   equipment is less than $250.  
  7.2      (g) For purposes of this section, residential care services 
  7.3   are services which are provided to individuals living in 
  7.4   residential care homes or elderly housing with services 
  7.5   establishments registered under chapter 144D.  Residential care 
  7.6   homes are currently licensed as board and lodging establishments 
  7.7   and are registered with the department of health as providing 
  7.8   special services.  Residential care services are defined as 
  7.9   "supportive services" and "health-related services."  
  7.10  "Supportive services" means the provision of up to 24-hour 
  7.11  supervision and oversight.  Supportive services includes:  (1) 
  7.12  transportation, when provided by the residential care center 
  7.13  only; (2) socialization, when socialization is part of the plan 
  7.14  of care, has specific goals and outcomes established, and is not 
  7.15  diversional or recreational in nature; (3) assisting clients in 
  7.16  setting up meetings and appointments; (4) assisting clients in 
  7.17  setting up medical and social services; (5) providing assistance 
  7.18  with personal laundry, such as carrying the client's laundry to 
  7.19  the laundry room.  Assistance with personal laundry does not 
  7.20  include any laundry, such as bed linen, that is included in the 
  7.21  room and board rate.  Health-related services are limited to 
  7.22  minimal assistance with dressing, grooming, and bathing and 
  7.23  providing reminders to residents to take medications that are 
  7.24  self-administered or providing storage for medications, if 
  7.25  requested.  Individuals receiving residential care services 
  7.26  cannot receive both personal care services and residential care 
  7.27  services.  
  7.28     (h) For the purposes of this section, "assisted living" 
  7.29  refers to supportive services provided by a single vendor to 
  7.30  clients who reside in the same apartment building of three or 
  7.31  more units.  Assisted living services are defined as up to 
  7.32  24-hour supervision, and oversight, supportive services as 
  7.33  defined in clause (1), individualized home care aide tasks as 
  7.34  defined in clause (2), and individualized home management tasks 
  7.35  as defined in clause (3) provided to residents of a residential 
  7.36  center living in their units or apartments with a full kitchen 
  8.1   and bathroom.  A full kitchen includes a stove, oven, 
  8.2   refrigerator, food preparation counter space, and a kitchen 
  8.3   utensil storage compartment.  Assisted living services must be 
  8.4   provided by the management of the residential center or by 
  8.5   providers under contract with the management or with the county. 
  8.6      (1) Supportive services include:  
  8.7      (i) socialization, when socialization is part of the plan 
  8.8   of care, has specific goals and outcomes established, and is not 
  8.9   diversional or recreational in nature; 
  8.10     (ii) assisting clients in setting up meetings and 
  8.11  appointments; and 
  8.12     (iii) providing transportation, when provided by the 
  8.13  residential center only.  
  8.14     Individuals receiving assisted living services will not 
  8.15  receive both assisted living services and homemaking or personal 
  8.16  care services.  Individualized means services are chosen and 
  8.17  designed specifically for each resident's needs, rather than 
  8.18  provided or offered to all residents regardless of their 
  8.19  illnesses, disabilities, or physical conditions.  
  8.20     (2) Home care aide tasks means:  
  8.21     (i) preparing modified diets, such as diabetic or low 
  8.22  sodium diets; 
  8.23     (ii) reminding residents to take regularly scheduled 
  8.24  medications or to perform exercises; 
  8.25     (iii) household chores in the presence of technically 
  8.26  sophisticated medical equipment or episodes of acute illness or 
  8.27  infectious disease; 
  8.28     (iv) household chores when the resident's care requires the 
  8.29  prevention of exposure to infectious disease or containment of 
  8.30  infectious disease; and 
  8.31     (v) assisting with dressing, oral hygiene, hair care, 
  8.32  grooming, and bathing, if the resident is ambulatory, and if the 
  8.33  resident has no serious acute illness or infectious disease.  
  8.34  Oral hygiene means care of teeth, gums, and oral prosthetic 
  8.35  devices.  
  8.36     (3) Home management tasks means:  
  9.1      (i) housekeeping; 
  9.2      (ii) laundry; 
  9.3      (iii) preparation of regular snacks and meals; and 
  9.4      (iv) shopping.  
  9.5      Assisted living services as defined in this section shall 
  9.6   not be authorized in boarding and lodging establishments 
  9.7   licensed according to sections 157.011 and 157.15 to 157.22. 
  9.8      (i) For the purposes of this section, reimbursement for 
  9.9   assisted living services and residential care services shall be 
  9.10  a monthly rate negotiated and authorized by the county agency.  
  9.11  The rate shall not exceed the nonfederal share of the greater of 
  9.12  either the statewide or any of the geographic groups' weighted 
  9.13  average monthly medical assistance nursing facility payment rate 
  9.14  of the case mix resident class to which the 180-day eligible 
  9.15  client would be assigned under Minnesota Rules, parts 9549.0050 
  9.16  to 9549.0059.  For services provided in a building that is 
  9.17  registered as an elderly housing with services establishment 
  9.18  under chapter 144D by a home care provider that is licensed by 
  9.19  the department of health and that provides 24-hour supervision, 
  9.20  reimbursement shall not exceed the statewide average monthly 
  9.21  nursing home payment for the case mix classification to which 
  9.22  the individual receiving assisted living services or residential 
  9.23  services is assigned.  For alternative care assisted living 
  9.24  projects established under Laws 1988, chapter 689, article 2, 
  9.25  section 256, monthly rates may not exceed 65 percent of the 
  9.26  greater of either statewide or any of the geographic groups' 
  9.27  weighted average monthly medical assistance nursing facility 
  9.28  payment rate of the case mix resident class to which the 180-day 
  9.29  eligible client would be assigned under Minnesota Rules, parts 
  9.30  9549.0050 to 9549.0059.  The rate may not cover rent and direct 
  9.31  food costs. 
  9.32     (j) For purposes of this section, companion services are 
  9.33  defined as nonmedical care, supervision and oversight, provided 
  9.34  to a functionally impaired adult.  Companions may assist the 
  9.35  individual with such tasks as meal preparation, laundry and 
  9.36  shopping, but do not perform these activities as discrete 
 10.1   services.  The provision of companion services does not entail 
 10.2   hands-on medical care.  Providers may also perform light 
 10.3   housekeeping tasks which are incidental to the care and 
 10.4   supervision of the recipient.  This service must be approved by 
 10.5   the case manager as part of the care plan.  Companion services 
 10.6   must be provided by individuals or nonprofit organizations who 
 10.7   are under contract with the local agency to provide the 
 10.8   service.  Any person related to the waiver recipient by blood, 
 10.9   marriage or adoption cannot be reimbursed under this service.  
 10.10  Persons providing companion services will be monitored by the 
 10.11  case manager. 
 10.12     (k) For purposes of this section, training for direct 
 10.13  informal caregivers is defined as a classroom or home course of 
 10.14  instruction which may include:  transfer and lifting skills, 
 10.15  nutrition, personal and physical cares, home safety in a home 
 10.16  environment, stress reduction and management, behavioral 
 10.17  management, long-term care decision making, care coordination 
 10.18  and family dynamics.  The training is provided to an informal 
 10.19  unpaid caregiver of a 180-day eligible client which enables the 
 10.20  caregiver to deliver care in a home setting with high levels of 
 10.21  quality.  The training must be approved by the case manager as 
 10.22  part of the individual care plan.  Individuals, agencies, and 
 10.23  educational facilities which provide caregiver training and 
 10.24  education will be monitored by the case manager. 
 10.25     Sec. 11.  Minnesota Statutes 1996, section 256B.0915, 
 10.26  subdivision 3, is amended to read: 
 10.27     Subd. 3.  [LIMITS OF CASES, RATES, REIMBURSEMENT, AND 
 10.28  FORECASTING.] (a) The number of medical assistance waiver 
 10.29  recipients that a county may serve must be allocated according 
 10.30  to the number of medical assistance waiver cases open on July 1 
 10.31  of each fiscal year.  Additional recipients may be served with 
 10.32  the approval of the commissioner. 
 10.33     (b) The monthly limit for the cost of waivered services to 
 10.34  an individual waiver client shall be the statewide average 
 10.35  payment rate of the case mix resident class to which the waiver 
 10.36  client would be assigned under the medical assistance case mix 
 11.1   reimbursement system.  If medical supplies and equipment or 
 11.2   adaptations are or will be purchased for an elderly waiver 
 11.3   services recipient, the costs may be prorated on a monthly basis 
 11.4   throughout the year in which they are purchased.  If the monthly 
 11.5   cost of a recipient's other waivered services exceeds the 
 11.6   monthly limit established in this paragraph, the annual cost of 
 11.7   the waivered services shall be determined.  In this event, the 
 11.8   annual cost of waivered services shall not exceed 12 times the 
 11.9   monthly limit calculated in this paragraph.  The statewide 
 11.10  average payment rate is calculated by determining the statewide 
 11.11  average monthly nursing home rate, effective July 1 of the 
 11.12  fiscal year in which the cost is incurred, less the statewide 
 11.13  average monthly income of nursing home residents who are age 65 
 11.14  or older, and who are medical assistance recipients in the month 
 11.15  of March of the previous state fiscal year.  The annual cost 
 11.16  divided by 12 of elderly or disabled waivered services for a 
 11.17  person who is a nursing facility resident at the time of 
 11.18  requesting a determination of eligibility for elderly or 
 11.19  disabled waivered services shall not exceed the monthly payment 
 11.20  for the resident class assigned under Minnesota Rules, parts 
 11.21  9549.0050 to 9549.0059, for that resident in the nursing 
 11.22  facility where the resident currently resides.  The following 
 11.23  costs must be included in determining the total monthly costs 
 11.24  for the waiver client: 
 11.25     (1) cost of all waivered services, including extended 
 11.26  medical supplies and equipment; and 
 11.27     (2) cost of skilled nursing, home health aide, and personal 
 11.28  care services reimbursable by medical assistance.  
 11.29     (c) Medical assistance funding for skilled nursing 
 11.30  services, private duty nursing, home health aide, and personal 
 11.31  care services for waiver recipients must be approved by the case 
 11.32  manager and included in the individual care plan. 
 11.33     (d) For both the elderly waiver and the nursing facility 
 11.34  disabled waiver, a county may purchase extended supplies and 
 11.35  equipment without prior approval from the commissioner when 
 11.36  there is no other funding source and the supplies and equipment 
 12.1   are specified in the individual's care plan as medically 
 12.2   necessary to enable the individual to remain in the community 
 12.3   according to the criteria in Minnesota Rules, part 9505.0210, 
 12.4   items A and B.  A county is not required to contract with a 
 12.5   provider of supplies and equipment if the monthly cost of the 
 12.6   supplies and equipment is less than $250.  
 12.7      (e) For the fiscal year beginning on July 1, 1993, and for 
 12.8   subsequent fiscal years, the commissioner of human services 
 12.9   shall not provide automatic annual inflation adjustments for 
 12.10  home and community-based waivered services.  The commissioner of 
 12.11  finance shall include as a budget change request in each 
 12.12  biennial detailed expenditure budget submitted to the 
 12.13  legislature under section 16A.11, annual adjustments in 
 12.14  reimbursement rates for home and community-based waivered 
 12.15  services, based on the forecasted percentage change in the Home 
 12.16  Health Agency Market Basket of Operating Costs, for the fiscal 
 12.17  year beginning July 1, compared to the previous fiscal year, 
 12.18  unless otherwise adjusted by statute.  The Home Health Agency 
 12.19  Market Basket of Operating Costs is published by Data Resources, 
 12.20  Inc.  The forecast to be used is the one published for the 
 12.21  calendar quarter beginning January 1, six months prior to the 
 12.22  beginning of the fiscal year for which rates are set.  The adult 
 12.23  foster care rate shall be considered a difficulty of care 
 12.24  payment and shall not include room and board. 
 12.25     (f) The adult foster care daily rate for the elderly and 
 12.26  disabled waivers shall be negotiated between the county agency 
 12.27  and the foster care provider.  The rate established under this 
 12.28  section shall not exceed the state average monthly nursing home 
 12.29  payment for the case mix classification to which the individual 
 12.30  receiving foster care is assigned; the rate must allow for other 
 12.31  waiver and medical assistance home care services to be 
 12.32  authorized by the case manager. 
 12.33     (g) The assisted living and residential care service rates 
 12.34  for elderly and community alternatives for disabled individuals 
 12.35  (CADI) waivers shall be made to the vendor as a monthly rate 
 12.36  negotiated with the county agency.  The rate shall not exceed 
 13.1   the nonfederal share of the greater of either the statewide or 
 13.2   any of the geographic groups' weighted average monthly medical 
 13.3   assistance nursing facility payment rate of the case mix 
 13.4   resident class to which the elderly or disabled client would be 
 13.5   assigned under Minnesota Rules, parts 9549.0050 to 
 13.6   9549.0059.  For services provided in a building that is 
 13.7   registered as an elderly housing with services establishment 
 13.8   under chapter 144D by a home care provider that is licensed by 
 13.9   the department of health and that provides 24-hour supervision, 
 13.10  reimbursement shall not exceed the statewide average monthly 
 13.11  nursing home payment for the case mix classification to which 
 13.12  the individual receiving assisted living services or residential 
 13.13  services is assigned.  For alternative care assisted living 
 13.14  projects established under Laws 1988, chapter 689, article 2, 
 13.15  section 256, monthly rates may not exceed 65 percent of the 
 13.16  greater of either the statewide or any of the geographic groups' 
 13.17  weighted average monthly medical assistance nursing facility 
 13.18  payment rate for the case mix resident class to which the 
 13.19  elderly or disabled client would be assigned under Minnesota 
 13.20  Rules, parts 9549.0050 to 9549.0059.  The rate may not cover 
 13.21  direct rent or food costs. 
 13.22     (h) The county shall negotiate individual rates with 
 13.23  vendors and may be reimbursed for actual costs up to the greater 
 13.24  of the county's current approved rate or 60 percent of the 
 13.25  maximum rate in fiscal year 1994 and 65 percent of the maximum 
 13.26  rate in fiscal year 1995 for each service within each program. 
 13.27     (i) On July 1, 1993, the commissioner shall increase the 
 13.28  maximum rate for home-delivered meals to $4.50 per meal. 
 13.29     (j) Reimbursement for the medical assistance recipients 
 13.30  under the approved waiver shall be made from the medical 
 13.31  assistance account through the invoice processing procedures of 
 13.32  the department's Medicaid Management Information System (MMIS), 
 13.33  only with the approval of the client's case manager.  The budget 
 13.34  for the state share of the Medicaid expenditures shall be 
 13.35  forecasted with the medical assistance budget, and shall be 
 13.36  consistent with the approved waiver.  
 14.1      (k) Beginning July 1, 1991, the state shall reimburse 
 14.2   counties according to the payment schedule in section 256.025 
 14.3   for the county share of costs incurred under this subdivision on 
 14.4   or after January 1, 1991, for individuals who are receiving 
 14.5   medical assistance. 
 14.6      Sec. 12.  Minnesota Statutes 1996, section 256I.04, 
 14.7   subdivision 2a, is amended to read: 
 14.8      Subd. 2a.  [LICENSE REQUIRED.] A county agency may not 
 14.9   enter into an agreement with an establishment to provide group 
 14.10  residential housing unless:  
 14.11     (1) the establishment is licensed or registered, as 
 14.12  required, by the department of health as a hotel and restaurant; 
 14.13  a board and lodging establishment; a residential care home; a 
 14.14  boarding care home before March 1, 1985; an elderly housing with 
 14.15  services establishment under chapter 144D offering three meals a 
 14.16  day; or a supervised living facility, and the service provider 
 14.17  for residents of the facility is licensed under chapter 245A.  
 14.18  However, an establishment licensed by the department of health 
 14.19  to provide lodging need not also be licensed to provide board if 
 14.20  meals are being supplied to residents under a contract with a 
 14.21  food vendor who is licensed by the department of health; or 
 14.22     (2) the residence is licensed by the commissioner of human 
 14.23  services under Minnesota Rules, parts 9555.5050 to 9555.6265, or 
 14.24  certified by a county human services agency prior to July 1, 
 14.25  1992, using the standards under Minnesota Rules, parts 9555.5050 
 14.26  to 9555.6265. 
 14.27     The requirements under clauses (1) and (2) do not apply to 
 14.28  establishments exempt from state licensure because they are 
 14.29  located on Indian reservations and subject to tribal health and 
 14.30  safety requirements. 
 14.31     Sec. 13.  Minnesota Statutes 1996, section 462.357, 
 14.32  subdivision 7, is amended to read: 
 14.33     Subd. 7.  [PERMITTED SINGLE FAMILY USE.] A state licensed 
 14.34  residential facility or an elderly housing with services 
 14.35  establishment registered under chapter 144D serving six or fewer 
 14.36  persons, a licensed day care facility serving 12 or fewer 
 15.1   persons, and a group family day care facility licensed under 
 15.2   Minnesota Rules, parts 9502.0315 to 9502.0445 to serve 14 or 
 15.3   fewer children shall be considered a permitted single family 
 15.4   residential use of property for the purposes of zoning, except 
 15.5   that a residential facility whose primary purpose is to treat 
 15.6   juveniles who have violated criminal statutes relating to sex 
 15.7   offenses or have been adjudicated delinquent on the basis of 
 15.8   conduct in violation of criminal statutes relating to sex 
 15.9   offenses shall not be considered a permitted use.