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Chapter 256B

Section 256B.0917


Recent History

    Subdivision 1. Purpose, mission, goals, and objectives. (a) The purpose of implementing
seniors' agenda for independent living (SAIL) projects under this section is to demonstrate a new
cooperative strategy for the long-term care system in the state of Minnesota.
The projects are part of the initial plan for a 20-year strategy. The mission of the 20-year
strategy is to create a new community-based care paradigm for long-term care in Minnesota in
order to maximize independence of the older adult population, and to ensure cost-effective use of
financial and human resources. The goals for the 20-year strategy are to:
(1) achieve a broad awareness and use of low-cost home care and other residential
alternatives to nursing homes;
(2) develop a statewide system of information and assistance to enable easy access to
long-term care services;
(3) develop sufficient alternatives to nursing homes to serve the increased number of people
needing long-term care;
(4) maintain the moratorium on new construction of nursing home beds and to lower the
percentage of elderly persons served in institutional settings; and
(5) build a community-based approach and community commitment to delivering long-term
care services for elderly persons in their homes.
(b) The objective for the fiscal years 1994 and 1995 biennial plan is to continue at least
four but not more than six projects in anticipation of a statewide program. These projects will
continue the process of implementing:
(1) a coordinated planning and administrative process;
(2) a refocused function of the preadmission screening program;
(3) the development of additional home, community, and residential alternatives to nursing
(4) a program to support the informal caregivers for elderly persons;
(5) programs to strengthen the use of volunteers; and
(6) programs to support the building of community commitment to provide long-term care
for elderly persons.
The services offered through these projects are available to those who have their own funds
to pay for services, as well as to persons who are eligible for medical assistance and to persons
who are 180-day eligible clients to the extent authorized in this section.
    Subd. 2. Design of SAIL projects; local long-term care coordinating team. (a) The
commissioner of human services shall contract with SAIL projects in four to six counties or
groups of counties to demonstrate the feasibility and cost-effectiveness of a local long-term care
strategy that is consistent with the state's long-term care goals identified in subdivision 1. The
commissioner shall publish a notice in the State Register announcing the availability of project
funding and giving instructions for making an application. The instructions for the application
shall identify the amount of funding available for project components.
(b) To be selected for the project, a county board or boards must establish a long-term care
coordinating team consisting of county social service agencies, public health nursing service
agencies, local boards of health, a representative of local nursing home providers, a representative
of local home care providers, and the area agencies on aging in a geographic area which is
responsible for:
(1) developing a local long-term care strategy consistent with state goals and objectives;
(2) submitting an application to be selected as a project;
(3) coordinating planning for funds to provide services to elderly persons, including funds
received under Title III of the Older Americans Act, Title XX of the Social Security Act and the
Local Public Health Act; and
(4) ensuring efficient services provision and nonduplication of funding.
(c) The board or boards shall designate a public agency to serve as the lead agency. The
lead agency receives and manages the project funds from the state and is responsible for the
implementation of the local strategy. If selected as a project, the local long-term care coordinating
team must semiannually evaluate the progress of the local long-term care strategy in meeting state
measures of performance and results as established in the contract.
(d) Each member of the local coordinating team must indicate its endorsement of the local
strategy. The local long-term care coordinating team may include in its membership other units of
government which provide funding for services to the frail elderly. The team must cooperate with
consumers and other public and private agencies, including nursing homes, in the geographic area
in order to develop and offer a variety of cost-effective services to the elderly and their caregivers.
(e) The board or boards shall apply to be selected as a project. If the project is selected, the
commissioner of human services shall contract with the lead agency for the project and shall
provide additional administrative funds for implementing the provisions of the contract, within
the appropriation available for this purpose.
(f) Projects shall be selected according to the following conditions.
No project may be selected unless it demonstrates that:
(i) the objectives of the local project will help to achieve the state's long-term care goals
as defined in subdivision 1;
(ii) in the case of a project submitted jointly by several counties, all of the participating
counties are contiguous;
(iii) there is a designated local lead agency that is empowered to make contracts with the
state and local vendors on behalf of all participants;
(iv) the project proposal demonstrates that the local cooperating agencies have the ability
to perform the project as described and that the implementation of the project has a reasonable
chance of achieving its objectives;
(v) the project will serve an area that covers at least four counties or contains at least 2,500
persons who are 85 years of age or older, according to the projections of the state demographer
or the census if the data is more recent; and
(vi) the local coordinating team documents efforts of cooperation with consumers and other
agencies and organizations, both public and private, in planning for service delivery.
    Subd. 3. Local long-term care strategy. The local long-term care strategy must list
performance outcomes and indicators which meet the state's objectives. The local strategy must
provide for:
(1) accessible information, assessment, and preadmission screening activities as described in
subdivision 4;
(2) an increase in numbers of alternative care clients served under section 256B.0913,
including those who are relocated from nursing homes, which results in a reduction of the medical
assistance nursing home caseload; and
(3) the development of additional services such as adult family foster care homes; family
adult day care; assisted living projects and congregate housing service projects in apartment
buildings; expanded home care services for evenings and weekends; expanded volunteer services;
and caregiver support and respite care projects.
The county or groups of counties selected for the projects shall be required to comply with
federal regulations, alternative care funding policies in section 256B.0913, and the federal waiver
programs' policies in section 256B.0915. The requirements for preadmission screening are
defined in section 256B.0911, subdivisions 1 to 6. Requirements for an access, screening, and
assessment function are defined in subdivision 4. Requirements for the service development and
service provision are defined in subdivision 5.
    Subd. 4. Information, screening, and assessment function. (a) The projects selected by and
under contract with the commissioner shall establish an accessible information, screening, and
assessment function for persons who need assistance and information regarding long-term care.
This accessible information, screening, and assessment activity shall include information and
referral, early intervention, follow-up contacts, telephone screening, home visits, assessments,
preadmission screening, and relocation case management for the frail elderly and their caregivers
in the area served by the county or counties. The purpose is to ensure that information and help
is provided to elderly persons and their families in a timely fashion, when they are making
decisions about long-term care. These functions may be split among various agencies, but must
be coordinated by the local long-term care coordinating team.
(b) Accessible information, screening, and assessment functions shall be reimbursed as
(1) The screenings of all persons entering nursing homes shall be reimbursed as defined in
section 256B.0911, subdivision 6; and
(2) Additional state administrative funds shall be available for the access, screening, and
assessment activities that are not reimbursed under clause (1). This amount shall not exceed the
amount authorized in the guidelines and in instructions for the application and must be within the
amount appropriated for this activity.
(c) Any information and referral functions funded by other sources, such as Title III of the
Older Americans Act and Title XX of the Social Security Act, shall be considered by the local
long-term care coordinating team in establishing this function to avoid duplication and to ensure
access to information for persons needing help and information regarding long-term care.
(d) The lead agency or the agencies under contract with the lead agency which are
responsible for the accessible information, screening, and assessment function must complete the
forms and reports required by the commissioner as specified in the contract.
    Subd. 5. Service development and delivery. (a) In addition to the access, screening, and
assessment activity, each local strategy may include provisions for the following:
(1) the addition of a full-time staff person who is responsible to develop the following
services and recruit providers as established in the contract:
(i) additional adult family foster care homes;
(ii) family adult day care providers as defined in section 256B.0919, subdivision 2;
(iii) an assisted living program in an apartment;
(iv) a congregate housing service project in a subsidized housing project; and
(v) the expansion of evening and weekend coverage of home care services as deemed
necessary by the local strategic plan;
(2) small incentive grants to new adult family care providers for renovations needed to
meet licensure requirements;
(3) a plan to divert new applicants to nursing homes and to relocate a targeted population
from nursing homes, using the individual's own resources or the funding available for services;
(4) one or more caregiver support and respite care projects, as described in subdivision 6; and
(5) one or more living-at-home/block nurse projects, as described in subdivisions 7 to 10.
(b) The expansion of alternative care clients under paragraph (a) shall be accomplished
with the funds provided under section 256B.0913, and includes the allocation of targeted funds.
The funding for all participating counties must be coordinated by the local long-term care
coordinating team and must be part of the local long-term care strategy. Alternative care funds
may be transferred from one SAIL county to another within a designated SAIL project area
during a fiscal year as authorized by the local long-term care coordinating team and approved by
the commissioner. The base allocation used for a future year shall reflect the final transfer. Each
county retains responsibility for reimbursement as defined in section 256B.0913, subdivision
. All other requirements for the alternative care program must be met unless an exception is
provided in this section. The commissioner may establish by contract a reimbursement mechanism
for alternative care that does not require invoice processing through the Medical Assistance
Management Information System (MMIS). The commissioner and local agencies must assure that
the same client and reimbursement data is obtained as is available under MMIS.
(c) The administration of these components is the responsibility of the agencies selected
by the local coordinating team and under contract with the local lead agency. However,
administrative funds for paragraph (a), clauses (2) to (4), and grant funds for paragraph (a), clause
(5), shall be granted to the local lead agency. The funding available for each component is based
on the plan submitted and the amount negotiated in the contract.
    Subd. 6. Caregiver support and respite care projects. (a) The commissioner shall establish
up to 36 projects to expand the respite care network in the state and to support caregivers in their
responsibilities for care. The purpose of each project shall be to:
(1) establish a local coordinated network of volunteer and paid respite workers;
(2) coordinate assignment of respite workers to clients and care receivers and assure the
health and safety of the client; and
(3) provide training for caregivers and ensure that support groups are available in the
(b) The caregiver support and respite care funds shall be available to the four to six local
long-term care strategy projects designated in subdivisions 1 to 5.
(c) The commissioner shall publish a notice in the State Register to solicit proposals from
public or private nonprofit agencies for the projects not included in the four to six local long-term
care strategy projects defined in subdivision 2. A county agency may, alone or in combination
with other county agencies, apply for caregiver support and respite care project funds. A public or
nonprofit agency within a designated SAIL project area may apply for project funds if the agency
has a letter of agreement with the county or counties in which services will be developed, stating
the intention of the county or counties to coordinate their activities with the agency requesting a
(d) The commissioner shall select grantees based on the following criteria:
(1) the ability of the proposal to demonstrate need in the area served, as evidenced by a
community needs assessment or other demographic data;
(2) the ability of the proposal to clearly describe how the project will achieve the purpose
defined in paragraph (b);
(3) the ability of the proposal to reach underserved populations;
(4) the ability of the proposal to demonstrate community commitment to the project, as
evidenced by letters of support and cooperation as well as formation of a community task force;
(5) the ability of the proposal to clearly describe the process for recruiting, training, and
retraining volunteers; and
(6) the inclusion in the proposal of the plan to promote the project in the community,
including outreach to persons needing the services.
(e) Funds for all projects under this subdivision may be used to:
(1) hire a coordinator to develop a coordinated network of volunteer and paid respite care
services and assign workers to clients;
(2) recruit and train volunteer providers;
(3) train caregivers;
(4) ensure the development of support groups for caregivers;
(5) advertise the availability of the caregiver support and respite care project; and
(6) purchase equipment to maintain a system of assigning workers to clients.
(f) Project funds may not be used to supplant existing funding sources.
    Subd. 7. Contract. (a) The commissioner of human services shall execute a contract with
Living at Home/Block Nurse Program, Inc. (LAH/BN, Inc.). The contract shall require LAH/BN,
Inc. to:
(1) develop criteria for and award grants to establish community-based organizations that
will implement living-at-home/block nurse programs throughout the state;
(2) award grants to enable living-at-home/block nurse programs to continue to implement
the combined living-at-home/block nurse program model;
(3) serve as a state technical assistance center to assist and coordinate the
living-at-home/block nurse programs established; and
(4) manage contracts with individual living-at-home/block nurse programs.
(b) The contract shall be effective July 1, 1997, and section 16B.17 shall not apply.
    Subd. 8. Living-at-home/block nurse program grant. (a) The organization awarded the
contract under subdivision 7, shall develop and administer a grant program to establish or
expand up to 33 community-based organizations that will implement living-at-home/block nurse
programs that are designed to enable senior citizens to live as independently as possible in their
homes and in their communities. At least one-half of the programs must be in counties outside
the seven-county metropolitan area. Nonprofit organizations and units of local government
are eligible to apply for grants to establish the community organizations that will implement
living-at-home/block nurse programs. In awarding grants, the organization awarded the contract
under subdivision 7 shall give preference to nonprofit organizations and units of local government
from communities that:
(1) have high nursing home occupancy rates;
(2) have a shortage of health care professionals;
(3) are located in counties adjacent to, or are located in, counties with existing
living-at-home/block nurse programs; and
(4) meet other criteria established by LAH/BN, Inc., in consultation with the commissioner.
(b) Grant applicants must also meet the following criteria:
(1) the local community demonstrates a readiness to establish a community model of care,
including the formation of a board of directors, advisory committee, or similar group, of which
at least two-thirds is comprised of community citizens interested in community-based care for
older persons;
(2) the program has sponsorship by a credible, representative organization within the
(3) the program has defined specific geographic boundaries and defined its organization,
staffing and coordination/delivery of services;
(4) the program demonstrates a team approach to coordination and care, ensuring that the
older adult participants, their families, the formal and informal providers are all part of the effort
to plan and provide services; and
(5) the program provides assurances that all community resources and funding will be
coordinated and that other funding sources will be maximized, including a person's own resources.
(c) Grant applicants must provide a minimum of five percent of total estimated development
costs from local community funding. Grants shall be awarded for four-year periods, and the base
amount shall not exceed $80,000 per applicant for the grant period. The organization under
contract may increase the grant amount for applicants from communities that have socioeconomic
characteristics that indicate a higher level of need for assistance. Subject to the availability of
funding, grants and grant renewals awarded or entered into on or after July 1, 1997, shall be
renewed by LAH/BN, Inc. every four years, unless LAH/BN, Inc. determines that the grant
recipient has not satisfactorily operated the living-at-home/block nurse program in compliance
with the requirements of paragraphs (b) and (d). Grants provided to living-at-home/block nurse
programs under this paragraph may be used for both program development and the delivery
of services.
(d) Each living-at-home/block nurse program shall be designed by representatives of
the communities being served to ensure that the program addresses the specific needs of the
community residents. The programs must be designed to:
(1) incorporate the basic community, organizational, and service delivery principles of the
living-at-home/block nurse program model;
(2) provide senior citizens with registered nurse directed assessment, provision and
coordination of health and personal care services on a sliding fee basis as an alternative to
expensive nursing home care;
(3) provide information, support services, homemaking services, counseling, and training
for the client and family caregivers;
(4) encourage the development and use of respite care, caregiver support, and in-home
support programs, such as adult foster care and in-home adult day care;
(5) encourage neighborhood residents and local organizations to collaborate in meeting the
needs of senior citizens in their communities;
(6) recruit, train, and direct the use of volunteers to provide informal services and other
appropriate support to senior citizens and their caregivers; and
(7) provide coordination and management of formal and informal services to senior citizens
and their families using less expensive alternatives.
    Subd. 9. State technical assistance center. The organization under contract shall be the state
technical assistance center to provide orientation and technical assistance, and to coordinate the
living-at-home/block nurse programs established. The state resource center shall:
(1) provide communities with criteria in planning and designing their living-at-home/block
nurse programs;
(2) provide general orientation and technical assistance to communities who desire to
establish living-at-home/block nurse programs;
(3) provide ongoing analysis and data collection of existing and newly established
living-at-home/block nurse programs and provide data to the organization performing the
independent assessment; and
(4) serve as the living-at-home/block nurse programs' liaison to the legislature and other
state agencies.
    Subd. 10. Implementation plan. The organization under contract shall develop a plan
that specifies a strategy for implementing living-at-home/block nurse programs statewide. The
plan must also analyze the data collected by the state technical assistance center and describe
the effectiveness of services provided by living-at-home/block nurse programs, including the
program's impact on acute care costs. The organization shall report to the commissioner of human
services and to the legislature by January 1, 1993.
    Subd. 11. SAIL evaluation and expansion. The commissioner shall evaluate the success of
the SAIL projects against the objective stated in subdivision 1, paragraph (b), and recommend to
the legislature the continuation or expansion of the long-term care strategy by February 15, 1995.
    Subd. 12. Public awareness campaign. The commissioner, with assistance from the
commissioner of health and with the advice of the long-term care planning committee, shall
contract for a public awareness campaign to educate the general public, seniors, consumers,
caregivers, and professionals about the aging process, the long-term care system, and alternatives
available including alternative care and residential alternatives. Particular emphasis will be given
to informing consumers on how to access the alternatives and obtain information on the long-term
care system. The commissioner shall pursue the development of new names for preadmission
screening, alternative care, foster care, and other services as deemed necessary for the public
awareness campaign.
    Subd. 13. Community service grants. The commissioner shall award contracts for grants to
public and private nonprofit agencies to establish services that strengthen a community's ability to
provide a system of home and community-based services for elderly persons. The commissioner
shall use a request for proposal process. The commissioner shall give preference when awarding
grants under this section to areas where nursing facility closures have occurred or are occurring.
The commissioner shall consider grants for:
(1) caregiver support and respite care projects under subdivision 6;
(2) the living-at-home/block nurse grant under subdivisions 7 to 10; and
(3) services identified as needed for community transition.
History: 1991 c 292 art 7 s 17; 1992 c 513 art 7 s 65-72; 1Sp1993 c 1 art 5 s 73-79; 1994 c
625 art 8 s 63; 1997 c 203 art 4 s 44,45; 1999 c 245 art 4 s 62; 2000 c 488 art 9 s 36; 2001 c
161 s 46,47; 1Sp2001 c 9 art 4 s 31,32; 2002 c 379 art 1 s 113; 2005 c 10 art 1 s 51,52; 2005 c
98 art 3 s 24; 2006 c 212 art 3 s 19

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