ARTICLE 6
TECHNICAL
Section 1.
Minnesota Statutes 2008, section 144A.46, subdivision 1, is amended to
read:
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Subdivision 1. License required. (a) A home care provider may not operate in
the state without a current license issued by the commissioner of health. A home care provider may hold a separate
license for each class of home care licensure.
(b) Within ten days after receiving an application for
a license, the commissioner shall acknowledge receipt of the application in
writing. The acknowledgment must
indicate whether the application appears to be complete or whether additional
information is required before the application will be considered complete. Within 90 days after receiving a complete
application, the commissioner shall either grant or deny the license. If an applicant is not granted or denied a
license within 90 days after submitting a complete application, the license
must be deemed granted. An applicant
whose license has been deemed granted must provide written notice to the
commissioner before providing a home care service.
(c) Each application for a home care provider license,
or for a renewal of a license, shall be accompanied by a fee to be set by the
commissioner under section 144.122.
(d) The commissioner of health, in consultation with
the commissioner of human services, shall provide recommendations to the
legislature by February 15, 2009, for provider standards for personal care
assistant services as described in section 256B.0655 256B.0659.
Sec. 2.
Minnesota Statutes 2008, section 176.011, subdivision 9, is amended to
read:
Subd. 9. Employee. "Employee" means any person who
performs services for another for hire including the following:
(1) an alien;
(2) a minor;
(3) a sheriff, deputy sheriff, police officer,
firefighter, county highway engineer, and peace officer while engaged in the
enforcement of peace or in the pursuit or capture of a person charged with or
suspected of crime;
(4) a person requested or commanded to aid an officer
in arresting or retaking a person who has escaped from lawful custody, or in
executing legal process, in which cases, for purposes of calculating
compensation under this chapter, the daily wage of the person shall be the
prevailing wage for similar services performed by paid employees;
(5) a county assessor;
(6) an elected or appointed official of the state, or
of a county, city, town, school district, or governmental subdivision in the
state. An officer of a political
subdivision elected or appointed for a regular term of office, or to complete
the unexpired portion of a regular term, shall be included only after the
governing body of the political subdivision has adopted an ordinance or
resolution to that effect;
(7) an executive officer of a corporation, except
those executive officers excluded by section 176.041;
(8) a voluntary uncompensated worker, other than an
inmate, rendering services in state institutions under the commissioners of
human services and corrections similar to those of officers and employees of
the institutions, and whose services have been accepted or contracted for by
the commissioner of human services or corrections as authorized by law. In the event of injury or death of the
worker, the daily wage of the worker, for the purpose of calculating
compensation under this chapter, shall be the usual wage paid at the time of
the injury or death for similar services in institutions where the services are
performed by paid employees;
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(9) a voluntary uncompensated worker engaged in
emergency management as defined in section 12.03, subdivision 4, who is:
(i) registered with the state or any political
subdivision of it, according to the procedures set forth in the state or
political subdivision emergency operations plan; and
(ii) acting under the direction and control of, and
within the scope of duties approved by, the state or political subdivision.
The daily wage of the worker, for the purpose of calculating
compensation under this chapter, shall be the usual wage paid at the time of
the injury or death for similar services performed by paid employees;
(10) a voluntary uncompensated worker participating in
a program established by a local social services agency. For purposes of this clause, "local
social services agency" means any agency established under section
393.01. In the event of injury or death
of the worker, the wage of the worker, for the purpose of calculating
compensation under this chapter, shall be the usual wage paid in the county at
the time of the injury or death for similar services performed by paid
employees working a normal day and week;
(11) a voluntary uncompensated worker accepted by the
commissioner of natural resources who is rendering services as a volunteer
pursuant to section 84.089. The daily
wage of the worker for the purpose of calculating compensation under this chapter,
shall be the usual wage paid at the time of injury or death for similar
services performed by paid employees;
(12) a voluntary uncompensated worker in the building
and construction industry who renders services for joint labor-management
nonprofit community service projects.
The daily wage of the worker for the purpose of calculating compensation
under this chapter shall be the usual wage paid at the time of injury or death
for similar services performed by paid employees;
(13) a member of the military forces, as defined in
section 190.05, while in state active service, as defined in section 190.05,
subdivision 5a. The daily wage of the
member for the purpose of calculating compensation under this chapter shall be
based on the member's usual earnings in civil life. If there is no evidence of previous
occupation or earning, the trier of fact shall consider the member's earnings
as a member of the military forces;
(14) a voluntary uncompensated worker, accepted by the
director of the Minnesota Historical Society, rendering services as a
volunteer, pursuant to chapter 138. The
daily wage of the worker, for the purposes of calculating compensation under
this chapter, shall be the usual wage paid at the time of injury or death for
similar services performed by paid employees;
(15) a voluntary uncompensated worker, other than a
student, who renders services at the Minnesota State Academy for the Deaf or
the Minnesota State Academy for the Blind, and whose services have been
accepted or contracted for by the commissioner of education, as authorized by
law. In the event of injury or death of
the worker, the daily wage of the worker, for the purpose of calculating
compensation under this chapter, shall be the usual wage paid at the time of
the injury or death for similar services performed in institutions by paid
employees;
(16) a voluntary uncompensated worker, other than a
resident of the veterans home, who renders services at a Minnesota veterans
home, and whose services have been accepted or contracted for by the
commissioner of veterans affairs, as authorized by law. In the event of injury or death of the
worker, the daily wage of the worker, for the purpose of calculating
compensation under this chapter, shall be the usual wage paid at the time of
the injury or death for similar services performed in institutions by paid
employees;
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(17) a
worker performing services under section 256B.0655 256B.0659 for
a recipient in the home of the recipient or in the community under section
256B.0625, subdivision 19a, who is paid from government funds through a fiscal
intermediary under section 256B.0655, subdivision 7 256B.0659,
subdivision 33. For purposes of
maintaining workers' compensation insurance, the employer of the worker is as
designated in law by the commissioner of the Department of Human Services,
notwithstanding any other law to the contrary;
(18) students
enrolled in and regularly attending the Medical School of the University of
Minnesota in the graduate school program or the postgraduate program. The students shall not be considered
employees for any other purpose. In the
event of the student's injury or death, the weekly wage of the student for the
purpose of calculating compensation under this chapter, shall be the annualized
educational stipend awarded to the student, divided by 52 weeks. The institution in which the student is
enrolled shall be considered the "employer" for the limited purpose
of determining responsibility for paying benefits under this chapter;
(19) a
faculty member of the University of Minnesota employed for an academic year is
also an employee for the period between that academic year and the succeeding
academic year if:
(a) the
member has a contract or reasonable assurance of a contract from the University
of Minnesota for the succeeding academic year; and
(b) the
personal injury for which compensation is sought arises out of and in the
course of activities related to the faculty member's employment by the
University of Minnesota;
(20) a
worker who performs volunteer ambulance driver or attendant services is an
employee of the political subdivision, nonprofit hospital, nonprofit
corporation, or other entity for which the worker performs the services. The daily wage of the worker for the purpose
of calculating compensation under this chapter shall be the usual wage paid at
the time of injury or death for similar services performed by paid employees;
(21) a
voluntary uncompensated worker, accepted by the commissioner of administration,
rendering services as a volunteer at the Department of Administration. In the event of injury or death of the
worker, the daily wage of the worker, for the purpose of calculating
compensation under this chapter, shall be the usual wage paid at the time of
the injury or death for similar services performed in institutions by paid
employees;
(22) a
voluntary uncompensated worker rendering service directly to the Pollution
Control Agency. The daily wage of the
worker for the purpose of calculating compensation payable under this chapter
is the usual going wage paid at the time of injury or death for similar
services if the services are performed by paid employees;
(23) a
voluntary uncompensated worker while volunteering services as a first responder
or as a member of a law enforcement assistance organization while acting under
the supervision and authority of a political subdivision. The daily wage of the worker for the purpose
of calculating compensation payable under this chapter is the usual going wage
paid at the time of injury or death for similar services if the services are
performed by paid employees;
(24) a
voluntary uncompensated member of the civil air patrol rendering service on the
request and under the authority of the state or any of its political
subdivisions. The daily wage of the
member for the purposes of calculating compensation payable under this chapter
is the usual going wage paid at the time of injury or death for similar
services if the services are performed by paid employees; and
(25) a
Minnesota Responds Medical Reserve Corps volunteer, as provided in sections
145A.04 and 145A.06, responding at the request of or engaged in training
conducted by the commissioner of health.
The daily wage of the volunteer for the purposes of calculating
compensation payable under this chapter is established in section 145A.06. A person who qualifies under this clause and
who may also qualify under another clause of this subdivision shall receive
benefits in accordance with this clause.
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If it is
difficult to determine the daily wage as provided in this subdivision, the
trier of fact may determine the wage upon which the compensation is payable.
Sec.
3. Minnesota Statutes 2008, section
245C.03, subdivision 2, is amended to read:
Subd.
2. Personal
care provider organizations. The
commissioner shall conduct background studies on any individual required under
sections 256B.0651 and 256B.0653 to 256B.0656 and 256B.0659 to
have a background study completed under this chapter.
Sec.
4. Minnesota Statutes 2008, section
245C.04, subdivision 3, is amended to read:
Subd.
3. Personal
care provider organizations. (a) The
commissioner shall conduct a background study of an individual required to be
studied under section 245C.03, subdivision 2, at least upon application for
initial enrollment under sections 256B.0651 and 256B.0653 to 256B.0656
and 256B.0659.
(b)
Organizations required to initiate background studies under sections 256B.0651 and
256B.0653 to 256B.0656 and 256B.0659 for individuals described in
section 245C.03, subdivision 2, must submit a completed background study form
to the commissioner before those individuals begin a position allowing direct
contact with persons served by the organization.
Sec.
5. Minnesota Statutes 2008, section
245C.10, subdivision 3, is amended to read:
Subd.
3. Personal
care provider organizations. The
commissioner shall recover the cost of background studies initiated by a
personal care provider organization under sections 256B.0651 and 256B.0653
to 256B.0656 and 256B.0659 through a fee of no more than $20 per study
charged to the organization responsible for submitting the background study
form. The fees collected under this
subdivision are appropriated to the commissioner for the purpose of conducting
background studies.
Sec.
6. Minnesota Statutes 2008, section
256B.04, subdivision 16, is amended to read:
Subd.
16. Personal
care services. (a) Notwithstanding
any contrary language in this paragraph, the commissioner of human services and
the commissioner of health shall jointly promulgate rules to be applied to the
licensure of personal care services provided under the medical assistance
program. The rules shall consider
standards for personal care services that are based on the World Institute on
Disability's recommendations regarding personal care services. These rules shall at a minimum consider the
standards and requirements adopted by the commissioner of health under section
144A.45, which the commissioner of human services determines are applicable to
the provision of personal care services, in addition to other standards or
modifications which the commissioner of human services determines are
appropriate.
The
commissioner of human services shall establish an advisory group including
personal care consumers and providers to provide advice regarding which
standards or modifications should be adopted.
The advisory group membership must include not less than 15 members, of
which at least 60 percent must be consumers of personal care services and
representatives of recipients with various disabilities and diagnoses and
ages. At least 51 percent of the members
of the advisory group must be recipients of personal care.
The
commissioner of human services may contract with the commissioner of health to
enforce the jointly promulgated licensure rules for personal care service
providers.
Prior to
final promulgation of the joint rule the commissioner of human services shall
report preliminary findings along with any comments of the advisory group and a
plan for monitoring and enforcement by the Department of Health to the
legislature by February 15, 1992.
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Limits on the extent of personal care services that
may be provided to an individual must be based on the cost-effectiveness of the
services in relation to the costs of inpatient hospital care, nursing home
care, and other available types of care.
The rules must provide, at a minimum:
(1) that agencies be selected to contract with or
employ and train staff to provide and supervise the provision of personal care
services;
(2) that agencies employ or contract with a qualified applicant
that a qualified recipient proposes to the agency as the recipient's choice of
assistant;
(3) that agencies bill the medical assistance program
for a personal care service by a personal care assistant and supervision by a
qualified professional supervising the personal care assistant unless the
recipient selects the fiscal agent option under section 256B.0655,
subdivision 7 256B.0659, subdivision 33;
(4) that agencies establish a grievance mechanism; and
(5) that agencies have a quality assurance program.
(b) The commissioner may waive the requirement for the
provision of personal care services through an agency in a particular county,
when there are less than two agencies providing services in that county and
shall waive the requirement for personal care assistants required to join an
agency for the first time during 1993 when personal care services are provided
under a relative hardship waiver under Minnesota Statutes 1992, section
256B.0627, subdivision 4, paragraph (b), clause (7), and at least two agencies
providing personal care services have refused to employ or contract with the
independent personal care assistant.
Sec. 7.
Minnesota Statutes 2008, section 256B.055, subdivision 12, is amended to
read:
Subd. 12. Disabled children. (a) A person is eligible for medical
assistance if the person is under age 19 and qualifies as a disabled individual
under United States Code, title 42, section 1382c(a), and would be eligible for
medical assistance under the state plan if residing in a medical institution,
and the child requires a level of care provided in a hospital, nursing
facility, or intermediate care facility for persons with developmental
disabilities, for whom home care is appropriate, provided that the cost to
medical assistance under this section is not more than the amount that medical
assistance would pay for if the child resides in an institution. After the child is determined to be eligible
under this section, the commissioner shall review the child's disability under
United States Code, title 42, section 1382c(a) and level of care defined under
this section no more often than annually and may elect, based on the
recommendation of health care professionals under contract with the state
medical review team, to extend the review of disability and level of care up to
a maximum of four years. The
commissioner's decision on the frequency of continuing review of disability and
level of care is not subject to administrative appeal under section
256.045. The county agency shall send a
notice of disability review to the enrollee six months prior to the date the
recertification of disability is due.
Nothing in this subdivision shall be construed as affecting other
redeterminations of medical assistance eligibility under this chapter and
annual cost-effective reviews under this section.
(b) For purposes of this subdivision,
"hospital" means an institution as defined in section 144.696,
subdivision 3, 144.55, subdivision 3, or Minnesota Rules, part 4640.3600, and
licensed pursuant to sections 144.50 to 144.58.
For purposes of this subdivision, a child requires a level of care
provided in a hospital if the child is determined by the commissioner to need
an extensive array of health services, including mental health services, for an
undetermined period of time, whose health condition requires frequent
monitoring and treatment by a health care professional or by a person
supervised by a health care professional, who would reside in a hospital or
require frequent hospitalization if these services were not provided, and the
daily care needs are more complex than a nursing facility level of care.
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A child with serious emotional disturbance requires a
level of care provided in a hospital if the commissioner determines that the
individual requires 24-hour supervision because the person exhibits recurrent
or frequent suicidal or homicidal ideation or behavior, recurrent or frequent
psychosomatic disorders or somatopsychic disorders that may become life
threatening, recurrent or frequent severe socially unacceptable behavior
associated with psychiatric disorder, ongoing and chronic psychosis or severe,
ongoing and chronic developmental problems requiring continuous skilled
observation, or severe disabling symptoms for which office-centered outpatient
treatment is not adequate, and which overall severely impact the individual's
ability to function.
(c) For purposes of this subdivision, "nursing
facility" means a facility which provides nursing care as defined in
section 144A.01, subdivision 5, licensed pursuant to sections 144A.02 to 144A.10,
which is appropriate if a person is in active restorative treatment; is in need
of special treatments provided or supervised by a licensed nurse; or has
unpredictable episodes of active disease processes requiring immediate judgment
by a licensed nurse. For purposes of
this subdivision, a child requires the level of care provided in a nursing
facility if the child is determined by the commissioner to meet the
requirements of the preadmission screening assessment document under section
256B.0911 and the home care independent rating document under section
256B.0655, subdivision 4, clause (3), adjusted to address age-appropriate
standards for children age 18 and under, pursuant to section 256B.0655,
subdivision 3.
(d) For purposes of this subdivision,
"intermediate care facility for persons with developmental
disabilities" or "ICF/MR" means a program licensed to provide
services to persons with developmental disabilities under section 252.28, and
chapter 245A, and a physical plant licensed as a supervised living facility
under chapter 144, which together are certified by the Minnesota Department of
Health as meeting the standards in Code of Federal Regulations, title 42, part
483, for an intermediate care facility which provides services for persons with
developmental disabilities who require 24-hour supervision and active treatment
for medical, behavioral, or habilitation needs.
For purposes of this subdivision, a child requires a level of care
provided in an ICF/MR if the commissioner finds that the child has a
developmental disability in accordance with section 256B.092, is in need of a
24-hour plan of care and active treatment similar to persons with developmental
disabilities, and there is a reasonable indication that the child will need
ICF/MR services.
(e) For purposes of this subdivision, a person requires
the level of care provided in a nursing facility if the person requires 24-hour
monitoring or supervision and a plan of mental health treatment because of
specific symptoms or functional impairments associated with a serious mental
illness or disorder diagnosis, which meet severity criteria for mental health
established by the commissioner and published in March 1997 as the Minnesota
Mental Health Level of Care for Children and Adolescents with Severe Emotional
Disorders.
(f) The determination of the level of care needed by
the child shall be made by the commissioner based on information supplied to
the commissioner by the parent or guardian, the child's physician or
physicians, and other professionals as requested by the commissioner. The commissioner shall establish a screening
team to conduct the level of care determinations according to this subdivision.
(g) If a child meets the conditions in paragraph (b),
(c), (d), or (e), the commissioner must assess the case to determine whether:
(1) the child qualifies as a disabled individual under
United States Code, title 42, section 1382c(a), and would be eligible for
medical assistance if residing in a medical institution; and
(2) the cost of medical assistance services for the
child, if eligible under this subdivision, would not be more than the cost to
medical assistance if the child resides in a medical institution to be
determined as follows:
(i) for a child who requires a level of care provided
in an ICF/MR, the cost of care for the child in an institution shall be
determined using the average payment rate established for the regional
treatment centers that are certified as ICF's/MR;
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(ii) for a child who requires a level of care provided
in an inpatient hospital setting according to paragraph (b), cost-effectiveness
shall be determined according to Minnesota Rules, part 9505.3520, items F and
G; and
(iii) for a child who requires a level of care
provided in a nursing facility according to paragraph (c) or (e),
cost-effectiveness shall be determined according to Minnesota Rules, part
9505.3040, except that the nursing facility average rate shall be adjusted to
reflect rates which would be paid for children under age 16. The commissioner may authorize an amount up
to the amount medical assistance would pay for a child referred to the commissioner
by the preadmission screening team under section 256B.0911.
(h) Children eligible for medical assistance services
under section 256B.055, subdivision 12, as of June 30, 1995, must be screened according
to the criteria in this subdivision prior to January 1, 1996. Children found to be ineligible may not be
removed from the program until January 1, 1996.
Sec. 8.
Minnesota Statutes 2008, section 256B.0621, subdivision 2, is amended to
read:
Subd. 2. Targeted case management; definitions. For purposes of subdivisions 3 to 10, the
following terms have the meanings given them:
(1) "home care service recipients" means
those individuals receiving the following services under sections 256B.0651 to
256B.0656 and 256B.0659: skilled
nursing visits, home health aide visits, private duty nursing, personal care
assistants, or therapies provided through a home health agency;
(2) "home care targeted case management"
means the provision of targeted case management services for the purpose of
assisting home care service recipients to gain access to needed services and
supports so that they may remain in the community;
(3) "institutions" means hospitals,
consistent with Code of Federal Regulations, title 42, section 440.10; regional
treatment center inpatient services, consistent with section 245.474; nursing
facilities; and intermediate care facilities for persons with developmental
disabilities;
(4) "relocation targeted case management"
includes the provision of both county targeted case management and public or
private vendor service coordination services for the purpose of assisting
recipients to gain access to needed services and supports if they choose to
move from an institution to the community.
Relocation targeted case management may be provided during the lesser
of:
(i) the last 180 consecutive days of an eligible
recipient's institutional stay; or
(ii) the limits and conditions which apply to federal
Medicaid funding for this service; and
(5) "targeted case management" means case
management services provided to help recipients gain access to needed medical,
social, educational, and other services and supports.
Sec. 9.
Minnesota Statutes 2008, section 256B.0652, subdivision 3, is amended to
read:
Subd. 3. Assessment and prior authorization process. Effective January 1, 1996, for purposes of
providing informed choice, coordinating of local planning decisions, and
streamlining administrative requirements, the assessment and prior
authorization process for persons receiving both home care and home and
community-based waivered services for persons with developmental disabilities
shall meet the requirements of sections 256B.0651 and 256B.0653 to
256B.0656 and 256B.0659 with the following exceptions:
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(a) Upon request for home care services and subsequent
assessment by the public health nurse under sections 256B.0651 and 256B.0653
to 256B.0656 and 256B.0659, the public health nurse shall participate in
the screening process, as appropriate, and, if home care services are
determined to be necessary, participate in the development of a service plan
coordinating the need for home care and home and community-based waivered
services with the assigned county case manager, the recipient of services, and
the recipient's legal representative, if any.
(b) The public health nurse shall give prior
authorization for home care services to the extent that home care services are:
(1) medically necessary;
(2) chosen by the recipient and their legal
representative, if any, from the array of home care and home and
community-based waivered services available;
(3) coordinated with other services to be received by
the recipient as described in the service plan; and
(4) provided within the county's reimbursement limits
for home care and home and community-based waivered services for persons with
developmental disabilities.
(c) If the public health agency is or may be the
provider of home care services to the recipient, the public health agency shall
provide the commissioner of human services with a written plan that specifies
how the assessment and prior authorization process will be held separate and
distinct from the provision of services.
Sec. 10.
Minnesota Statutes 2008, section 256B.0657, subdivision 2, is amended to
read:
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.055, 256B.056, and 256B.057, subdivision 9;
(2) is eligible for personal care assistant services
under section 256B.0655 256B.0659;
(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 year; and
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(3) when the department determines that the recipient
cannot manage recipient responsibilities under the program.
Sec. 11.
Minnesota Statutes 2008, section 256B.0657, subdivision 6, is amended to
read:
Subd. 6. Services covered. (a) Services covered under the self-directed
supports option include:
(1) personal care assistant services under section 256B.0655
256B.0659; and
(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 144A.43.
Sec. 12.
Minnesota Statutes 2008, section 256B.0657, subdivision 8, is amended to
read:
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 256B.0655 256B.0659 that the 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.
Sec. 13.
Minnesota Statutes 2008, section 256B.49, subdivision 17, is amended to
read:
Subd. 17. Cost of services and supports. (a) The commissioner shall ensure that the
average per capita expenditures estimated in any fiscal year for home and
community-based waiver recipients does not exceed the average per capita
expenditures that would have been made to provide institutional services for
recipients in the absence of the waiver.
(b) The commissioner shall implement on January 1,
2002, one or more aggregate, need-based methods for allocating to local
agencies the home and community-based waivered service resources available to
support recipients with disabilities in need of the level of care provided in a
nursing facility or a hospital. The
commissioner shall allocate resources to single counties and county
partnerships in a manner that reflects consideration of:
(1) an incentive-based payment process for achieving
outcomes;
(2) the need for a state-level risk pool;
(3) the need for retention of management responsibility
at the state agency level; and
(4) a phase-in strategy as appropriate.
(c) Until the allocation methods described in paragraph
(b) are implemented, the annual allowable reimbursement level of home and
community-based waiver services shall be the greater of:
(1) the statewide average payment amount which the
recipient is assigned under the waiver reimbursement system in place on June
30, 2001, modified by the percentage of any provider rate increase appropriated
for home and community-based services; or
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(2) an
amount approved by the commissioner based on the recipient's extraordinary
needs that cannot be met within the current allowable reimbursement level. The increased reimbursement level must be
necessary to allow the recipient to be discharged from an institution or to
prevent imminent placement in an institution.
The additional reimbursement may be used to secure environmental
modifications; assistive technology and equipment; and increased costs for
supervision, training, and support services necessary to address the
recipient's extraordinary needs. The
commissioner may approve an increased reimbursement level for up to one year of
the recipient's relocation from an institution or up to six months of a
determination that a current waiver recipient is at imminent risk of being
placed in an institution.
(d)
Beginning July 1, 2001, medically necessary private duty nursing services will
be authorized under this section as complex and regular care according to
sections 256B.0651 and 256B.0653 to 256B.0656 and 256B.0659. The rate established by the commissioner for
registered nurse or licensed practical nurse services under any home and
community-based waiver as of January 1, 2001, shall not be reduced.
Sec.
14. Minnesota Statutes 2008, section
256B.501, subdivision 4a, is amended to read:
Subd.
4a. Inclusion
of home care costs in waiver rates.
The commissioner shall adjust the limits of the established average
daily reimbursement rates for waivered services to include the cost of home
care services that may be provided to waivered services recipients. This adjustment must be used to maintain or
increase services and shall not be used by county agencies for inflation
increases for waivered services vendors.
Home care services referenced in this section are those listed in
section 256B.0651, subdivision 2. The
average daily reimbursement rates established in accordance with the provisions
of this subdivision apply only to the combined average, daily costs of waivered
and home care services and do not change home care limitations under sections
256B.0651 and 256B.0653 to 256B.0656 and 256B.0659. Waivered services recipients receiving home
care as of June 30, 1992, shall not have the amount of their services reduced
as a result of this section.
Sec.
15. Minnesota Statutes 2008, section
256G.02, subdivision 6, is amended to read:
Subd.
6. Excluded
time. "Excluded time"
means:
(a) any
period an applicant spends in a hospital, sanitarium, nursing home, shelter
other than an emergency shelter, halfway house, foster home, semi-independent
living domicile or services program, residential facility offering care, board
and lodging facility or other institution for the hospitalization or care of
human beings, as defined in section 144.50, 144A.01, or 245A.02, subdivision
14; maternity home, battered women's shelter, or correctional facility; or any
facility based on an emergency hold under sections 253B.05, subdivisions 1 and
2, and 253B.07, subdivision 6;
(b) any
period an applicant spends on a placement basis in a training and habilitation
program, including a rehabilitation facility or work or employment program as defined
in section 268A.01; or receiving personal care assistant services pursuant to
section 256B.0655, subdivision 2 256B.0659; semi-independent
living services provided under section 252.275, and Minnesota Rules, parts
9525.0500 to 9525.0660; day training and habilitation programs and assisted
living services; and
(c) any
placement for a person with an indeterminate commitment, including independent
living.
Sec.
16. Minnesota Statutes 2008, section
256I.05, subdivision 1a, is amended to read:
Subd.
1a. Supplementary
service rates. (a) Subject to the
provisions of section 256I.04, subdivision 3, the county agency may negotiate a
payment not to exceed $426.37 for other services necessary to provide room and
board provided by the group residence if the residence is licensed by or
registered by the Department of Health, or licensed by the Department of Human
Services to provide services in addition to room and board, and if the provider
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of
services is not also concurrently receiving funding for services for a
recipient under a home and community-based waiver under title XIX of the Social
Security Act; or funding from the medical assistance program under section 256B.0655,
subdivision 2 256B.0659, for personal care services for residents in
the setting; or residing in a setting which receives funding under Minnesota
Rules, parts 9535.2000 to 9535.3000. If
funding is available for other necessary services through a home and
community-based waiver, or personal care services under section 256B.0655,
subdivision 2 256B.0659, then the GRH rate is limited to the rate
set in subdivision 1. Unless otherwise
provided in law, in no case may the supplementary service rate exceed
$426.37. The registration and licensure
requirement does not apply to establishments which are exempt from state
licensure because they are located on Indian reservations and for which the tribe
has prescribed health and safety requirements.
Service payments under this section may be prohibited under rules to
prevent the supplanting of federal funds with state funds. The commissioner shall pursue the feasibility
of obtaining the approval of the Secretary of Health and Human Services to
provide home and community-based waiver services under title XIX of the Social
Security Act for residents who are not eligible for an existing home and
community-based waiver due to a primary diagnosis of mental illness or chemical
dependency and shall apply for a waiver if it is determined to be
cost-effective.
(b) The
commissioner is authorized to make cost-neutral transfers from the GRH fund for
beds under this section to other funding programs administered by the
department after consultation with the county or counties in which the affected
beds are located. The commissioner may
also make cost-neutral transfers from the GRH fund to county human service
agencies for beds permanently removed from the GRH census under a plan
submitted by the county agency and approved by the commissioner. The commissioner shall report the amount of
any transfers under this provision annually to the legislature.
(c) The
provisions of paragraph (b) do not apply to a facility that has its
reimbursement rate established under section 256B.431, subdivision 4, paragraph
(c).
Sec.
17. Minnesota Statutes 2008, section
256J.45, subdivision 3, is amended to read:
Subd.
3. Good
cause exemptions for not attending orientation. (a) The county agency shall not impose the
sanction under section 256J.46 if it determines that the participant has good
cause for failing to attend orientation.
Good cause exists when:
(1)
appropriate child care is not available;
(2) the
participant is ill or injured;
(3) a
family member is ill and needs care by the participant that prevents the
participant from attending orientation.
For a caregiver with a child or adult in the household who meets the
disability or medical criteria for home care services under section 256B.0655,
subdivision 1c 256B.0659, or a home and community-based waiver
services program under chapter 256B, or meets the criteria for severe emotional
disturbance under section 245.4871, subdivision 6, or for serious and
persistent mental illness under section 245.462, subdivision 20, paragraph (c),
good cause also exists when an interruption in the provision of those services
occurs which prevents the participant from attending orientation;
(4) the
caregiver is unable to secure necessary transportation;
(5) the
caregiver is in an emergency situation that prevents orientation attendance;
(6) the
orientation conflicts with the caregiver's work, training, or school schedule;
or
(7) the
caregiver documents other verifiable impediments to orientation attendance
beyond the caregiver's control.
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(b)
Counties must work with clients to provide child care and transportation
necessary to ensure a caregiver has every opportunity to attend orientation.
Sec.
18. Minnesota Statutes 2008, section
604A.33, subdivision 1, is amended to read:
Subdivision
1. Application. This section applies to residential treatment
programs for children or group homes for children licensed under chapter 245A,
residential services and programs for juveniles licensed under section 241.021,
providers licensed pursuant to sections 144A.01 to 144A.33 or sections 144A.43
to 144A.47, personal care provider organizations under section 256B.0655,
subdivision 1g 256B.0659, providers of day training and habilitation
services under sections 252.40 to 252.46, board and lodging facilities licensed
under chapter 157, intermediate care facilities for persons with developmental
disabilities, and other facilities licensed to provide residential services to
persons with developmental disabilities.
Sec.
19. Minnesota Statutes 2008, section 609.232,
subdivision 11, is amended to read:
Subd.
11. Vulnerable
adult. "Vulnerable adult"
means any person 18 years of age or older who:
(1) is a
resident inpatient of a facility;
(2)
receives services at or from a facility required to be licensed to serve adults
under sections 245A.01 to 245A.15, except that a person receiving outpatient
services for treatment of chemical dependency or mental illness, or one who is
committed as a sexual psychopathic personality or as a sexually dangerous
person under chapter 253B, is not considered a vulnerable adult unless the
person meets the requirements of clause (4);
(3)
receives services from a home care provider required to be licensed under
section 144A.46; or from a person or organization that exclusively offers,
provides, or arranges for personal care assistant services under the medical
assistance program as authorized under sections 256B.04, subdivision 16,
256B.0625, subdivision 19a, 256B.0651, and 256B.0653 to 256B.0656 and
256B.0659; or
(4)
regardless of residence or whether any type of service is received, possesses a
physical or mental infirmity or other physical, mental, or emotional
dysfunction:
(i) that
impairs the individual's ability to provide adequately for the individual's own
care without assistance, including the provision of food, shelter, clothing,
health care, or supervision; and
(ii)
because of the dysfunction or infirmity and the need for assistance, the
individual has an impaired ability to protect the individual from maltreatment.
Sec.
20. Minnesota Statutes 2008, section
626.5572, subdivision 6, is amended to read:
Subd.
6. Facility. (a) "Facility" means a hospital or
other entity required to be licensed under sections 144.50 to 144.58; a nursing
home required to be licensed to serve adults under section 144A.02; a
residential or nonresidential facility required to be licensed to serve adults
under sections 245A.01 to 245A.16; a home care provider licensed or required to
be licensed under section 144A.46; a hospice provider licensed under sections
144A.75 to 144A.755; or a person or organization that exclusively offers,
provides, or arranges for personal care assistant services under the medical
assistance program as authorized under sections 256B.04, subdivision 16,
256B.0625, subdivision 19a, 256B.0651, and 256B.0653 to 256B.0656,
and 256B.0659.
(b) For
home care providers and personal care attendants, the term "facility"
refers to the provider or person or organization that exclusively offers,
provides, or arranges for personal care services, and does not refer to the
client's home or other location at which services are rendered.
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Sec. 21.
Minnesota Statutes 2008, section 626.5572, subdivision 21, is amended to
read:
Subd. 21. Vulnerable adult. "Vulnerable adult" means any person
18 years of age or older who:
(1) is a resident or inpatient of a facility;
(2) receives services at or from a facility required
to be licensed to serve adults under sections 245A.01 to 245A.15, except that a
person receiving outpatient services for treatment of chemical dependency or
mental illness, or one who is served in the Minnesota sex offender program on a
court-hold order for commitment, or is committed as a sexual psychopathic
personality or as a sexually dangerous person under chapter 253B, is not
considered a vulnerable adult unless the person meets the requirements of
clause (4);
(3) receives services from a home care provider
required to be licensed under section 144A.46; or from a person or organization
that exclusively offers, provides, or arranges for personal care assistant
services under the medical assistance program as authorized under sections
256B.04, subdivision 16, 256B.0625, subdivision 19a, 256B.0651, and
256B.0653 to 256B.0656, and 256B.0659; or
(4) regardless of residence or whether any type of
service is received, possesses a physical or mental infirmity or other physical,
mental, or emotional dysfunction:
(i) that impairs the individual's ability to provide
adequately for the individual's own care without assistance, including the
provision of food, shelter, clothing, health care, or supervision; and
(ii) because of the dysfunction or infirmity and the
need for assistance, the individual has an impaired ability to protect the
individual from maltreatment.
ARTICLE 7
CHEMICAL AND MENTAL HEALTH
Section 1.
Minnesota Statutes 2008, section 245.462, subdivision 18, is amended to
read:
Subd. 18. Mental health professional. "Mental health professional" means
a person providing clinical services in the treatment of mental illness who is
qualified in at least one of the following ways:
(1) in psychiatric nursing: a registered nurse who is licensed under
sections 148.171 to 148.285; and:
(i) who is certified as a clinical specialist or as a
nurse practitioner in adult or family psychiatric and mental health nursing by
a national nurse certification organization; or
(ii) who has a master's degree in nursing or one of
the behavioral sciences or related fields from an accredited college or
university or its equivalent, with at least 4,000 hours of post-master's
supervised experience in the delivery of clinical services in the treatment of
mental illness;
(2) in clinical social work: a person licensed as an independent clinical
social worker under chapter 148D, or a person with a master's degree in social
work from an accredited college or university, with at least 4,000 hours of
post-master's supervised experience in the delivery of clinical services in the
treatment of mental illness;
(3) in psychology:
an individual licensed by the Board of Psychology under sections 148.88
to 148.98 who has stated to the Board of Psychology competencies in the
diagnosis and treatment of mental illness;
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(4) in
psychiatry: a physician licensed under
chapter 147 and certified by the American Board of Psychiatry and Neurology or
eligible for board certification in psychiatry;
(5) in
marriage and family therapy: the mental
health professional must be a marriage and family therapist licensed under
sections 148B.29 to 148B.39 with at least two years of post-master's supervised
experience in the delivery of clinical services in the treatment of mental
illness; or
(6) in
licensed professional clinical counseling, the mental health professional shall
be a licensed professional clinical counselor under section 148B.5301 with at
least 4,000 hours of postmaster's supervised experience in the delivery of
clinical services in the treatment of mental illness; or
(7) in allied fields:
a person with a master's degree from an accredited college or university
in one of the behavioral sciences or related fields, with at least 4,000 hours
of post-master's supervised experience in the delivery of clinical services in
the treatment of mental illness.
Sec.
2. Minnesota Statutes 2008, section
245.470, subdivision 1, is amended to read:
Subdivision
1. Availability
of outpatient services. (a) County
boards must provide or contract for enough outpatient services within the
county to meet the needs of adults with mental illness residing in the
county. Services may be provided
directly by the county through county-operated mental health centers or mental
health clinics approved by the commissioner under section 245.69, subdivision
2; by contract with privately operated mental health centers or mental health
clinics approved by the commissioner under section 245.69, subdivision 2; by
contract with hospital mental health outpatient programs certified by the Joint
Commission on Accreditation of Hospital Organizations; or by contract with a
licensed mental health professional as defined in section 245.462, subdivision
18, clauses (1) to (4) (6).
Clients may be required to pay a fee according to section 245.481. Outpatient services include:
(1)
conducting diagnostic assessments;
(2)
conducting psychological testing;
(3)
developing or modifying individual treatment plans;
(4)
making referrals and recommending placements as appropriate;
(5) treating
an adult's mental health needs through therapy;
(6)
prescribing and managing medication and evaluating the effectiveness of
prescribed medication; and
(7)
preventing placement in settings that are more intensive, costly, or
restrictive than necessary and appropriate to meet client needs.
(b)
County boards may request a waiver allowing outpatient services to be provided
in a nearby trade area if it is determined that the client can best be served
outside the county.
Sec.
3. Minnesota Statutes 2008, section
245.4871, subdivision 27, is amended to read:
Subd.
27. Mental
health professional. "Mental
health professional" means a person providing clinical services in the
diagnosis and treatment of children's emotional disorders. A mental health professional must have
training and experience in working with children consistent with the age group
to which the mental health professional is assigned. A mental health professional must be
qualified in at least one of the following ways:
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(1) in
psychiatric nursing, the mental health professional must be a registered nurse
who is licensed under sections 148.171 to 148.285 and who is certified as a
clinical specialist in child and adolescent psychiatric or mental health
nursing by a national nurse certification organization or who has a master's
degree in nursing or one of the behavioral sciences or related fields from an
accredited college or university or its equivalent, with at least 4,000 hours
of post-master's supervised experience in the delivery of clinical services in
the treatment of mental illness;
(2) in
clinical social work, the mental health professional must be a person licensed
as an independent clinical social worker under chapter 148D, or a person with a
master's degree in social work from an accredited college or university, with
at least 4,000 hours of post-master's supervised experience in the delivery of
clinical services in the treatment of mental disorders;
(3) in
psychology, the mental health professional must be an individual licensed by
the board of psychology under sections 148.88 to 148.98 who has stated to the
board of psychology competencies in the diagnosis and treatment of mental
disorders;
(4) in
psychiatry, the mental health professional must be a physician licensed under
chapter 147 and certified by the American board of psychiatry and neurology or
eligible for board certification in psychiatry;
(5) in
marriage and family therapy, the mental health professional must be a marriage
and family therapist licensed under sections 148B.29 to 148B.39 with at least
two years of post-master's supervised experience in the delivery of clinical
services in the treatment of mental disorders or emotional disturbances; or
(6) in
licensed professional clinical counseling, the mental health professional shall
be a licensed professional clinical counselor under section 148B.5301 with at
least 4,000 hours of postmaster's supervised experience in the delivery of
clinical services in the treatment of mental disorders or emotional
disturbances; or
(7) in allied fields, the mental health professional must
be a person with a master's degree from an accredited college or university in
one of the behavioral sciences or related fields, with at least 4,000 hours of
post-master's supervised experience in the delivery of clinical services in the
treatment of emotional disturbances.
Sec.
4. Minnesota Statutes 2008, section
245.488, subdivision 1, is amended to read:
Subdivision
1. Availability
of outpatient services. (a) County
boards must provide or contract for enough outpatient services within the
county to meet the needs of each child with emotional disturbance residing in
the county and the child's family.
Services may be provided directly by the county through county-operated
mental health centers or mental health clinics approved by the commissioner
under section 245.69, subdivision 2; by contract with privately operated mental
health centers or mental health clinics approved by the commissioner under
section 245.69, subdivision 2; by contract with hospital mental health
outpatient programs certified by the Joint Commission on Accreditation of
Hospital Organizations; or by contract with a licensed mental health
professional as defined in section 245.4871, subdivision 27, clauses (1) to (4)
(6). A child or a child's parent may
be required to pay a fee based in accordance with section 245.481. Outpatient services include:
(1)
conducting diagnostic assessments;
(2)
conducting psychological testing;
(3)
developing or modifying individual treatment plans;
(4)
making referrals and recommending placements as appropriate;
(5)
treating the child's mental health needs through therapy; and
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(6) prescribing and managing medication and evaluating
the effectiveness of prescribed medication.
(b) County boards may request a waiver allowing
outpatient services to be provided in a nearby trade area if it is determined
that the child requires necessary and appropriate services that are only
available outside the county.
(c) Outpatient services offered by the county board to
prevent placement must be at the level of treatment appropriate to the child's
diagnostic assessment.
Sec. 5.
Minnesota Statutes 2008, section 254A.02, is amended by adding a
subdivision to read:
Subd. 8a.
Placing authority. "Placing authority" means a
county, prepaid health plan, or tribal governing board governed by Minnesota Rules,
parts 9530.6600 to 9530.6655.
Sec. 6.
Minnesota Statutes 2008, section 254A.16, is amended by adding a
subdivision to read:
Subd. 6.
Monitoring. The commissioner shall gather and placing
authorities shall provide information to measure compliance with Minnesota
Rules, parts 9530.6600 to 9530.6655. The
commissioner shall specify the format for data collection to facilitate
tracking, aggregating, and using the information.
Sec. 7.
Minnesota Statutes 2008, section 254B.03, subdivision 1, is amended to
read:
Subdivision 1. Local agency duties. (a) Every local agency shall provide chemical
dependency services to persons residing within its jurisdiction who meet
criteria established by the commissioner for placement in a chemical dependency
residential or nonresidential treatment service. Chemical dependency money must be
administered by the local agencies according to law and rules adopted by the
commissioner under sections 14.001 to 14.69.
(b) In order to contain costs, the county board
shall, with the approval of the commissioner of human services, shall
select eligible vendors of chemical dependency services who can provide
economical and appropriate treatment.
Unless the local agency is a social services department directly
administered by a county or human services board, the local agency shall not be
an eligible vendor under section 254B.05.
The commissioner may approve proposals from county boards to provide
services in an economical manner or to control utilization, with safeguards to ensure
that necessary services are provided. If
a county implements a demonstration or experimental medical services funding
plan, the commissioner shall transfer the money as appropriate. If a county selects a vendor located in
another state, the county shall ensure that the vendor is in compliance with
the rules governing licensure of programs located in the state.
(c) A culturally specific vendor that provides
assessments under a variance under Minnesota Rules, part 9530.6610, shall be
allowed to provide assessment services to persons not covered by the variance.
EFFECTIVE DATE.
This section is effective July 1, 2011.
Sec. 8.
Minnesota Statutes 2008, section 254B.03, subdivision 3, is amended to
read:
Subd. 3. Local agencies to pay state for county
share. Local agencies shall pay the
state for the county share of the services authorized by the local agency,
except when the payment is made according to section 254B.09, subdivision 8.
Sec. 9.
Minnesota Statutes 2008, section 254B.03, is amended by adding a
subdivision to read:
Subd. 9.
Commissioner to select vendors
and set rates. (a) Effective
July 1, 2011, the commissioner shall:
(1) enter into agreements with
eligible vendors that:
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(i)
meet the standards in section 254B.05, subdivision 1;
(ii)
have good standing in all applicable licensure; and
(iii)
have a current approved provider agreement as a Minnesota health care program
provider; and
(2)
set rates for services reimbursed under this chapter.
(b)
When setting rates, the commissioner shall consider the complexity and the
acuity of the problems presented by the client.
(c)
When rates set under this section and rates set under section 254B.09,
subdivision 8, apply to the same treatment placement, section 254B.09,
subdivision 8, supersedes.
Sec.
10. Minnesota Statutes 2008, section
254B.05, subdivision 1, is amended to read:
Subdivision
1. Licensure
required. Programs licensed by the
commissioner are eligible vendors.
Hospitals may apply for and receive licenses to be eligible vendors,
notwithstanding the provisions of section 245A.03. American Indian programs located on federally
recognized tribal lands that provide chemical dependency primary treatment,
extended care, transitional residence, or outpatient treatment services, and
are licensed by tribal government are eligible vendors. Detoxification programs are not eligible
vendors. Programs that are not licensed
as a chemical dependency residential or nonresidential treatment program by the
commissioner or by tribal government are not eligible vendors. To be eligible for payment under the
Consolidated Chemical Dependency Treatment Fund, a vendor of a chemical
dependency service must participate in the Drug and Alcohol Abuse Normative
Evaluation System and the treatment accountability plan.
Effective
January 1, 2000, vendors of room and board are eligible for chemical dependency
fund payment if the vendor:
(1) is
certified by the county or tribal governing body as having has rules
prohibiting residents bringing chemicals into the facility or using chemicals
while residing in the facility and provide consequences for infractions of
those rules;
(2) has
a current contract with a county or tribal governing body;
(3) is
determined to meet applicable health and safety requirements;
(4) is
not a jail or prison; and
(5) is
not concurrently receiving funds under chapter 256I for the recipient.
EFFECTIVE DATE. This section is effective
July 1, 2011.
Sec.
11. Minnesota Statutes 2008, section
254B.09, subdivision 2, is amended to read:
Subd.
2. American
Indian agreements. The commissioner
may enter into agreements with federally recognized tribal units to pay for
chemical dependency treatment services provided under Laws 1986, chapter 394,
sections 8 to 20. The agreements must
clarify how the governing body of the tribal unit fulfills local agency
responsibilities regarding:
(1)
selection of eligible vendors under section 254B.03, subdivision 1;
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(2) negotiation of agreements that
establish vendor services and rates for programs located on the tribal
governing body's reservation;
(3) (1) the form and manner of invoicing; and
(4) (2) provide that only invoices for eligible
vendors according to section 254B.05 will be included in invoices sent to the
commissioner for payment, to the extent that money allocated under subdivisions
4 and 5 is used.
EFFECTIVE DATE.
This section is effective July 1, 2011.
Sec. 12. [254B.11] MAXIMUM RATES.
The commissioner shall publish maximum
rates for vendors of the consolidated chemical dependency treatment fund by
July 1 of each year for implementation the following January 1. Rates for calendar year 2010 must not exceed
185 percent of the average rate on January 1, 2009, for each group of vendors
with similar attributes. Unless a new
rate methodology is developed under section 254B.12, rates for services
provided on and after July 1, 2011, must not exceed 160 percent of the average
rate on January 1, 2009, for each group of vendors with similar
attributes. Payment for services
provided by Indian Health Services or by agencies operated by Indian tribes for
medical assistance-eligible individuals must be governed by the applicable
federal rate methodology.
Sec. 13. [254B.12] RATE METHODOLOGY.
The commissioner shall, with
broad-based stakeholder input, develop a recommendation and present a report to
the 2011 legislature, including proposed legislation for a new rate methodology
for the consolidated chemical dependency treatment fund. The new methodology must replace
county-negotiated rates with a uniform statewide methodology that must include
a graduated reimbursement scale based on the patients' level of acuity and complexity.
Sec. 14.
Minnesota Statutes 2008, section 256B.0622, subdivision 2, is amended to
read:
Subd. 2. Definitions. For purposes of this section, the following
terms have the meanings given them.
(a) "Intensive nonresidential rehabilitative
mental health services" means adult rehabilitative mental health services
as defined in section 256B.0623, subdivision 2, paragraph (a), except that
these services are provided by a multidisciplinary staff using a total team
approach consistent with assertive community treatment, the Fairweather Lodge
treatment model, as defined by the standards established by the National
Coalition for Community Living, and other evidence-based practices, and
directed to recipients with a serious mental illness who require intensive
services.
(b) "Intensive residential rehabilitative mental
health services" means short-term, time-limited services provided in a
residential setting to recipients who are in need of more restrictive settings
and are at risk of significant functional deterioration if they do not receive
these services. Services are designed to
develop and enhance psychiatric stability, personal and emotional adjustment,
self-sufficiency, and skills to live in a more independent setting. Services must be directed toward a targeted
discharge date with specified client outcomes and must be consistent with the
Fairweather Lodge treatment model as defined in paragraph (a), and other
evidence-based practices.
(c) "Evidence-based practices" are nationally
recognized mental health services that are proven by substantial research to be
effective in helping individuals with serious mental illness obtain specific
treatment goals.
(d) "Overnight staff" means a member of the
intensive residential rehabilitative mental health treatment team who is
responsible during hours when recipients are typically asleep.
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(e) "Treatment team" means all staff who
provide services under this section to recipients. At a minimum, this includes the clinical
supervisor, mental health professionals as defined in section 245.462,
subdivision 18, clauses (1) to (5) (6); mental health
practitioners as defined in section 245.462, subdivision 17; mental health
rehabilitation workers under section 256B.0623, subdivision 5, clause (3); and
certified peer specialists under section 256B.0615.
Sec. 15. Minnesota
Statutes 2008, section 256B.0623, subdivision 5, is amended to read:
Subd. 5. Qualifications of provider staff. Adult rehabilitative mental health services
must be provided by qualified individual provider staff of a certified provider
entity. Individual provider staff must
be qualified under one of the following criteria:
(1) a mental health professional as defined in section
245.462, subdivision 18, clauses (1) to (5) (6). If the recipient has a current diagnostic
assessment by a licensed mental health professional as defined in section
245.462, subdivision 18, clauses (1) to (5) (6), recommending
receipt of adult mental health rehabilitative services, the definition of
mental health professional for purposes of this section includes a person who
is qualified under section 245.462, subdivision 18, clause (6) (7),
and who holds a current and valid national certification as a certified
rehabilitation counselor or certified psychosocial rehabilitation practitioner;
(2) a mental health practitioner as defined in section
245.462, subdivision 17. The mental
health practitioner must work under the clinical supervision of a mental health
professional;
(3) a certified peer specialist under section
256B.0615. The certified peer specialist
must work under the clinical supervision of a mental health professional; or
(4) a mental health rehabilitation worker. A mental health rehabilitation worker means a
staff person working under the direction of a mental health practitioner or
mental health professional and under the clinical supervision of a mental
health professional in the implementation of rehabilitative mental health
services as identified in the recipient's individual treatment plan who:
(i) is at least 21 years of age;
(ii) has a high school diploma or equivalent;
(iii) has successfully completed 30 hours of training
during the past two years in all of the following areas: recipient rights,
recipient-centered individual treatment planning, behavioral terminology,
mental illness, co-occurring mental illness and substance abuse, psychotropic
medications and side effects, functional assessment, local community resources,
adult vulnerability, recipient confidentiality; and
(iv) meets the qualifications in subitem (A) or (B):
(A) has an associate of arts degree in one of the
behavioral sciences or human services, or is a registered nurse without a
bachelor's degree, or who within the previous ten years has:
(1) three years of personal life experience with
serious and persistent mental illness;
(2) three years of life experience as a primary
caregiver to an adult with a serious mental illness or traumatic brain injury;
or
(3) 4,000 hours of supervised paid work experience in the
delivery of mental health services to adults with a serious mental illness or
traumatic brain injury; or
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(B)(1) is fluent in the non-English language or
competent in the culture of the ethnic group to which at least 20 percent of
the mental health rehabilitation worker's clients belong;
(2) receives during the first 2,000 hours of work,
monthly documented individual clinical supervision by a mental health
professional;
(3) has 18 hours of documented field supervision by a
mental health professional or practitioner during the first 160 hours of
contact work with recipients, and at least six hours of field supervision
quarterly during the following year;
(4) has review and cosignature of charting of recipient
contacts during field supervision by a mental health professional or
practitioner; and
(5) has 40 hours of additional continuing education on
mental health topics during the first year of employment.
Sec. 16.
Minnesota Statutes 2008, section 256B.0624, subdivision 5, is amended to
read:
Subd. 5. Mobile crisis intervention staff
qualifications. For provision of
adult mental health mobile crisis intervention services, a mobile crisis
intervention team is comprised of at least two mental health professionals as
defined in section 245.462, subdivision 18, clauses (1) to (5) (6),
or a combination of at least one mental health professional and one mental health
practitioner as defined in section 245.462, subdivision 17, with the required
mental health crisis training and under the clinical supervision of a mental
health professional on the team. The
team must have at least two people with at least one member providing on-site
crisis intervention services when needed.
Team members must be experienced in mental health assessment, crisis
intervention techniques, and clinical decision-making under emergency
conditions and have knowledge of local services and resources. The team must recommend and coordinate the
team's services with appropriate local resources such as the county social
services agency, mental health services, and local law enforcement when
necessary.
Sec. 17.
Minnesota Statutes 2008, section 256B.0624, subdivision 8, is amended to
read:
Subd. 8. Adult crisis stabilization staff
qualifications. (a) Adult mental
health crisis stabilization services must be provided by qualified individual
staff of a qualified provider entity.
Individual provider staff must have the following qualifications:
(1) be a mental health professional as defined in
section 245.462, subdivision 18, clauses (1) to (5) (6);
(2) be a mental health practitioner as defined in
section 245.462, subdivision 17. The mental
health practitioner must work under the clinical supervision of a mental health
professional; or
(3) be a mental health rehabilitation worker who meets
the criteria in section 256B.0623, subdivision 5, clause (3); works under the
direction of a mental health practitioner as defined in section 245.462,
subdivision 17, or under direction of a mental health professional; and works
under the clinical supervision of a mental health professional.
(b) Mental health practitioners and mental health
rehabilitation workers must have completed at least 30 hours of training in
crisis intervention and stabilization during the past two years.
Sec. 18.
Minnesota Statutes 2008, section 256B.0625, subdivision 42, is amended
to read:
Subd. 42. Mental health professional. Notwithstanding Minnesota Rules, part
9505.0175, subpart 28, the definition of a mental health professional shall
include a person who is qualified as specified in section 245.462, subdivision
18, clause clauses (5) and (6); or 245.4871, subdivision
27, clause clauses (5) and (6), for the purpose of this
section and Minnesota Rules, parts 9505.0170 to 9505.0475.
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Sec. 19.
Minnesota Statutes 2008, section 256B.0943, subdivision 1, is amended to
read:
Subdivision 1. Definitions. For purposes of this section, the following
terms have the meanings given them.
(a) "Children's therapeutic services and supports"
means the flexible package of mental health services for children who require
varying therapeutic and rehabilitative levels of intervention. The services are time-limited interventions
that are delivered using various treatment modalities and combinations of
services designed to reach treatment outcomes identified in the individual
treatment plan.
(b) "Clinical supervision" means the overall
responsibility of the mental health professional for the control and direction
of individualized treatment planning, service delivery, and treatment review
for each client. A mental health
professional who is an enrolled Minnesota health care program provider accepts
full professional responsibility for a supervisee's actions and decisions,
instructs the supervisee in the supervisee's work, and oversees or directs the
supervisee's work.
(c) "County board" means the county board of
commissioners or board established under sections 402.01 to 402.10 or
471.59.
(d) "Crisis assistance" has the meaning given
in section 245.4871, subdivision 9a.
(e) "Culturally competent provider" means a
provider who understands and can utilize to a client's benefit the client's
culture when providing services to the client.
A provider may be culturally competent because the provider is of the
same cultural or ethnic group as the client or the provider has developed the
knowledge and skills through training and experience to provide services to
culturally diverse clients.
(f) "Day treatment program" for children
means a site-based structured program consisting of group psychotherapy for
more than three individuals and other intensive therapeutic services provided
by a multidisciplinary team, under the clinical supervision of a mental health
professional.
(g) "Diagnostic assessment" has the meaning
given in section 245.4871, subdivision 11.
(h) "Direct service time" means the time
that a mental health professional, mental health practitioner, or mental health
behavioral aide spends face-to-face with a client and the client's family. Direct service time includes time in which
the provider obtains a client's history or provides service components of
children's therapeutic services and supports.
Direct service time does not include time doing work before and after
providing direct services, including scheduling, maintaining clinical records,
consulting with others about the client's mental health status, preparing
reports, receiving clinical supervision directly related to the client's
psychotherapy session, and revising the client's individual treatment plan.
(i) "Direction of mental health behavioral
aide" means the activities of a mental health professional or mental
health practitioner in guiding the mental health behavioral aide in providing
services to a client. The direction of a
mental health behavioral aide must be based on the client's individualized
treatment plan and meet the requirements in subdivision 6, paragraph (b),
clause (5).
(j) "Emotional disturbance" has the meaning
given in section 245.4871, subdivision 15.
For persons at least age 18 but under age 21, mental illness has the
meaning given in section 245.462, subdivision 20, paragraph (a).
(k) "Individual behavioral plan" means a
plan of intervention, treatment, and services for a child written by a mental
health professional or mental health practitioner, under the clinical
supervision of a mental health professional, to guide the work of the mental
health behavioral aide.
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(l)
"Individual treatment plan" has the meaning given in section
245.4871, subdivision 21.
(m)
"Mental health professional" means an individual as defined in
section 245.4871, subdivision 27, clauses (1) to (5) (6), or
tribal vendor as defined in section 256B.02, subdivision 7, paragraph (b).
(n)
"Preschool program" means a day program licensed under Minnesota
Rules, parts 9503.0005 to 9503.0175, and enrolled as a children's therapeutic
services and supports provider to provide a structured treatment program to a
child who is at least 33 months old but who has not yet attended the first day
of kindergarten.
(o)
"Skills training" means individual, family, or group training
designed to improve the basic functioning of the child with emotional
disturbance and the child's family in the activities of daily living and
community living, and to improve the social functioning of the child and the
child's family in areas important to the child's maintaining or reestablishing
residency in the community. Individual,
family, and group skills training must:
(1)
consist of activities designed to promote skill development of the child and
the child's family in the use of age-appropriate daily living skills,
interpersonal and family relationships, and leisure and recreational services;
(2)
consist of activities that will assist the family's understanding of normal
child development and to use parenting skills that will help the child with
emotional disturbance achieve the goals outlined in the child's individual
treatment plan; and
(3)
promote family preservation and unification, promote the family's integration
with the community, and reduce the use of unnecessary out-of-home placement or
institutionalization of children with emotional disturbance.
Sec.
20. Minnesota Statutes 2008, section
256B.0625, subdivision 47, is amended to read:
Subd.
47. Treatment
foster care services. Effective July
1, 2007 2011, and subject to federal approval, medical assistance
covers treatment foster care services according to section 256B.0946.
Sec.
21. Minnesota Statutes 2008, section
256B.0943, subdivision 12, is amended to read:
Subd.
12. Excluded
services. The following services are
not eligible for medical assistance payment as children's therapeutic services
and supports:
(1)
service components of children's therapeutic services and supports
simultaneously provided by more than one provider entity unless prior
authorization is obtained;
(2) treatment
by multiple providers within the same agency at the same clock time;
(3) children's therapeutic services and supports provided
in violation of medical assistance policy in Minnesota Rules, part 9505.0220;
(3) (4) mental
health behavioral aide services provided by a personal care assistant who is
not qualified as a mental health behavioral aide and employed by a certified
children's therapeutic services and supports provider entity;
(4) (5) service components of CTSS that are the
responsibility of a residential or program license holder, including foster
care providers under the terms of a service agreement or administrative rules
governing licensure;
(5) (6) adjunctive activities that may be offered
by a provider entity but are not otherwise covered by medical assistance,
including:
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(i) a service that is primarily recreation oriented or
that is provided in a setting that is not medically supervised. This includes sports activities, exercise
groups, activities such as craft hours, leisure time, social hours, meal or
snack time, trips to community activities, and tours;
(ii) a social or educational service that does not
have or cannot reasonably be expected to have a therapeutic outcome related to
the client's emotional disturbance;
(iii) consultation with other providers or service
agency staff about the care or progress of a client;
(iv) prevention or education programs provided to the
community; and
(v) treatment for clients with primary diagnoses of
alcohol or other drug abuse; and
(6) (7) activities that are not direct service
time.
Sec. 22.
Minnesota Statutes 2008, section 256B.0944, is amended by adding a
subdivision to read:
Subd. 4a.
Alternative provider
standards. If a provider
entity demonstrates that, due to geographic or other barriers, it is not feasible
to provide mobile crisis intervention services 24 hours a day, seven days a
week, according to the standards in subdivision 4, paragraph (b), clause (1),
the commissioner may approve a crisis response provider based on an alternative
plan proposed by a provider entity. The
alternative plan must:
(1) result in increased access and a
reduction in disparities in the availability of crisis services; and
(2) provide mobile services outside of
the usual nine-to-five office hours and on weekends and holidays.
Sec. 23.
Minnesota Statutes 2008, section 256B.0947, subdivision 1, is amended to
read:
Subdivision 1. Scope.
Subject to federal approval Effective November 1, 2010, and
subject to federal approval, medical assistance covers medically necessary,
intensive nonresidential rehabilitative mental health services as defined in
subdivision 2, for recipients as defined in subdivision 3, when the services
are provided by an entity meeting the standards in this section.
Sec. 24.
Minnesota Statutes 2008, section 256J.08, subdivision 73a, is amended to
read:
Subd. 73a. Qualified professional. (a) For physical illness, injury, or
incapacity, a "qualified professional" means a licensed physician, a
physician's assistant, a nurse practitioner, or a licensed chiropractor.
(b) For developmental disability and intelligence
testing, a "qualified professional" means an individual qualified by
training and experience to administer the tests necessary to make
determinations, such as tests of intellectual functioning, assessments of
adaptive behavior, adaptive skills, and developmental functioning. These professionals include licensed
psychologists, certified school psychologists, or certified psychometrists
working under the supervision of a licensed psychologist.
(c) For learning disabilities, a "qualified
professional" means a licensed psychologist or school psychologist with
experience determining learning disabilities.
(d) For mental health, a "qualified
professional" means a licensed physician or a qualified mental health
professional. A "qualified mental
health professional" means:
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(1) for
children, in psychiatric nursing, a registered nurse who is licensed under
sections 148.171 to 148.285, and who is certified as a clinical specialist in
child and adolescent psychiatric or mental health nursing by a national nurse
certification organization or who has a master's degree in nursing or one of
the behavioral sciences or related fields from an accredited college or
university or its equivalent, with at least 4,000 hours of post-master's
supervised experience in the delivery of clinical services in the treatment of
mental illness;
(2) for
adults, in psychiatric nursing, a registered nurse who is licensed under
sections 148.171 to 148.285, and who is certified as a clinical specialist in
adult psychiatric and mental health nursing by a national nurse certification
organization or who has a master's degree in nursing or one of the behavioral
sciences or related fields from an accredited college or university or its
equivalent, with at least 4,000 hours of post-master's supervised experience in
the delivery of clinical services in the treatment of mental illness;
(3) in
clinical social work, a person licensed as an independent clinical social
worker under chapter 148D, or a person with a master's degree in social work
from an accredited college or university, with at least 4,000 hours of
post-master's supervised experience in the delivery of clinical services in the
treatment of mental illness;
(4) in
psychology, an individual licensed by the Board of Psychology under sections
148.88 to 148.98, who has stated to the Board of Psychology competencies in the
diagnosis and treatment of mental illness;
(5) in
psychiatry, a physician licensed under chapter 147 and certified by the
American Board of Psychiatry and Neurology or eligible for board certification
in psychiatry; and
(6) in
marriage and family therapy, the mental health professional must be a marriage
and family therapist licensed under sections 148B.29 to 148B.39, with at least
two years of post-master's supervised experience in the delivery of clinical
services in the treatment of mental illness; and
(7)
in licensed professional clinical counseling, the mental health professional
shall be a licensed professional clinical counselor under section 148B.5301
with at least 4,000 hours of postmaster's supervised experience in the delivery
of clinical services in the treatment of mental illness.
Sec.
25. AUTISM
SPECTRUM DISORDER TASK FORCE.
(a)
The Autism Spectrum Disorder Task Force is composed of 15 members, appointed as
follows:
(1)
two members of the senate appointed by the Subcommittee on Committees of the
Committee on Rules and Administration, one of whom must be a member of the
minority;
(2)
two members of the house of representatives, one from the majority party,
appointed by the speaker of the house, and one from the minority party,
appointed by the minority leader;
(3)
two members appointed by the legislature, with regard to geographic diversity
in the state, who are parents of children with autism spectrum disorder (ASD);
one member shall be appointed by the senate Subcommittee on Committees of the
Committee on Rules and Administration making appointments for the senate; and
one member shall be appointed by the speaker of the house making the
appointments for the house;
(4)
one member appointed by the Minnesota chapter of the American Academy of
Pediatrics who is a general primary care pediatrician;
(5)
one member appointed by the Minnesota Academy of Family Physicians who is a
family practice physician;
(6)
one member appointed by the Minnesota Psychological Association who is a
neuropsychologist;
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(7)
one member appointed by the directors of public school student support
services;
(8)
one member appointed by the Somali American Autism Foundation;
(9)
one member appointed by the ARC of Minnesota;
(10)
one member appointed by the Autism Society of Minnesota;
(11)
one member appointed by the Parent Advocacy Coalition for Educational Rights;
and
(12)
one member appointed by the Minnesota Council of Health Plans.
Appointments must be
made by September 1, 2009. The
Legislative Coordinating Commission shall provide meeting space for the task
force. The senate member appointed by
the minority leader of the senate shall convene the first meeting of the task
force no later than October 1, 2009. The
task force shall elect a chair at the first meeting.
(b)
If federal or state funding is available, the commissioners of education,
employment and economic development, health, and human services shall provide
assistance to the task force.
(c)
The task force shall develop recommendations and report on the following
topics:
(1)
ways to improve services provided by all state and political subdivisions;
(2)
sources of public and private funding available for treatment and ways to
improve efficiency in the use of these funds;
(3)
methods to improve coordination in the delivery of service between public and
private agencies, health providers, and schools, and to address any geographic
discrepancies in the delivery of services;
(4)
increasing the availability of and the training for medical providers and
educators who identify and provide services to individuals with ASD; and
(5)
treatment options supported by peer-reviewed, established scientific research
for individuals with ASD.
(d)
The task force shall coordinate with existing efforts at the Departments of
Education, Health, Human Services, and Employment and Economic Development
related to ASD.
(e)
By January 15 of each year, the task force shall provide a report regarding its
findings and consideration of the topics listed under paragraph (c), and the
action taken under paragraph (d), including draft legislation if necessary, to
the chairs and ranking minority members of the legislative committees with
jurisdiction over health and human services.
(f)
This section expires June 30, 2011.
Sec.
26. STATE-COUNTY
CHEMICAL HEALTH CARE HOME PILOT PROJECT.
Subdivision
1.
Establishment; purpose. There is established a state-county
chemical health care home pilot project.
The purpose of the pilot project is for the Department of Human Services
and counties to authentically and creatively work in partnership to redesign
the current chemical health service delivery system in a way that promotes
greater accountability, productivity, and results in the delivery of state
chemical dependency services. The pilot
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project
or projects must look to provide appropriate flexibility in a way that ensures
timely access to needed services as well as better aligning systems and
services to offer the most appropriate level of chemical health care services
to the client. This may include, but is
not limited to, looking into new governance agreements, performance agreements,
or service level agreements. Pilot
projects must maintain eligibility requirements for the consolidated chemical
dependency treatment fund, continue to meet the requirements of Minnesota
Rules, parts 9530.6600 to 9530.6655 (also known as Rule 25) and Minnesota
Rules, parts 9530.6405 to 9530.6505 (also known as Rule 31), and must not put
at risk current and future federal funding toward chemical health-related
services in the state of Minnesota.
Subd. 2.
Workgroup; report. A workgroup must be convened on or before
July 15, 2009, consisting of representatives from the Department of Human
Services and potential participating counties to develop draft proposals for
pilot projects meeting the requirements of this section. The workgroup shall report back to the
legislative committees with jurisdiction over chemical health by January 15,
2010, for potential approval of one metro and one nonmetro county pilot project
to be implemented beginning July 10, 2010.
Subd. 3.
Report. The Department of Human Services shall
evaluate the efficacy and feasibility of the pilot projects and report the
results of that evaluation to the legislative committees having jurisdiction
over chemical health by June 30, 2011.
Expansion of pilot projects may occur only if the department's report
finds the pilot projects effective.
Subd. 4.
Expiration. This section expires June 30, 2012.
EFFECTIVE DATE.
This section is effective the day following final enactment.
ARTICLE 8
CONTINUING CARE
Section 1.
Minnesota Statutes 2008, section 144.0724, subdivision 2, is amended to
read:
Subd. 2. Definitions. For purposes of this section, the following
terms have the meanings given.
(a) "Assessment reference date" means the
last day of the minimum data set observation period. The date sets the designated endpoint of the
common observation period, and all minimum data set items refer back in time
from that point.
(b) "Case mix index" means the weighting
factors assigned to the RUG-III classifications.
(c) "Index maximization" means classifying a
resident who could be assigned to more than one category, to the category with
the highest case mix index.
(d) "Minimum data set" means the assessment
instrument specified by the Centers for Medicare and Medicaid Services and
designated by the Minnesota Department of Health.
(e) "Representative" means a person who is
the resident's guardian or conservator, the person authorized to pay the
nursing home expenses of the resident, a representative of the nursing home
ombudsman's office whose assistance has been requested, or any other individual
designated by the resident.
(f) "Resource utilization groups" or
"RUG" means the system for grouping a nursing facility's residents
according to their clinical and functional status identified in data supplied
by the facility's minimum data set.
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(g)
"Activities of daily living" means grooming, dressing, bathing,
transferring, mobility, positioning, eating, and toileting.
(h)
"Nursing facility level of care determination" means the assessment
process that results in a determination of a resident's or prospective
resident's need for nursing facility level of care as established in
subdivision 11 for purposes of medical assistance payment of long-term care
services for:
(1)
nursing facility services under section 256B.434 or 256B.441;
(2)
elderly waiver services under section 256B.0915;
(3)
CADI and TBI waiver services under section 256B.49; and
(4)
state payment of alternative care services under section 256B.0913.
EFFECTIVE DATE. The section is effective January
1, 2011.
Sec.
2. Minnesota Statutes 2008, section
144.0724, subdivision 4, is amended to read:
Subd.
4. Resident
assessment schedule. (a) A facility
must conduct and electronically submit to the commissioner of health case mix
assessments that conform with the assessment schedule defined by Code of
Federal Regulations, title 42, section 483.20, and published by the United
States Department of Health and Human Services, Centers for Medicare and
Medicaid Services, in the Long Term Care Assessment Instrument User's Manual,
version 2.0, October 1995, and subsequent clarifications made in the Long-Term
Care Assessment Instrument Questions and Answers, version 2.0, August
1996. The commissioner of health may
substitute successor manuals or question and answer documents published by the
United States Department of Health and Human Services, Centers for Medicare and
Medicaid Services, to replace or supplement the current version of the manual
or document.
(b) The
assessments used to determine a case mix classification for reimbursement
include the following:
(1) a
new admission assessment must be completed by day 14 following admission;
(2) an
annual assessment must be completed within 366 days of the last comprehensive
assessment;
(3) a
significant change assessment must be completed within 14 days of the
identification of a significant change; and
(4) the
second quarterly assessment following either a new admission assessment, an
annual assessment, or a significant change assessment, and all quarterly
assessments beginning October 1, 2006.
Each quarterly assessment must be completed within 92 days of the
previous assessment.
(c)
In addition to the assessments listed in paragraph (b), the assessments used to
determine nursing facility level of care include the following:
(1)
preadmission screening completed under section 256B.0911, subdivision 4a, by a
county, tribe, or managed care organization under contract with the Department
of Human Services; and
(2) a
face-to-face long-term care consultation assessment completed under section
256B.0911, subdivision 3a, 3b, or 4d, by a county, tribe, or managed care
organization under contract with the Department of Human Services.
EFFECTIVE DATE. The section is effective
January 1, 2011.
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Sec. 3.
Minnesota Statutes 2008, section 144.0724, subdivision 8, is amended to
read:
Subd. 8. Request for reconsideration of resident
classifications. (a) The resident,
or resident's representative, or the nursing facility or boarding care home may
request that the commissioner of health reconsider the assigned reimbursement
classification. The request for
reconsideration must be submitted in writing to the commissioner within 30 days
of the day the resident or the resident's representative receives the resident
classification notice. The request for
reconsideration must include the name of the resident, the name and address of
the facility in which the resident resides, the reasons for the
reconsideration, the requested classification changes, and documentation
supporting the requested classification.
The documentation accompanying the reconsideration request is limited to
documentation which establishes that the needs of the resident at the time of
the assessment justify a classification which is different than the
classification established by the commissioner of health.
(b) Upon request, the nursing facility must give the
resident or the resident's representative a copy of the assessment form and the
other documentation that was given to the commissioner of health to support the
assessment findings. The nursing
facility shall also provide access to and a copy of other information from the
resident's record that has been requested by or on behalf of the resident to
support a resident's reconsideration request.
A copy of any requested material must be provided within three working
days of receipt of a written request for the information. If a facility fails to provide the material
within this time, it is subject to the issuance of a correction order and
penalty assessment under sections 144.653 and 144A.10. Notwithstanding those sections, any correction
order issued under this subdivision must require that the nursing facility
immediately comply with the request for information and that as of the date of
the issuance of the correction order, the facility shall forfeit to the state a
$100 fine for the first day of noncompliance, and an increase in the $100 fine
by $50 increments for each day the noncompliance continues.
(c) In addition to the information required under
paragraphs (a) and (b), a reconsideration request from a nursing facility must
contain the following information: (i) the date the reimbursement
classification notices were received by the facility; (ii) the date the
classification notices were distributed to the resident or the resident's
representative; and (iii) a copy of a notice sent to the resident or to the
resident's representative. This notice
must inform the resident or the resident's representative that a
reconsideration of the resident's classification is being requested, the reason
for the request, that the resident's rate will change if the request is
approved by the commissioner, the extent of the change, that copies of the
facility's request and supporting documentation are available for review, and
that the resident also has the right to request a reconsideration. If the facility fails to provide the required
information with the reconsideration request, the request must be denied, and
the facility may not make further reconsideration requests on that specific
reimbursement classification.
(d) Reconsideration by the commissioner must be made
by individuals not involved in reviewing the assessment, audit, or
reconsideration that established the disputed classification. The reconsideration must be based upon the
initial assessment and upon the information provided to the commissioner under
paragraphs (a) and (b). If necessary for
evaluating the reconsideration request, the commissioner may conduct on-site
reviews. Within 15 working days of
receiving the request for reconsideration, the commissioner shall affirm or
modify the original resident classification.
The original classification must be modified if the commissioner
determines that the assessment resulting in the classification did not
accurately reflect the needs or assessment characteristics of the resident at
the time of the assessment. The resident
and the nursing facility or boarding care home shall be notified within five
working days after the decision is made.
A decision by the commissioner under this subdivision is the final administrative
decision of the agency for the party requesting reconsideration.
(e) The resident classification established by the
commissioner shall be the classification that applies to the resident while the
request for reconsideration is pending. If
a request for reconsideration applies to an assessment used to determine
nursing facility level of care under subdivision 4, paragraph (c), the resident
shall continue to be eligible for nursing facility level of care while the
request for reconsideration is pending.
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(f) The commissioner may request additional
documentation regarding a reconsideration necessary to make an accurate
reconsideration determination.
EFFECTIVE DATE.
The section is effective January 1, 2011.
Sec. 4.
Minnesota Statutes 2008, section 144.0724, is amended by adding a
subdivision to read:
Subd. 11.
Nursing facility level of
care. (a) For purposes of
medical assistance payment of long-term care services, a recipient must be
determined, using assessments defined in subdivision 4, to meet one of the
following nursing facility level of care criteria:
(1) the person needs the assistance
of another person or constant supervision to begin and complete at least four
of the following activities of living:
bathing, bed mobility, dressing, eating, grooming, toileting,
transferring, and walking;
(2) the person needs the assistance
of another person or constant supervision to begin and complete toileting,
transferring, or positioning and the assistance cannot be scheduled;
(3) the person has significant
difficulty with memory, using information, daily decision making, or behavioral
needs that require intervention;
(4) the person has had a qualifying
nursing facility stay of at least 90 days; or
(5) the person is determined to be at
risk for nursing facility admission or readmission through a face-to-face long-term
care consultation assessment as specified in section 256B.0911, subdivision 3a,
3b, or 4d, by a county, tribe, or managed care organization under contract with
the Department of Human Services. The
person is considered at risk under this clause if the person currently lives
alone or will live alone upon discharge and also meets one of the following
criteria:
(i) the person has experienced a fall
resulting in a fracture;
(ii) the person has been determined
to be at risk of maltreatment or neglect, including self-neglect; or
(iii) the person has a sensory
impairment that substantially impacts functional ability and maintenance of a
community residence.
(b) The assessment used to establish
medical assistance payment for nursing facility services must be the most
recent assessment performed under subdivision 4, paragraph (b), that occurred
no more than 90 calendar days before the effective date of medical assistance
eligibility for payment of long-term care services. In no case shall medical assistance payment
for long-term care services occur prior to the date of the determination of
nursing facility level of care.
(c) The assessment used to establish
medical assistance payment for long-term care services provided under sections
256B.0915 and 256B.49 and alternative care payment for services provided under
section 256B.0913 must be the most recent face-to-face assessment performed
under section 256B.0911, subdivision 3a, that occurred no more than 60 calendar
days before the effective date of medical assistance eligibility for payment of
long-term care services.
EFFECTIVE DATE.
The section is effective January 1, 2011.
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Sec. 5.
Minnesota Statutes 2008, section 144.0724, is amended by adding a
subdivision to read:
Subd. 12.
Appeal of nursing facility
level of care determination. A
resident or prospective resident whose level of care determination results in a
denial of long-term care services can appeal the determination as outlined in
section 256B.0911, subdivision 3a, paragraph (h), clause (7).
EFFECTIVE DATE.
The section is effective January 1, 2011.
Sec. 6.
Minnesota Statutes 2008, section 144A.073, is amended by adding a
subdivision to read:
Subd. 12.
Extension of approval of
moratorium exception projects. Notwithstanding
subdivision 3, the commissioner of health shall extend project approval by an additional
18 months for an approved proposal for an exception to the nursing home
licensure and certification moratorium if the proposal was approved under this
section between July 1, 2007, and June 30, 2009.
Sec. 7.
Minnesota Statutes 2008, section 144A.44, subdivision 2, is amended to
read:
Subd. 2. Interpretation and enforcement of rights. These rights are established for the benefit
of persons who receive home care services. "Home care services" means
home care services as defined in section 144A.43, subdivision 3, and
unlicensed personal care assistance services, including services covered by
medical assistance under section 256B.0625, subdivision 19a. A home care provider may not require a person
to surrender these rights as a condition of receiving services. A guardian or conservator or, when there is
no guardian or conservator, a designated person, may seek to enforce these
rights. This statement of rights does
not replace or diminish other rights and liberties that may exist relative to
persons receiving home care services, persons providing home care services, or
providers licensed under Laws 1987, chapter 378. A copy of these rights must be provided to an
individual at the time home care services, including personal care
assistance services, are initiated.
The copy shall also contain the address and phone number of the Office
of Health Facility Complaints and the Office of Ombudsman for Long-Term Care
and a brief statement describing how to file a complaint with these
offices. Information about how to
contact the Office of Ombudsman for Long-Term Care shall be included in notices
of change in client fees and in notices where home care providers initiate
transfer or discontinuation of services.
Sec. 8.
Minnesota Statutes 2008, section 245A.03, is amended by adding a
subdivision to read:
Subd. 7.
Licensing moratorium. (a) The commissioner shall not issue an
initial license for child foster care licensed under Minnesota Rules, parts
2960.3000 to 2960.3340, or adult foster care licensed under Minnesota Rules,
parts 9555.5105 to 9555.6265, under this chapter for a physical location that
will not be the primary residence of the license holder for the entire period
of licensure. If a license is issued
during this moratorium, and the license holder changes the license holder's
primary residence away from the physical location of the foster care license,
the commissioner shall revoke the license according to section 245A.07. Exceptions to the moratorium include:
(1) foster care settings that are
required to be registered under chapter 144D;
(2) foster care licenses replacing
foster care licenses in existence on the effective date of this section and
determined to be needed by the commissioner under paragraph (b);
(3) new foster care licenses
determined to be needed by the commissioner under paragraph (b) for the closure
of a nursing facility, ICF/MR, or regional treatment center;
(4) new foster care licenses
determined to be needed by the commissioner under paragraph (b) for persons
requiring hospital level care; or
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(5) new foster care licenses
determined to be needed by the commissioner for the transition of people from
personal care assistance to the home and community-based services.
(b) The commissioner shall determine
the need for newly licensed foster care homes as defined under this
subdivision. As part of the determination,
the commissioner shall consider the availability of foster care capacity in the
area which the licensee seeks to operate, and the recommendation of the local
county board. The determination by the
commissioner must be final. A
determination of need is not required for a change in ownership at the same
address.
(c) Residential settings that would
otherwise be subject to the moratorium established in paragraph (a), that are
in the process of receiving an adult or child foster care license as of July 1,
2009, shall be allowed to continue to complete the process of receiving an
adult or child foster care license. For
this paragraph, all of the following conditions must be met to be considered in
process of receiving an adult or child foster care license:
(1) participants have made decisions
to move into the residential setting, including documentation in each
participant's care plan;
(2) the provider has purchased housing
or has made a financial investment in the property;
(3) the lead agency has approved the
plans, including costs for the residential setting for each individual;
(4) the completion of the licensing
process, including all necessary inspections, is the only remaining component
prior to being able to provide services; and
(5) the needs of the individuals
cannot be met within the existing capacity in that county.
To qualify for the process under this paragraph, the lead
agency must submit documentation to the commissioner by August 1, 2009, that
all of the above criteria are met.
(d) The commissioner shall study the
effects of the license moratorium under this subdivision and shall report back
to the legislature by January 15, 2011.
EFFECTIVE DATE.
This section is effective the day following final enactment.
Sec. 9. Minnesota
Statutes 2008, section 245A.11, is amended by adding a subdivision to read:
Subd. 8.
Community residential setting
license. (a) The commissioner
shall establish provider standards for residential support services that
integrate service standards and the residential setting under one license. The commissioner shall propose statutory
language and an implementation plan for licensing requirements for residential
support services to the legislature by January 15, 2011.
(b) Providers licensed under chapter
245B, and providing, contracting, or arranging for services in settings
licensed as adult foster care under Minnesota Rules, parts 9555.5105 to
9555.6265, or child foster care under Minnesota Rules, parts 2960.3000 to 2960.3340;
and meeting the provisions of section 256B.092, subdivision 11, paragraph (b),
must be required to obtain a community residential setting license.
Sec. 10.
Minnesota Statutes 2008, section 252.46, is amended by adding a
subdivision to read:
Subd. 1a.
Day training and habilitation
rates. The commissioner shall
establish a statewide rate-setting methodology for all day training and
habilitation services. The rate-setting
methodology must abide by the principles of transparency and equitability
across the state. The methodology must
involve a uniform process of structuring rates for each service and must
promote quality and participant choice.
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Sec. 11.
Minnesota Statutes 2008, section 252.50, subdivision 1, is amended to
read:
Subdivision 1. Community-based programs established. The commissioner shall establish a system of
state-operated, community-based programs for persons with developmental
disabilities. For purposes of this
section, "state-operated, community-based program" means a program
administered by the state to provide treatment and habilitation in
noninstitutional community settings to persons with developmental
disabilities. Employees of the programs,
except clients who work within and benefit from these treatment and
habilitation programs, must be state employees under chapters 43A and 179A. Although any clients who work within and
benefit from these treatment and habilitation programs are not employees under
chapters 43A and 179A, the Department of Human Services may consider clients
who work within and benefit from these programs employees for federal tax
purposes. The establishment of state-operated,
community-based programs must be within the context of a comprehensive
definition of the role of state-operated services in the state. The role of state-operated services must be
defined within the context of a comprehensive system of services for persons
with developmental disabilities.
State-operated, community-based programs may include, but are not
limited to, community group homes, foster care, supportive living services, day
training and habilitation programs, and respite care arrangements. The commissioner may operate the pilot
projects established under Laws 1985, First Special Session chapter 9, article
1, section 2, subdivision 6, and shall, within the limits of available
appropriations, establish additional state-operated, community-based programs
for persons with developmental disabilities.
State-operated, community-based programs may accept admissions from
regional treatment centers, from the person's own home, or from community
programs. State-operated,
community-based programs offering day program services may be provided for
persons with developmental disabilities who are living in state-operated,
community-based residential programs until July 1, 2000. No later than 1994, the commissioner,
together with family members, counties, advocates, employee representatives,
and other interested parties, shall begin planning so that by July 1, 2000,
state-operated, community-based residential facilities will be in compliance
with section 252.41, subdivision 9.
Sec. 12.
Minnesota Statutes 2008, section 256.01, is amended by adding a
subdivision to read:
Subd. 29.
State medical review team. (a) To ensure the timely processing of
determinations of disability by the commissioner's state medical review team
under sections 256B.055, subdivision 7, paragraph (b), 256B.057, subdivision 9,
paragraph (j), and 256B.055, subdivision 12, the commissioner shall review all
medical evidence submitted by county agencies with a referral and seek
additional information from providers, applicants, and enrollees to support the
determination of disability where necessary.
Disability shall be determined according to the rules of title XVI and
title XIX of the Social Security Act and pertinent rules and policies of the
Social Security Administration.
(b) Prior to a denial or withdrawal of
a requested determination of disability due to insufficient evidence, the
commissioner shall (1) ensure that the missing evidence is necessary and
appropriate to a determination of disability, and (2) assist applicants and
enrollees to obtain the evidence, including, but not limited to, medical
examinations and electronic medical records.
(c) The commissioner shall provide the
chairs of the legislative committees with jurisdiction over health and human
services finance and budget the following information on the activities of the
state medical review team by February 1, 2010, and annually thereafter:
(1) the number of applications to the
state medical review team that were denied, approved, or withdrawn;
(2) the average length of time from
receipt of the application to a decision;
(3) the number of appeals and appeal
results;
(4) for applicants, their age, health
coverage at the time of application, hospitalization history within three
months of application, and whether an application for Social Security or
Supplemental Security Income benefits is pending; and
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(5) specific information on the
medical certification, licensure, or other credentials of the person or persons
performing the medical review determinations and length of time in that
position.
Sec. 13. [256.0281] INTERAGENCY DATA EXCHANGE.
The Department of Human Services, the
Department of Health, and the Office of the Ombudsman for Mental Health and
Developmental Disabilities may establish interagency agreements governing the
electronic exchange of data on providers and individuals collected, maintained,
or used by each agency when such exchange is outlined by each agency in an
interagency agreement to accomplish the purposes in clauses (1) to (4):
(1) to improve provider enrollment
processes for home and community-based services and state plan home care
services;
(2) to improve quality management of
providers between state agencies;
(3) to establish and maintain provider
eligibility to participate as providers under Minnesota health care programs;
or
(4) to meet the quality assurance
reporting requirements under federal law under section 1915(c) of the Social
Security Act related to home and community-based waiver programs.
Each interagency agreement must include provisions to ensure
anonymity of individuals, including mandated reporters, and must outline the
specific uses of and access to shared data within each agency. Electronic interfaces between source data
systems developed under these interagency agreements must incorporate these
provisions as well as other HIPPA provisions related to individual data.
Sec. 14.
Minnesota Statutes 2008, section 256.476, subdivision 5, is amended to
read:
Subd. 5. Reimbursement, allocations, and reporting. (a) For the purpose of transferring persons to
the consumer support grant program from the family support program and personal
care assistant services, home health aide services, or private duty nursing
services, the amount of funds transferred by the commissioner between the
family support program account, the medical assistance account, or the consumer
support grant account shall be based on each county's participation in
transferring persons to the consumer support grant program from those programs
and services.
(b) At the beginning of each fiscal year, county
allocations for consumer support grants shall be based on:
(1) the number of persons to whom the county board
expects to provide consumer supports grants;
(2) their eligibility for current program and services;
(3) the amount of nonfederal dollars monthly
grant levels allowed under subdivision 11; and
(4) projected dates when persons will start receiving
grants. County allocations shall be
adjusted periodically by the commissioner based on the actual transfer of
persons or service openings, and the nonfederal dollars monthly grant
levels associated with those persons or service openings, to the consumer
support grant program.
(c) The amount of funds transferred by the commissioner
from the medical assistance account for an individual may be changed if it is
determined by the county or its agent that the individual's need for support
has changed.
(d) The authority to utilize funds transferred to the
consumer support grant account for the purposes of implementing and
administering the consumer support grant program will not be limited or
constrained by the spending authority provided to the program of origination.
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(e) The commissioner may use up to five percent of each
county's allocation, as adjusted, for payments for administrative expenses, to
be paid as a proportionate addition to reported direct service expenditures.
(f) The county allocation for each person or the
person's legal representative or other authorized representative cannot exceed
the amount allowed under subdivision 11.
(g) The commissioner may recover, suspend, or withhold
payments if the county board, local agency, or grantee does not comply with the
requirements of this section.
(h) Grant funds unexpended by consumers shall return to
the state once a year. The annual return
of unexpended grant funds shall occur in the quarter following the end of the
state fiscal year.
Sec. 15.
Minnesota Statutes 2008, section 256.476, subdivision 11, is amended to
read:
Subd. 11. Consumer support grant program after July
1, 2001. (a) Effective July
1, 2001, the commissioner shall allocate consumer support grant resources to
serve additional individuals based on a review of Medicaid authorization and
payment information of persons eligible for a consumer support grant from the
most recent fiscal year. The
commissioner shall use the following methodology to calculate maximum allowable
monthly consumer support grant levels:
(1) For individuals whose program of origination is
medical assistance home care under sections 256B.0651 and 256B.0653 to
256B.0656, the maximum allowable monthly grant levels are calculated by:
(i) determining the nonfederal share 50
percent of the average service authorization for each home care rating;
(ii) calculating the overall ratio of actual payments
to service authorizations by program;
(iii) applying the overall ratio to the average service
authorization level of each home care rating;
(iv) adjusting the result for any authorized rate
increases provided by the legislature; and
(v) adjusting the result for the average monthly
utilization per recipient.
(2) The commissioner may review and evaluate the
methodology to reflect changes in the home care program's overall ratio of
actual payments to service authorizations programs.
(b) Effective January 1, 2004, persons
previously receiving exception grants will have their grants calculated using
the methodology in paragraph (a), clause (1).
If a person currently receiving an exception grant wishes to have their
home care rating reevaluated, they may request an assessment as defined in
section 256B.0651, subdivision 1, paragraph (b).
Sec. 16.
Minnesota Statutes 2008, section 256.975, subdivision 7, is amended to
read:
Subd. 7. Consumer information and assistance and
long-term care options counseling; senior linkage Senior LinkAge
Line. (a) The Minnesota Board on
Aging shall operate a statewide information and assistance service to
aid older Minnesotans and their families in making informed choices about
long-term care options and health care benefits. Language services to persons with limited
English language skills may be made available.
The service, known as Senior LinkAge Line, must be available during
business hours through a statewide toll-free number and must also be available
through the Internet.
(b) The service must assist provide long-term
care options counseling by assisting older adults, caregivers, and
providers in accessing information and options counseling about choices
in long-term care services that are purchased through private providers or
available through public options. The
service must:
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(1)
develop a comprehensive database that includes detailed listings in both
consumer- and provider-oriented formats;
(2) make
the database accessible on the Internet and through other telecommunication and
media-related tools;
(3) link
callers to interactive long-term care screening tools and make these tools
available through the Internet by integrating the tools with the database;
(4)
develop community education materials with a focus on planning for long-term
care and evaluating independent living, housing, and service options;
(5)
conduct an outreach campaign to assist older adults and their caregivers in
finding information on the Internet and through other means of communication;
(6)
implement a messaging system for overflow callers and respond to these callers
by the next business day;
(7) link
callers with county human services and other providers to receive more in-depth
assistance and consultation related to long-term care options;
(8) link
callers with quality profiles for nursing facilities and other providers
developed by the commissioner of health; and
(9)
incorporate information about housing with services and consumer rights within
the MinnesotaHelp.info network long-term care database to facilitate consumer
comparison of services and costs among housing with services establishments and
with other in-home services and to support financial self-sufficiency as long
as possible. Housing with services
establishments and their arranged home care providers shall provide information
to the commissioner of human services that is consistent with information
required by the commissioner of health under section 144G.06, the Uniform
Consumer Information Guide. The
commissioner of human services shall provide the data to the Minnesota Board on
Aging for inclusion in the MinnesotaHelp.info network long-term care database.;
(10)
provide long-term care options counseling.
Long-term care options counselors shall:
(i)
for individuals not eligible for case management under a public program or
public funding source, provide interactive decision support under which
consumers, family members, or other helpers are supported in their
deliberations to determine appropriate long-term care choices in the context of
the consumer's needs, preferences, values, and individual circumstances,
including implementing a community support plan;
(ii)
provide Web-based educational information and collateral written materials to
familiarize consumers, family members, or other helpers with the long-term care
basics, issues to be considered, and the range of options available in the
community;
(iii)
provide long-term care futures planning, which means providing assistance to
individuals who anticipate having long-term care needs to develop a plan for
the more distant future; and
(iv)
provide expertise in benefits and financing options for long-term care,
including Medicare, long-term care insurance, tax or employer-based incentives,
reverse mortgages, private pay options, and ways to access low or no-cost
services or benefits through volunteer-based or charitable programs; and
(11)
using risk management and support planning protocols, provide long-term care
options counseling to current residents of nursing homes deemed appropriate for
discharge by the commissioner. In order
to meet this requirement, the commissioner shall provide designated Senior
LinkAge Line contact centers with a list of nursing
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home
residents appropriate for discharge planning via a secure Web portal. Senior LinkAge Line shall provide these
residents, if they indicate a preference to receive long-term care options
counseling, with initial assessment, review of risk factors, independent living
support consultation, or referral to:
(i)
services under section 256B.0911, subdivision 3;
(ii)
designated care coordinators of contracted entities under section 256B.035 for
persons who are enrolled in a managed care plan; or
(iii)
the long-term care consultation team for those who are appropriate for
relocation service coordination due to high-risk factors or psychological or
physical disability.
(c)
The Minnesota Board on Aging shall conduct an evaluation of the effectiveness
of the statewide information and assistance, and submit this evaluation to the
legislature by December 1, 2002. The
evaluation must include an analysis of funding adequacy, gaps in service
delivery, continuity in information between the service and identified
linkages, and potential use of private funding to enhance the service.
Sec.
17. Minnesota Statutes 2008, section
256B.055, subdivision 7, is amended to read:
Subd.
7. Aged,
blind, or disabled persons. (a) Medical
assistance may be paid for a person who meets the categorical eligibility
requirements of the supplemental security income program or, who would meet
those requirements except for excess income or assets, and who meets the other
eligibility requirements of this section.
(b)
Following a determination that the applicant is not aged or blind and does not
meet any other category of eligibility for medical assistance and has not been
determined disabled by the Social Security Administration, applicants under
this subdivision shall be referred to the commissioner's state medical review
team for a determination of disability.
Sec.
18. Minnesota Statutes 2008, section
256B.0625, subdivision 6a, is amended to read:
Subd.
6a. Home
health services. Home health
services are those services specified in Minnesota Rules, part 9505.0295 and
sections 256B.0651 and 256B.0653.
Medical assistance covers home health services at a recipient's home
residence. Medical assistance does not
cover home health services for residents of a hospital, nursing facility, or
intermediate care facility, unless the commissioner of human services has prior
authorized skilled nurse visits for less than 90 days for a resident at an
intermediate care facility for persons with developmental disabilities, to
prevent an admission to a hospital or nursing facility or unless a resident who
is otherwise eligible is on leave from the facility and the facility either
pays for the home health services or forgoes the facility per diem for the
leave days that home health services are used.
Home health services must be provided by a Medicare certified home
health agency. All nursing and home
health aide services must be provided according to sections 256B.0651 to 256B.0656
256B.0653.
Sec.
19. Minnesota Statutes 2008, section
256B.0625, subdivision 7, is amended to read:
Subd.
7. Private
duty nursing. Medical assistance
covers private duty nursing services in a recipient's home. Recipients who are authorized to receive
private duty nursing services in their home may use approved hours outside of
the home during hours when normal life activities take them outside of their
home. To use private duty nursing
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.
Medical assistance does not cover private duty nursing services for
residents of a hospital, nursing facility, intermediate care facility, or a
health care facility licensed by the commissioner of health, except as authorized
in section 256B.64 for ventilator-dependent recipients in hospitals or unless a
resident who is otherwise eligible is on leave from the facility and the
facility either pays for
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the
private duty nursing services or forgoes the facility per diem for the leave
days that private duty nursing services are used. Total hours of service and payment allowed
for services outside the home cannot exceed that which is otherwise allowed in
an in-home setting according to sections 256B.0651 and 256B.0653 256B.0654
to 256B.0656. All private duty
nursing services must be provided according to the limits established under
sections 256B.0651 and 256B.0653 to 256B.0656.
Private duty nursing services may not be reimbursed if the nurse is the family
foster care provider of a recipient who is under age 18, unless allowed
under section 256B.0654, subdivision 4.
Sec. 20. Minnesota
Statutes 2008, section 256B.0625, subdivision 19a, is amended to read:
Subd. 19a. Personal care assistant
assistance services. Medical
assistance covers personal care assistant assistance services in
a recipient's home. Effective January
1, 2010, to qualify for personal care assistant assistance services,
a recipient must require assistance and be determined dependent in one
activity of daily living as defined in section 256B.0659, subdivision 1,
paragraph (b), or in a Level I behavior as defined in section 256B.0659,
subdivision 1, paragraph (c). Beginning
July 1, 2011, to qualify for personal care assistance services, a recipient
must require assistance and be determined dependent in at least two activities
of daily living as defined in section 256B.0659. 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 assistant
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 assistant assistance services
in an in-home setting according to sections 256B.0651 and 256B.0653 to 256B.0656. Medical assistance does not cover personal
care assistant 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 assistant
assistance services or forgoes the facility per diem for the leave days
that personal care assistant assistance services are used. All personal care assistant
assistance services must be provided according to sections 256B.0651 and
256B.0653 to 256B.0656. Personal
care assistant assistance services may not be reimbursed if the
personal care assistant is the spouse or legal 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.
Parents of adult recipients, adult children of the recipient or adult
siblings of the recipient may be reimbursed for personal care assistant
services, if they are granted a waiver under sections 256B.0651 and 256B.0653
to 256B.0656. Notwithstanding the
provisions of section 256B.0655, subdivision 2, paragraph (b), clause (4)
256B.0659, the noncorporate legal unpaid guardian or
conservator of an adult, who is not the responsible party and not the personal
care provider organization, may be granted a hardship waiver under sections
256B.0651 and 256B.0653 to 256B.0656, to be reimbursed to provide personal care
assistant 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. 21.
Minnesota Statutes 2008, section 256B.0625, subdivision 19c, is amended
to read:
Subd. 19c. Personal care. Medical assistance covers personal care assistant
assistance services provided by an individual who is qualified to provide
the services according to subdivision 19a and sections 256B.0651 and
256B.0653 to 256B.0656, where the services have a statement of need by a
physician, provided in accordance with a plan, and are supervised by
the recipient or a qualified professional. The physician's statement of need for
personal care assistant services shall be documented on a form approved by the
commissioner and include the diagnosis or condition of the person that results
in a need for personal care assistant services and be updated when the person's
medical condition requires a change, but at least annually if the need for
personal care assistant services is ongoing.
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"Qualified professional" means a mental health
professional as defined in section 245.462, subdivision 18, or 245.4871,
subdivision 27; or a registered nurse as defined in sections 148.171 to
148.285, or a licensed social worker as defined in section 148B.21,
or a qualified developmental disabilities specialist undersection 245B.07,
subdivision 4. As part of the
assessment, the county public health nurse will assist the recipient or
responsible party to identify the most appropriate person to provide
supervision of the personal care assistant.
The qualified professional shall perform the duties described
required in Minnesota Rules, part 9505.0335, subpart 4 section
256B.0659.
Sec. 22.
Minnesota Statutes 2008, section 256B.0641, subdivision 3, is amended to
read:
Subd. 3. Facility in receivership. Subdivision 2 does not apply to the change of
ownership of a facility to a nonrelated organization while the facility to be
sold, transferred or reorganized is in receivership under section 144A.14,
144A.15, 245A.12, or 245A.13, and the commissioner during the
receivership has not determined the need to place residents of the facility
into a newly constructed or newly established facility. Nothing in this subdivision limits the
liability of a former owner.
Sec. 23.
Minnesota Statutes 2008, section 256B.0651, is amended to read:
256B.0651 HOME CARE
SERVICES.
Subdivision 1. Definitions. (a) "Activities of daily living"
includes eating, toileting, grooming, dressing, bathing, transferring,
mobility, and positioning For the purposes of sections 256B.0651 to
256B.0656 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. Assessments for home health agency services
shall be conducted by a home health agency nurse. Assessments for medical assistance home care
services for developmental disability and alternative care services for
developmentally disabled home and community-based waivered recipients may be conducted
by the county public health nurse to ensure coordination and avoid
duplication. Assessments must be
completed on forms provided by the commissioner within 30 days of a request for
home care services by a recipient or responsible party.
(c) (d) "Home care services" means a health
service, determined by the commissioner as medically necessary, that is ordered
by a physician and documented in a service plan that is reviewed by the
physician at least once every 60 days for the provision of home health
services, or private duty nursing, or at least once every 365 days for personal
care. Home care services are provided to
the recipient at the recipient's residence that is a place other than a
hospital or long-term care facility or as specified in section 256B.0625
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; private duty nursing; and personal care assistance.
(e) "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.0651,
subdivision 9, and 256B.0654, subdivision 4.
(d) (f) "Medically necessary" has the meaning given
in Minnesota Rules, parts 9505.0170 to 9505.0475.
(e) "Telehomecare" means the
use of telecommunications technology by a home health care professional to
deliver home health care services, within the professional's scope of practice,
to a patient located at a site other than the site where the practitioner is
located.
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(g)
"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.
Subd.
2. Services
covered. Home care services covered
under this section and sections 256B.0653 256B.0652 to 256B.0656 and 256B.0659 include:
(1)
nursing services under section sections 256B.0625, subdivision 6a,
and 256B.0653;
(2)
private duty nursing services under section sections 256B.0625, subdivision
7, and 256B.0654;
(3) home
health services under section sections 256B.0625, subdivision 6a,
and 256B.0653;
(4)
personal care assistant assistance services under section
sections 256B.0625, subdivision 19a, and 256B.0659;
(5)
supervision of personal care assistant assistance services
provided by a qualified professional under section sections
256B.0625, subdivision 19a, and 256B.0659;
(6) qualified
professional of personal care assistant services under the fiscal intermediary
option as specified in section 256B.0655, subdivision 7;
(7) face-to-face assessments by county public health
nurses for services under section sections 256B.0625, subdivision
19a, 256B.0655, and 256B.0659; and
(8) (7) service
updates and review of temporary increases for personal care assistant
assistance services by the county public health nurse for services under section
sections 256B.0625, subdivision 19a, and 256B.0659.
Subd.
3. Noncovered
home care services. The following
home care services are not eligible for payment under medical assistance:
(1)
skilled nurse visits for the sole purpose of supervision of the home health
aide;
(2) a
skilled nursing visit:
(i)
only for the purpose of monitoring medication compliance with an established medication
program for a recipient; or
(ii)
to administer or assist with medication administration, including injections,
prefilling syringes for injections, or oral medication set-up of an adult
recipient, when as determined and documented by the registered nurse, the need
can be met by an available pharmacy or the recipient is physically and mentally
able to self-administer or prefill a medication;
(3)
home care services to a recipient who is eligible for covered services under
the Medicare program or any other insurance held by the recipient;
(4)
services to other members of the recipient's household;
(5) a
visit made by a skilled nurse solely to train other home health agency workers;
(6)
any home care service included in the daily rate of the community-based
residential facility where the recipient is residing;
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(7) nursing and rehabilitation
therapy services that are reasonably accessible to a recipient outside the recipient's
place of residence, excluding the assessment, counseling and education, and
personal assistant care;
(8) any home health agency service,
excluding personal care assistant services and private duty nursing services,
which are performed in a place other than the recipient's residence; and
(9) Medicare evaluation or
administrative nursing visits on dual-eligible recipients that do not qualify
for Medicare visit billing.
(1) services provided in a nursing
facility, hospital, or intermediate care facility with exceptions in section
256B.0653;
(2) services for the sole purpose of
monitoring medication compliance with an established medication program for a
recipient;
(3) home care services for covered
services under the Medicare program or any other insurance held by the
recipient;
(4) services to other members of the
recipient's household;
(5) any home care service included in
the daily rate of the community-based residential facility where the recipient
is residing;
(6) nursing and rehabilitation
therapy services that are reasonably accessible to a recipient outside the
recipient's place of residence, excluding the assessment, counseling and
education, and personal assistance care; or
(7) Medicare evaluation or
administrative nursing visits on dual-eligible recipients that do not qualify
for Medicare visit billing.
Subd. 4. Prior Authorization; exceptions. All home care services above the limits in
subdivision 11 must receive the commissioner's prior authorization
before services begin, except when:
(1) the home care services were required to treat an
emergency medical condition that if not immediately treated could cause a
recipient serious physical or mental disability, continuation of severe pain,
or death. The provider must request
retroactive authorization no later than five working days after giving the
initial service. The provider must be
able to substantiate the emergency by documentation such as reports, notes, and
admission or discharge histories;
(2) the home care services were provided on or
after the date on which the recipient's eligibility began, but before the date
on which the recipient was notified that the case was opened. Authorization will be considered if the
request is submitted by the provider within 20 working days of the date the
recipient was notified that the case was opened; a recipient's medical
assistance eligibility has lapsed, is then retroactively reinstated, and an
authorization for home care services is completed based on the date of a
current assessment, eligibility, and request for authorization;
(3) a third-party payor for home care services has
denied or adjusted a payment.
Authorization requests must be submitted by the provider within 20
working days of the notice of denial or adjustment. A copy of the notice must be included with
the request;
(4) the commissioner has determined that a county or
state human services agency has made an error; or
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(5) the
professional nurse determines an immediate need for up to 40 skilled nursing or
home health aide visits per calendar year and submits a request for
authorization within 20 working days of the initial service date, and medical
assistance is determined to be the appropriate payer. if a recipient
enrolled in managed care experiences a temporary disenrollment from a health
plan, the commissioner shall accept the current health plan authorization for
personal care assistance services for up to 60 days. The request must be received within the first
30 days of the disenrollment. If the
recipient's reenrollment in managed care is after the 60 days and before 90
days, the provider shall request an additional 30-day extension of the current
health plan authorization, for a total limit of 90 days from the time of
disenrollment.
Subd.
5.
Retroactive authorization. A request for retroactive authorization
will be evaluated according to the same criteria applied to prior authorization
requests.
Subd.
6. Prior
Authorization. (a) The
commissioner, or the commissioner's designee, shall review the assessment, service
update, request for temporary services, request for flexible use option,
service plan, and any additional information that is submitted. The commissioner shall, within 30 days after
receiving a complete request, assessment, and service plan, authorize home care
services as follows: provided
in this section.
(a) Home health services. (b) All Home health services provided
by a home health aide including skilled nurse visits and home health
aide visits must be prior authorized by the commissioner or the
commissioner's designee. Prior Authorization
must be based on medical necessity and cost-effectiveness when compared with
other care options. The commissioner
must receive the request for authorization of skilled nurse visits and home
health aide visits within 20 working days of the start of service. When home health services are used in
combination with personal care and private duty nursing, the cost of all home
care services shall be considered for cost-effectiveness. The commissioner shall limit home health
aide visits to no more than one visit each per day. The commissioner, or the commissioner's
designee, may authorize up to two skilled nurse visits per day.
(b) Ventilator-dependent recipients. (c) If the recipient is ventilator-dependent,
the monthly medical assistance authorization for home care services shall not
exceed what the commissioner would pay for care at the highest cost hospital
designated as a long-term hospital under the Medicare program. For purposes of this paragraph, home care
services means all direct care services provided in the home that would
be included in the payment for care at the long-term hospital. "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 for at
least 30 consecutive days. Recipients who meet the definition of
ventilator dependent and the EN home care rating and utilize a combination of
home care services are limited up to a total of 24 hours of home care services
per day. Additional hours may be
authorized when a recipient's assessment indicates a need for two staff to
perform activities. Additional time is
limited to four hours per day.
Subd.
7. Prior
Authorization; time limits. (a) The
commissioner or the commissioner's designee shall determine the time period for
which a prior an authorization shall be effective and, if
flexible use has been requested, whether to allow the flexible use option. If the recipient continues to require home
care services beyond the duration of the prior authorization, the home
care provider must request a new prior authorization. A personal care provider agency must request
a new personal care assistant assistance services assessment, or
service update if allowed, at least 60 days prior to the end of the current prior
authorization time period. The request
for the assessment must be made on a form approved by the commissioner. Under no circumstances, other than the
exceptions in subdivision 4, shall a prior An authorization must be
valid prior to the date the commissioner receives the request or for no
more than 12 months.
(b)
The amount and type of personal care assistance services authorized based upon
the assessment and service plan must remain in effect for the recipient whether
the recipient chooses a different provider or enrolls or disenrolls from a
managed care plan under section 256B.0659, unless the service needs of the
recipient change and new assessment is warranted under section 256B.0655,
subdivision 1b.
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(c) A recipient who appeals a reduction in previously
authorized home care services may continue previously authorized services,
other than temporary services under subdivision 8, pending an appeal under
section 256.045. The commissioner must provide
ensure that the recipient has a copy of the most recent service plan that
contains a detailed explanation of why the authorized services which
areas of covered personal care assistance tasks are reduced in amount
from those requested by the home care provider, and provide notice of
the amount of time per day reduced, and the reasons for the reduction in the
recipient's notice of denial, termination, or reduction.
Subd.
8. Prior
Authorization requests; temporary services.
The agency nurse, the independently enrolled private duty nurse,
or county public health nurse may request a temporary authorization for home
care services by telephone. The
commissioner may approve a temporary level of home care services based on the
assessment, and service or care plan information, and primary payer coverage
determination information as required.
Authorization for a temporary level of home care services including
nurse supervision is limited to the time specified by the commissioner, but
shall not exceed 45 days, unless extended because the county public health
nurse has not completed the required assessment and service plan, or the
commissioner's determination has not been made. The level of services authorized under this
provision shall have no bearing on a future prior authorization.
Subd.
9. Prior
Authorization for foster care setting.
(a) Home care services provided in an adult or child foster care
setting must receive prior authorization by the department
commissioner according to the limits established in subdivision 11.
(b) The commissioner may not authorize:
(1) home
care services that are the responsibility of the foster care provider under the
terms of the foster care placement agreement, difficulty of care rate as of
January 1, 2010, and administrative rules;
(2)
personal care assistant assistance services when the foster care
license holder is also the personal care provider or personal care assistant unless
the recipient can direct the recipient's own care, or case management is
provided as required in section 256B.0625, subdivision 19a, unless the
foster home is the licensed provider's primary residence as defined in section
256B.0625, subdivision 19a; or
(3)
personal care assistant services when the responsible party is an employee of,
or under contract with, or has any direct or indirect financial relationship
with the personal care provider or personal care assistant, unless case
management is provided as required in section 256B.0625, subdivision 19a; or
(4) (3)
personal care assistant and private duty nursing services when the number
of foster care residents licensed capacity is greater than four unless
the county responsible for the recipient's foster placement made the placement
prior to April 1, 1992, requests that personal care assistant and private duty
nursing services be provided, and case management is provided as required in
section 256B.0625, subdivision 19a.
Subd.
10.
Limitation on payments. Medical assistance payments for home care
services shall be limited according to subdivisions 4 to 12 and sections
256B.0654, subdivision 2, and 256B.0655, subdivisions 3 and 4.
Subd.
11. Limits
on services without prior authorization. A recipient may receive the following home
care services during a calendar year:
(1) up
to two face-to-face assessments to determine a recipient's need for personal
care assistant assistance services;
(2) one
service update done to determine a recipient's need for personal care assistant
assistance services; and
(3) up
to nine face-to-face skilled nurse visits.
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Subd.
12. Approval
of home care services. The
commissioner or the commissioner's designee shall determine the medical
necessity of home care services, the level of caregiver according to
subdivision 2, and the institutional comparison according to subdivisions 4 to
12 and sections 256B.0654, subdivision 2, and 256B.0655, subdivisions 3
and 4, and 256B.0659, the cost-effectiveness of services, and the
amount, scope, and duration of home care services reimbursable by medical
assistance, based on the assessment, primary payer coverage determination
information as required, the service plan, the recipient's age, the cost of
services, the recipient's medical condition, and diagnosis or disability. The commissioner may publish additional
criteria for determining medical necessity according to section 256B.04.
Subd.
13. Recovery
of excessive payments. The
commissioner shall seek monetary recovery from providers of payments made for
services which exceed the limits established in this section and sections
256B.0653 to 256B.0656, and 256B.0659.
This subdivision does not apply to services provided to a recipient at
the previously authorized level pending an appeal under section 256.045,
subdivision 10.
Subd.
14.
Referrals to Medicare
providers required. Home care
providers that do not participate in or accept Medicare assignment must refer
and document the referral of dual-eligible recipients to Medicare providers
when Medicare is determined to be the appropriate payer for services and
supplies and equipment. Providers must
be terminated from participation in the medical assistance program for failure
to make these referrals.
Subd.
15.
Quality assurance for program
integrity. The commissioner
shall establish an ongoing quality assurance process for home care services to
monitor program integrity, including provider standards and training, consumer
surveys, and random reviews of documentation.
Subd.
16.
Oversight of enrolled
providers. The commissioner has
the authority to request proof of documentation of meeting provider standards,
quality standards of care, correct billing practices, and other
information. Failure to comply with or
to provide access and information to demonstrate compliance with laws, rules,
or policies may result in suspension, denial, or termination of the provider
agency's enrollment with the department.
Sec.
24. Minnesota Statutes 2008, section
256B.0652, is amended to read:
256B.0652 PRIOR AUTHORIZATION AND REVIEW OF
HOME CARE SERVICES.
Subdivision
1. State
coordination. The commissioner shall
supervise the coordination of the prior authorization and review of home
care services that are reimbursed by medical assistance.
Subd.
2. Duties. (a) The commissioner may contract with or
employ qualified registered nurses and necessary support staff,
or contract with qualified agencies, to provide home care prior
authorization and review services for medical assistance recipients who are
receiving home care services.
(b)
Reimbursement for the prior authorization function shall be made through
the medical assistance administrative authority. The state shall pay the nonfederal
share. The functions will be to:
(1)
assess the recipient's individual need for services required to be cared for
safely in the community;
(2)
ensure that a service care plan that meets the recipient's needs
is developed by the appropriate agency or individual;
(3)
ensure cost-effectiveness and nonduplication of medical assistance home
care services;
(4)
recommend the approval or denial of the use of medical assistance funds to pay
for home care services;
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(5)
reassess the recipient's need for and level of home care services at a
frequency determined by the commissioner; and
(6)
conduct on-site assessments when determined necessary by the commissioner and
recommend changes to care plans that will provide more efficient and
appropriate home care; and
(7)
on the department's Web site:
(i)
provide a link to MinnesotaHelp.info for a list of enrolled home care agencies
with the following information: main office address, contact information for
the agency, counties in which services are provided, type of home care services
provided, whether the personal care assistance choice option is offered, types
of qualified professionals employed, number of personal care assistants
employed, and data on staff turnover; and
(ii)
post data on home care services including information from both fee-for-service
and managed care plans on recipients as available.
(c) In
addition, the commissioner or the commissioner's designee may:
(1)
review care plans, service plans, and reimbursement data for
utilization of services that exceed community-based standards for home care,
inappropriate home care services, medical necessity, home care services that do
not meet quality of care standards, or unauthorized services and make
appropriate referrals within the department or to other appropriate entities
based on the findings;
(2)
assist the recipient in obtaining services necessary to allow the recipient to
remain safely in or return to the community;
(3)
coordinate home care services with other medical assistance services under
section 256B.0625;
(4)
assist the recipient with problems related to the provision of home care
services;
(5)
assure the quality of home care services; and
(6)
assure that all liable third-party payers including, but not limited to,
Medicare have been used prior to medical assistance for home care services,
including but not limited to, home health agency, elected hospice benefit,
waivered services, alternative care program services, and personal care
services.
(d) For
the purposes of this section, "home care services" means medical
assistance services defined under section 256B.0625, subdivisions 6a, 7, and
19a.
Subd.
3. Assessment
and prior authorization process for persons receiving personal care
assistance and developmental disabilities services. Effective January 1, 1996, For
purposes of providing informed choice, coordinating of local planning decisions,
and streamlining administrative requirements, the assessment and prior
authorization process for persons receiving both home care and home and
community-based waivered services for persons with developmental disabilities
shall meet the requirements of sections 256B.0651 and 256B.0653 to 256B.0656
with the following exceptions:
(a) Upon
request for home care services and subsequent assessment by the public health
nurse under sections 256B.0651 and 256B.0653 to 256B.0656, the public health
nurse shall participate in the screening process, as appropriate, and, if home
care services are determined to be necessary, participate in the development of
a service plan coordinating the need for home care and home and community-based
waivered services with the assigned county case manager, the recipient of
services, and the recipient's legal representative, if any.
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(b) The public health nurse shall give prior
authorization for home care services to the extent that home care services are:
(1) medically necessary;
(2) chosen by the recipient and their legal representative,
if any, from the array of home care and home and community-based waivered
services available;
(3) coordinated with other services to be received by
the recipient as described in the service plan; and
(4) provided within the county's reimbursement limits
for home care and home and community-based waivered services for persons with
developmental disabilities.
(c) If the public health agency is or may be the
provider of home care services to the recipient, the public health agency shall
provide the commissioner of human services with a written plan that specifies
how the assessment and prior authorization process will be held separate
and distinct from the provision of services.
Sec. 25.
Minnesota Statutes 2008, section 256B.0653, is amended to read:
256B.0653 HOME HEALTH
AGENCY COVERED SERVICES.
Subdivision 1. Homecare; skilled nurse visits
Scope. "Skilled nurse
visits" are provided in a recipient's residence under a plan of care or
service plan that specifies a level of care which the nurse is qualified to
provide. These services are:
(1) nursing services according to the
written plan of care or service plan and accepted standards of medical and
nursing practice in accordance with chapter 148;
(2) services which due to the recipient's
medical condition may only be safely and effectively provided by a registered
nurse or a licensed practical nurse;
(3) assessments performed only by a
registered nurse; and
(4) teaching and training the
recipient, the recipient's family, or other caregivers requiring the skills of
a registered nurse or licensed practical nurse. This section applies to home health
agency services including, home health aide, skilled nursing visits, physical
therapy, occupational therapy, respiratory therapy, and speech language
pathology therapy.
Subd. 2. Telehomecare; skilled nurse visits
Definitions. Medical
assistance covers skilled nurse visits according to section 256B.0625,
subdivision 6a, provided via telehomecare, for services which do not require
hands-on care between the home care nurse and recipient. The provision of telehomecare must be made
via live, two-way interactive audiovisual technology and may be augmented by
utilizing store-and-forward technologies.
Store-and-forward technology includes telehomecare services that do not
occur in real time via synchronous transmissions, and that do not require a
face-to-face encounter with the recipient for all or any part of any such
telehomecare visit. Individually identifiable
patient data obtained through real-time or store-and-forward technology must be
maintained as health records according to sections 144.291 to 144.298. If the video is used for research, training,
or other purposes unrelated to the care of the patient, the identity of the
patient must be concealed. A
communication between the home care nurse and recipient that consists solely of
a telephone conversation, facsimile, electronic mail, or a consultation between
two health care practitioners, is not to be considered a telehomecare
visit. Multiple daily skilled nurse
visits provided via telehomecare are allowed.
Coverage of telehomecare is limited to two visits per day. All skilled nurse visits provided via
telehomecare must be prior authorized by the commissioner or the commissioner's
designee and will be covered at the same allowable rate as skilled nurse visits
provided in-person. For the purposes of this section, the following
terms have the meanings given.
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(a)
"Assessment" means an evaluation of the recipient's medical need for
home health agency services by a registered nurse or appropriate therapist that
is conducted within 30 days of a request.
(b)
"Home care therapies" means occupational, physical, and respiratory
therapy and speech-language pathology services provided in the home by a
Medicare certified home health agency.
(c)
"Home health agency services" means services delivered in the
recipient's home residence, except as specified in section 256B.0625, by a home
health agency to a recipient with medical needs due to illness, disability, or
physical conditions.
(d)
"Home health aide" means an employee of a home health agency who
completes medically oriented tasks written in the plan of care for a recipient.
(e)
"Home health agency" means a home care provider agency that is
Medicare-certified.
(f)
"Occupational therapy services" mean the services defined in
Minnesota Rules, part 9505.0390.
(g)
"Physical therapy services" mean the services defined in Minnesota
Rules, part 9505.0390.
(h)
"Respiratory therapy services" mean the services defined in chapter
147C and Minnesota Rules, part 4668.0003, subpart 37.
(i)
"Speech-language pathology services" mean the services defined in
Minnesota Rules, part 9505.0390.
(j)
"Skilled nurse visit" means a professional nursing visit to complete
nursing tasks required due to a recipient's medical condition that can only be
safely provided by a professional nurse to restore and maintain optimal health.
(k)
"Store-and-forward technology" means telehomecare services that do
not occur in real time via synchronous transmissions such as diabetic and vital
sign monitoring.
(l)
"Telehomecare" means the use of telecommunications technology via
live, two-way interactive audiovisual technology which may be augmented by
store-and-forward technology.
(m)
"Telehomecare skilled nurse visit" means a visit by a professional
nurse to deliver a skilled nurse visit to a recipient located at a site other
than the site where the nurse is located and is used in combination with
face-to-face skilled nurse visits to adequately meet the recipient's needs.
Subd.
3. Therapies
through home health agencies Home health aide visits. (a) Medical assistance covers physical
therapy and related services, including specialized maintenance therapy. Services provided by a physical therapy
assistant shall be reimbursed at the same rate as services performed by a
physical therapist when the services of the physical therapy assistant are
provided under the direction of a physical therapist who is on the
premises. Services provided by a
physical therapy assistant that are provided under the direction of a physical
therapist who is not on the premises shall be reimbursed at 65 percent of the
physical therapist rate. Direction of
the physical therapy assistant must be provided by the physical therapist as
described in Minnesota Rules, part 9505.0390, subpart 1, item B. The physical therapist and physical therapist
assistant may not both bill for services provided to a recipient on the same
day.
(b)
Medical assistance covers occupational therapy and related services, including
specialized maintenance therapy.
Services provided by an occupational therapy assistant shall be
reimbursed at the same rate as services performed by an occupational therapist
when the services of the occupational therapy assistant are provided under the
direction of the occupational therapist who is on the premises. Services provided by an occupational therapy
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assistant
under the direction of an occupational therapist who is not on the premises
shall be reimbursed at 65 percent of the occupational therapist rate. Direction of the occupational therapy
assistant must be provided by the occupational therapist as described in
Minnesota Rules, part 9505.0390, subpart 1, item B. The occupational therapist and occupational
therapist assistant may not both bill for services provided to a recipient on
the same day.
(a) Home health aide visits must be
provided by a certified home health aide using a written plan of care that is
updated in compliance with Medicare regulations. A home health aide shall provide hands-on
personal care, perform simple procedures as an extension of therapy or nursing
services, and assist in instrumental activities of daily living as defined in
section 256B.0659. Home health aide
visits must be provided in the recipient's home.
(b) All home health aide visits must
have authorization under section 256B.0652.
The commissioner shall limit home health aide visits to no more than one
visit per day per recipient.
(c) Home health aides must be
supervised by a registered nurse or an appropriate therapist when providing
services that are an extension of therapy.
Subd. 4.
Skilled nurse visit services. (a) Skilled nurse visit services must be
provided by a registered nurse or a licensed practical nurse under the
supervision of a registered nurse, according to the written plan of care and
accepted standards of medical and nursing practice according to chapter
148. Skilled nurse visit services must
be ordered by a physician and documented in a plan of care that is reviewed and
approved by the ordering physician at least once every 60 days. All skilled nurse visits must be medically
necessary and provided in the recipient's home residence except as allowed
under section 256B.0625, subdivision 6a.
(b) Skilled nurse visits include
face-to-face and telehomecare visits with a limit of up to two visits per day
per recipient. All visits must be based
on assessed needs.
(c) Telehomecare skilled nurse visits
are allowed when the recipient's health status can be accurately measured and
assessed without a need for a face-to-face, hands-on encounter. All telehomecare skilled nurse visits must
have authorization and are paid at the same allowable rates as face-to-face
skilled nurse visits.
(d) The provision of telehomecare
must be made via live, two-way interactive audiovisual technology and may be augmented
by utilizing store-and-forward technologies.
Individually identifiable patient data obtained through real-time or
store-and-forward technology must be maintained as health records according to
sections 144.291 to 144.298. If the
video is used for research, training, or other purposes unrelated to the care
of the patient, the identity of the patient must be concealed.
(e) Authorization for skilled nurse
visits must be completed under section 256B.0652. A total of nine face-to-face skilled nurses
visits per calendar year do not require authorization. All telehomecare skilled nurse visits require
authorization.
Subd. 5.
Home care therapies. (a) Home care therapies include the
following: physical therapy,
occupational therapy, respiratory therapy, and speech and language pathology
therapy services.
(b) Home care therapies must be:
(1) provided in the recipient's
residence after it has been determined the recipient is unable to access
outpatient therapy;
(2) prescribed, ordered, or referred
by a physician and documented in a plan of care and reviewed, according to
Minnesota Rules, part 9505.0390;
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(3)
assessed by an appropriate therapist; and
(4)
provided by a Medicare-certified home health agency enrolled as a Medicaid
provider agency.
(c)
Restorative and specialized maintenance therapies must be provided according to
Minnesota Rules, part 9505.0390.
Physical and occupational therapy assistants may be used as allowed
under Minnesota Rules, part 9505.0390, subpart 1, item B.
(d)
For both physical and occupational therapies, the therapist and the therapist's
assistant may not both bill for services provided to a recipient on the same
day.
Subd.
6.
Noncovered home health agency
services. The following are
not eligible for payment under medical assistance as a home health agency
service:
(1)
telehomecare skilled nurses services that is communication between the home
care nurse and recipient that consists solely of a telephone conversation,
facsimile, electronic mail, or a consultation between two health care
practitioners;
(2)
the following skilled nurse visits:
(i)
for the purpose of monitoring medication compliance with an established
medication program for a recipient;
(ii)
administering or assisting with medication administration, including
injections, prefilling syringes for injections, or oral medication setup of an
adult recipient, when, as determined and documented by the registered nurse,
the need can be met by an available pharmacy or the recipient or a family
member is physically and mentally able to self-administer or prefill a
medication;
(iii)
services done for the sole purpose of supervision of the home health aide or
personal care assistant;
(iv)
services done for the sole purpose to train other home health agency workers;
(v)
services done for the sole purpose of blood samples or lab draw when the recipient
is able to access these services outside the home; and
(vi)
Medicare evaluation or administrative nursing visits required by Medicare;
(3)
home health aide visits when the following activities are the sole purpose for
the visit: companionship, socialization,
household tasks, transportation, and education; and
(4)
home care therapies provided in other settings such as a clinic, day program,
or as an inpatient or when the recipient can access therapy outside of the
recipient's residence.
Sec. 26.
Minnesota Statutes 2008, section
256B.0654, is amended to read:
256B.0654 PRIVATE DUTY NURSING.
Subdivision
1. Definitions. (a) "Assessment" means a review
and evaluation of a recipient's need for home care services conducted in
person. Assessments for private duty
nursing shall be conducted by a registered private duty nurse. Assessments for medical assistance home care
services for developmental disabilities and alternative care services for
developmentally disabled home and community-based waivered recipients may be
conducted by the county public health nurse to ensure coordination and avoid
duplication.
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(b) (a)
"Complex and regular private duty nursing care" means:
(1)
complex care is private duty nursing
services provided to recipients who are ventilator dependent or for whom a
physician has certified that were it not for private duty nursing the
recipient would meet the criteria for inpatient hospital intensive care unit
(ICU) level of care; and
(2)
regular care is private duty nursing provided to all other recipients.
(b)
"Private duty nursing" means ongoing professional nursing services by
a registered or licensed practical nurse including assessment, professional
nursing tasks, and education, based on an assessment and physician orders to
maintain or restore optimal health of the recipient.
(c)
"Private duty nursing agency" means a medical assistance enrolled
provider licensed under chapter 144A to provide private duty nursing services.
(d)
"Regular private duty nursing" means nursing services provided to a
recipient who is considered stable and not at an inpatient hospital intensive
care unit level of care, but may have episodes of instability that are not life
threatening.
(e)
"Shared private duty nursing" means the provision of nursing services
by a private duty nurse to two recipients at the same time and in the same
setting.
Subd.
2. Authorization;
private duty nursing services.
(a) All private duty nursing services shall be prior authorized
by the commissioner or the commissioner's designee. Prior Authorization for private duty
nursing services shall be based on medical necessity and cost-effectiveness
when compared with alternative care options.
The commissioner may authorize medically necessary private duty nursing
services in quarter-hour units when:
(1) the
recipient requires more individual and continuous care than can be provided
during a skilled nurse visit; or
(2) the
cares are outside of the scope of services that can be provided by a home
health aide or personal care assistant.
(b) The
commissioner may authorize:
(1) up
to two times the average amount of direct care hours provided in nursing
facilities statewide for case mix classification "K" as established
by the annual cost report submitted to the department by nursing facilities in
May 1992;
(2)
private duty nursing in combination with other home care services up to the
total cost allowed under section 256B.0655, subdivision 4;
(3) up
to 16 hours per day if the recipient requires more nursing than the maximum
number of direct care hours as established in clause (1) and the recipient
meets the hospital admission criteria established under Minnesota Rules, parts
9505.0501 to 9505.0540.
(c) The
commissioner may authorize up to 16 hours per day of medically necessary
private duty nursing services or up to 24 hours per day of medically necessary
private duty nursing services until such time as the commissioner is able to
make a determination of eligibility for recipients who are cooperatively
applying for home care services under the community alternative care program
developed under section 256B.49, or until it is determined by the appropriate
regulatory agency that a health benefit plan is or is not required to pay for
appropriate medically
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necessary
health care services. Recipients or
their representatives must cooperatively assist the commissioner in obtaining
this determination. Recipients who are eligible
for the community alternative care program may not receive more hours of
nursing under this section and sections 256B.0651, 256B.0653, 256B.0655, and
256B.0656, and 256B.0659 than would otherwise be authorized under
section 256B.49.
Subd.
2a.
Private duty nursing services. (a) Private duty nursing services must be
used:
(1)
in the recipient's home or outside the home when normal life activities
require;
(2)
when the recipient requires more individual and continuous care than can be
provided during a skilled nurse visit; and
(3)
when the care required is outside of the scope of services that can be provided
by a home health aide or personal care assistant.
(b)
Private duty nursing services must be:
(1)
assessed by a registered nurse on a form approved by the commissioner;
(2)
ordered by a physician and documented in a plan of care that is reviewed by the
physician at least once every 60 days; and
(3)
authorized by the commissioner under section 256B.0652.
Subd.
2b.
Noncovered private duty nursing
services. Private duty
nursing services do not cover the following:
(1)
nursing services by a nurse who is the family foster care provider of a person
who has not reached 18 years of age unless allowed under subdivision 4;
(2)
nursing services to more than two persons receiving shared private duty nursing
services from a private duty nurse in a single setting; and
(3)
nursing services provided by a registered nurse or licensed practical nurse who
is the recipient's legal guardian or related to the recipient as spouse,
parent, or family foster parent whether by blood, marriage, or adoption except
as specified in section 256B.0652, subdivision 4.
Subd.
3. Shared
private duty nursing care option.
(a) Medical assistance payments for shared private duty nursing services
by a private duty nurse shall be limited according to this subdivision. For the purposes of this section and
sections 256B.0651, 256B.0653, 256B.0655, and 256B.0656, "private duty
nursing agency" means an agency licensed under chapter 144A to provide
private duty nursing services. Unless otherwise provided in this
subdivision, all other statutory and regulatory provisions relating to private
duty nursing services apply to shared private duty nursing services. Nothing in this subdivision shall be
construed to reduce the total number of private duty nursing hours authorized
for an individual recipient.
(b)
Recipients of private duty nursing services may share nursing staff and the
commissioner shall provide a rate methodology for shared private duty
nursing. For two persons sharing nursing
care, the rate paid to a provider shall not exceed 1.5 times the regular
private duty nursing rates paid for serving a single individual by a registered
nurse or licensed practical nurse. These
rates apply only to situations in which both recipients are present and receive
shared private duty nursing care on the date for which the service is
billed. No more than two persons may
receive shared private duty nursing services from a private duty nurse in a
single setting.
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(c) (b) Shared
private duty nursing care is the provision of nursing services by a private
duty nurse to two medical assistance eligible recipients at the same
time and in the same setting. This
subdivision does not apply when a private duty nurse is caring for multiple
recipients in more than one setting.
(c) For the purposes of this subdivision,
"setting" means:
(1) the
home residence or foster care home of one of the individual recipients
as defined in section 256B.0651; or
(2) a
child care program licensed under chapter 245A or operated by a local school
district or private school; or
(3) an
adult day care service licensed under chapter 245A; or
(4)
outside the home residence or foster care home of one of the recipients
when normal life activities take the recipients outside the home.
This
subdivision does not apply when a private duty nurse is caring for multiple
recipients in more than one setting.
(d)
The private duty nursing agency must offer the recipient the option of shared
or one-on-one private duty nursing services.
The recipient may withdraw from participating in a shared service
arrangement at any time.
(d) (e) The
recipient or the recipient's legal representative, and the recipient's
physician, in conjunction with the home health care private duty
nursing agency, shall determine:
(1)
whether shared private duty nursing care is an appropriate option based on the
individual needs and preferences of the recipient; and
(2) the
amount of shared private duty nursing services authorized as part of the
overall authorization of nursing services.
(e) (f) The
recipient or the recipient's legal representative, in conjunction with the
private duty nursing agency, shall approve the setting, grouping, and
arrangement of shared private duty nursing care based on the individual needs
and preferences of the recipients. Decisions
on the selection of recipients to share services must be based on the ages of
the recipients, compatibility, and coordination of their care needs.
(f) (g) The
following items must be considered by the recipient or the recipient's legal
representative and the private duty nursing agency, and documented in the
recipient's health service record:
(1) the
additional training needed by the private duty nurse to provide care to two
recipients in the same setting and to ensure that the needs of the recipients
are met appropriately and safely;
(2) the
setting in which the shared private duty nursing care will be provided;
(3) the
ongoing monitoring and evaluation of the effectiveness and appropriateness of
the service and process used to make changes in service or setting;
(4) a
contingency plan which accounts for absence of the recipient in a shared
private duty nursing setting due to illness or other circumstances;
(5)
staffing backup contingencies in the event of employee illness or absence; and
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(6) arrangements for additional assistance to respond
to urgent or emergency care needs of the recipients.
(g) The provider must offer the
recipient or responsible party the option of shared or one-on-one private duty nursing
services. The recipient or responsible
party can withdraw from participating in a shared service arrangement at any
time.
(h) The private duty nursing agency must document
the following in the health service record for each individual recipient sharing
private duty nursing care The documentation for shared private duty
nursing must be on a form approved by the commissioner for each individual
recipient sharing private duty nursing.
The documentation must be part of the recipient's health service record
and include:
(1) permission by the recipient or the recipient's
legal representative for the maximum number of shared nursing care hours
per week chosen by the recipient and permission for shared private duty
nursing services provided in and outside the recipient's home residence;
(2) permission by the recipient or the recipient's
legal representative for shared private duty nursing services provided outside
the recipient's residence;
(3) permission by the recipient or the
recipient's legal representative for others to receive shared private duty
nursing services in the recipient's residence;
(4) revocation by the recipient or the recipient's legal
representative of for the shared private duty nursing care
authorization, or the shared care to be provided to others in the recipient's
residence, or the shared private duty nursing services to be provided outside
permission, or services provided to others in and outside the recipient's
residence; and
(5) (3) daily documentation of the shared private duty nursing
services provided by each identified private duty nurse, including:
(i) the names of each recipient receiving shared
private duty nursing services together;
(ii) the setting for the shared services, including the
starting and ending times that the recipient received shared private duty
nursing care; and
(iii) notes by the private duty nurse regarding changes
in the recipient's condition, problems that may arise from the sharing of
private duty nursing services, and scheduling and care issues.
(i) Unless otherwise provided in this
subdivision, all other statutory and regulatory provisions relating to private
duty nursing services apply to shared private duty nursing services.
Nothing in this subdivision shall be construed
to reduce the total number of private duty nursing hours authorized for an
individual recipient under subdivision 2.
(i) The commissioner shall provide a
rate methodology for shared private duty nursing. For two persons sharing nursing care, the
rate paid to a provider must not exceed 1.5 times the regular private duty
nursing rates paid for serving a single individual by a registered nurse or
licensed practical nurse. These rates
apply only to situations in which both recipients are present and receive
shared private duty nursing care on the date for which the service is billed.
Subd. 4. Hardship criteria; private duty nursing. (a) Payment is allowed for extraordinary
services that require specialized nursing skills and are provided by parents of
minor children, family foster parents, spouses, and legal guardians who
are providing private duty nursing care under the following conditions:
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(1) the
provision of these services is not legally required of the parents, spouses, or
legal guardians;
(2) the
services are necessary to prevent hospitalization of the recipient; and
(3) the
recipient is eligible for state plan home care or a home and community-based
waiver and one of the following hardship criteria are met:
(i) the
parent, spouse, or legal guardian resigns from a part-time or full-time job to
provide nursing care for the recipient; or
(ii) the
parent, spouse, or legal guardian goes from a full-time to a part-time job with
less compensation to provide nursing care for the recipient; or
(iii)
the parent, spouse, or legal guardian takes a leave of absence without pay to
provide nursing care for the recipient; or
(iv)
because of labor conditions, special language needs, or intermittent hours of
care needed, the parent, spouse, or legal guardian is needed in order to
provide adequate private duty nursing services to meet the medical needs of the
recipient.
(b)
Private duty nursing may be provided by a parent, spouse, family foster
parent, or legal guardian who is a nurse licensed in Minnesota. Private duty nursing services provided by a
parent, spouse, family foster parent, or legal guardian cannot be used
in lieu of nursing services covered and available under liable third-party
payors, including Medicare. The private
duty nursing provided by a parent, spouse, family foster parent, or
legal guardian must be included in the service plan agreement. Authorized skilled nursing services
for a single recipient or recipients with the same residence and provided
by the parent, spouse, family foster parent, or legal guardian may not
exceed 50 percent of the total approved nursing hours, or eight hours per day,
whichever is less, up to a maximum of 40 hours per week. A parent or parents, spouse, family foster
parent, or legal guardian shall not provide more than 40 hours of services in a
seven-day period. For parents, family
foster parents, and legal guardians, 40 hours is the total amount allowed
regardless of the number of children or adults who receive services. Nothing in this subdivision precludes the
parent's, spouse's, or legal guardian's obligation of assuming the
nonreimbursed family responsibilities of emergency backup caregiver and primary
caregiver.
(c) A
parent, family foster parent, or a spouse may not be paid to provide
private duty nursing care if:
(1) the parent or spouse fails to pass a criminal
background check according to chapter 245C, or if;
(2) it has been determined by the home health private
duty nursing agency, the case manager, or the physician that the private
duty nursing care provided by the parent, family foster parent, spouse,
or legal guardian is unsafe; or
(3)
the parent, family foster parent, spouse, or legal guardian do not follow
physician orders.
(d)
For purposes of this section, "assessment" means a review and
evaluation of a recipient's need for home care services conducted in
person. Assessments for private duty
nursing must be conducted by a registered nurse.
Sec.
27. Minnesota Statutes 2008, section
256B.0655, subdivision 1b, is amended to read:
Subd.
1b. Assessment. "Assessment" means a review and
evaluation of a recipient's need for home care services conducted in
person. Assessments for personal care
assistant services shall be conducted by the county public health nurse or a
certified public health nurse under contract with the county. A face-to-face An in-person
assessment must include: documentation
of health status, determination of need, evaluation of service effectiveness,
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identification
of appropriate services, service plan development or modification, coordination
of services, referrals and follow-up to appropriate payers and community
resources, completion of required reports, recommendation of service
authorization, and consumer education.
Once the need for personal care assistant services is determined under
this section or sections 256B.0651, 256B.0653, 256B.0654, and 256B.0656, the
county public health nurse or certified public health nurse under contract with
the county is responsible for communicating this recommendation to the
commissioner and the recipient. A
face-to-face assessment for personal care assistant services is conducted on
those recipients who have never had a county public health nurse
assessment. A face-to-face An
in-person assessment must occur at least annually or when there is a
significant change in the recipient's condition or when there is a change in
the need for personal care assistant services.
A service update may substitute for the annual face-to-face assessment
when there is not a significant change in recipient condition or a change in
the need for personal care assistant service.
A service update may be completed by telephone, used when there is no
need for an increase in personal care assistant services, and used for two
consecutive assessments if followed by a face-to-face assessment. A service update must be completed on a form
approved by the commissioner. A service update
or review for temporary increase includes a review of initial baseline data,
evaluation of service effectiveness, redetermination of service need,
modification of service plan and appropriate referrals, update of initial
forms, obtaining service authorization, and on going consumer education. Assessments must be completed on forms
provided by the commissioner within 30 days of a request for home care services
by a recipient or responsible party or personal care provider agency.
Sec. 28.
Minnesota Statutes 2008, section 256B.0655, subdivision 4, is amended to
read:
Subd. 4. Prior Authorization; personal
care assistance and qualified professional. The commissioner, or the commissioner's
designee, shall review the assessment, service update, request for temporary
services, request for flexible use option, service plan, and any additional
information that is submitted. The
commissioner shall, within 30 days after receiving a complete request,
assessment, and service plan, authorize home care services as follows:
(1) (a) All personal care assistant
assistance services and, supervision by a qualified
professional, if requested by the recipient, and additional services
beyond the limits established in section 256B.0651, subdivision 11, must be
prior authorized by the commissioner or the commissioner's designee before
services begin except for the assessments established in section
sections 256B.0651, subdivision 11, and 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 assistant
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:
(1) total number of dependencies of
activities of daily living as defined in section 256B.0659;
(2) number of complex health-related
functions as defined in section 256B.0659; and
(3) number of behavior descriptions
as defined in section 256B.0659.
(c) 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 living as defined in section
256B.0659;
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(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.
(d) 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.
A child may not be found to be
dependent in an activity of daily living if because of the child's age an adult
would either perform the activity for the child or assist the child with the
activity and the amount of assistance needed is similar to the assistance
appropriate for a typical child of the same age. Based on medical necessity, the commissioner
may authorize:
(A) up to two times the average number
of direct care hours provided in nursing facilities for the recipient's
comparable case mix level; or
(B) up to three times the average
number of direct care hours provided in nursing facilities for recipients who
have complex medical needs or are dependent in at least seven activities of
daily living and need physical assistance with eating or have a neurological
diagnosis; or
(C) up to 60 percent of the average
reimbursement rate, as of July 1, 1991, for care provided in a regional
treatment center for recipients who have Level I behavior, plus any inflation
adjustment as provided by the legislature for personal care service; or
(D) up to the amount the commissioner
would pay, as of July 1, 1991, plus any inflation adjustment provided for home
care services, for care provided in a regional treatment center for recipients
referred to the commissioner by a regional treatment center preadmission
evaluation team. For purposes of this
clause, home care services means all services provided in the home or community
that would be included in the payment to a regional treatment center; or
(E) up to the amount medical
assistance would reimburse for facility care for recipients referred to the
commissioner by a preadmission screening team established under section
256B.0911 or 256B.092; and
(F) a reasonable amount of time for
the provision of supervision by a qualified professional of personal care
assistant services, if a qualified professional is requested by the recipient
or responsible party.
(2) The number of direct care hours
shall be determined according to the annual cost report submitted to the
department by nursing facilities. The
average number of direct care hours, as established by May 1, 1992, shall be
calculated and incorporated into the home care limits on July 1, 1992. These limits shall be calculated to the
nearest quarter hour.
(3) The home care rating shall be
determined by the commissioner or the commissioner's designee based on
information submitted to the commissioner by the county public health nurse on
forms specified by the commissioner. The
home care rating shall be a combination of current assessment tools developed
under sections 256B.0911 and 256B.501 with an addition for seizure activity
that will assess the frequency and severity of seizure activity and with
adjustments, additions, and clarifications that are necessary to reflect the
needs and conditions of recipients who need home care including children and
adults under 65 years of age. The
commissioner shall establish these forms and protocols under this section and
sections 256B.0651, 256B.0653, 256B.0654, and 256B.0656 and shall use an
advisory group, including representatives of recipients, providers, and
counties, for consultation in establishing and revising the forms and
protocols.
(4) A recipient shall qualify as
having complex medical needs if the care required is difficult to perform and
because of recipient's medical condition requires more time than
community-based standards allow or requires more skill than would ordinarily be
required and the recipient needs or has one or more of the following:
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(A) daily tube feedings;
(B) daily parenteral therapy;
(C) wound or decubiti care;
(D) postural drainage, percussion,
nebulizer treatments, suctioning, tracheotomy care, oxygen, mechanical
ventilation;
(E) catheterization;
(F) ostomy care;
(G) quadriplegia; or
(H) other comparable medical
conditions or treatments the commissioner determines would otherwise require
institutional care.
(5) A recipient shall qualify as
having Level I behavior if there is reasonable supporting evidence that the
recipient exhibits, or that without supervision, observation, or redirection
would exhibit, one or more of the following behaviors that cause, or have the
potential to cause:
(A) injury to the recipient's own
body;
(B) physical injury to other people;
or
(C) destruction of property.
(6) Time authorized for personal care relating
to Level I behavior in paragraph (5), clauses (A) to (C), shall be based on the
predictability, frequency, and amount of intervention required.
(7) A recipient shall qualify as
having Level II behavior if the recipient exhibits on a daily basis one or more
of the following behaviors that interfere with the completion of personal care
assistant services under subdivision 2, paragraph (a):
(A) unusual or repetitive habits;
(B) withdrawn behavior; or
(C) offensive behavior.
(8) A recipient with a home care
rating of Level II behavior in paragraph (7), clauses (A) to (C), shall be
rated as comparable to a recipient with complex medical needs under paragraph
(4). If a recipient has both complex
medical needs and Level II behavior, the home care rating shall be the next
complex category up to the maximum rating under paragraph (1), clause (B).
EFFECTIVE DATE.
The amendments to paragraphs (a) and (b) are effective January 1,
2010.
Sec. 29.
Minnesota Statutes 2008, section 256B.0657, subdivision 8, is amended to
read:
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
established based on:
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(1) the annual amount of personal care assistant
services under section 256B.0655 that the recipient has used in the most recent
12-month period assessed personal care assistance units, not to exceed
the maximum number of personal care assistance units available, as determined
by section 256B.0655; or and
(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. the personal care assistance unit rate:
(i) with a reduction to the unit rate
to pay for a program administrator as defined in subdivision 10; and
(ii) an additional adjustment to the
unit rate as needed to ensure cost neutrality for the state.
Sec. 30.
Minnesota Statutes 2008, section 256B.0657, is amended by adding a
subdivision to read:
Subd. 12.
Enrollment and evaluation. Enrollment in the self-directed supports
option is available to current personal care assistance recipients upon annual
personal care assistance reassessment, with a maximum enrollment of 1,000
people in the first fiscal year of implementation and an additional 1,000
people in the second fiscal year. The
commissioner shall evaluate the self-directed supports option during the first
two years of implementation and make any necessary changes prior to the option
becoming available statewide.
Sec. 31. [256B.0659] PERSONAL CARE ASSISTANCE
PROGRAM.
Subdivision 1.
Definitions. (a) For the purposes of this section, the
terms defined in paragraphs (b) to (p) 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) "Behavior," effective
January 1, 2010, 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
needs," effective January 1, 2010, means a category to determine the home
care rating and is based on the criteria found in this section.
(e) "Critical activities of
daily living," effective January 1, 2010, means transferring, mobility,
eating, and toileting.
(f) "Dependency in activities of
daily living" means a person requires assistance to begin and complete one
or more of the activities of daily living.
(g) "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.
(h) "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.
(i) "Managing employee" has
the same definition as Code of Federal Regulations, title 42, section 455.
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(j) "Qualified professional"
means a professional providing supervision of personal care assistance services
and staff as defined in section 256B.0625, subdivision 19c.
(k) "Personal care assistance
provider agency" means a medical assistance enrolled provider that
provides or assists with providing personal care assistance services and
includes personal care assistance provider organizations, personal care
assistance choice agency, class A licensed nursing agency, and Medicare-certified
home health agency.
(l) "Personal care
assistant" or "PCA" means an individual employed by a personal
care assistance agency who provides personal care assistance services.
(m) "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.
(n) "Responsible party"
means an individual who is capable of providing the support necessary to assist
the recipient to live in the community.
(o) "Self-administered
medication" means medication taken orally, by injection or insertion, or
applied topically without the need for assistance.
(p) "Service plan" means a
written summary of the assessment and description of the services needed by the
recipient.
Subd. 2.
Personal care assistance
services; covered services. (a)
The personal care assistance services eligible for payment include services and
supports furnished to an individual, as needed, to assist in:
(1) activities of daily living;
(2) health-related procedures and
tasks;
(3) observation and redirection of
behaviors; and
(4) instrumental activities of daily
living.
(b) Activities of daily living include
the following covered services:
(1) dressing, including assistance
with choosing, application, and changing of clothing and application of special
appliances, wraps, or clothing;
(2) grooming, including assistance
with basic hair care, oral care, shaving, applying cosmetics and deodorant, and
care of eyeglasses and hearing aids.
Nail care is included, except for recipients who are diabetic or have
poor circulation;
(3) bathing, including assistance with
basic personal hygiene and skin care;
(4) eating, including assistance with
hand washing and application of orthotics required for eating, transfers, and
feeding;
(5) transfers, including assistance
with transferring the recipient from one seating or reclining area to another;
(6) mobility, including assistance
with ambulation, including use of a wheelchair.
Mobility does not include providing transportation for a recipient;
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(7)
positioning, including assistance with positioning or turning a recipient for
necessary care and comfort; and
(8)
toileting, including assistance with helping recipient with bowel or bladder
elimination and care including transfers, mobility, positioning, feminine hygiene,
use of toileting equipment or supplies, cleansing the perineal area, inspection
of the skin, and adjusting clothing.
(c)
Health-related procedures and tasks include the following covered services:
(1)
range of motion and passive exercise to maintain a recipient's strength and
muscle functioning;
(2)
assistance with self-administered medication as defined by this section,
including reminders to take medication, bringing medication to the recipient,
and assistance with opening medication under the direction of the recipient or
responsible party;
(3)
interventions for seizure disorders, including monitoring and observation; and
(4)
other activities considered within the scope of the personal care service and
meeting the definition of health-related procedures and tasks under this
section.
(d) A
personal care assistant may provide health-related procedures and tasks
associated with the complex health-related needs of a recipient if the
procedures and tasks meet the definition of health-related procedures and tasks
under this section and the personal care assistant is trained by a qualified
professional and demonstrates competency to safely complete the procedures and
tasks. Delegation of health-related
procedures and tasks and all training must be documented in the personal care
assistance care plan and the recipient's and personal care
assistant's files.
(e)
Effective January 1, 2010, for a personal care assistant to provide the
health-related procedures and tasks of tracheostomy suctioning and services to
recipients on ventilator support there must be:
(1)
delegation and training by a registered nurse, certified or licensed
respiratory therapist, or a physician;
(2)
utilization of clean rather than sterile procedure;
(3)
specialized training about the health-related procedures and tasks and
equipment, including ventilator operation and maintenance;
(4)
individualized training regarding the needs of the recipient; and
(5)
supervision by a qualified professional who is a registered nurse.
(f)
Effective January 1, 2010, a personal care assistant may observe and redirect
the recipient for episodes where there is a need for redirection due to
behaviors. Training of the personal care
assistant must occur based on the needs of the recipient, the personal care
assistance care plan, and any other support services provided.
(g)
Instrumental activities of daily living under subdivision 1, paragraph (h).
Subd.
3.
Noncovered personal care
assistance services. (a) Personal
care assistance services are not eligible for medical assistance payment under
this section when provided:
(1)
by the recipient's spouse, parent of a recipient under the age of 18, paid
legal guardian, licensed foster provider, except as allowed under section
256B.0651, subdivision 9a, or responsible party;
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(2) in lieu of other staffing options
in a residential or child care setting;
(3) solely as a child care or
babysitting service; or
(4) without authorization by the
commissioner or the commissioner's designee.
(b) The following personal care
services are not eligible for medical assistance payment under this section
when provided in residential settings:
(1) effective January 1, 2010, when
the provider of home care services who is not related by blood, marriage, or
adoption owns or otherwise controls the living arrangement, including licensed
or unlicensed services; or
(2) when personal care assistance
services are the responsibility of a residential or program license holder
under the terms of a service agreement and administrative rules.
(c) Other specific tasks not covered
under paragraph (a) or (b) that are not eligible for medical assistance
reimbursement for personal care assistance services under this section include:
(1) sterile procedures;
(2) injections of fluids and
medications into veins, muscles, or skin;
(3) home maintenance or chore
services;
(4) homemaker services not an integral
part of assessed personal care assistance services needed by a recipient;
(5) application of restraints or
implementation of procedures under section 245.825;
(6) instrumental activities of daily
living for children under the age of 18; and
(7) assessments for personal care
assistance services by personal care assistance provider agencies or by
independently enrolled registered nurses.
Subd. 4.
Assessment for personal care assistance
services. (a) An assessment
as defined in section 256B.0655, subdivision 1b, must be completed for personal
care assistance services.
(b) The following limitations apply to
the assessment:
(1) a person must be assessed as
dependent in an activity of daily living based on the person's need, on a daily
basis, for:
(i) cueing and constant supervision to
complete the task; or
(ii) hands-on assistance to complete
the task; and
(2) a child may not be found to be
dependent in an activity of daily living if because of the child's age an adult
would either perform the activity for the child or assist the child with the
activity. Assistance needed is the
assistance appropriate for a typical child of the same age.
(c) Assessment for complex health-related
needs must meet the criteria in this paragraph.
During the assessment process, a recipient qualifies as having complex
health-related needs if the recipient has one or more of the interventions that
are ordered by a physician, specified in a personal care assistance care plan,
and found in the following:
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(1) tube feedings requiring:
(i) a gastro/jejunostomy tube; or
(ii) continuous tube feeding lasting
longer than 12 hours per day;
(2) wounds described as:
(i) stage III or stage IV;
(ii) multiple wounds;
(iii) requiring sterile or clean
dressing changes or a wound vac; or
(iv) open lesions such as burns,
fistulas, tube sites, or ostomy sites that require specialized care;
(3) parenteral therapy described as:
(i) IV therapy more than two times per
week lasting longer than four hours for each treatment; or
(ii) total parenteral nutrition (TPN)
daily;
(4) respiratory interventions
including:
(i) oxygen required more than eight
hours per day;
(ii) respiratory vest more than one
time per day;
(iii) bronchial drainage treatments
more than two times per day;
(iv) sterile or clean suctioning more
than six times per day;
(v) dependence on another to apply
respiratory ventilation augmentation devises such as BiPAP and CPAP; and
(vi) ventilator dependence under
section 256B.0652;
(5) insertion and maintenance of
catheter including:
(i) sterile catheter changes more than
one time per month;
(ii) clean self-catheterization more
than six times per day; or
(iii) bladder irrigations;
(6) bowel program more than two times
per week requiring more than 30 minutes to perform each time;
(7) neurological intervention
including:
(i) seizures more than two times per
week and requiring significant physical assistance to maintain safety; or
(ii) swallowing disorders diagnosed by
a physician and requiring specialized assistance from another on a daily basis;
and
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(8) other congenital or acquired
diseases creating a need for significantly increased direct hands-on assistance
and interventions in six to eight activities of daily living.
(d) An assessment of behaviors must
meet the criteria in this paragraph. A
recipient qualifies as having a need for assistance due to behaviors if the
recipient's behavior requires assistance at least four times per week and shows
one or more of the following behaviors:
(1) physical aggression towards self
or others, or destruction of property that requires the immediate response of
another person;
(2) increased vulnerability due to
cognitive deficits or socially inappropriate behavior; or
(3) verbally aggressive and resistive
to care.
Subd. 5.
Service, support planning, and
referral. (a) The assessor,
with the recipient or responsible party, shall review the assessment
information and determine referrals for other payers, services, and community
supports as appropriate.
(b) The recipient must be referred for
evaluation, services, or supports that are appropriate to help meet the
recipient's needs including, but not limited to, the following circumstances:
(1) when there is another payer who is
responsible to provide the service to meet the recipient's needs;
(2) when the recipient qualifies for
assistance due to mental illness or behaviors under this section, a referral
for a mental health diagnostic and functional assessment must be completed, or
referral must be made for other specific mental health services or other
community services;
(3) when the recipient is eligible for
medical assistance and meets medical assistance eligibility for a home health
aide or skilled nurse visit;
(4) when the recipient would benefit from
an evaluation for another service; and
(5) when there is a more appropriate
service to meet the assessed needs.
(c) The reimbursement rates for public
health nurse visits that relate to the provision of personal care assistance
services under this section and section 256B.0625, subdivision 19a, are:
(1) $210.50 for a face-to-face
assessment visit;
(2) $105.25 for each service update;
and
(3) $105.25 for each request for a
temporary service increase.
(d) The rates specified in paragraph
(c) must be adjusted to reflect provider rate increases for personal care
assistance services that are approved by the legislature for the fiscal year
ending June 30, 2000, and subsequent fiscal years. Any requirements applied by the legislature
to provider rate increases for personal care assistance services also apply to
adjustments under this paragraph.
(e) Effective July 1, 2008, the
payment rate for an assessment under this section and section 256B.0651 shall
be reduced by 25 percent when the assessment is not completed on time and the
service agreement documentation is not submitted in time to continue
services. The commissioner shall reduce
the amount of the claim for those assessments that are not submitted on time.
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Subd.
6.
Service plan. The service plan must be completed by the
assessor with the recipient and responsible party on a form determined by the
commissioner and include a summary of the assessment with a description of the
need, authorized amount, and expected outcomes and goals of personal care
assistance services. The recipient and
the provider chosen by the recipient or responsible party must be given a copy
of the completed service plan within ten working days of the assessment. The recipient or responsible party must be
given information by the assessor about the options in the personal care
assistance program to allow for review and decision making.
Subd.
7.
Personal care assistance care
plan. (a) Each recipient must
have a current personal care assistance care plan based on the service plan in
subdivision 6 that is developed by the qualified professional with the
recipient and responsible party. A copy
of the most current personal care assistance care plan is required to be in the
recipient's home and in the recipient's file at the provider agency.
(b)
The personal care assistance care plan must have the following components:
(1)
start and end date of the care plan;
(2)
recipient demographic information, including name and telephone number;
(3)
emergency numbers, procedures, and a description of measures to address
identified safety and vulnerability issues, including a backup staffing plan;
(4)
name of responsible party and instructions for contact;
(5)
description of the recipient's individualized needs for assistance with
activities of daily living, instrumental activities of daily living,
health-related tasks, and behaviors; and
(6)
dated signatures of recipient or responsible party and qualified professional.
(c)
The personal care assistance care plan must have instructions and comments
about the recipient's needs for assistance and any special instructions or
procedures required. The month-to-month
plan for the use of personal care assistance services is part of the personal
care assistance care plan. The personal
care assistance care plan must be completed within the first week after start
of services with a personal care provider agency and must be updated as needed
when there is a change in need for personal care assistance services. A new personal care assistance care plan is
required annually at the time of the reassessment.
Subd.
8.
Communication with recipient's
physician. The personal care
assistance program requires communication with the recipient's physician about
a recipient's assessed needs for personal care assistance services. The commissioner shall work with the state
medical director to develop options for communication with the recipient's
physician.
Subd.
9.
Responsible party; generally. (a) "Responsible party,"
effective January 1, 2010, means an individual who is capable of providing the
support necessary to assist the recipient to live in the community.
(b) A
responsible party must be 18 years of age, actively participate in planning and
directing of personal care assistance services, and attend all assessments for
the recipient.
(c) A
responsible party must not be the:
(1)
personal care assistant;
(2)
home care provider agency owner or staff; or
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(3) county staff acting as part of
employment.
(d) A licensed family foster parent
who lives with the recipient may be the responsible party as long as the family
foster parent meets the other responsible party requirements.
(e) A responsible party is required
when:
(1) the person is a minor according to
section 524.5-102, subdivision 10;
(2) the person is an incapacitated
adult according to section 524.5-102, subdivision 6, resulting in a
court-appointed guardian; or
(3) the assessment according to
section 256B.0655, subdivision 1b, determines that the recipient is in need of
a responsible party to direct the recipient's care.
(f) There may be two persons
designated as the responsible party for reasons such as divided households and
court-ordered custodies. Each person
named as responsible party must meet the program criteria and responsibilities.
(g) The recipient or the recipient's
legal representative shall appoint a responsible party if necessary to direct
and supervise the care provided to the recipient. The responsible party must be identified at
the time of assessment and listed on the recipient's service agreement and
personal care assistance care plan.
Subd. 10.
Responsible party; duties;
delegation. (a) A responsible
party shall enter into a written agreement with a personal care assistance
provider agency, on a form determined by the commissioner, to perform the
following duties:
(1) be available while care is
provided in a method agreed upon by the individual or the individual's legal
representative and documented in the recipient's personal care assistance care
plan;
(2) monitor personal care assistance
services to ensure the recipient's personal care assistance care plan is being
followed; and
(3) review and sign personal care
assistance time sheets after services are provided to provide verification of
the personal care assistance services.
Failure to provide the support required by the recipient must
result in a referral to the county common entry point.
(b) Responsible parties who are
parents of minors or guardians of minors or incapacitated persons may delegate the
responsibility to another adult who is not the personal care assistant during a
temporary absence of at least 24 hours but not more than six months. The person delegated as a responsible party
must be able to meet the definition of the responsible party, except that the
delegated responsible party is required to reside with the recipient only while
serving as the responsible party. The
responsible party must ensure that the delegate performs the functions of the
responsible party, is identified at the time of the assessment, and is listed
on the personal care assistance care plan.
The responsible party must communicate to the personal care assistance
provider agency about the need for a delegate responsible party, including the
name of the delegated responsible party, dates the delegated responsible party
will be living with the recipient, and contact numbers.
Subd. 11.
Personal care assistant;
requirements. (a) A personal
care assistant must meet the following requirements:
(1) be at least 18 years of age with
the exception of persons who are 16 or 17 years of age with these additional
requirements:
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(i) supervision by a qualified
professional every 60 days; and
(ii) employment by only one personal
care assistance provider agency responsible for compliance with current labor
laws;
(2) be employed by a personal care
assistance provider agency;
(3) enroll with the department as a
personal care assistant after clearing a background study. Before a personal care assistant provides
services, the personal care assistance provider agency must initiate a
background study on the personal care assistant under chapter 245C, and the
personal care assistance provider agency must have received a notice from the
commissioner that the personal care assistant is:
(i) not disqualified under section
245C.14; or
(ii) is disqualified, but the personal
care assistant has received a set aside of the disqualification under
section 245C.22;
(4) be able to effectively communicate
with the recipient and personal care assistance provider agency;
(5) be able to provide covered personal
care assistance services according to the recipient's personal care assistance
care plan, respond appropriately to recipient needs, and report changes in the
recipient's condition to the supervising qualified professional or physician;
(6) not be a consumer of personal care
assistance services;
(7) maintain daily written records
including, but not limited to, time sheets under subdivision 12;
(8) effective January 1, 2010,
complete standardized training as determined by the commissioner before completing
enrollment. Personal care assistant
training must include successful completion of the following training
components: basic first aid, vulnerable
adult, child maltreatment, OSHA universal precautions, basic roles and
responsibilities of personal care assistants including information about
assistance with lifting and transfers for recipients, emergency preparedness,
orientation to positive behavioral practices, fraud issues, and completion of
time sheets. Upon completion of the
training components, the personal care assistant must demonstrate the
competency to provide assistance to recipients;
(9) complete training and orientation
on the needs of the recipient within the first seven days after the services
begin; and
(10) be limited to providing and being
paid for up to 310 hours per month of personal care assistance services
regardless of the number of recipients being served or the number of personal
care assistance provider agencies enrolled with.
(b) A legal guardian may be a personal
care assistant if the guardian is not being paid for the guardian services and
meets the criteria for personal care assistants in paragraph (a).
(c) Effective January 1, 2010, persons
who do not qualify as a personal care assistant include parents and stepparents
of minors, spouses, paid legal guardians, family foster care providers, except
as otherwise allowed in section 256B.0625, subdivision 19a, or staff of a
residential setting.
Subd. 12.
Documentation of personal care
assistance services provided. (a)
Personal care assistance services for a recipient must be documented daily by
each personal care assistant, on a time sheet form approved by the
commissioner. All documentation may be
Web-based, electronic, or paper documentation.
The completed form must be submitted on a monthly basis to the provider
and kept in the recipient's health record.
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(b) The activity documentation must
correspond to the personal care assistance care plan and be reviewed by the
qualified professional.
(c) The personal care assistant time
sheet must be on a form approved by the commissioner documenting time the
personal care assistant provides services in the home. The following criteria must be included in
the time sheet:
(1) full name of personal care
assistant and individual provider number;
(2) provider name and telephone numbers;
(3) full name of recipient;
(4) consecutive dates, including
month, day, and year, and arrival and departure time with a.m. or p.m.
notations;
(5) signatures of recipient or the
responsible party;
(6) personal signature of the personal
care assistant;
(7) any shared care provided, if
applicable;
(8) a statement that it is a federal
crime to provide false information on personal care service billings for
medical assistance payments; and
(9) dates and location of recipient
stays in a hospital, care facility, or incarceration.
Subd. 13.
Qualified professional;
qualifications. (a) The
qualified professional must be employed by a personal care assistance provider
agency and meet the definition under section 256B.0625, subdivision 19c. Before a qualified professional provides
services, the personal care assistance provider agency must initiate a
background study on the qualified professional under chapter 245C, and the
personal care assistance provider agency must have received a notice from the
commissioner that the qualified professional:
(1) is not disqualified under section
245C.14; or
(2) is disqualified, but the qualified
professional has received a set aside of the disqualification under
section 245C.22.
(b) The qualified professional shall perform
the duties of training, supervision, and evaluation of the personal care
assistance staff and evaluation of the effectiveness of personal care
assistance services. The qualified
professional shall:
(1) develop and monitor with the
recipient a personal care assistance care plan based on the service plan and
individualized needs of the recipient;
(2) develop and monitor with the
recipient a monthly plan for the use of personal care assistance services;
(3) review documentation of personal
care assistance services provided;
(4) provide training and ensure
competency for the personal care assistant in the individual needs of the
recipient; and
(5) document all training,
communication, evaluations, and needed actions to improve performance of the personal
care assistants.
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(c) The qualified professional shall
complete the provider training with basic information about the personal care
assistance program approved by the commissioner within six months of the date
hired by a personal care assistance provider agency. Qualified professionals who have completed
the required trainings as an employee with a personal care assistance provider
agency do not need to repeat the required trainings if they are hired by
another agency, if they have completed the training within the last three
years.
Subd. 14.
Qualified professional;
duties. (a) Effective January
1, 2010, all personal care assistants must be supervised by a qualified
professional.
(b) Through direct training, observation,
return demonstrations, and consultation with the staff and the recipient, the
qualified professional must ensure and document that the personal care
assistant is:
(1) capable of providing the required
personal care assistance services;
(2) knowledgeable about the plan of
personal care assistance services before services are performed; and
(3) able to identify conditions that
should be immediately brought to the attention of the qualified professional.
(c) The qualified professional shall
evaluate the personal care assistant within the first 14 days of starting to
provide services for a recipient except for the personal care assistance choice
option under subdivision 19, paragraph (a), clause (4). The qualified professional shall evaluate the
personal care assistance services for a recipient through direct observation of
a personal care assistant's work:
(1) at least every 90 days thereafter
for the first year of a recipient's services; and
(2) every 120 days after the first
year of a recipient's service or whenever needed for response to a recipient's
request for increased supervision of the personal care assistance staff.
(d) Communication with the recipient
is a part of the evaluation process of the personal care assistance staff.
(e) At each supervisory visit, the
qualified professional shall evaluate personal care assistance services
including the following information:
(1) satisfaction level of the
recipient with personal care assistance services;
(2) review of the month-to-month plan
for use of personal care assistance services;
(3) review of documentation of
personal care assistance services provided;
(4) whether the personal care
assistance services are meeting the goals of the service as stated in the
personal care assistance care plan and service plan;
(5) a written record of the results
of the evaluation and actions taken to correct any deficiencies in the work of
a personal care assistant; and
(6) revision of the personal care assistance
care plan as necessary in consultation with the recipient or responsible party,
to meet the needs of the recipient.
(f) The qualified professional shall
complete the required documentation in the agency recipient and employee files
and the recipient's home, including the following documentation:
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(1) the personal care assistance care
plan based on the service plan and individualized needs of the recipient;
(2) a month-to-month plan for use of
personal care assistance services;
(3) changes in need of the recipient
requiring a change to the level of service and the personal care assistance
care plan;
(4) evaluation results of supervision
visits and identified issues with personal care assistance staff with
actions taken;
(5) all communication with the
recipient and personal care assistance staff; and
(6) hands-on training or
individualized training for the care of the recipient.
(g) The documentation in paragraph (f)
must be done on agency forms.
(h) The services that are not eligible
for payment as qualified professional services include:
(1) direct professional nursing tasks
that could be assessed and authorized as skilled nursing tasks;
(2) supervision of personal care
assistance completed by telephone;
(3) agency administrative activities;
(4) training other than the
individualized training required to provide care for a recipient; and
(5) any other activity that is not
described in this section.
Subd. 15.
Flexible use. (a) "Flexible use" means the
scheduled use of authorized hours of personal care assistance services, which vary
within a service authorization period covering no more than six months, in
order to more effectively meet the needs and schedule of the recipient. Each 12-month service agreement is divided
into two six-month authorization date spans.
No more than 75 percent of the total authorized units for a 12-month
service agreement may be used in a six-month date span.
(b) Authorization of flexible use
occurs during the authorization process under section 256B.0652. The flexible use of authorized hours does not
increase the total amount of authorized hours available to a recipient. The commissioner shall not authorize
additional personal care assistance services to supplement a service
authorization that is exhausted before the end date under a flexible service
use plan, unless the assessor determines a change in condition and a need for
increased services is established.
Authorized hours not used within the six-month period must not be
carried over to another time period.
(c) A recipient who has terminated personal
care assistance services before the end of the 12-month authorization period
must not receive additional hours upon reapplying during the same 12-month
authorization period, except if a change in condition is documented. Services must be prorated for the remainder
of the 12-month authorization period based on the first six-month assessment.
(d) The recipient, responsible party,
and qualified professional must develop a written month-to-month plan of the
projected use of personal care assistance services that is part of the personal
care assistance care plan and ensures:
(1) that the health and safety needs
of the recipient are met throughout both date spans of the authorization
period; and
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(2) that the total authorized amount
of personal care assistance services for each date span must not be used before
the end of each date span in the authorization period.
(e) The personal care assistance
provider agency shall monitor the use of personal care assistance services to
ensure health and safety needs of the recipient are met throughout both date
spans of the authorization period. The
commissioner or the commissioner's designee shall provide written notice to the
provider and the recipient or responsible party when a recipient is at risk of
exceeding the personal care assistance services prior to the end of the
six-month period.
(f) Misuse and abuse of the flexible
use of personal care assistance services resulting in the overuse of units in a
manner where the recipient will not have enough units to meet their needs for
assistance and ensure health and safety for the entire six-month date span may
lead to an action by the commissioner.
The commissioner may take action including, but not limited to: (1)
restricting recipients to service authorizations of no more than one month in
duration; (2) requiring the recipient to have a responsible party; and (3)
requiring a qualified professional to monitor and report services on a monthly
basis.
Subd. 16.
Shared services. (a) Medical assistance payments for shared
personal care assistance services are limited according to this subdivision.
(b) Shared service is the provision
of personal care assistance services by a personal care assistant to two or
three recipients, eligible for medical assistance, who voluntarily enter into
an agreement to receive services at the same time and in the same setting.
(c) For the purposes of this
subdivision, "setting" means:
(1) the home residence or family
foster care home of one or more of the individual recipients; or
(2) a child care program licensed
under chapter 245A or operated by a local school district or private school.
(d) Shared personal care assistance
services follow the same criteria for covered services as subdivision 2.
(e) Noncovered shared personal care
assistance services include the following:
(1) services for more than three
recipients by one personal care assistant at one time;
(2) staff requirements for child care
programs under chapter 245C;
(3) caring for multiple recipients in
more than one setting;
(4) additional units of personal care
assistance based on the selection of the option; and
(5) use of more than one personal
care assistance provider agency for the shared care services.
(f) The option of shared personal
care assistance is elected by the recipient or the responsible party with the assistance
of the assessor. The option must be
determined appropriate based on the ages of the recipients, compatibility, and
coordination of their assessed care needs.
The recipient or the responsible party, in conjunction with the
qualified professional, shall arrange the setting and grouping of shared
services based on the individual needs and preferences of the recipients. The personal care assistance provider agency
shall offer the recipient or the responsible party the option of shared or
one-on-one personal care assistance services or a combination of both. The recipient or the responsible party may
withdraw from participating in a shared services arrangement at any time.
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(g) Authorization for the shared
service option must be determined by the commissioner based on the criteria
that the shared service is appropriate to meet all of the recipients' needs and
their health and safety is maintained.
The authorization of shared services is part of the overall
authorization of personal care assistance services. Nothing in this subdivision must be construed
to reduce the total number of hours authorized for an individual recipient.
(h) A personal care assistant
providing shared personal care assistance services must:
(1) receive training specific for
each recipient served; and
(2) follow all required documentation
requirements for time and services provided.
(i) A qualified professional shall:
(1) evaluate the ability of the
personal care assistant to provide services for all of the recipients in a
shared setting;
(2) visit the shared setting as
services are being provided at least once every six months or whenever needed
for response to a recipient's request for increased supervision of the personal
care assistance staff;
(3) provide ongoing monitoring and
evaluation of the effectiveness and appropriateness of the shared services;
(4) develop a contingency plan with
each of the recipients which accounts for absence of the recipient in a share
services setting due to illness or other circumstances;
(5) obtain permission from each of the
recipients who are sharing a personal care assistant for number of shared hours
for services provided inside and outside the home residence; and
(6) document the training completed
by the personal care assistants specific to the shared setting and recipients
sharing services.
Subd. 17.
Shared services; rates. The commissioner shall provide a rate
system for shared personal care assistance services. For two persons sharing services, the rate
paid to a provider must not exceed one and one-half times the rate paid for
serving a single individual, and for three persons sharing services, the rate
paid to a provider must not exceed twice the rate paid for serving a single
individual. These rates apply only when
all of the criteria for the shared care personal care assistance service have
been met.
Subd. 18.
Personal care assistance
choice option; generally. (a)
The commissioner may allow a recipient of personal care assistance services to
use a fiscal intermediary to assist the recipient in paying and accounting for
medically necessary covered personal care assistance services. Unless otherwise provided in this section,
all other statutory and regulatory provisions relating to personal care
assistance services apply to a recipient using the personal care assistance
choice option.
(b) Personal care assistance choice
is an option of the personal care assistance program that allows the recipient
who receives personal care assistance services to be responsible for the
hiring, training, scheduling, and firing of personal care assistants. This program offers greater control and
choice for the recipient in who provides the personal care assistance service
and when the service is scheduled. The
recipient or the recipient's responsible party must choose a personal care
assistance choice provider agency as a fiscal intermediary. This personal care assistance choice provider
agency manages payroll, invoices the state, is responsible for all payroll
related taxes and insurance, and is responsible for providing the consumer
training and support in managing the recipient's personal care assistance
services.
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Subd. 19.
Personal care assistance
choice option; qualifications; duties.
(a) Under personal care assistance choice, the recipient or
responsible party shall:
(1) recruit, hire, schedule, and
terminate personal care assistants and a qualified professional;
(2) develop a personal care
assistance care plan based on the assessed needs and addressing the health and
safety of the recipient with the assistance of a qualified professional as
needed;
(3) orient and train the personal
care assistant with assistance as needed from the qualified professional;
(4) effective January 1, 2010,
supervise and evaluate the personal care assistant with the qualified
professional, who is required to visit the recipient at least every 180 days;
(5) monitor and verify in writing and
report to the personal care assistance choice agency the number of hours worked
by the personal care assistant and the qualified professional;
(6) engage in an annual face-to-face
reassessment to determine continuing eligibility and service
authorization; and
(7) use the same personal care
assistance choice provider agency if shared personal assistance care is being
used.
(b) The personal care assistance
choice provider agency shall:
(1) meet all personal care assistance
provider agency standards;
(2) enter into a written agreement
with the recipient, responsible party, and personal care assistants;
(3) not be related as a parent,
child, sibling, or spouse to the recipient, qualified professional, or the
personal care assistant; and
(4) ensure arm's-length transactions
without undue influence or coercion with the recipient and personal care
assistant.
(c) The duties of the personal care
assistance choice provider agency are to:
(1) be the employer of the personal
care assistant and the qualified professional for employment law and related
regulations including, but not limited to, purchasing and maintaining workers'
compensation, unemployment insurance, surety and fidelity bonds, and liability
insurance, and submit any or all necessary documentation including, but not
limited to, workers' compensation and unemployment insurance;
(2) bill the medical assistance
program for personal care assistance services and qualified professional
services;
(3) request and complete background
studies that comply with the requirements for personal care assistants and
qualified professionals;
(4) pay the personal care assistant
and qualified professional based on actual hours of services provided;
(5) withhold and pay all applicable
federal and state taxes;
(6) verify and keep records of hours
worked by the personal care assistant and qualified professional;
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(7) make the arrangements and pay
taxes and other benefits, if any; and comply with any legal requirements for a
Minnesota employer;
(8) enroll in the medical assistance
program as a personal care assistance choice agency; and
(9) enter into a written agreement as
specified in subdivision 20 before services are provided.
Subd. 20.
Personal care assistance
choice option; administration. (a)
Before services commence under the personal care assistance choice option, and
annually thereafter, the personal care assistance choice provider agency,
recipient, or responsible party, each personal care assistant, and the
qualified professional shall enter into a written agreement. The agreement must include at a minimum:
(1) duties of the recipient, qualified
professional, personal care assistant, and personal care assistance choice
provider agency;
(2) salary and benefits for the
personal care assistant and the qualified professional;
(3) administrative fee of the personal
care assistance choice provider agency and services paid for with that fee,
including background study fees;
(4) grievance procedures to respond to
complaints;
(5) procedures for hiring and
terminating the personal care assistant; and
(6) documentation requirements
including, but not limited to, time sheets, activity records, and the personal
care assistance care plan.
(b) Effective January 1, 2010, except
for the administrative fee of the personal care assistance choice provider
agency as reported on the written agreement, the remainder of the rates paid to
the personal care assistance choice provider agency must be used to pay for the
salary and benefits for the personal care assistant or the qualified
professional. The provider agency must
use a minimum of 72.5 percent of the revenue generated by the medical
assistance rate for personal care assistance services for employee personal
care assistant wages and benefits.
(c) The commissioner shall deny,
revoke, or suspend the authorization to use the personal care assistance choice
option if:
(1) it has been determined by the
qualified professional or public health nurse that the use of this option
jeopardizes the recipient's health and safety;
(2) the parties have failed to comply
with the written agreement specified in this subdivision;
(3) the use of the option has led to
abusive or fraudulent billing for personal care assistance services; or
(4) the department terminates the
personal care assistance choice option.
(d) The recipient or responsible party
may appeal the commissioner's decision in paragraph (c) according to section
256.045. The denial, revocation, or
suspension to use the personal care assistance choice option must not affect the
recipient's authorized level of personal care assistance services.
Subd. 21.
Requirements for initial
enrollment of personal care assistance provider agencies. (a) All personal care assistance provider
agencies must provide, at the time of enrollment as a personal care assistance
provider agency in a format determined by the commissioner, information and
documentation that includes, but is not limited to, the following:
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(1)
the personal care assistance provider agency's current contact information
including address, telephone number, and e-mail address;
(2)
proof of surety bond coverage in the amount of $50,000 or ten percent of the
provider's payments from Medicaid in the previous year, whichever is less;
(3)
proof of fidelity bond coverage in the amount of $20,000;
(4)
proof of workers' compensation insurance coverage;
(5) a
description of the personal care assistance provider agency's organization
identifying the names of all owners, managing employees, staff, board of
directors, and the affiliations of the directors, owners, or staff to other
service providers;
(6) a
copy of the personal care assistance provider agency's written policies and
procedures including: hiring of
employees; training requirements; service delivery; and employee and consumer
safety including process for notification and resolution of consumer
grievances, identification and prevention of communicable diseases, and
employee misconduct;
(7)
copies of all other forms the personal care assistance provider agency uses in
the course of daily business including, but not limited to:
(i) a
copy of the personal care assistance provider agency's time sheet if the time
sheet varies from the standard time sheet for personal care assistance services
approved by the commissioner, and a letter requesting approval of the personal
care assistance provider agency's nonstandard time sheet;
(ii)
the personal care assistance provider agency's template for the personal care
assistance care plan; and
(iii)
the personal care assistance provider agency's template and the written
agreement in subdivision 20 for recipients using the personal care assistance
choice option, if applicable;
(8) a
list of all trainings and classes that the personal care assistance provider
agency requires of its staff providing personal care assistance services;
(9)
documentation that the personal care assistance provider agency and staff have
successfully completed all the training required by this section;
(10)
documentation of the agency's marketing practices;
(11)
disclosure of ownership, leasing, or management of all residential properties
that is used or could be used for providing home care services; and
(12)
documentation that the agency will use the following percentages of revenue
generated from the medical assistance rate paid for personal care assistance
services for employee personal care assistant wages and benefits: 72.5 percent
of revenue in the personal care assistance choice option and 72.5 percent of
revenue from other personal care assistance providers.
(b)
Personal care assistance provider agencies shall provide the information
specified in paragraph (a) to the commissioner at the time the personal care
assistance provider agency enrolls as a vendor or upon request from the
commissioner. The commissioner shall
collect the information specified in paragraph (a) from all personal care
assistance providers beginning upon enactment of this section.
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(c) All personal care assistance
provider agencies shall complete mandatory training as determined by the
commissioner before enrollment as a provider.
Personal care assistance provider agencies are required to send all
owners, qualified professionals employed by the agency, and all other managing
employees to the initial and subsequent trainings. Personal care assistance provider agency
billing staff shall complete training about personal care assistance program
financial management. This training is
effective upon enactment of this section.
Any personal care assistance provider agency enrolled before that date
shall, if it has not already, complete the provider training within 18 months
of the effective date of this section.
Any new owners, new qualified professionals, and new managing employees
are required to complete mandatory training as a requisite of hiring.
Subd. 22.
Annual review for personal
care providers. (a) All
personal care assistance provider agencies shall resubmit, on an annual basis,
the information specified in subdivision 21, in a format determined by the
commissioner, and provide a copy of the personal care assistance provider
agency's most current version of its grievance policies and procedures along
with a written record of grievances and resolutions of the grievances that the
personal care assistance provider agency has received in the previous year and
any other information requested by the commissioner.
(b) The commissioner shall send annual
review notification to personal care assistance provider agencies 30 days prior
to renewal. The notification must:
(1) list the materials and information
the personal care assistance provider agency is required to submit;
(2) provide instructions on submitting
information to the commissioner; and
(3) provide a due date by which the
commissioner must receive the requested information.
Personal care assistance provider agencies shall submit
required documentation for annual review within 30 days of notification from
the commissioner. If no documentation is
submitted, the personal care assistance provider agency enrollment number must
be terminated or suspended.
(c) Personal care assistance provider
agencies also currently licensed under Minnesota Rules, part 4668.0012, as a
class A provider or currently certified for participation in Medicare as a home
health agency are deemed in compliance with the personal care assistance
requirements for enrollment, annual review process, and documentation.
Subd. 23.
Enrollment requirements following
termination. (a) A terminated
personal care assistance provider agency, including all named individuals on
the current enrollment disclosure form and known or discovered affiliates of
the personal care assistance provider agency, is not eligible to enroll as a
personal care assistance provider agency for two years following the
termination.
(b) After the two-year period in
paragraph (a), if the provider seeks to reenroll as a personal care assistance
provider agency, the personal care assistance provider agency must be placed on
a one-year probation period, beginning after completion of the following:
(1) the department's provider
trainings under this section; and
(2) initial enrollment requirements
under subdivision 21.
(c) During the probationary period the
commissioner shall complete site visits and request submission of documentation
to review compliance with program policy.
Subd. 24.
Personal care assistance
provider agency; general duties.
A personal care assistance provider agency shall:
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(1)
enroll as a Medicaid provider meeting all provider standards, including
completion of the required provider training;
(2)
comply with general medical assistance coverage requirements;
(3)
demonstrate compliance with law and policies of the personal care assistance
program to be determined by the commissioner;
(4)
comply with background study requirements;
(5)
verify and keep records of hours worked by the personal care assistant and
qualified professional;
(6)
market agency services only through printed information in brochures and on Web
sites and not engage in any agency-initiated direct contact or marketing in
person, by phone, or other electronic means to potential recipients, guardians,
or family members;
(7)
pay the personal care assistant and qualified professional based on actual
hours of services provided;
(8)
withhold and pay all applicable federal and state taxes;
(9)
effective January 1, 2010, document that the agency uses a minimum of 72.5
percent of the revenue generated by the medical assistance rate for personal
care assistance services for employee personal care assistant wages and
benefits;
(10)
make the arrangements and pay unemployment insurance, taxes, workers'
compensation, liability insurance, and other benefits, if any;
(11)
enter into a written agreement under subdivision 20 before services are
provided;
(12)
report suspected neglect and abuse to the common entry point according to
section 256B.0651;
(13)
provide the recipient with a copy of the home care bill of rights at start of
service; and
(14)
request reassessments at least 60 days prior to the end of the current
authorization for personal care assistance services, on forms provided by the
commissioner.
Subd.
25.
Personal care assistance
provider agency; background studies.
Personal care assistance provider agencies enrolled to provide
personal care assistance services under the medical assistance program shall
comply with the following:
(1)
owners who have a five percent interest or more and all managing employees are
subject to a background study as provided in chapter 245C. This applies to currently enrolled personal
care assistance provider agencies and those agencies seeking enrollment as a
personal care assistance provider agency.
Managing employee has the same meaning as Code of Federal Regulations,
title 42, section 455. An organization
is barred from enrollment if:
(i)
the organization has not initiated background studies on owners and managing
employees; or
(ii)
the organization has initiated background studies on owners and managing
employees, but the commissioner has sent the organization a notice that an
owner or managing employee of the organization has been disqualified under
section 245C.14, and the owner or managing employee has not received a set
aside of the disqualification under section 245C.22;
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(2) a background study must be
initiated and completed for all qualified professionals; and
(3) a background study must be
initiated and completed for all personal care assistants.
Subd. 26.
Personal care assistance provider
agency; communicable disease prevention. A personal care assistance provider agency
shall establish and implement policies and procedures for prevention, control,
and investigation of infections and communicable diseases according to current
nationally recognized infection control practices or guidelines established by
the United States Centers for Disease Control and Prevention, as well as
applicable regulations of other federal or state agencies.
Subd. 27.
Personal care assistance
provider agency; ventilator training.
The personal care assistance provider agency is required to provide
training for the personal care assistant responsible for working with a
recipient who is ventilator dependent.
All training must be administered by a respiratory therapist, nurse, or
physician. Qualified professional
supervision by a nurse must be completed and documented on file in the personal
care assistant's employment record and the recipient's health record. If offering personal care services to a
ventilator-dependent recipient, the personal care assistance provider agency
shall demonstrate the ability to:
(1) train the personal care
assistant;
(2) supervise the personal care
assistant in ventilator operation and maintenance; and
(3) supervise the recipient and
responsible party in ventilator operation and maintenance.
Subd. 28.
Personal care assistance
provider agency; required documentation. Required documentation must be completed
and kept in the personal care assistance provider agency file or the
recipient's home residence. The required
documentation consists of:
(1) employee files, including:
(i) applications for employment;
(ii) background study requests and
results;
(iii) orientation records about the
agency policies;
(iv) trainings completed with
demonstration of competence;
(v) supervisory visits;
(vi) evaluations of employment; and
(vii) signature on fraud statement;
(2) recipient files, including:
(i) demographics;
(ii) emergency contact information
and emergency backup plan;
(iii) personal care assistance
service plan;
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(iv) personal care assistance care
plan;
(v) month-to-month service use plan;
(vi) all communication records;
(vii) start of service information,
including the written agreement with recipient; and
(viii) date the home care bill of
rights was given to the recipient;
(3) agency policy manual, including:
(i) policies for employment and
termination;
(ii) grievance policies with
resolution of consumer grievances;
(iii) staff and consumer safety;
(iv) staff misconduct; and
(v) staff hiring, service delivery,
staff and consumer safety, staff misconduct, and resolution of consumer
grievances;
(4) time sheets for each personal care
assistant along with completed activity sheets for each recipient
served; and
(5) agency marketing and advertising
materials and documentation of marketing activities and costs.
Subd. 29.
Transitional assistance. The commissioner, counties, health plans,
tribes, and personal care assistance providers shall work together to provide
transitional assistance for recipients and families to come into compliance
with the new requirements of this section and ensure the personal care
assistance services are not provided by the housing provider.
Subd. 30.
Notice of service changes to
recipients. The commissioner
must provide:
(1) by October 31, 2009, information to
recipients likely to be affected that (i) describes the changes to the personal
care assistance program that may result in the loss of access to personal care
assistance services, and (ii) includes resources to obtain further information;
and
(2) notice of changes in medical
assistance home care services to each affected recipient at least 30 days
before the effective date of the change.
The notice shall include how to get further information on the
changes, how to get help to obtain other services, a list of community
resources, and appeal rights.
Notwithstanding section 256.045, a recipient may request continued
services pending appeal within the time period allowed to request an appeal.
EFFECTIVE DATE.
Subdivisions 4, 22, and 27 are effective January 1, 2010.
Sec. 32.
Minnesota Statutes 2008, section 256B.0911, subdivision 1, is amended to
read:
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,
including
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assessment and support planning, 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. Long-term
consultation services must be available to any person regardless of public
program eligibility. The commissioners
commissioner 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 long-term care
options counseling provided under section 256.975, subdivision 7, and with
services provided by other public and private agencies in the community section
256.01, subdivision 24, for telephone assistance and follow up and to offer
a variety of cost-effective alternatives to persons with disabilities and
elderly persons. The county or tribal
agency or managed care plan 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.
Sec.
33. Minnesota Statutes 2008, section
256B.0911, subdivision 1a, is amended to read:
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 most inclusive environment;
(5) (2) providing recommendations on
cost-effective community services that are available to the individual;
(6) (3) development of an individual's person-centered
community support plan;
(7) (4) providing information regarding
eligibility for Minnesota health care programs;
(5)
face-to-face long-term care consultation assessments, which may be completed in
a hospital, nursing facility, intermediate care facility for persons with
developmental disabilities (ICF/DDs), regional treatment centers, or the
person's current or planned residence;
(8)
preadmission (6) federally
mandated screening to determine the need for a nursing facility institutional
level of care under section 256B.0911, subdivision 4, paragraph (a);
(9)
preliminary (7) determination
of Minnesota health care programs home and community-based waiver
service eligibility including level of care determination for
individuals who need a nursing facility an institutional level of
care as defined under section 144.0724, subdivision 11, or 256B.092, service
eligibility including state plan home care services identified in section
256B.0625, subdivisions 6, 7, and 19, paragraphs (a) and (c), based on
assessment and support plan development with appropriate referrals for
final determination;
(10) (8) providing recommendations for nursing
facility placement when there are no cost-effective community services available; and
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(11) (9) assistance to transition people back to
community settings after facility admission.
(b)
"Long-term options counseling" means the services provided by the
linkage lines as mandated by sections 256.01 and 256.975, subdivision 7, and
also includes telephone assistance and follow up once a long-term care
consultation assessment has been completed.
(b) (c)
"Minnesota health care programs" means the medical assistance program
under chapter 256B and the alternative care program under section 256B.0913.
(d)
"Lead agencies" means counties or a collaboration of counties,
tribes, and health plans administering long-term care consultation assessment
and support planning services.
EFFECTIVE DATE. This section is effective
January 1, 2011.
Sec.
34. Minnesota Statutes 2008, section
256B.0911, is amended by adding a subdivision to read:
Subd.
2b.
Certified assessors. (a) Beginning January 1, 2011, each lead
agency shall use certified assessors who have completed training and
certification process determined by the commissioner in subdivision 2c. Certified assessors shall demonstrate best
practices in assessment and support planning including person-centered planning
principals and have a common set of skills that must ensure consistency and
equitable access to services statewide.
Assessors must be part of a multidisciplinary team of professionals that
includes public health nurses, social workers, and other professionals as defined
in paragraph (b). For persons with complex
health care needs, a public health nurse or registered nurse from a
multidisciplinary team must be consulted.
(b)
Certified assessors are persons with a minimum of a bachelor's degree in social
work, nursing with a public health nursing certificate, or other closely
related field with at least one year of home and community-based experience or
a two-year registered nursing degree with at least three years of home and
community-based experience that have received training and certification
specific to assessment and consultation for long-term care services in the
state.
Sec.
35. Minnesota Statutes 2008, section
256B.0911, is amended by adding a subdivision to read:
Subd.
2c.
Assessor training and
certification. The
commissioner shall develop a curriculum and an assessor certification process
to begin no later than January 1, 2010.
All existing lead agency staff designated to provide the services
defined in subdivision 1a must be certified by December 30, 2010. Each lead agency is required to ensure that
they have sufficient numbers of certified assessors to provide long-term
consultation assessment and support planning within the timelines and
parameters of the service by January 1, 2011.
Certified assessors are required to be recertified every three years.
Sec.
36. Minnesota Statutes 2008, section
256B.0911, subdivision 3, is amended to read:
Subd.
3. Long-term
care consultation team. (a) Until
January 1, 2011, 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.
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(c) The commissioner shall allow arrangements
and make recommendations that encourage counties to collaborate to establish
joint local long-term care consultation teams to ensure that long-term care
consultations are done within the timelines and parameters of the service. This includes integrated service models as
required in subdivision 1, paragraph (b).
Sec. 37.
Minnesota Statutes 2008, section 256B.0911, subdivision 3a, is amended
to read:
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 15 calendar days after the
date on which an assessment was requested or recommended. After January 1, 2011, these requirements
also apply to personal care assistance services, private duty nursing, and home
health agency services, on timelines established in subdivision 5. Face-to-face 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,. After January 1, 2011, lead agencies shall
use certified assessors 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 assessment must be
comprehensive and include a person-centered assessment of the health,
psychological, functional, environmental, and social needs of referred
individuals and provide information necessary to develop a support plan that meets
the consumers needs, using an assessment form provided by the commissioner.
(d) The team must conduct the assessment must
be conducted in a face-to-face interview with the person being assessed and
the person's legal representative, if applicable as required by
legally executed documents, and other individuals as requested by the person,
who can provide information on the needs, strengths, and preferences of the
person necessary to develop a support plan that ensures the person's health and
safety, but who is not a provider of service or has any financial interest in
the provision of services.
(e) The team must provide the person, or the
person's legal representative, must be provided with written
recommendations for facility- or community-based services. The team must document or
institutional care that include documentation 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
institutional care.
(f) If the person chooses to use community-based
services, the team must provide the person or the person's legal
representative must be provided with a written community support plan,
regardless of whether the individual is eligible for Minnesota health care
programs. The A person may
request assistance in developing a community support plan identifying
community supports without participating in a complete assessment. Upon a request for assistance identifying
community support, the person must be transferred or referred to the services
available under sections 256.975, subdivision 7, and 256.01, subdivision 24,
for telephone assistance and follow up.
(g) The person has the right to make the final
decision between nursing facility institutional placement and
community placement after the screening team's recommendation
recommendations have been provided, 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 information:
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(1) the need for and purpose of preadmission screening
if the person selects nursing facility placement;
(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 institutional level of
care as determined under criteria established in section 144.0724,
subdivision 11, or 256B.092; 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.
Sec. 38.
Minnesota Statutes 2008, section 256B.0911, subdivision 3b, is amended
to read:
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 long-term care
options counseling under section 256B.975, subdivision 10, for community
support plan implementation and 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 the Senior LinkAge
Line, 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 available;
(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.
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Sec. 39.
Minnesota Statutes 2008, section 256B.0911, subdivision 3c, is amended
to read:
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 commissioner;
(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. The
Senior LinkAge Line and long-term care consultation team shall give the highest
priority to referrals who are at highest risk of nursing facility placement or
as needed for determining eligibility.
Sec. 40.
Minnesota Statutes 2008, section 256B.0911, subdivision 4a, is amended
to read:
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
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(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 established in section
144.0724, subdivision 11, and 256B.092, using forms 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.
EFFECTIVE DATE.
The section is effective January 1, 2011.
Sec. 41.
Minnesota Statutes 2008, section 256B.0911, subdivision 5, is amended to
read:
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 streamline the processes, including timelines for when
assessments need to be completed, required to provide the services in this
section and shall implement integrated solutions to automate the business
processes to the extent necessary for community support plan approval,
reimbursement, program planning, evaluation, and policy development.
Sec. 42.
Minnesota Statutes 2008, section 256B.0911, subdivision 6, is amended to
read:
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.
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(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.
(h)
The commissioner shall develop an alternative payment methodology for long-term
care consultation services that includes the funding available under this
subdivision, and sections 256B.092 and 256B.0659. In developing the new payment methodology,
the commissioner shall consider the maximization of federal funding for this
activity.
Sec.
43. Minnesota Statutes 2008, section
256B.0911, subdivision 7, is amended to read:
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 in section 144.0724, subdivision 11, 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.
EFFECTIVE DATE. The section is effective
January 1, 2011.
Sec.
44. Minnesota Statutes 2008, section
256B.0913, subdivision 4, is amended to read:
Subd.
4. Eligibility
for funding for services for nonmedical assistance recipients. (a) Funding for services under the
alternative care program is available to persons who meet the following
criteria:
(1) the
person has been determined by a community assessment under section 256B.0911 to
be a person who would require the level of care provided in a nursing facility,
but for the provision of services under the alternative care program. Effective January 1, 2011, this determination
must be made according to the criteria established in section 144.0724,
subdivision 11;
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(2) the person is age 65 or older;
(3) the person would be eligible for medical assistance
within 135 days of admission to a nursing facility;
(4) the person is not ineligible for the payment of long-term
care services by the medical assistance program due to an asset transfer
penalty under section 256B.0595 or equity interest in the home exceeding
$500,000 as stated in section 256B.056;
(5) the person needs long-term care services that are
not funded through other state or federal funding;
(6) except for individuals described in clause (7), the
monthly cost of the alternative care services funded by the program for this
person does not exceed 75 percent of the monthly limit described under section
256B.0915, subdivision 3a. This monthly
limit does not prohibit the alternative care client from payment for additional
services, but in no case may the cost of additional services purchased under
this section exceed the difference between the client's monthly service limit
defined under section 256B.0915, subdivision 3, and the alternative care
program monthly service limit defined in this paragraph. If care-related supplies and equipment or
environmental modifications and adaptations are or will be purchased for an
alternative care services recipient, the costs may be prorated on a monthly
basis for up to 12 consecutive months beginning with the month of
purchase. If the monthly cost of a
recipient's other alternative care services exceeds the monthly limit
established in this paragraph, the annual cost of the alternative care services
shall be determined. In this event, the
annual cost of alternative care services shall not exceed 12 times the monthly
limit described in this paragraph; and
(7) for individuals assigned a case mix
classification A as described under section 256B.0915, subdivision 3a,
paragraph (a), with (i) no dependencies in activities of daily living, (ii)
only one dependency in bathing, dressing, grooming, or walking, or (iii) a dependency
score of less than three if eating is the only dependency as determined by an
assessment performed under section 256B.0911, the monthly cost of alternative
care services funded by the program cannot exceed $600 per month for all new
participants enrolled in the program on or after July 1, 2009. 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 section 256B.0915, subdivision 3a, paragraph (a). This monthly limit does not prohibit the
alternative care client from payment for additional services, but in no case
may the cost of additional services purchased exceed the difference between the
client's monthly service limit defined in this clause and the limit described
in clause (6) for case mix classification A; and
(8) the person is making timely payments of the assessed
monthly fee.
A person is ineligible if payment of the fee is over 60 days
past due, unless the person agrees to:
(i) the appointment of a representative payee;
(ii) automatic payment from a financial account;
(iii) the establishment of greater family involvement
in the financial management of payments; or
(iv) another method acceptable to the lead agency to
ensure prompt fee payments.
The lead agency may extend the client's eligibility as
necessary while making arrangements to facilitate payment of past-due amounts
and future premium payments. Following
disenrollment due to nonpayment of a monthly fee, eligibility shall not be
reinstated for a period of 30 days.
(b) Alternative care funding under this subdivision is
not available for a person who is a medical assistance recipient or who would
be eligible for medical assistance without a spenddown or waiver obligation. A person whose initial application for
medical assistance and the elderly waiver program is being processed may be
served under the alternative care program for a period up to 60 days. If the individual is found to be eligible for
medical
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assistance, medical assistance must be billed for
services payable under the federally approved elderly waiver plan and delivered
from the date the individual was found eligible for the federally approved
elderly waiver plan. Notwithstanding
this provision, alternative care funds may not be used to pay for any service
the cost of which: (i) is payable by medical assistance; (ii) is used by a
recipient to meet a waiver obligation; or (iii) is used to pay a medical
assistance income spenddown for a person who is eligible to participate in the
federally approved elderly waiver program under the special income standard
provision.
(c)
Alternative care funding is not available for a person who resides in a
licensed nursing home, certified boarding care home, hospital, or intermediate
care facility, except for case management services which are provided in
support of the discharge planning process for a nursing home resident or
certified boarding care home resident to assist with a relocation process to a
community-based setting.
(d)
Alternative care funding is not available for a person whose income is greater
than the maintenance needs allowance under section 256B.0915, subdivision 1d,
but equal to or less than 120 percent of the federal poverty guideline
effective July 1 in the fiscal year for which alternative care eligibility is
determined, who would be eligible for the elderly waiver with a waiver
obligation.
Sec.
45. Minnesota Statutes 2008, section
256B.0915, subdivision 3a, is amended to read:
Subd.
3a. Elderly
waiver cost limits. (a) The monthly
limit for the cost of waivered services to an individual elderly waiver client except
for individuals described in paragraph (b) 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.438 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.438 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)
The monthly limit for the cost of waivered services to an individual elderly
waiver client assigned to a case mix classification A under paragraph (a) with
(1) no dependencies in activities of daily living, (2) only one dependency in
bathing, dressing, grooming, or walking, or (3) a dependency score of less than
three if eating is the only dependency, shall be the lower of the case mix
classification amount for case mix A as determined under paragraph (a) or the
case mix classification amount for case mix A effective on October 1, 2008, per
month for all new participants enrolled in the program on or after July 1,
2009. This monthly limit shall be
applied to all other participants who meet this criteria at reassessment.
(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) or (b), 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) or (b).
Sec.
46. Minnesota Statutes 2008, section
256B.0915, subdivision 3e, is amended to read:
Subd.
3e. Customized
living service rate. (a) Payment for
customized living services shall be a monthly rate negotiated and
authorized by the lead agency within the parameters established by the
commissioner. The payment agreement must
delineate the services that have been customized for each recipient and
specify the amount of each
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component
service included in the recipient's customized living service to be provided plan. The lead agency shall ensure that there is a
documented need for all within the parameters established by the
commissioner for all component customized living services authorized. Customized living services must not
include rent or raw food costs.
(b) The negotiated payment rate must be based on the
amount of component services to be provided utilizing component rates
established by the commissioner.
Counties and tribes shall use tools issued by the commissioner to
develop and document customized living service plans and rates.
Negotiated (c) Component service rates must not exceed payment rates for comparable
elderly waiver or medical assistance services and must reflect economies of
scale. Customized living services
must not include rent or raw food costs.
(b) (d) The individualized monthly negotiated
authorized payment for the customized living services
service plan shall not exceed the nonfederal share, in effect on July 1
of the state fiscal year for which the rate limit is being calculated,
50 percent 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.438 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.438 for
nursing home rate determination is implemented and July 1 of each subsequent
state fiscal year, the individualized monthly negotiated authorized
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
updated annually based on legislatively adopted changes to all service rate
maximums for home and community-based service providers.
(c) (e) Customized living services are delivered
by a provider licensed by the Department of Health as a class A or class F home
care provider and provided in a building that is registered as a housing with
services establishment under chapter 144D.
Sec.
47. Minnesota Statutes 2008, section
256B.0915, subdivision 3h, is amended to read:
Subd.
3h. Service
rate limits; 24-hour customized living services. (a) The payment rates rate
for 24-hour customized living services is a monthly rate negotiated and
authorized by the lead agency within the parameters established by the
commissioner of human services. The
payment agreement must delineate the services that have been customized for
each recipient and specify the amount of each component service included
in each recipient's customized living service to be provided plan. The lead agency shall ensure that there is a
documented need within the parameters established by the commissioner for
all component customized living services authorized. The lead agency shall not authorize 24-hour customized
living services unless there is a documented need for 24-hour supervision.
(b) For purposes of this section, "24-hour
supervision" means that the recipient requires assistance due to needs
related to one or more of the following:
(1)
intermittent assistance with toileting, positioning, or transferring;
(2)
cognitive or behavioral issues;
(3) a
medical condition that requires clinical monitoring; or
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(4) other conditions or needs as defined by the
commissioner of human services for all new participants enrolled in the
program on or after January 1, 2011, and all other participants at their first
reassessment after January 1, 2011, dependency in at least two of the following
activities of daily living as determined by assessment under section
256B.0911: bathing; dressing; grooming;
walking; or eating; and needs medication management and at least 50 hours of
service per month. The lead agency
shall ensure that the frequency and mode of supervision of the recipient and
the qualifications of staff providing supervision are described and meet the
needs of the recipient. Customized
living services must not include rent or raw food costs.
(c) The negotiated payment rate for 24-hour
customized living services must be based on the amount of component services
to be provided utilizing component rates established by the
commissioner. Counties and tribes will
use tools issued by the commissioner to develop and document customized living
plans and authorize rates.
Negotiated (d) Component service rates must not exceed payment rates
for comparable elderly waiver or medical assistance services and must reflect
economies of scale.
(e) The individually negotiated authorized
24-hour customized living payments, in combination with the payment for other
elderly waiver services, including case management, must not exceed the
recipient's community budget cap specified in subdivision 3a. Customized living services must not
include rent or raw food costs.
(f) The individually authorized
24-hour customized living payment rates shall not exceed the 95 percentile of
statewide monthly authorizations for 24-hour customized living services in
effect and in the Medicaid management information systems on March 31, 2009,
for each case mix resident class under Minnesota Rules, parts 9549.0050 to
9549.0059, to which elderly waiver service clients are assigned. When there are fewer than 50 authorizations
in effect in the case mix resident class, the commissioner shall multiply the
calculated service payment rate maximum for the A classification by the
standard weight for that classification under Minnesota Rules, parts 9549.0050
to 9549.0059, to determine the applicable payment rate maximum. Service payment rate maximums shall be
updated annually based on legislatively adopted changes to all service rates
for home and community-based service providers.
(g) Notwithstanding the requirements
of paragraphs (d) and (f), the commissioner may establish alternative payment
rate systems for 24-hour customized living services in housing with services
establishments which are freestanding buildings with a capacity of 16 or fewer,
by applying a single hourly rate for covered component services provided in
either:
(1) licensed corporate adult foster
homes; or
(2) specialized dementia care units
which meet the requirements of section 144D.065 and in which:
(i) each resident is offered the
option of having their own apartment; or
(ii) the units are licensed as board
and lodge establishments with maximum capacity of eight residents, and which
meet the requirements of Minnesota Rules, part 9555.6205, subparts 1, 2, 3, and
4, item A.
Sec. 48.
Minnesota Statutes 2008, section 256B.0915, subdivision 5, is amended to
read:
Subd. 5. Assessments and reassessments for waiver
clients. (a) 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. There must be a determination that the
client requires nursing facility level of care as defined in section 144.0724,
subdivision 11, at initial and subsequent assessments to initiate and maintain
participation in the waiver program.
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(b) Regardless of other assessments
identified in section 144.0724, subdivision 4, as appropriate to determine
nursing facility level of care for purposes of medical assistance payment for
nursing facility services, only face-to-face assessments conducted according to
section 256B.0911, subdivisions 3a and 3b, that result in a nursing facility
level of care determination will be accepted for purposes of initial and
ongoing access to waiver service payment.
EFFECTIVE DATE.
This section is effective January 1, 2011.
Sec. 49.
Minnesota Statutes 2008, section 256B.0915, is amended by adding a
subdivision to read:
Subd. 10.
Waiver payment rates; managed
care organizations. The
commissioner shall adjust the elderly waiver capitation payment rates for
managed care organizations paid under section 256B.69, subdivisions 6a and 23,
to reflect the maximum service rate limits for customized living services and
24-hour customized living services under subdivisions 3e and 3h for the
contract period beginning October 1, 2009.
Medical assistance rates paid to customized living providers by managed
care organizations under this section shall not exceed the maximum service rate
limits determined by the commissioner under subdivisions 3e and 3h.
Sec. 50.
Minnesota Statutes 2008, section 256B.0916, subdivision 2, is amended to
read:
Subd. 2. Distribution of funds; partnerships. (a) Beginning with fiscal year 2000, the
commissioner shall distribute all funding available for home and
community-based waiver services for persons with developmental disabilities to
individual counties or to groups of counties that form partnerships to jointly
plan, administer, and authorize funding for eligible individuals. The commissioner shall encourage counties to
form partnerships that have a sufficient number of recipients and funding to
adequately manage the risk and maximize use of available resources.
(b) Counties must submit a request for funds and a plan
for administering the program as required by the commissioner. The plan must identify the number of clients
to be served, their ages, and their priority listing based on:
(1) requirements in Minnesota Rules, part 9525.1880;
and
(2) unstable living situations due to the age or
incapacity of the primary caregiver; statewide priorities identified in
section 256B.092, subdivision 12.
(3) the need for services to avoid
out-of-home placement of children;
(4) the need to serve persons affected
by private sector ICF/MR closures; and
(5) the need to serve persons whose
consumer support grant exception amount was eliminated in 2004.
The plan must also identify changes made to improve services
to eligible persons and to improve program management.
(c) In allocating resources to counties, priority must
be given to groups of counties that form partnerships to jointly plan,
administer, and authorize funding for eligible individuals and to counties
determined by the commissioner to have sufficient waiver capacity to maximize
resource use.
(d) Within 30 days after receiving the county request
for funds and plans, the commissioner shall provide a written response to the
plan that includes the level of resources available to serve additional
persons.
(e) Counties are eligible to receive medical assistance
administrative reimbursement for administrative costs under criteria
established by the commissioner.
Journal of the
House - 51st Day - Monday, May 11, 2009 - Top of Page 5330
Sec. 51.
Minnesota Statutes 2008, section 256B.0917, is amended by adding a
subdivision to read:
Subd. 14.
Essential community supports
grants. (a) The purpose of
the essential community supports grant program is to provide targeted services
to persons 65 years and older who need essential community support, but whose
needs do not meet the level of care required for nursing facility placement
under section 144.0724, subdivision 11.
(b) Within the limits of the
appropriation and not to exceed $400 per person per month, funding must be
available to a person who:
(1) is age 65 or older;
(2) is not eligible for medical
assistance;
(3) would otherwise be financially
eligible for the alternative care program under section 256B.0913,
subdivision 4;