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Chapter 256B

Section 256B.0911

Recent History

    Subdivision 1. Purpose and goal. (a) The purpose of long-term care consultation services is
to assist persons with long-term or chronic care needs in making long-term care decisions and
selecting options that meet their needs and reflect their preferences. The availability of, and access
to, information and other types of assistance is also intended to prevent or delay certified nursing
facility placements and to provide transition assistance after admission. Further, the goal of these
services is to contain costs associated with unnecessary certified nursing facility admissions. The
commissioners of human services and health shall seek to maximize use of available federal and
state funds and establish the broadest program possible within the funding available.
(b) These services must be coordinated with services provided under section 256.975,
subdivision 7
, and with services provided by other public and private agencies in the community
to offer a variety of cost-effective alternatives to persons with disabilities and elderly persons.
The county agency providing long-term care consultation services shall encourage the use of
volunteers from families, religious organizations, social clubs, and similar civic and service
organizations to provide community-based services.
    Subd. 1a. Definitions. For purposes of this section, the following definitions apply:
(a) "Long-term care consultation services" means:
(1) providing information and education to the general public regarding availability of the
services authorized under this section;
(2) an intake process that provides access to the services described in this section;
(3) assessment of the health, psychological, and social needs of referred individuals;
(4) assistance in identifying services needed to maintain an individual in the least restrictive
(5) providing recommendations on cost-effective community services that are available to
the individual;
(6) development of an individual's community support plan;
(7) providing information regarding eligibility for Minnesota health care programs;
(8) preadmission screening to determine the need for a nursing facility level of care;
(9) preliminary determination of Minnesota health care programs eligibility for individuals
who need a nursing facility level of care, with appropriate referrals for final determination;
(10) providing recommendations for nursing facility placement when there are no
cost-effective community services available; and
(11) assistance to transition people back to community settings after facility admission.
(b) "Minnesota health care programs" means the medical assistance program under chapter
256B and the alternative care program under section 256B.0913.
    Subd. 2.[Repealed, 1Sp2001 c 9 art 4 s 34]
    Subd. 2a.[Repealed, 1Sp2001 c 9 art 4 s 34]
    Subd. 3. Long-term care consultation team. (a) A long-term care consultation team
shall be established by the county board of commissioners. Each local consultation team shall
consist of at least one social worker and at least one public health nurse from their respective
county agencies. The board may designate public health or social services as the lead agency for
long-term care consultation services. If a county does not have a public health nurse available, it
may request approval from the commissioner to assign a county registered nurse with at least one
year experience in home care to participate on the team. Two or more counties may collaborate to
establish a joint local consultation team or teams.
(b) The team is responsible for providing long-term care consultation services to all persons
located in the county who request the services, regardless of eligibility for Minnesota health
care programs.
    Subd. 3a. Assessment and support planning. (a) Persons requesting assessment, services
planning, or other assistance intended to support community-based living, including persons who
need assessment in order to determine waiver or alternative care program eligibility, must be
visited by a long-term care consultation team within ten working days after the date on which
an assessment was requested or recommended. Assessments must be conducted according to
paragraphs (b) to (i).
    (b) The county may utilize a team of either the social worker or public health nurse, or both,
to conduct the assessment in a face-to-face interview. The consultation team members must confer
regarding the most appropriate care for each individual screened or assessed.
    (c) The long-term care consultation team must assess the health and social needs of the
person, using an assessment form provided by the commissioner.
    (d) The team must conduct the assessment in a face-to-face interview with the person being
assessed and the person's legal representative, if applicable.
    (e) The team must provide the person, or the person's legal representative, with written
recommendations for facility- or community-based services. The team must document that the
most cost-effective alternatives available were offered to the individual. For purposes of this
requirement, "cost-effective alternatives" means community services and living arrangements that
cost the same as or less than nursing facility care.
    (f) If the person chooses to use community-based services, the team must provide the person
or the person's legal representative with a written community support plan, regardless of whether
the individual is eligible for Minnesota health care programs. The person may request assistance
in developing a community support plan without participating in a complete assessment.
    (g) The person has the right to make the final decision between nursing facility placement
and community placement after the screening team's recommendation, except as provided in
subdivision 4a, paragraph (c).
    (h) The team must give the person receiving assessment or support planning, or the person's
legal representative, materials, and forms supplied by the commissioner containing the following
    (1) the need for and purpose of preadmission screening if the person selects nursing facility
    (2) the role of the long-term care consultation assessment and support planning in waiver and
alternative care program eligibility determination;
    (3) information about Minnesota health care programs;
    (4) the person's freedom to accept or reject the recommendations of the team;
    (5) the person's right to confidentiality under the Minnesota Government Data Practices
Act, chapter 13;
    (6) the long-term care consultant's decision regarding the person's need for nursing facility
level of care; and
    (7) the person's right to appeal the decision regarding the need for nursing facility level of
care or the county's final decisions regarding public programs eligibility according to section
256.045, subdivision 3.
    (i) Face-to-face assessment completed as part of eligibility determination for the alternative
care, elderly waiver, community alternatives for disabled individuals, community alternative
care, and traumatic brain injury waiver programs under sections 256B.0915, 256B.0917, and
256B.49 is valid to establish service eligibility for no more than 60 calendar days after the date of
assessment. The effective eligibility start date for these programs can never be prior to the date
of assessment. If an assessment was completed more than 60 days before the effective waiver
or alternative care program eligibility start date, assessment and support plan information must
be updated in a face-to-face visit and documented in the department's Medicaid Management
Information System (MMIS). The effective date of program eligibility in this case cannot be prior
to the date the updated assessment is completed.
    Subd. 3b. Transition assistance. (a) A long-term care consultation team shall provide
assistance to persons residing in a nursing facility, hospital, regional treatment center, or
intermediate care facility for persons with developmental disabilities who request or are
referred for assistance. Transition assistance must include assessment, community support plan
development, referrals to Minnesota health care programs, and referrals to programs that provide
assistance with housing. Transition assistance must also include information about the Centers
for Independent Living and about other organizations that can provide assistance with relocation
efforts, and information about contacting these organizations to obtain their assistance and support.
    (b) The county shall develop transition processes with institutional social workers and
discharge planners to ensure that:
    (1) persons admitted to facilities receive information about transition assistance that is
    (2) the assessment is completed for persons within ten working days of the date of request or
recommendation for assessment; and
    (3) there is a plan for transition and follow-up for the individual's return to the community.
The plan must require notification of other local agencies when a person who may require
assistance is screened by one county for admission to a facility located in another county.
    (c) If a person who is eligible for a Minnesota health care program is admitted to a nursing
facility, the nursing facility must include a consultation team member or the case manager in the
discharge planning process.
    Subd. 3c. Transition to housing with services. (a) Housing with services establishments
offering or providing assisted living under chapter 144G shall inform all prospective residents
of the availability of and contact information for transitional consultation services under this
subdivision prior to executing a lease or contract with the prospective resident. The purpose of
transitional long-term care consultation is to support persons with current or anticipated long-term
care needs in making informed choices among options that include the most cost-effective and
least restrictive settings, and to delay spenddown to eligibility for publicly funded programs by
connecting people to alternative services in their homes before transition to housing with services.
Regardless of the consultation, prospective residents maintain the right to choose housing with
services or assisted living if that option is their preference.
    (b) Transitional consultation services are provided as determined by the commissioner
of human services in partnership with county long-term care consultation units, and the Area
Agencies on Aging, and are a combination of telephone-based and in-person assistance provided
under models developed by the commissioner. The consultation shall be performed in a manner
that provides objective and complete information. Transitional consultation must be provided
within five working days of the request of the prospective resident as follows:
    (1) the consultation must be provided by a qualified professional as determined by the
    (2) the consultation must include a review of the prospective resident's reasons for
considering assisted living, the prospective resident's personal goals, a discussion of the
prospective resident's immediate and projected long-term care needs, and alternative community
services or assisted living settings that may meet the prospective resident's needs; and
    (3) the prospective resident shall be informed of the availability of long-term care
consultation services described in subdivision 3a that are available at no charge to the prospective
resident to assist the prospective resident in assessment and planning to meet the prospective
resident's long-term care needs.
    Subd. 4.[Repealed, 1Sp2001 c 9 art 4 s 34]
    Subd. 4a. Preadmission screening activities related to nursing facility admissions. (a)
All applicants to Medicaid certified nursing facilities, including certified boarding care facilities,
must be screened prior to admission regardless of income, assets, or funding sources for nursing
facility care, except as described in subdivision 4b. The purpose of the screening is to determine
the need for nursing facility level of care as described in paragraph (d) and to complete activities
required under federal law related to mental illness and developmental disability as outlined in
paragraph (b).
(b) A person who has a diagnosis or possible diagnosis of mental illness or developmental
disability must receive a preadmission screening before admission regardless of the exemptions
outlined in subdivision 4b, paragraph (b), to identify the need for further evaluation and
specialized services, unless the admission prior to screening is authorized by the local mental
health authority or the local developmental disabilities case manager, or unless authorized by the
county agency according to Public Law 101-508.
The following criteria apply to the preadmission screening:
(1) the county must use forms and criteria developed by the commissioner to identify
persons who require referral for further evaluation and determination of the need for specialized
services; and
(2) the evaluation and determination of the need for specialized services must be done by:
(i) a qualified independent mental health professional, for persons with a primary or
secondary diagnosis of a serious mental illness; or
(ii) a qualified developmental disability professional, for persons with a primary or
secondary diagnosis of developmental disability. For purposes of this requirement, a qualified
developmental disability professional must meet the standards for a qualified developmental
disability professional under Code of Federal Regulations, title 42, section 483.430.
(c) The local county mental health authority or the state developmental disability authority
under Public Law Numbers 100-203 and 101-508 may prohibit admission to a nursing facility
if the individual does not meet the nursing facility level of care criteria or needs specialized
services as defined in Public Law Numbers 100-203 and 101-508. For purposes of this section,
"specialized services" for a person with developmental disability means active treatment as that
term is defined under Code of Federal Regulations, title 42, section 483.440 (a)(1).
(d) The determination of the need for nursing facility level of care must be made according
to criteria developed by the commissioner. In assessing a person's needs, consultation team
members shall have a physician available for consultation and shall consider the assessment
of the individual's attending physician, if any. The individual's physician must be included if
the physician chooses to participate. Other personnel may be included on the team as deemed
appropriate by the county.
    Subd. 4b. Exemptions and emergency admissions. (a) Exemptions from the federal
screening requirements outlined in subdivision 4a, paragraphs (b) and (c), are limited to:
    (1) a person who, having entered an acute care facility from a certified nursing facility, is
returning to a certified nursing facility;
    (2) a person transferring from one certified nursing facility in Minnesota to another certified
nursing facility in Minnesota; and
    (3) a person, 21 years of age or older, who satisfies the following criteria, as specified in
Code of Federal Regulations, title 42, section 483.106(b)(2):
    (i) the person is admitted to a nursing facility directly from a hospital after receiving acute
inpatient care at the hospital;
    (ii) the person requires nursing facility services for the same condition for which care was
provided in the hospital; and
    (iii) the attending physician has certified before the nursing facility admission that the person
is likely to receive less than 30 days of nursing facility services.
    (b) Persons who are exempt from preadmission screening for purposes of level of care
determination include:
    (1) persons described in paragraph (a);
    (2) an individual who has a contractual right to have nursing facility care paid for indefinitely
by the veterans' administration;
    (3) an individual enrolled in a demonstration project under section 256B.69, subdivision 8, at
the time of application to a nursing facility; and
    (4) an individual currently being served under the alternative care program or under a
home and community-based services waiver authorized under section 1915(c) of the federal
Social Security Act.
    (c) Persons admitted to a Medicaid-certified nursing facility from the community on an
emergency basis as described in paragraph (d) or from an acute care facility on a nonworking day
must be screened the first working day after admission.
    (d) Emergency admission to a nursing facility prior to screening is permitted when all of
the following conditions are met:
    (1) a person is admitted from the community to a certified nursing or certified boarding
care facility during county nonworking hours;
    (2) a physician has determined that delaying admission until preadmission screening is
completed would adversely affect the person's health and safety;
    (3) there is a recent precipitating event that precludes the client from living safely in the
community, such as sustaining an injury, sudden onset of acute illness, or a caregiver's inability to
continue to provide care;
    (4) the attending physician has authorized the emergency placement and has documented
the reason that the emergency placement is recommended; and
    (5) the county is contacted on the first working day following the emergency admission.
Transfer of a patient from an acute care hospital to a nursing facility is not considered an
emergency except for a person who has received hospital services in the following situations:
hospital admission for observation, care in an emergency room without hospital admission, or
following hospital 24-hour bed care.
    (e) A nursing facility must provide written information to all persons admitted regarding the
person's right to request and receive long-term care consultation services as defined in subdivision
1a. The information must be provided prior to the person's discharge from the facility and in a
format specified by the commissioner.
    Subd. 4c. Screening requirements. (a) A person may be screened for nursing facility
admission by telephone or in a face-to-face screening interview. Consultation team members shall
identify each individual's needs using the following categories:
    (1) the person needs no face-to-face screening interview to determine the need for nursing
facility level of care based on information obtained from other health care professionals;
    (2) the person needs an immediate face-to-face screening interview to determine the need for
nursing facility level of care and complete activities required under subdivision 4a; or
    (3) the person may be exempt from screening requirements as outlined in subdivision 4b, but
will need transitional assistance after admission or in-person follow-along after a return home.
    (b) Persons admitted on a nonemergency basis to a Medicaid-certified nursing facility must
be screened prior to admission.
    (c) The county screening or intake activity must include processes to identify persons who
may require transition assistance as described in subdivision 3b.
    Subd. 4d. Preadmission screening of individuals under 65 years of age. (a) It is the policy
of the state of Minnesota to ensure that individuals with disabilities or chronic illness are served
in the most integrated setting appropriate to their needs and have the necessary information to
make informed choices about home and community-based service options.
(b) Individuals under 65 years of age who are admitted to a nursing facility from a hospital
must be screened prior to admission as outlined in subdivisions 4a through 4c.
(c) Individuals under 65 years of age who are admitted to nursing facilities with only a
telephone screening must receive a face-to-face assessment from the long-term care consultation
team member of the county in which the facility is located or from the recipient's county case
manager within 40 calendar days of admission.
(d) Individuals under 65 years of age who are admitted to a nursing facility without
preadmission screening according to the exemption described in subdivision 4b, paragraph
(a), clause (3), and who remain in the facility longer than 30 days must receive a face-to-face
assessment within 40 days of admission.
(e) At the face-to-face assessment, the long-term care consultation team member or county
case manager must perform the activities required under subdivision 3b.
(f) For individuals under 21 years of age, a screening interview which recommends nursing
facility admission must be face-to-face and approved by the commissioner before the individual
is admitted to the nursing facility.
(g) In the event that an individual under 65 years of age is admitted to a nursing facility on
an emergency basis, the county must be notified of the admission on the next working day, and
a face-to-face assessment as described in paragraph (c) must be conducted within 40 calendar
days of admission.
(h) At the face-to-face assessment, the long-term care consultation team member or the case
manager must present information about home and community-based options so the individual
can make informed choices. If the individual chooses home and community-based services, the
long-term care consultation team member or case manager must complete a written relocation
plan within 20 working days of the visit. The plan shall describe the services needed to move out
of the facility and a time line for the move which is designed to ensure a smooth transition to the
individual's home and community.
(i) An individual under 65 years of age residing in a nursing facility shall receive a
face-to-face assessment at least every 12 months to review the person's service choices and
available alternatives unless the individual indicates, in writing, that annual visits are not desired.
In this case, the individual must receive a face-to-face assessment at least once every 36 months
for the same purposes.
(j) Notwithstanding the provisions of subdivision 6, the commissioner may pay county
agencies directly for face-to-face assessments for individuals under 65 years of age who are being
considered for placement or residing in a nursing facility.
    Subd. 5. Administrative activity. The commissioner shall minimize the number of forms
required in the provision of long-term care consultation services and shall limit the screening
document to items necessary for community support plan approval, reimbursement, program
planning, evaluation, and policy development.
    Subd. 6. Payment for long-term care consultation services. (a) The total payment for each
county must be paid monthly by certified nursing facilities in the county. The monthly amount to
be paid by each nursing facility for each fiscal year must be determined by dividing the county's
annual allocation for long-term care consultation services by 12 to determine the monthly payment
and allocating the monthly payment to each nursing facility based on the number of licensed beds
in the nursing facility. Payments to counties in which there is no certified nursing facility must be
made by increasing the payment rate of the two facilities located nearest to the county seat.
    (b) The commissioner shall include the total annual payment determined under paragraph (a)
for each nursing facility reimbursed under section 256B.431 or 256B.434 according to section
256B.431, subdivision 2b, paragraph (g).
    (c) In the event of the layaway, delicensure and decertification, or removal from layaway of
25 percent or more of the beds in a facility, the commissioner may adjust the per diem payment
amount in paragraph (b) and may adjust the monthly payment amount in paragraph (a). The
effective date of an adjustment made under this paragraph shall be on or after the first day of the
month following the effective date of the layaway, delicensure and decertification, or removal
from layaway.
    (d) Payments for long-term care consultation services are available to the county or counties
to cover staff salaries and expenses to provide the services described in subdivision 1a. The
county shall employ, or contract with other agencies to employ, within the limits of available
funding, sufficient personnel to provide long-term care consultation services while meeting the
state's long-term care outcomes and objectives as defined in section 256B.0917, subdivision 1.
The county shall be accountable for meeting local objectives as approved by the commissioner
in the biennial home and community-based services quality assurance plan on a form provided
by the commissioner.
    (e) Notwithstanding section 256B.0641, overpayments attributable to payment of the
screening costs under the medical assistance program may not be recovered from a facility.
    (f) The commissioner of human services shall amend the Minnesota medical assistance plan
to include reimbursement for the local consultation teams.
    (g) The county may bill, as case management services, assessments, support planning, and
follow-along provided to persons determined to be eligible for case management under Minnesota
health care programs. No individual or family member shall be charged for an initial assessment
or initial support plan development provided under subdivision 3a or 3b.
    Subd. 6a. Withholding. If any provider obligated to pay the long-term care consultation
amount as described in subdivision 6 is more than two months delinquent in the timely payment
of the monthly installment, the commissioner may withhold payments, penalties, and interest in
accordance with the methods outlined in section 256.9657, subdivision 7a. Any amount withheld
under this provision must be returned to the county to whom the delinquent payments were due.
    Subd. 7. Reimbursement for certified nursing facilities. (a) Medical assistance
reimbursement for nursing facilities shall be authorized for a medical assistance recipient only if a
preadmission screening has been conducted prior to admission or the county has authorized an
exemption. Medical assistance reimbursement for nursing facilities shall not be provided for any
recipient who the local screener has determined does not meet the level of care criteria for nursing
facility placement or, if indicated, has not had a level II OBRA evaluation as required under the
federal Omnibus Budget Reconciliation Act of 1987 completed unless an admission for a recipient
with mental illness is approved by the local mental health authority or an admission for a recipient
with developmental disability is approved by the state developmental disability authority.
    (b) The nursing facility must not bill a person who is not a medical assistance recipient
for resident days that preceded the date of completion of screening activities as required under
subdivisions 4a, 4b, and 4c. The nursing facility must include unreimbursed resident days in the
nursing facility resident day totals reported to the commissioner.
    Subd. 8.[Repealed, 2001 c 161 s 58]
    Subd. 9.[Repealed, 1Sp2001 c 9 art 4 s 34]
History: 1991 c 292 art 7 s 14; 1992 c 513 art 7 s 53-55; 1Sp1993 c 1 art 5 s 56-61,135;
1995 c 207 art 6 s 57-61; 1997 c 203 art 4 s 34; art 9 s 10; 1997 c 225 art 8 s 6; 1998 c 407 art 4
s 33-35; 1999 c 245 art 3 s 12; 1Sp2001 c 9 art 3 s 42; art 4 s 4-14; 2002 c 277 s 32; 2002 c 375
art 2 s 18,19; 2002 c 379 art 1 s 113; 1Sp2003 c 14 art 2 s 56; art 3 s 29; 2004 c 288 art 5 s 4;
2005 c 56 s 1; 2005 c 98 art 2 s 5; 1Sp2005 c 4 art 8 s 45; 2007 c 147 art 6 s 23-28; art 7 s 13,14
NOTE:Subdivision 3c as added by Laws 2007, chapter 147, article 7, section 14, is effective
October 1, 2008. Laws 2007, chapter 147, article 7, section 14, the effective date.

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