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Chapter 256B

Section 256B.0915

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256B.0915 MEDICAID WAIVER FOR ELDERLY SERVICES.
    Subdivision 1. Authority. The commissioner is authorized to apply for a home and
community-based services waiver for the elderly, authorized under section 1915(c) of the Social
Security Act, in order to obtain federal financial participation to expand the availability of
services for persons who are eligible for medical assistance. The commissioner may apply for
additional waivers or pursue other federal financial participation which is advantageous to the
state for funding home care services for the frail elderly who are eligible for medical assistance.
The provision of waivered services to elderly and disabled medical assistance recipients must
comply with the criteria approved in the waiver.
    Subd. 1a. Elderly waiver case management services. (a) Elderly case management services
under the home and community-based services waiver for elderly individuals are available from
providers meeting qualification requirements and the standards specified in subdivision 1b.
Eligible recipients may choose any qualified provider of elderly case management services.
(b) The county of service or tribe must provide access to and arrange for case management
services.
    Subd. 1b. Provider qualifications and standards. The commissioner must enroll qualified
providers of elderly case management services under the home and community-based waiver for
the elderly under section 1915(c) of the Social Security Act. The enrollment process shall ensure
the provider's ability to meet the qualification requirements and standards in this subdivision and
other federal and state requirements of this service. An elderly case management provider is an
enrolled medical assistance provider who is determined by the commissioner to have all of the
following characteristics:
(1) the demonstrated capacity and experience to provide the components of case management
to coordinate and link community resources needed by the eligible population;
(2) administrative capacity and experience in serving the target population for whom it will
provide services and in ensuring quality of services under state and federal requirements;
(3) a financial management system that provides accurate documentation of services and
costs under state and federal requirements;
(4) the capacity to document and maintain individual case records under state and federal
requirements; and
(5) the county may allow a case manager employed by the county to delegate certain
aspects of the case management activity to another individual employed by the county provided
there is oversight of the individual by the case manager. The case manager may not delegate
those aspects which require professional judgment including assessments, reassessments, and
care plan development.
    Subd. 1c. Case management activities under the state plan. The commissioner shall seek
an amendment to the home and community-based services waiver for the elderly to implement
the provisions of subdivisions 1a and 1b. If the commissioner is unable to secure the approval of
the secretary of health and human services for the requested waiver amendment by December
31, 1993, the commissioner shall amend the medical assistance state plan to provide that case
management provided under the home and community-based services waiver for the elderly is
performed by counties as an administrative function for the proper and effective administration
of the state medical assistance plan. The state shall reimburse counties for the nonfederal share
of costs for case management performed as an administrative function under the home and
community-based services waiver for the elderly.
    Subd. 1d. Posteligibility treatment of income and resources for elderly waiver.
Notwithstanding the provisions of section 256B.056, the commissioner shall make the following
amendment to the medical assistance elderly waiver program effective July 1, 1999, or upon
federal approval, whichever is later.
A recipient's maintenance needs will be an amount equal to the Minnesota supplemental aid
equivalent rate as defined in section 256I.03, subdivision 5, plus the medical assistance personal
needs allowance as defined in section 256B.35, subdivision 1, paragraph (a), when applying
posteligibility treatment of income rules to the gross income of elderly waiver recipients, except
for individuals whose income is in excess of the special income standard according to Code of
Federal Regulations, title 42, section 435.236. Recipient maintenance needs shall be adjusted
under this provision each July 1.
    Subd. 2. Spousal impoverishment policies. The commissioner shall seek to amend the
federal waiver and the medical assistance state plan to allow spousal impoverishment criteria as
authorized under United States Code, title 42, section 1396r-5, and as implemented in sections
256B.0575, 256B.058, and 256B.059, except that the amendment shall seek to add to the personal
needs allowance permitted in section 256B.0575, an amount equivalent to the group residential
housing rate as set by section 256I.03, subdivision 5.
    Subd. 3. Limits of cases. The number of medical assistance waiver recipients that a county
may serve must be allocated according to the number of medical assistance waiver cases open
on July 1 of each fiscal year. Additional recipients may be served with the approval of the
commissioner.
    Subd. 3a.[Repealed, 1Sp2001 c 9 art 3 s 76; art 4 s 34]
    Subd. 3a. Elderly waiver cost limits. (a) The monthly limit for the cost of waivered services
to an individual elderly waiver client shall be the weighted average monthly nursing facility
rate of the case mix resident class to which the elderly waiver client would be assigned under
Minnesota Rules, parts 9549.0050 to 9549.0059, less the recipient's maintenance needs allowance
as described in subdivision 1d, paragraph (a), until the first day of the state fiscal year in which the
resident assessment system as described in section 256B.437 for nursing home rate determination
is implemented. Effective on the first day of the state fiscal year in which the resident assessment
system as described in section 256B.437 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 rate of the case mix resident class to
which the waiver client would be assigned under Minnesota Rules, parts 9549.0050 to 9549.0059,
in effect on the last day of the previous state fiscal year, adjusted by the greater of any legislatively
adopted home and community-based services percentage rate increase or the average statewide
percentage increase in nursing facility payment rates.
(b) 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), 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).
    Subd. 3b.[Repealed, 1Sp2001 c 9 art 3 s 76; art 4 s 34]
    Subd. 3b. Cost limits for elderly waiver applicants who reside in a nursing facility.
(a) For a person who is a nursing facility resident at the time of requesting a determination of
eligibility for elderly waivered services, a monthly conversion limit for the cost of elderly
waivered services may be requested. The monthly conversion limit for the cost of elderly
waiver services shall be the resident class assigned under Minnesota Rules, parts 9549.0050 to
9549.0059, for that resident in the nursing facility where the resident currently resides until July 1
of the state fiscal year in which the resident assessment system as described in section 256B.437
for nursing home rate determination is implemented. Effective on July 1 of the state fiscal year in
which the resident assessment system as described in section 256B.437 for nursing home rate
determination is implemented, the monthly conversion limit for the cost of elderly waiver services
shall be the per diem nursing facility rate as determined by the resident assessment system as
described in section 256B.437 for that resident in the nursing facility where the resident currently
resides multiplied by 365 and divided by 12, less the recipient's maintenance needs allowance as
described in subdivision 1d. The initially approved conversion rate may be adjusted by the greater
of any subsequent legislatively adopted home and community-based services percentage rate
increase or the average statewide percentage increase in nursing facility payment rates. The limit
under this subdivision only applies to persons discharged from a nursing facility after a minimum
30-day stay and found eligible for waivered services on or after July 1, 1997.
(b) The following costs must be included in determining the total monthly costs for the
waiver client:
(1) cost of all waivered services, including extended medical supplies and equipment and
environmental modifications; and
(2) cost of skilled nursing, home health aide, and personal care services reimbursable by
medical assistance.
    Subd. 3c.[Repealed, 1Sp2001 c 9 art 3 s 76; art 4 s 34]
    Subd. 3c. Service approval and contracting provisions. (a) Medical assistance funding for
skilled nursing services, private duty nursing, home health aide, and personal care services for
waiver recipients must be approved by the case manager and included in the individual care plan.
(b) A county is not required to contract with a provider of supplies and equipment if the
monthly cost of the supplies and equipment is less than $250.
    Subd. 3d. Adult foster care rate. The adult foster care rate shall be considered a difficulty of
care payment and shall not include room and board. The adult foster care service rate shall be
negotiated between the county agency and the foster care provider. The elderly waiver payment
for the foster care service in combination with the payment for all other elderly waiver services,
including case management, must not exceed the limit specified in subdivision 3a, paragraph (a).
    Subd. 3e. Assisted living service rate. (a) Payment for assisted living service shall be a
monthly rate negotiated and authorized by the county agency based on an individualized service
plan for each resident and may not cover direct rent or food costs.
(b) The individualized monthly negotiated payment for assisted living services as described
in section 256B.0913, subdivisions 5d to 5f, and residential care services as described in section
256B.0913, subdivision 5c, shall not exceed the nonfederal share, in effect on July 1 of the state
fiscal year for which the rate limit is being calculated, of the greater of either the statewide or any
of the geographic groups' weighted average monthly nursing facility rate of the case mix resident
class to which the elderly waiver eligible client would be assigned under Minnesota Rules, parts
9549.0050 to 9549.0059, less the maintenance needs allowance as described in subdivision 1d,
paragraph (a), until the July 1 of the state fiscal year in which the resident assessment system as
described in section 256B.437 for nursing home rate determination is implemented. Effective
on July 1 of the state fiscal year in which the resident assessment system as described in section
256B.437 for nursing home rate determination is implemented and July 1 of each subsequent
state fiscal year, the individualized monthly negotiated payment for the services described in this
clause shall not exceed the limit described in this clause which was in effect on June 30 of the
previous state fiscal year and which has been adjusted by the greater of any legislatively adopted
home and community-based services cost-of-living percentage increase or any legislatively
adopted statewide percent rate increase for nursing facilities.
(c) The individualized monthly negotiated payment for assisted living services described in
section 144A.4605 and delivered by a provider licensed by the Department of Health as a class A
home care provider or an assisted living home care provider and provided in a building that is
registered as a housing with services establishment under chapter 144D and that provides 24-hour
supervision in combination with the payment for other elderly waiver services, including case
management, must not exceed the limit specified in subdivision 3a.
    Subd. 3f. Individual service rates; expenditure forecasts. (a) The county shall negotiate
individual service rates with vendors and may authorize payment for actual costs up to the
county's current approved rate. Persons or agencies must be employed by or under a contract with
the county agency or the public health nursing agency of the local board of health in order to
receive funding under the elderly waiver program, except as a provider of supplies and equipment
when the monthly cost of the supplies and equipment is less than $250.
(b) Reimbursement for the medical assistance recipients under the approved waiver shall
be made from the medical assistance account through the invoice processing procedures of the
department's Medicaid Management Information System (MMIS), only with the approval of
the client's case manager. The budget for the state share of the Medicaid expenditures shall be
forecasted with the medical assistance budget, and shall be consistent with the approved waiver.
    Subd. 3g. Service rate limits; state assumption of costs. (a) To improve access to
community services and eliminate payment disparities between the alternative care program and
the elderly waiver, the commissioner shall establish statewide maximum service rate limits and
eliminate county-specific service rate limits.
(b) Effective July 1, 2001, for service rate limits, except those described or defined in
subdivisions 3d and 3e, the rate limit for each service shall be the greater of the alternative care
statewide maximum rate or the elderly waiver statewide maximum rate.
(c) Counties may negotiate individual service rates with vendors for actual costs up to the
statewide maximum service rate limit.
    Subd. 4. Termination notice. The case manager must give the individual a ten-day written
notice of any denial, reduction, or termination of waivered services.
    Subd. 5. Assessments and reassessments for waiver clients. Each client shall receive
an initial assessment of strengths, informal supports, and need for services in accordance with
section 256B.0911, subdivisions 3, 3a, and 3b. A reassessment of a client served under the elderly
waiver must be conducted at least every 12 months and at other times when the case manager
determines that there has been significant change in the client's functioning. This may include
instances where the client is discharged from the hospital.
    Subd. 6. Implementation of care plan. Each elderly waiver client shall be provided a copy
of a written care plan that meets the requirements outlined in section 256B.0913, subdivision 8.
The care plan must be implemented by the county administering waivered services when it is
different than the county of financial responsibility. The county administering waivered services
must notify the county of financial responsibility of the approved care plan.
    Subd. 7. Prepaid elderly waiver services. An individual for whom a prepaid health plan
is liable for nursing home services or elderly waiver services according to section 256B.69,
subdivision 6a
, is not eligible to receive county-administered elderly waiver services under
this section.
    Subd. 8. Services and supports. (a) Services and supports shall meet the requirements set
out in United States Code, title 42, section 1396n.
(b) Services and supports shall promote consumer choice and be arranged and provided
consistent with individualized, written care plans.
(c) The state of Minnesota, county, or tribal government under contract to administer the
elderly waiver shall not be liable for damages, injuries, or liabilities sustained through the purchase
of direct supports or goods by the person, the person's family, or the authorized representatives
with funds received through consumer-directed community support services under the federally
approved waiver plan. Liabilities include, but are not limited to, workers' compensation liability,
the Federal Insurance Contributions Act (FICA), or the Federal Unemployment Tax Act (FUTA).
    Subd. 9. Tribal management of elderly waiver. Notwithstanding contrary provisions of this
section, or those in other state laws or rules, the commissioner may develop a model for tribal
management of the elderly waiver program and implement this model through a contract between
the state and any of the state's federally recognized tribal governments. The model shall include
the provision of tribal waiver case management, assessment for personal care assistance, and
administrative requirements otherwise carried out by counties but shall not include tribal financial
eligibility determination for medical assistance.
History: 1991 c 292 art 7 s 16; 1992 c 513 art 7 s 62-64; 1Sp1993 c 1 art 5 s 68-72;
1Sp1993 c 6 s 13; 1995 c 207 art 6 s 70-74; 1995 c 263 s 9; 1996 c 451 art 2 s 26-28; art 5 s
23,24; 1997 c 113 s 18; 1997 c 203 art 4 s 40-43; 1998 c 407 art 4 s 37,38; 1Sp2001 c 9 art 4 s
28-30; 2002 c 277 s 16,17; 2002 c 375 art 2 s 26-30; 2002 c 379 art 1 s 113; 1Sp2003 c 14 art 2 s
26; art 3 s 30; 2004 c 288 art 5 s 5,6; 2005 c 68 art 2 s 2-4