Minnesota Legislature
SF 983
as introduced - 91st Legislature (2019 - 2020) Posted on 02/07/2019 03:06pm
Current Version - as introduced
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A bill for an act
relating to human services; modifying eligibility for personal care assistance
services; modifying the intermediate care facility for persons with developmental
disabilities level of care criteria; establishing allocation caps for the developmental
disabilities and community access for daily inclusion waivers; amending Minnesota
Statutes 2018, sections 256B.0625, subdivision 19a; 256B.0651, subdivision 1;
256B.0652, subdivision 6; 256B.0659, subdivision 1; 256B.0911, subdivision 4e;
256B.0915, subdivision 3a; 256B.092, by adding a subdivision; 256B.49, by adding
a subdivision.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Section 1.
Minnesota Statutes 2018, section 256B.0625, subdivision 19a, is amended to
read:
Subd. 19a.
Personal care assistance services.
Medical assistance covers personal care
assistance services in a recipient's home. deleted text begin Effective January 1, 2010,deleted text end To qualify for personal
care assistance services, a recipient must require assistance and be determined dependent
in deleted text begin one activitydeleted text end new text begin two or more activitiesnew text end of daily living as defined in section 256B.0659,
subdivision 1, paragraph (b), new text begin one critical activity of daily living as defined in section
256B.0659, subdivision 1, paragraph (e), new text end or deleted text begin in adeleted text end new text begin onenew text end Level I behavior as defined in section
256B.0659, subdivision 1, paragraph (c). Recipients or responsible parties must be able to
identify the recipient's needs, direct and evaluate task accomplishment, and provide for
health and safety. Approved hours may be used outside the home when normal life activities
take them outside the home. To use personal care assistance services at school, the recipient
or responsible party must provide written authorization in the care plan identifying the
chosen provider and the daily amount of services to be used at school. Total hours for
services, whether actually performed inside or outside the recipient's home, cannot exceed
that which is otherwise allowed for personal care assistance services in an in-home setting
according to sections 256B.0651 to 256B.0654. Medical assistance does not cover personal
care assistance services for residents of a hospital, nursing facility, intermediate care facility,
health care facility licensed by the commissioner of health, or unless a resident who is
otherwise eligible is on leave from the facility and the facility either pays for the personal
care assistance services or forgoes the facility per diem for the leave days that personal care
assistance services are used. All personal care assistance services must be provided according
to sections 256B.0651 to 256B.0654. Personal care assistance services may not be reimbursed
if the personal care assistant is the spouse or paid guardian of the recipient or the parent of
a recipient under age 18, or the responsible party or the family foster care provider of a
recipient who cannot direct the recipient's own care unless, in the case of a foster care
provider, a county or state case manager visits the recipient as needed, but not less than
every six months, to monitor the health and safety of the recipient and to ensure the goals
of the care plan are met. Notwithstanding the provisions of section 256B.0659, the unpaid
guardian or conservator of an adult, who is not the responsible party and not the personal
care provider organization, may be reimbursed to provide personal care assistance services
to the recipient if the guardian or conservator meets all criteria for a personal care assistant
according to section 256B.0659, and shall not be considered to have a service provider
interest for purposes of participation on the screening team under section 256B.092,
subdivision 7.
Sec. 2.
Minnesota Statutes 2018, section 256B.0651, subdivision 1, is amended to read:
Subdivision 1.
Definitions.
(a) For the purposes of sections 256B.0651 to 256B.0654
and 256B.0659, the terms in paragraphs (b) to (g) have the meanings given.
(b) "Activities of daily living" has the meaning given in section 256B.0659, subdivision
1, paragraph (b).
(c) "Assessment" means a review and evaluation of a recipient's need for home care
services conducted in person.
(d) new text begin "Critical activities of daily living" has the meaning given in section 256B.0659,
subdivision 1, paragraph (e).
new text end
new text begin (e) new text end "Home care services" means medical assistance covered services that are home health
agency services, including skilled nurse visits; home health aide visits; physical therapy,
occupational therapy, respiratory therapy, and language-speech pathology therapy; home
care nursing; and personal care assistance.
deleted text begin (e)deleted text end new text begin (f)new text end "Home residence," effective January 1, 2010, means a residence owned or rented
by the recipient either alone, with roommates of the recipient's choosing, or with an unpaid
responsible party or legal representative; or a family foster home where the license holder
lives with the recipient and is not paid to provide home care services for the recipient except
as allowed under sections 256B.0652, subdivision 10, and 256B.0654, subdivision 4.
deleted text begin (f)deleted text end new text begin (g)new text end "Medically necessary" has the meaning given in Minnesota Rules, parts 9505.0170
to 9505.0475.
deleted text begin (g)deleted text end new text begin (h)new text end "Ventilator-dependent" means an individual who receives mechanical ventilation
for life support at least six hours per day and is expected to be or has been dependent on a
ventilator for at least 30 consecutive days.
Sec. 3.
Minnesota Statutes 2018, section 256B.0652, subdivision 6, is amended to read:
Subd. 6.
Authorization; personal care assistance and qualified professional.
(a) All
personal care assistance services, supervision by a qualified professional, and additional
services beyond the limits established in subdivision 11, must be authorized by the
commissioner or the commissioner's designee before services begin except for the
assessments established in deleted text begin subdivision 11 anddeleted text end section 256B.0911. The authorization for
personal care assistance and qualified professional services under section 256B.0659 must
be completed within 30 days after receiving a complete request.
(b) The amount of personal care assistance services authorized must be based on the
recipient's home care rating. The home care rating shall be determined by the commissioner
or the commissioner's designee based on information submitted to the commissioner
identifying the following for recipients with dependencies in two or more activities of daily
living:
(1) total number of dependencies of activities of daily living as defined in section
256B.0659;
(2) presence of complex health-related needs as defined in section 256B.0659; and
(3) presence of Level I behavior as defined in section 256B.0659.
(c) For purposes meeting the criteria in paragraph (b), the methodology to determine
total time for personal care assistance services for each home care rating is based on the
median paid units per day for each home care rating from fiscal year 2007 data for the
personal care assistance program. Each home care rating has a base level of hours assigned.
Additional time is added through the assessment and identification of the following:
(1) 30 additional minutes per day for a dependency in each critical activity of daily livingdeleted text begin
as defined in section 256B.0659deleted text end ;
(2) 30 additional minutes per day for each complex health-related function as defined
in section 256B.0659; and
(3) 30 additional minutes per day for each behavior issue as defined in section 256B.0659,
subdivision 4, paragraph (d).
(d) deleted text begin Effective July 1, 2011,deleted text end The home care rating for recipients who have a dependency
in new text begin two activities of daily living, new text end one new text begin critical new text end activity of daily livingnew text begin ,new text end or new text begin one new text end Level I behavior
shall equal no more than two units per day. Recipients with this home care rating are not
subject to the methodology in paragraph (c) and are not eligible for more than two units per
day.
(e) A limit of 96 units of qualified professional supervision may be authorized for each
recipient receiving personal care assistance services. A request to the commissioner to
exceed this total in a calendar year must be requested by the personal care provider agency
on a form approved by the commissioner.
Sec. 4.
Minnesota Statutes 2018, section 256B.0659, subdivision 1, is amended to read:
Subdivision 1.
Definitions.
(a) For the purposes of this section, the terms defined in
paragraphs (b) to (r) have the meanings given unless otherwise provided in text.
(b) "Activities of daily living" means grooming, dressing, bathing, transferring, mobility,
positioning, eating, and toileting.
(c) "Behaviordeleted text begin ,deleted text end " deleted text begin effective January 1, 2010,deleted text end means a category to determine the home care
rating and is based on the criteria found in this section. "Level I behavior" means physical
aggression towards self, others, or destruction of property that requires the immediate
response of another person.
(d) "Complex health-related needsdeleted text begin ,deleted text end " deleted text begin effective January 1, 2010,deleted text end means a category to
determine the home care rating and is based on the criteria found in this section.
(e) "Critical activities of daily livingdeleted text begin ,deleted text end " deleted text begin effective January 1, 2010,deleted text end means transferring,
mobility, eating, and toileting.
(f) "Dependency in activities of daily living" means a person requires assistance to begin
and complete deleted text begin onedeleted text end new text begin twonew text end or more of the activities of daily livingnew text begin or one or more critical activities
of daily livingnew text end .
(g) "Extended personal care assistance service" means personal care assistance services
included in a service plan under one of the home and community-based services waivers
authorized under sections 256B.0915, 256B.092, subdivision 5, and 256B.49, which exceed
the amount, duration, and frequency of the state plan personal care assistance services for
participants who:
(1) need assistance provided periodically during a week, but less than daily will not be
able to remain in their homes without the assistance, and other replacement services are
more expensive or are not available when personal care assistance services are to be reduced;
or
(2) need additional personal care assistance services beyond the amount authorized by
the state plan personal care assistance assessment in order to ensure that their safety, health,
and welfare are provided for in their homes.
(h) "Health-related procedures and tasks" means procedures and tasks that can be
delegated or assigned by a licensed health care professional under state law to be performed
by a personal care assistant.
(i) "Instrumental activities of daily living" means activities to include meal planning and
preparation; basic assistance with paying bills; shopping for food, clothing, and other
essential items; performing household tasks integral to the personal care assistance services;
communication by telephone and other media; and traveling, including to medical
appointments and to participate in the community.
(j) "Managing employee" has the same definition as Code of Federal Regulations, title
42, section 455.
(k) "Qualified professional" means a professional providing supervision of personal care
assistance services and staff as defined in section 256B.0625, subdivision 19c.
(l) "Personal care assistance provider agency" means a medical assistance enrolled
provider that provides or assists with providing personal care assistance services and includes
a personal care assistance provider organization, personal care assistance choice agency,
class A licensed nursing agency, and Medicare-certified home health agency.
(m) "Personal care assistant" or "PCA" means an individual employed by a personal
care assistance agency who provides personal care assistance services.
(n) "Personal care assistance care plan" means a written description of personal care
assistance services developed by the personal care assistance provider according to the
service plan.
(o) "Responsible party" means an individual who is capable of providing the support
necessary to assist the recipient to live in the community.
(p) "Self-administered medication" means medication taken orally, by injection, nebulizer,
or insertion, or applied topically without the need for assistance.
(q) "Service plan" means a written summary of the assessment and description of the
services needed by the recipient.
(r) "Wages and benefits" means wages and salaries, the employer's share of FICA taxes,
Medicare taxes, state and federal unemployment taxes, workers' compensation, mileage
reimbursement, health and dental insurance, life insurance, disability insurance, long-term
care insurance, uniform allowance, and contributions to employee retirement accounts.
Sec. 5.
Minnesota Statutes 2018, section 256B.0911, subdivision 4e, is amended to read:
Subd. 4e.
Determination of institutional level of care.
new text begin (a) new text end The determination of the
need for deleted text begin nursing facility,deleted text end hospitaldeleted text begin , and intermediate care facility levelsdeleted text end new text begin level new text end of care must
be made according to criteria developed by the commissioner, deleted text begin and in section 256B.092,deleted text end
using forms developed by the commissioner. deleted text begin Effective January 1, 2014, for individuals age
21 and older,
deleted text end
new text begin (b) new text end The determination of new text begin the new text end need for nursing facility level of care shall be based on
criteria in section 144.0724, subdivision 11. deleted text begin For individuals under age 21, the determination
of the need for nursing facility level of care must be made according to criteria developed
by the commissioner until criteria in section 144.0724, subdivision 11, becomes effective
on or after October 1, 2019.
deleted text end
new text begin
(c) The determination of the need for intermediate care facility level of care shall be
based on the following criteria:
new text end
new text begin
(1) the person has been determined according to the diagnostic requirements outlined
in Minnesota Rules, part 9525.0016, subpart 3, to have a developmental disability as defined
in Minnesota Rules, part 9525.0016, subpart 2, item B, or a related condition as defined in
section 252.27, subdivision 1a; and
new text end
new text begin
(2) the person has assessed needs that require systematic instruction available 24 hours
a day by trained staff in order to acquire and maintain skills related to the following
behaviors:
new text end
new text begin
(i) toileting;
new text end
new text begin
(ii) communicating basic wants and needs;
new text end
new text begin
(iii) comprehending spoken language; or
new text end
new text begin
(iv) self-moderating challenging behavior that jeopardizes the person's own or other's
health and safety.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective October 1, 2019.
new text end
Sec. 6.
Minnesota Statutes 2018, section 256B.0915, subdivision 3a, is amended to read:
Subd. 3a.
Elderly waiver cost limits.
(a) Effective on the first day of the state fiscal
year in which the resident assessment system as described in section 256R.17 for nursing
home rate determination is implemented and the first day of each subsequent state fiscal
year, the monthly limit for the cost of waivered services to an individual elderly waiver
client shall be the monthly limit of the case mix resident class to which the waiver client
would be assigned under Minnesota Rules, parts 9549.0051 to 9549.0059, in effect on the
last day of the previous state fiscal year, adjusted by any legislatively adopted home and
community-based services percentage rate adjustment. If a legislatively authorized increase
is service-specific, the monthly cost limit shall be adjusted based on the overall average
increase to the elderly waiver program.
(b) The monthly limit for the cost of waivered services under paragraph (a) to an
individual elderly waiver client assigned to a case mix classification A with:
(1) no dependencies in activities of daily living; or
(2) up to two dependencies in bathing, dressing, grooming, walking, and eating when
the dependency score in eating is three or greater as determined by an assessment performed
under section 256B.0911 shall be $1,750 per month effective on July 1, 2011, for all new
participants enrolled in the program on or after July 1, 2011. This monthly limit shall be
applied to all other participants who meet this criteria at reassessment. This monthly limit
shall be increased annually as described in paragraphs (a) and (e).
(c) If extended medical supplies and equipment or environmental modifications are or
will be purchased for an elderly waiver client, the costs may be prorated for up to 12
consecutive months beginning with the month of purchase. If the monthly cost of a recipient's
waivered services exceeds the monthly limit established in paragraph (a), (b), (d), or (e),
the annual cost of all waivered services shall be determined. In this event, the annual cost
of all waivered services shall not exceed 12 times the monthly limit of waivered services
as described in paragraph (a), (b), (d), or (e).
(d) deleted text begin Effective July 1, 2013,deleted text end The monthly cost limit of waiver services, including any
necessary home care services described in section 256B.0651, subdivision 2, for individuals
who meet the criteria as ventilator-dependent given in section 256B.0651, subdivision 1,
paragraph deleted text begin (g)deleted text end new text begin (h)new text end , shall be the average of the monthly medical assistance amount established
for home care services as described in section 256B.0652, subdivision 7, and the annual
average contracted amount established by the commissioner for nursing facility services
for ventilator-dependent individuals. This monthly limit shall be increased annually as
described in paragraphs (a) and (e).
(e) Effective January 1, 2018, and each January 1 thereafter, the monthly cost limits for
elderly waiver services in effect on the previous December 31 shall be increased by the
difference between any legislatively adopted home and community-based provider rate
increases effective on January 1 or since the previous January 1 and the average statewide
percentage increase in nursing facility operating payment rates under chapter 256R, effective
the previous January 1. This paragraph shall only apply if the average statewide percentage
increase in nursing facility operating payment rates is greater than any legislatively adopted
home and community-based provider rate increases effective on January 1, or occurring
since the previous January 1.
Sec. 7.
Minnesota Statutes 2018, section 256B.092, is amended by adding a subdivision
to read:
new text begin Subd. 12a. new text end
new text begin Developmental disabilities waiver growth limit. new text end
new text begin
The commissioner shall
limit growth in the developmental disabilities waiver to ... allocations per month. Waiver
allocations for the developmental disabilities waiver must be targeted to persons who meet
the priorities for accessing waiver services identified in subdivision 12. The allocation limits
do not include conversions from intermediate care facilities for persons with developmental
disabilities.
new text end
Sec. 8.
Minnesota Statutes 2018, section 256B.49, is amended by adding a subdivision to
read:
new text begin Subd. 11b. new text end
new text begin Community access for disability inclusion waiver growth limit. new text end
new text begin
The
commissioner shall limit the growth in the community access for disability inclusion waiver
to ... allocations per month. Waiver allocations for the community access for disability
inclusion must be targeted to individuals who meet the priorities for accessing waiver
services identified in subdivision 11a. The allocation limit includes conversions and
diversions, unless the commissioner approves a plan to convert funding due to the closure
or downsizing of a residential facility or nursing facility in order to use the converted funding
to serve individuals who were directly affected by the closure or downsizing with the
community access for disability inclusion waiver.
new text end