256B.0657 SELF-DIRECTED SUPPORTS OPTION.
Subdivision 1. Definition.
"Self-directed supports option" means personal assistance,
supports, items, and related services purchased under an approved budget plan and budget by a
Subd. 2. Eligibility.
(a) The self-directed supports option is available to a person who:
(1) is a recipient of medical assistance as determined under sections
256B.057, subdivision 9
(2) is eligible for personal care assistant services under section
(3) lives in the person's own apartment or home, which is not owned, operated, or controlled
by a provider of services not related by blood or marriage;
(4) has the ability to hire, fire, supervise, establish staff compensation for, and manage the
individuals providing services, and to choose and obtain items, related services, and supports as
described in the participant's plan. If the recipient is not able to carry out these functions but has a
legal guardian or parent to carry them out, the guardian or parent may fulfill these functions on
behalf of the recipient; and
(5) has not been excluded or disenrolled by the commissioner.
(b) The commissioner may disenroll or exclude recipients, including guardians and parents,
under the following circumstances:
(1) recipients who have been restricted by the Primary Care Utilization Review Committee
may be excluded for a specified time period;
(2) recipients who exit the self-directed supports option during the recipient's service plan
year shall not access the self-directed supports option for the remainder of that service plan
(3) when the department determines that the recipient cannot manage recipient
responsibilities under the program.
Subd. 3. Eligibility for other services.
Selection of the self-directed supports option by a
recipient shall not restrict access to other medically necessary care and services furnished under
the state plan medical assistance benefit, including home care targeted case management, except
that a person receiving home and community-based waiver services, a family support grant, or a
consumer support grant is not eligible for funding under the self-directed supports option.
Subd. 4. Assessment requirements.
(a) The self-directed supports option assessment must
meet the following requirements:
(1) it shall be conducted by the county public health nurse or a certified public health nurse
under contract with the county;
(2) it shall be conducted face-to-face in the recipient's home initially, and at least annually
thereafter; when there is a significant change in the recipient's condition; and when there is a
change in the need for personal care assistant services. A recipient who is residing in a facility
may be assessed for the self-directed support option for the purpose of returning to the community
using this option; and
(3) it shall be completed using the format established by the commissioner.
(b) The results of the assessment and recommendations shall be communicated to the
commissioner and the recipient by the county public health nurse or certified public health nurse
under contract with the county.
Subd. 5. Self-directed supports option plan requirements.
(a) The plan for the self-directed
supports option must meet the following requirements:
(1) the plan must be completed using a person-centered process that:
(i) builds upon the recipient's capacity to engage in activities that promote community life;
(ii) respects the recipient's preferences, choices, and abilities;
(iii) involves families, friends, and professionals in the planning or delivery of services or
supports as desired or required by the recipient; and
(iv) addresses the need for personal care assistant services identified in the recipient's
self-directed supports option assessment;
(2) the plan shall be developed by the recipient or by the guardian of an adult recipient or
by a parent or guardian of a minor child, with the assistance of an enrolled medical assistance
home care targeted case manager provider who meets the requirements established for using a
person-centered planning process and shall be reviewed at least annually upon reassessment or
when there is a significant change in the recipient's condition; and
(3) the plan must include the total budget amount available divided into monthly amounts
that cover the number of months of personal care assistant services authorization included in
the budget. The amount used each month may vary, but additional funds shall not be provided
above the annual personal care assistant services authorized amount unless a change in condition
(b) The commissioner shall:
(1) establish the format and criteria for the plan as well as the requirements for providers
who assist with plan development;
(2) review the assessment and plan and, within 30 days after receiving the assessment and
plan, make a decision on approval of the plan;
(3) notify the recipient, parent, or guardian of approval or denial of the plan and provide
notice of the right to appeal under section
(4) provide a copy of the plan to the fiscal support entity selected by the recipient.
Subd. 6. Services covered.
(a) Services covered under the self-directed supports option
(1) personal care assistant services under section
(2) items, related services, and supports, including assistive technology, that increase
independence or substitute for human assistance to the extent expenditures would otherwise be
used for human assistance.
(b) Items, supports, and related services purchased under this option shall not be considered
home care services for the purposes of section
Subd. 7. Noncovered services.
Services or supports that are not eligible for payment under
the self-directed supports option include:
(1) services, goods, or supports that do not benefit the recipient;
(2) any fees incurred by the recipient, such as Minnesota health care program fees and
co-pays, legal fees, or costs related to advocate agencies;
(3) insurance, except for insurance costs related to employee coverage or fiscal support
(4) room and board and personal items that are not related to the disability, except that
medically prescribed specialized diet items may be covered if they reduce the need for human
(5) home modifications that add square footage;
(6) home modifications for a residence other than the primary residence of the recipient, or in
the event of a minor with parents not living together, the primary residences of the parents;
(7) expenses for travel, lodging, or meals related to training the recipient, the parent or
guardian of an adult recipient, or the parent or guardian of a minor child, or paid or unpaid
caregivers that exceed $500 in a 12-month period;
(8) experimental treatment;
(9) any service or item covered by other medical assistance state plan services, including
prescription and over-the-counter medications, compounds, and solutions and related fees,
including premiums and co-payments;
(10) membership dues or costs, except when the service is necessary and appropriate to treat
a physical condition or to improve or maintain the recipient's physical condition. The condition
must be identified in the recipient's plan of care and monitored by a Minnesota health care
program enrolled physician;
(11) vacation expenses other than the cost of direct services;
(12) vehicle maintenance or modifications not related to the disability;
(13) tickets and related costs to attend sporting or other recreational events; and
(14) costs related to Internet access, except when necessary for operation of assistive
technology, to increase independence, or to substitute for human assistance.
Subd. 8. Self-directed budget requirements.
The budget for the provision of the
self-directed service option shall be equal to the greater of either:
(1) the annual amount of personal care assistant services under section
recipient has used in the most recent 12-month period; or
(2) the amount determined using the consumer support grant methodology under section
256.476, subdivision 11
, except that the budget amount shall include the federal and nonfederal
share of the average service costs.
Subd. 9. Quality assurance and risk management.
(a) The commissioner shall establish
quality assurance and risk management measures for use in developing and implementing
self-directed plans and budgets that (1) recognize the roles and responsibilities involved in
obtaining services in a self-directed manner, and (2) assure the appropriateness of such plans and
budgets based upon a recipient's resources and capabilities. These measures must include (i)
background studies, and (ii) backup and emergency plans, including disaster planning.
(b) The commissioner shall provide ongoing technical assistance and resource and
educational materials for families and recipients selecting the self-directed option.
(c) Performance assessments measures, such as of a recipient's satisfaction with the services
and supports, and ongoing monitoring of health and well-being shall be identified in consultation
with the stakeholder group.
Subd. 10. Fiscal support entity.
(a) Each recipient shall choose a fiscal support entity
provider certified by the commissioner to make payments for services, items, supports, and
administrative costs related to managing a self-directed service plan authorized for payment in
the approved plan and budget. Recipients shall also choose the payroll, agency with choice, or
the fiscal conduit model of financial and service management.
(b) The fiscal support entity:
(1) may not limit or restrict the recipient's choice of service or support providers, including
use of the payroll, agency with choice, or fiscal conduit model of financial and service
(2) must have a written agreement with the recipient or the recipient's representative that
identifies the duties and responsibilities to be performed and the specific related charges;
(3) must provide the recipient and the home care targeted case manager with a monthly
written summary of the self-directed supports option services that were billed, including charges
from the fiscal support entity;
(4) must be knowledgeable of and comply with Internal Revenue Service requirements
necessary to process employer and employee deductions, provide appropriate and timely
submission of employer tax liabilities, and maintain documentation to support medical assistance
(5) must have current and adequate liability insurance and bonding and sufficient cash
flow and have on staff or under contract a certified public accountant or an individual with a
baccalaureate degree in accounting; and
(6) must maintain records to track all self-directed supports option services expenditures,
including time records of persons paid to provide supports and receipts for any goods purchased.
The records must be maintained for a minimum of five years from the claim date and be available
for audit or review upon request. Claims submitted by the fiscal support entity must correspond
with services, amounts, and time periods as authorized in the recipient's self-directed supports
(c) The commissioner shall have authority to:
(1) set or negotiate rates with fiscal support entities;
(2) limit the number of fiscal support entities;
(3) identify a process to certify and recertify fiscal support entities and assure fiscal support
entities are available to recipients throughout the state; and
(4) establish a uniform format and protocol to be used by eligible fiscal support entities.
Subd. 11. Stakeholder consultation.
The commissioner shall consult with a statewide
consumer-directed services stakeholder group, including representatives of all types of
consumer-directed service users, advocacy organizations, counties, and consumer-directed
service providers. The commissioner shall seek recommendations from this stakeholder group
(1) the self-directed plan format;
(2) requirements and guidelines for the person-centered plan assessment and planning
(3) implementation of the option and the quality assurance and risk management techniques;
(4) standards and requirements, including rates for the personal support plan development
provider and the fiscal support entity; policies; training; and implementation. The stakeholder
group shall provide recommendations on the repeal of the personal care assistant choice option,
transition issues, and whether the consumer support grant program under section
be modified. The stakeholder group shall meet at least three times each year to provide advice on
policy, implementation, and other aspects of consumer and self-directed services.
History: 2007 c 147 art 7 s 12
Subdivisions 1 to 10 as added by Laws 2007, chapter 147, article 7, section 12, are
effective upon federal approval of the state Medicaid plan amendment. Laws 2007, chapter
147, article 7, section 12, the effective date.