1.1                          A bill for an act 
  1.2             relating to human services; authorizing an increase in 
  1.3             reimbursement rates; including home modification to 
  1.4             the alternative care program and the waivered programs 
  1.5             without prior authorization; requiring rate 
  1.6             consolidation for the waivered programs for certain 
  1.7             services; exempting certain individuals from 
  1.8             preadmission screening; requiring the monthly cap for 
  1.9             elderly waiver conversion clients to be the higher of 
  1.10            either the statewide average or the actual nursing 
  1.11            home cost; extending the alternative care pilot 
  1.12            projects; amending Minnesota Statutes 1996, sections 
  1.13            256B.0911, subdivision 2; 256B.0912, by adding a 
  1.14            subdivision; 256B.0913, subdivision 5; and 256B.0915, 
  1.15            subdivision 3; Laws 1995, chapter 207, article 6, 
  1.16            section 115; repealing Minnesota Statutes 1996, 
  1.17            sections 144.0721, subdivision 3; and 256B.0913, 
  1.18            subdivision 15. 
  1.19  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.20     Section 1.  Minnesota Statutes 1996, section 256B.0911, 
  1.21  subdivision 2, is amended to read: 
  1.22     Subd. 2.  [PERSONS REQUIRED TO BE SCREENED; EXEMPTIONS.] 
  1.23  All applicants to Medicaid certified nursing facilities must be 
  1.24  screened prior to admission, regardless of income, assets, or 
  1.25  funding sources, except the following: 
  1.26     (1) patients who, having entered acute care facilities from 
  1.27  certified nursing facilities, are returning to a certified 
  1.28  nursing facility; 
  1.29     (2) residents transferred from other certified nursing 
  1.30  facilities located within the state of Minnesota; 
  1.31     (3) individuals who have a contractual right to have their 
  1.32  nursing facility care paid for indefinitely by the veteran's 
  2.1   administration; 
  2.2      (4) individuals who are enrolled in the Ebenezer/Group 
  2.3   Health social health maintenance organization project, or 
  2.4   enrolled in a demonstration project under section 256B.69, 
  2.5   subdivision 18, at the time of application to a nursing home; ~~or~~ 
  2.6      (5) individuals previously screened and currently being 
  2.7   served under the alternative care program or under a home and 
  2.8   community-based services waiver authorized under section 1915(c) 
  2.9   of the Social Security Act; or 
  2.10     (6) individuals who are admitted to a certified nursing 
  2.11  facility for a short-term stay, which, based upon a physician's 
  2.12  certification, is expected to be 14 days or less in duration, 
  2.13  and who have been screened and approved for nursing facility 
  2.14  admission within the previous six months.  This exemption 
  2.15  applies only if the screener determines at the time of the 
  2.16  initial screening of the six-month period that it is appropriate 
  2.17  to use the nursing facility for short-term stays and that there 
  2.18  is an adequate plan of care for return to the home or 
  2.19  community-based setting.  If a stay exceeds 14 days, the 
  2.20  individual must be referred no later than the first county 
  2.21  working day following the 14th resident day for a screening. 
  2.22     Regardless of the exemptions in clauses (2) to (4), persons 
  2.23  who have a diagnosis or possible diagnosis of mental illness, 
  2.24  mental retardation, or a related condition must be screened 
  2.25  before admission unless the admission prior to screening is 
  2.26  authorized by the local mental health authority or the local 
  2.27  developmental disabilities case manager, or unless authorized by 
  2.28  the county agency according to Public Law Number 101-508. 
  2.29     Before admission to a Medicaid certified nursing home or 
  2.30  boarding care home, all persons must be screened and approved 
  2.31  for admission through an assessment process.  The nursing 
  2.32  facility is authorized to conduct case mix assessments which are 
  2.33  not conducted by the county public health nurse under Minnesota 
  2.34  Rules, part 9549.0059.  The designated county agency is 
  2.35  responsible for distributing the quality assurance and review 
  2.36  form for all new applicants to nursing homes. 
  3.1      Other persons who are not applicants to nursing facilities 
  3.2   must be screened if a request is made for a screening. 
  3.3      Sec. 2.  Minnesota Statutes 1996, section 256B.0912, is 
  3.4   amended by adding a subdivision to read: 
  3.5      Subd. 3.  [RATE CONSOLIDATION AND EQUALIZATION.] (a) The 
  3.6   commissioner of human services shall use one reimbursement rate 
  3.7   for personal care services rendered after June 30, 1997, 
  3.8   regardless of whether the services are provided through the 
  3.9   medical assistance program, the alternative care program, and 
  3.10  the elderly and disabled waiver program.  The reimbursement rate 
  3.11  to be paid must be the reimbursement rate paid for personal care 
  3.12  services received under the medical assistance program on June 
  3.13  30, 1997. 
  3.14     (b) The commissioner of human services shall equalize the 
  3.15  reimbursement rate provided in the alternative care program, the 
  3.16  community alternatives for disabled individuals waiver, the 
  3.17  elderly waiver, and the traumatic brain injury waiver for the 
  3.18  following services:  skilled nursing services provided by a 
  3.19  registered nurse, nursing services provided by a licensed 
  3.20  practical nurse, and homemaker services so that each of these 
  3.21  services are reimbursed at the same rate for the alternative 
  3.22  care program, the community alternatives for disabled 
  3.23  individuals waiver, the elderly waiver, and the traumatic brain 
  3.24  injury waiver for services rendered after June 30, 1997.  The 
  3.25  reimbursement rate for each of these services after June 30, 
  3.26  1997, must be the maximum rate in effect for these services on 
  3.27  June 30, 1997. 
  3.28     (c) The reimbursement rates for behavior programming and 
  3.29  cognitive therapy services provided through the traumatic brain 
  3.30  injury waiver must be equivalent to the medical assistance 
  3.31  reimbursement rates for mental health services. 
  3.32     Sec. 3.  Minnesota Statutes 1996, section 256B.0913, 
  3.33  subdivision 5, is amended to read: 
  3.34     Subd. 5.  [SERVICES COVERED UNDER ALTERNATIVE CARE.] (a) 
  3.35  Alternative care funding may be used for payment of costs of: 
  3.36     (1) adult foster care; 
  4.1      (2) adult day care; 
  4.2      (3) home health aide; 
  4.3      (4) homemaker services; 
  4.4      (5) personal care; 
  4.5      (6) case management; 
  4.6      (7) respite care; 
  4.7      (8) assisted living; 
  4.8      (9) residential care services; 
  4.9      (10) care-related supplies and equipment; 
  4.10     (11) meals delivered to the home; 
  4.11     (12) transportation; 
  4.12     (13) skilled nursing; 
  4.13     (14) chore services; 
  4.14     (15) companion services; 
  4.15     (16) nutrition services; 
  4.16     (17) training for direct informal caregivers; ~~and~~ 
  4.17     (18) telemedicine devices to monitor recipients in their 
  4.18  own homes as an alternative to hospital care, nursing home care, 
  4.19  or home visits; and 
  4.20     (19) minor adaptations to the recipient's home or vehicle. 
  4.21     (b) The county agency must ensure that the funds are used 
  4.22  only to supplement and not supplant services available through 
  4.23  other public assistance or services programs. 
  4.24     (c) Unless specified in statute, the service standards for 
  4.25  alternative care services shall be the same as the service 
  4.26  standards defined in the elderly waiver.  Persons or agencies 
  4.27  must be employed by or under a contract with the county agency 
  4.28  or the public health nursing agency of the local board of health 
  4.29  in order to receive funding under the alternative care program. 
  4.30     (d) The adult foster care rate shall be considered a 
  4.31  difficulty of care payment and shall not include room and 
  4.32  board.  The adult foster care daily rate shall be negotiated 
  4.33  between the county agency and the foster care provider.  The 
  4.34  rate established under this section shall not exceed 75 percent 
  4.35  of the state average monthly nursing home payment for the case 
  4.36  mix classification to which the individual receiving foster care 
  5.1   is assigned, and it must allow for other alternative care 
  5.2   services to be authorized by the case manager. 
  5.3      (e) Personal care services may be provided by a personal 
  5.4   care provider organization.  A county agency may contract with a 
  5.5   relative of the client to provide personal care services, but 
  5.6   must ensure nursing supervision.  Covered personal care services 
  5.7   defined in section 256B.0627, subdivision 4, must meet 
  5.8   applicable standards in Minnesota Rules, part 9505.0335. 
  5.9      (f) A county may use alternative care funds to purchase 
  5.10  medical supplies and equipment without prior approval from the 
  5.11  commissioner when:  (1) there is no other funding source; (2) 
  5.12  the supplies and equipment are specified in the individual's 
  5.13  care plan as medically necessary to enable the individual to 
  5.14  remain in the community according to the criteria in Minnesota 
  5.15  Rules, part 9505.0210, item A; and (3) the supplies and 
  5.16  equipment represent an effective and appropriate use of 
  5.17  alternative care funds.  A county may use alternative care funds 
  5.18  to purchase supplies and equipment from a non-Medicaid certified 
  5.19  vendor if the cost for the items is less than that of a Medicaid 
  5.20  vendor.  A county is not required to contract with a provider of 
  5.21  supplies and equipment if the monthly cost of the supplies and 
  5.22  equipment is less than $250.  
  5.23     (g) For purposes of this section, residential care services 
  5.24  are services which are provided to individuals living in 
  5.25  residential care homes.  Residential care homes are currently 
  5.26  licensed as board and lodging establishments and are registered 
  5.27  with the department of health as providing special services.  
  5.28  Residential care services are defined as "supportive services" 
  5.29  and "health-related services."  "Supportive services" means the 
  5.30  provision of up to 24-hour supervision and oversight.  
  5.31  Supportive services includes:  (1) transportation, when provided 
  5.32  by the residential care center only; (2) socialization, when 
  5.33  socialization is part of the plan of care, has specific goals 
  5.34  and outcomes established, and is not diversional or recreational 
  5.35  in nature; (3) assisting clients in setting up meetings and 
  5.36  appointments; (4) assisting clients in setting up medical and 
  6.1   social services; (5) providing assistance with personal laundry, 
  6.2   such as carrying the client's laundry to the laundry room.  
  6.3   Assistance with personal laundry does not include any laundry, 
  6.4   such as bed linen, that is included in the room and board rate.  
  6.5   Health-related services are limited to minimal assistance with 
  6.6   dressing, grooming, and bathing and providing reminders to 
  6.7   residents to take medications that are self-administered or 
  6.8   providing storage for medications, if requested.  Individuals 
  6.9   receiving residential care services cannot receive both personal 
  6.10  care services and residential care services.  
  6.11     (h) For the purposes of this section, "assisted living" 
  6.12  refers to supportive services provided by a single vendor to 
  6.13  clients who reside in the same apartment building of three or 
  6.14  more units.  Assisted living services are defined as up to 
  6.15  24-hour supervision, and oversight, supportive services as 
  6.16  defined in clause (1), individualized home care aide tasks as 
  6.17  defined in clause (2), and individualized home management tasks 
  6.18  as defined in clause (3) provided to residents of a residential 
  6.19  center living in their units or apartments with a full kitchen 
  6.20  and bathroom.  A full kitchen includes a stove, oven, 
  6.21  refrigerator, food preparation counter space, and a kitchen 
  6.22  utensil storage compartment.  Assisted living services must be 
  6.23  provided by the management of the residential center or by 
  6.24  providers under contract with the management or with the county. 
  6.25     (1) Supportive services include:  
  6.26     (i) socialization, when socialization is part of the plan 
  6.27  of care, has specific goals and outcomes established, and is not 
  6.28  diversional or recreational in nature; 
  6.29     (ii) assisting clients in setting up meetings and 
  6.30  appointments; and 
  6.31     (iii) providing transportation, when provided by the 
  6.32  residential center only.  
  6.33     Individuals receiving assisted living services will not 
  6.34  receive both assisted living services and homemaking or personal 
  6.35  care services.  Individualized means services are chosen and 
  6.36  designed specifically for each resident's needs, rather than 
  7.1   provided or offered to all residents regardless of their 
  7.2   illnesses, disabilities, or physical conditions.  
  7.3      (2) Home care aide tasks means:  
  7.4      (i) preparing modified diets, such as diabetic or low 
  7.5   sodium diets; 
  7.6      (ii) reminding residents to take regularly scheduled 
  7.7   medications or to perform exercises; 
  7.8      (iii) household chores in the presence of technically 
  7.9   sophisticated medical equipment or episodes of acute illness or 
  7.10  infectious disease; 
  7.11     (iv) household chores when the resident's care requires the 
  7.12  prevention of exposure to infectious disease or containment of 
  7.13  infectious disease; and 
  7.14     (v) assisting with dressing, oral hygiene, hair care, 
  7.15  grooming, and bathing, if the resident is ambulatory, and if the 
  7.16  resident has no serious acute illness or infectious disease.  
  7.17  Oral hygiene means care of teeth, gums, and oral prosthetic 
  7.18  devices.  
  7.19     (3) Home management tasks means:  
  7.20     (i) housekeeping; 
  7.21     (ii) laundry; 
  7.22     (iii) preparation of regular snacks and meals; and 
  7.23     (iv) shopping.  
  7.24     Assisted living services as defined in this section shall 
  7.25  not be authorized in boarding and lodging establishments 
  7.26  licensed according to sections 157.011 and 157.15 to 157.22. 
  7.27     (i) For the purposes of this section, reimbursement for 
  7.28  assisted living services and residential care services shall be 
  7.29  a monthly rate negotiated and authorized by the county agency.  
  7.30  The rate shall not exceed the nonfederal share of the greater of 
  7.31  either the statewide or any of the geographic groups' weighted 
  7.32  average monthly medical assistance nursing facility payment rate 
  7.33  of the case mix resident class to which the 180-day eligible 
  7.34  client would be assigned under Minnesota Rules, parts 9549.0050 
  7.35  to 9549.0059.  For alternative care assisted living projects 
  7.36  established under Laws 1988, chapter 689, article 2, section 
  8.1   256, monthly rates may not exceed 65 percent of the greater of 
  8.2   either statewide or any of the geographic groups' weighted 
  8.3   average monthly medical assistance nursing facility payment rate 
  8.4   of the case mix resident class to which the 180-day eligible 
  8.5   client would be assigned under Minnesota Rules, parts 9549.0050 
  8.6   to 9549.0059.  The rate may not cover rent and direct food costs.
  8.7      (j) For purposes of this section, companion services are 
  8.8   defined as nonmedical care, supervision and oversight, provided 
  8.9   to a functionally impaired adult.  Companions may assist the 
  8.10  individual with such tasks as meal preparation, laundry and 
  8.11  shopping, but do not perform these activities as discrete 
  8.12  services.  The provision of companion services does not entail 
  8.13  hands-on medical care.  Providers may also perform light 
  8.14  housekeeping tasks which are incidental to the care and 
  8.15  supervision of the recipient.  This service must be approved by 
  8.16  the case manager as part of the care plan.  Companion services 
  8.17  must be provided by individuals or nonprofit organizations who 
  8.18  are under contract with the local agency to provide the 
  8.19  service.  Any person related to the waiver recipient by blood, 
  8.20  marriage or adoption cannot be reimbursed under this service.  
  8.21  Persons providing companion services will be monitored by the 
  8.22  case manager. 
  8.23     (k) For purposes of this section, training for direct 
  8.24  informal caregivers is defined as a classroom or home course of 
  8.25  instruction which may include:  transfer and lifting skills, 
  8.26  nutrition, personal and physical cares, home safety in a home 
  8.27  environment, stress reduction and management, behavioral 
  8.28  management, long-term care decision making, care coordination 
  8.29  and family dynamics.  The training is provided to an informal 
  8.30  unpaid caregiver of a 180-day eligible client which enables the 
  8.31  caregiver to deliver care in a home setting with high levels of 
  8.32  quality.  The training must be approved by the case manager as 
  8.33  part of the individual care plan.  Individuals, agencies, and 
  8.34  educational facilities which provide caregiver training and 
  8.35  education will be monitored by the case manager. 
  8.36     (l) A county may use alternative care program funds for 
  9.1   minor adaptations to a recipient's residence or vehicle without 
  9.2   prior approval from the commissioner if there is no other 
  9.3   funding source and the adaptation: 
  9.4      (1) is necessary to avoid institutionalization; 
  9.5      (2) has no utility apart from the needs of the recipient; 
  9.6   and 
  9.7      (3) meets the criteria in Minnesota Rules, part 9505.0210, 
  9.8   items A and B. 
  9.9   For purposes of this subdivision, "residence" is defined to 
  9.10  include the recipient's own residence, the recipient's family 
  9.11  residence, or a family foster home.  For purposes of this 
  9.12  subdivision, "vehicle" is defined to include the recipient's 
  9.13  vehicle, the recipient's family vehicle, or the recipient's 
  9.14  family foster home vehicle.  
  9.15     Sec. 4.  Minnesota Statutes 1996, section 256B.0915, 
  9.16  subdivision 3, is amended to read: 
  9.17     Subd. 3.  [LIMITS OF CASES, RATES, REIMBURSEMENT, AND 
  9.18  FORECASTING.] (a) The number of medical assistance waiver 
  9.19  recipients that a county may serve must be allocated according 
  9.20  to the number of medical assistance waiver cases open on July 1 
  9.21  of each fiscal year.  Additional recipients may be served with 
  9.22  the approval of the commissioner. 
  9.23     (b) The monthly limit for the cost of elderly and disabled 
  9.24  waivered services to an individual waiver client shall either be 
  9.25  the statewide average payment rate or the actual payment rate of 
  9.26  the case mix resident class to which the waiver client would be 
  9.27  assigned under the medical assistance case mix reimbursement 
  9.28  system, whichever is higher.  If medical supplies and equipment 
  9.29  or adaptations are or will be purchased for an elderly waiver 
  9.30  services recipient, the costs may be prorated on a monthly basis 
  9.31  throughout the year in which they are purchased.  If the monthly 
  9.32  cost of a recipient's other waivered services exceeds the 
  9.33  monthly limit established in this paragraph, the annual cost of 
  9.34  the waivered services shall be determined.  In this event, the 
  9.35  annual cost of waivered services shall not exceed 12 times the 
  9.36  monthly limit calculated in this paragraph.  The statewide 
 10.1   average payment rate is calculated by determining the statewide 
 10.2   average monthly nursing home rate, effective July 1 of the 
 10.3   fiscal year in which the cost is incurred, less the statewide 
 10.4   average monthly income of nursing home residents who are age 65 
 10.5   or older, and who are medical assistance recipients in the month 
 10.6   of March of the previous state fiscal year.  The annual cost 
 10.7   divided by 12 of elderly or disabled waivered services for a 
 10.8   person who is a nursing facility resident at the time of 
 10.9   requesting a determination of eligibility for elderly or 
 10.10  disabled waivered services shall not exceed the monthly payment 
 10.11  for the resident class assigned under Minnesota Rules, parts 
 10.12  9549.0050 to 9549.0059, for that resident in the nursing 
 10.13  facility where the resident currently resides.  The following 
 10.14  costs must be included in determining the total monthly costs 
 10.15  for the waiver client: 
 10.16     (1) cost of all waivered services, including extended 
 10.17  medical supplies and equipment; and 
 10.18     (2) cost of skilled nursing, home health aide, and personal 
 10.19  care services reimbursable by medical assistance.  
 10.20     (c) Medical assistance funding for skilled nursing 
 10.21  services, private duty nursing, home health aide, and personal 
 10.22  care services for waiver recipients must be approved by the case 
 10.23  manager and included in the individual care plan. 
 10.24     (d) For both the elderly waiver and the nursing facility 
 10.25  disabled waiver, a county may purchase extended supplies and 
 10.26  equipment without prior approval from the commissioner when 
 10.27  there is no other funding source and the supplies and equipment 
 10.28  are specified in the individual's care plan as medically 
 10.29  necessary to enable the individual to remain in the community 
 10.30  according to the criteria in Minnesota Rules, part 9505.0210, 
 10.31  items A and B.  A county is not required to contract with a 
 10.32  provider of supplies and equipment if the monthly cost of the 
 10.33  supplies and equipment is less than $250.  
 10.34     (e) For the fiscal year beginning on July 1, 1993, and for 
 10.35  subsequent fiscal years, the commissioner of human services 
 10.36  shall not provide automatic annual inflation adjustments for 
 11.1   home and community-based waivered services.  The commissioner of 
 11.2   finance shall include as a budget change request in each 
 11.3   biennial detailed expenditure budget submitted to the 
 11.4   legislature under section 16A.11, annual adjustments in 
 11.5   reimbursement rates for home and community-based waivered 
 11.6   services, based on the forecasted percentage change in the Home 
 11.7   Health Agency Market Basket of Operating Costs, for the fiscal 
 11.8   year beginning July 1, compared to the previous fiscal year, 
 11.9   unless otherwise adjusted by statute.  The Home Health Agency 
 11.10  Market Basket of Operating Costs is published by Data Resources, 
 11.11  Inc.  The forecast to be used is the one published for the 
 11.12  calendar quarter beginning January 1, six months prior to the 
 11.13  beginning of the fiscal year for which rates are set.  The adult 
 11.14  foster care rate shall be considered a difficulty of care 
 11.15  payment and shall not include room and board. 
 11.16     (f) The adult foster care daily rate for the elderly and 
 11.17  disabled waivers shall be negotiated between the county agency 
 11.18  and the foster care provider.  The rate established under this 
 11.19  section shall not exceed the state average monthly nursing home 
 11.20  payment for the case mix classification to which the individual 
 11.21  receiving foster care is assigned; the rate must allow for other 
 11.22  waiver and medical assistance home care services to be 
 11.23  authorized by the case manager. 
 11.24     (g) The assisted living and residential care service rates 
 11.25  for elderly and community alternatives for disabled individuals 
 11.26  (CADI) waivers shall be made to the vendor as a monthly rate 
 11.27  negotiated with the county agency.  The rate shall not exceed 
 11.28  the nonfederal share of the greater of either the statewide or 
 11.29  any of the geographic groups' weighted average monthly medical 
 11.30  assistance nursing facility payment rate of the case mix 
 11.31  resident class to which the elderly or disabled client would be 
 11.32  assigned under Minnesota Rules, parts 9549.0050 to 9549.0059.  
 11.33  For alternative care assisted living projects established under 
 11.34  Laws 1988, chapter 689, article 2, section 256, monthly rates 
 11.35  may not exceed 65 percent of the greater of either the statewide 
 11.36  or any of the geographic groups' weighted average monthly 
 12.1   medical assistance nursing facility payment rate for the case 
 12.2   mix resident class to which the elderly or disabled client would 
 12.3   be assigned under Minnesota Rules, parts 9549.0050 to 
 12.4   9549.0059.  The rate may not cover direct rent or food costs. 
 12.5      (h) The county shall negotiate individual rates with 
 12.6   vendors and may be reimbursed for actual costs up to the greater 
 12.7   of the county's current approved rate or 60 percent of the 
 12.8   maximum rate in fiscal year 1994 and 65 percent of the maximum 
 12.9   rate in fiscal year 1995 for each service within each program. 
 12.10     (i) On July 1, 1993, the commissioner shall increase the 
 12.11  maximum rate for home-delivered meals to $4.50 per meal. 
 12.12     (j) Reimbursement for the medical assistance recipients 
 12.13  under the approved waiver shall be made from the medical 
 12.14  assistance account through the invoice processing procedures of 
 12.15  the department's Medicaid Management Information System (MMIS), 
 12.16  only with the approval of the client's case manager.  The budget 
 12.17  for the state share of the Medicaid expenditures shall be 
 12.18  forecasted with the medical assistance budget, and shall be 
 12.19  consistent with the approved waiver.  
 12.20     (k) Beginning July 1, 1991, the state shall reimburse 
 12.21  counties according to the payment schedule in section 256.025 
 12.22  for the county share of costs incurred under this subdivision on 
 12.23  or after January 1, 1991, for individuals who are receiving 
 12.24  medical assistance. 
 12.25     (l) For the elderly waiver, community alternatives for 
 12.26  disabled individuals waiver, and nursing facility disabled 
 12.27  waivers, a county may pay for the cost of minor adaptations to a 
 12.28  client's residence or vehicle without prior approval from the 
 12.29  commissioner if there is no other source of funding and the 
 12.30  adaptation: 
 12.31     (1) is necessary to avoid institutionalization; 
 12.32     (2) has no utility apart from the needs of the client; and 
 12.33     (3) meets the criteria in Minnesota Rules, part 9505.0210, 
 12.34  items A and B.  
 12.35  For purposes of this subdivision, "residence" means the client's 
 12.36  own home, the client's family residence, or a family foster 
 13.1   home.  For purposes of this subdivision, "vehicle" means the 
 13.2   client's vehicle, the client's family vehicle, or the client's 
 13.3   family foster home vehicle. 
 13.4      (m) The commissioner shall establish a daily rate unit for 
 13.5   baths provided by an adult day care provider that are not 
 13.6   included in the provider's contractual daily or hourly rate.  
 13.7   This rate must equal the home health aide extended rate and 
 13.8   shall be paid for baths provided to clients served under the 
 13.9   elderly and disabled waivers.  
 13.10     Sec. 5.  Laws 1995, chapter 207, article 6, section 115, is 
 13.11  amended to read: 
 13.12     Sec. 115.  [CONTINUATION OF PILOT PROJECTS.] 
 13.13     The alternative care pilot projects authorized in Laws 
 13.14  1993, First Special Session chapter 1, article 5, section 133, 
 13.15  shall not expire on June 30, 1995, but shall continue until June 
 13.16  30, ~~1997~~ 2001, except that the three percent rate increases 
 13.17  authorized in Laws 1993, First Special Session chapter 1, 
 13.18  article 1, section 2, subdivision 4, and any subsequent rate 
 13.19  increases shall be incorporated in average monthly cost 
 13.20  effective July 1, 1995.  Beginning July 1, 1997, a county may 
 13.21  spend up to ten percent of grant funds for needed client 
 13.22  services that are not listed under Minnesota Statutes, section 
 13.23  256B.0913, subdivision 5.  The commissioner shall allow 
 13.24  additional counties at their option to implement the alternative 
 13.25  care program within the parameters established in Laws 1993, 
 13.26  First Special Session chapter 1, article 5, section 133.  If 
 13.27  more than five counties exercise this option, the commissioner 
 13.28  may require counties to make this change on a phased schedule if 
 13.29  necessary in order to implement this provision within the limit 
 13.30  of available resources.  For newly participating counties, the 
 13.31  previous fiscal year shall be the base year. 
 13.32     Sec. 6.  [COST OF LIVING ADJUSTMENT (COLA) RATE INCREASE.] 
 13.33     Notwithstanding statutory provisions to the contrary, the 
 13.34  commissioner of human services shall increase reimbursement 
 13.35  rates by three percent for the fiscal year ending June 30, 1998, 
 13.36  for the following:  nursing services and home health aide 
 14.1   services under Minnesota Statutes, section 256B.0625, 
 14.2   subdivision 6a; personal care services and nursing supervision 
 14.3   of personal care services under Minnesota Statutes, section 
 14.4   256B.0625, subdivision 19a; private duty nursing services under 
 14.5   Minnesota Statutes, section 256B.0625, subdivision 7; physical 
 14.6   therapy under Minnesota Statutes, section 256B.0625, subdivision 
 14.7   8; occupational therapy under Minnesota Statutes, section 
 14.8   256B.0625, subdivision 8a; speech language pathology services 
 14.9   under Minnesota Rules, part 9505.0390; respiratory therapy 
 14.10  services under Minnesota Rules, part 9505.0295, subpart 2, item 
 14.11  E; home and community-based services waiver for persons with 
 14.12  mental retardation and related conditions under Minnesota 
 14.13  Statutes, section 256B.501; community alternatives for disabled 
 14.14  individuals waiver under Minnesota Statutes, section 256B.49; 
 14.15  community alternative care waiver under Minnesota Statutes, 
 14.16  section 256B.49; home and community-based services waiver for 
 14.17  the elderly under Minnesota Statutes, section 256B.0915; 
 14.18  alternative care program under Minnesota Statutes, section 
 14.19  256B.0913; and traumatic brain injury waiver under Minnesota 
 14.20  Statutes, section 256B.49.  
 14.21     Sec. 7.  [REPEALER.] 
 14.22     Minnesota Statutes 1996, sections 144.0721, subdivision 3; 
 14.23  and 256B.0913, subdivision 15, are repealed.