STATE OF
MINNESOTA
EIGHTY-SEVENTH
SESSION - 2012
_____________________
EIGHTY-THIRD
DAY
Saint Paul, Minnesota, Thursday, March 8, 2012
The House of Representatives convened at 3:00
p.m. and was called to order by Kurt Zellers, Speaker of the House.
Prayer was offered by the Reverend Craig
Hanson, Roseville Lutheran Church, Roseville, Minnesota.
The members of the House gave the pledge
of allegiance to the flag of the United States of America.
The roll was called and the following
members were present:
Abeler
Allen
Anderson, B.
Anderson, D.
Anderson, P.
Anderson, S.
Anzelc
Atkins
Banaian
Barrett
Beard
Benson, J.
Benson, M.
Bills
Brynaert
Buesgens
Carlson
Champion
Clark
Cornish
Crawford
Daudt
Davids
Davnie
Dean
Dettmer
Dill
Dittrich
Doepke
Downey
Drazkowski
Eken
Erickson
Falk
Franson
Fritz
Garofalo
Gottwalt
Greene
Greiling
Gruenhagen
Gunther
Hackbarth
Hamilton
Hancock
Hansen
Hausman
Hilstrom
Holberg
Hoppe
Hornstein
Hortman
Hosch
Howes
Huntley
Johnson
Kahn
Kath
Kelly
Kieffer
Kiel
Kiffmeyer
Knuth
Koenen
Kriesel
Laine
Lanning
Leidiger
LeMieur
Lenczewski
Lesch
Liebling
Lillie
Loeffler
Lohmer
Loon
Mack
Mahoney
Mariani
Marquart
Mazorol
McDonald
McElfatrick
McFarlane
McNamara
Melin
Moran
Morrow
Mullery
Murphy, E.
Murphy, M.
Murray
Myhra
Nelson
Nornes
Norton
O'Driscoll
Paymar
Pelowski
Peppin
Persell
Petersen, B.
Peterson, S.
Poppe
Quam
Rukavina
Runbeck
Sanders
Scalze
Schomacker
Scott
Shimanski
Simon
Slawik
Slocum
Smith
Stensrud
Swedzinski
Thissen
Tillberry
Torkelson
Urdahl
Vogel
Wagenius
Ward
Wardlow
Westrom
Winkler
Woodard
Spk. Zellers
A quorum was present.
Fabian, Gauthier, Hilty and Murdock were
excused.
The Chief Clerk proceeded to read the
Journal of the preceding day. There
being no objection, further reading of the Journal was dispensed with and the
Journal was approved as corrected by the Chief Clerk.
PETITIONS AND COMMUNICATIONS
The following communications were
received:
STATE OF
MINNESOTA
OFFICE OF THE GOVERNOR
SAINT PAUL 55155
March 5, 2012
The
Honorable Kurt Zellers
Speaker
of the House of Representatives
The State
of Minnesota
Dear Speaker Zellers:
I have vetoed and am returning
H. F. No. 1467, Chapter No. 126.
I greatly appreciate the House Author's sincere efforts to address the
concerns of law enforcement organizations and to enlist my support. However, most of Minnesota's major law
enforcement and public safety organizations remain strongly opposed to the bill
and, I believe, their concerns must be honored.
The MN Police and Peace Officers
Association, the MN Chiefs of Police, and the MN Sheriffs Association represent
the men and women who risk their lives every day and night to protect the rest
of us. When they strongly oppose a
measure, because they believe it will increase the dangers to them in the
performance of their duties, I cannot support it.
The US Bureau of Alcohol, Tobacco, and
Firearms reports that in 2007, there were about 294 million guns in the United
States: 106 million handguns, 105
million rifles, and 83 million shotguns.
On a proportionate basis, that would mean there are over 5 million
firearms in Minnesota. Clearly, the Second Amendment of the US Constitution is
properly being supported by lawmakers and law enforcers throughout America.
The question addressed by this proposed
legislation is: Under what circumstances
can deadly force lawfully be used?
Current Minnesota law already provides a definitive answer. Minn.
Stat., Sec. 624.711 DECLARATION OF POLICY states:
"It is not the intent of the
legislature to regulate shotguns, rifles and other longguns of the type
commonly used for hunting and not defined as pistols or semiautomatic
military-style assault weapons, or to place costs of administration upon those
citizens who wish to possess or carry pistols or semiautomatic military-style
assault weapons lawfully, or to confiscate or otherwise restrict the use of
pistols or semiautomatic military-style assault weapons by law-abiding
citizens."
Furthermore, the laws of Minnesota ensure
the rights of most law-abiding citizens to carry firearms in their possessions
outside their homes, by application to their County Sheriff. The law states that "A sheriff must
issue a permit to an applicant if the person:
(1) has training in the safe use of a pistol; (2) is at least 21 years
old and a citizen or a permanent resident of the United States; (3) completes
an application for a permit; (4) is not prohibited from possessing a firearm
under certain sections of the law; (5) is not listed in the criminal gang
investigative data system."
Current Minnesota law also defines the
circumstances under which force can be used.
Minn. Stat., Sec. 609.06, subd. 1
AUTHORIZED USE OF FORCE, says:
"Reasonable force may be used upon or toward the person of another
without the other's consent when certain circumstances exist or the actor
reasonably believes them to exist."
Those circumstances include:
"…. (3) when used by any person in resisting or aiding another to
resist an offense against the person; or (4) when used by any person in lawful
possession of real or personal property, or by another assisting the person in
lawful possession, in resisting a trespass upon or other unlawful interference
with such property…."
Further authorization for the use of
deadly force is provided in Minn. Stat.,
Sec. 609.065, JUSTIFIABLE TAKING OF LIFE, which allows "the
intentional taking of the life of another …. when necessary in resisting or
preventing an offense which the actor reasonably believes exposes the actor or
another to great bodily harm or death, or preventing the commission of a felony
in the actor's place of abode."
The Minnesota Supreme Court's case law has
defined when deadly force is reasonable.
To justify the taking of a life, the "killing must have been done
in the belief that it was necessary to avert death or grievous bodily
harm"; the "judgment of the defendant as to the gravity of the peril
to which he was exposed must have been reasonable under the circumstances";
the "defendant's election to kill must have been such as a reasonable man
would have made in light of the danger to be apprehended." State v. Richardson, 670 N.W.2d 267,
277-78 (Minn. 2003).
The Supreme Court further states that,
under current Minnesota law, there is no duty to retreat before using force
when in one's home. "We agree that
when acting in self-defense in the home, a person should not be required to
retreat from the home before using reasonable force to defend himself,
regardless of whether the aggressor is also rightfully in the home. Thus, we adopt the following rule: There is no duty to retreat from one's own
home when acting in self-defense in the home, regardless of whether the
aggressor is a co-resident. But the lack
of a duty to retreat does not abrogate the obligation to act reasonably when
using force in self-defense. Therefore,
in all situations in which a party claims self-defense, even absent a duty to
retreat, the key inquiry will still be into the reasonableness of the use of
force and the level of force under the specific circumstances of each
case." State v. Glowacki,
630 N.W.2d 392, 402 (Minn. 1991).
Thus, it
appears clear to me that existing Minnesota Statutes and law already provide
the authorizations for law-abiding citizens to use deadly force to
defend themselves or others either inside or outside of their homes, so long as
that use of deadly force constitutes "reasonable force." That, I believe, is a reasonable standard.
H. F. No. 1467 does go beyond current law
by stating that an individual using deadly force would be presumed to possess a
reasonable belief that there exists an imminent threat of substantial bodily
harm, great bodily harm, or death to the individual or person. As the MN County Attorneys Association has
noted, this change would effectively allow anyone to claim that he or she acted
reasonably when using deadly force, making it virtually impossible to find him
or her guilty of using excessive force. That
change from the current standard seems, to me, ill-advised.
Of additional concern to the MN Department
of Public Safety is the provision in the bill, which mandates "universal
reciprocity" of firearm carry permits from any other state "or other
non-Minnesota governmental jurisdiction."
Minn. Stat., Sec. 624.714, subd.
16, Recognition of permits from
other states already requires the Commissioner of Public Safety to
determine which states and other jurisdictions have permitting laws similar to
Minnesota's and which do not. The
Commissioner is further required to execute reciprocity agreements regarding
carry permits with those states or jurisdictions, which do have similar
permitting laws. Currently, Minnesota
has such reciprocity agreements with 15 other states.
However, making all permits issued by
other states and governmental jurisdictions valid in Minnesota would allow
people to carry guns here under the considerably lower standards for the
issuance of permits of some other states.
For these reasons, I have vetoed H. F. No.
1467.
Sincerely,
Mark
Dayton
Governor
STATE OF
MINNESOTA
OFFICE OF
THE SECRETARY OF STATE
ST. PAUL
55155
The Honorable Kurt Zellers
Speaker of the House of
Representatives
The Honorable Michelle L.
Fischbach
President of the Senate
I have the honor to inform you that the
following enrolled Act of the 2012 Session of the State Legislature has been
received from the Office of the Governor and is deposited in the Office of the
Secretary of State for preservation, pursuant to the State Constitution, Article
IV, Section 23:
S. F. No. |
H. F. No. |
Session Laws Chapter No. |
Time and Date Approved 2012 |
Date Filed 2012 |
1371 127 3:34 p.m.
March 5 March
5
Sincerely,
Mark
Ritchie
Secretary
of State
REPORTS OF STANDING COMMITTEES AND
DIVISIONS
Hoppe from the Committee on Commerce and Regulatory Reform to which was referred:
H. F. No. 1416, A bill for an act relating to military affairs; extending reemployment rights protections to certain nonpublic employees; amending Minnesota Statutes 2010, section 192.261, subdivision 6.
Reported the same back with the following amendments:
Page 1, line 11, after "leave" insert "from" and after "reinstatement" insert "in the person's civilian position of employment within Minnesota"
With the recommendation that when so amended the bill pass.
The
report was adopted.
Gottwalt from the Committee on Health
and Human Services Reform to which was referred:
H. F. No. 1994, A bill for an act relating to
state government; making changes to health and human services policy
provisions; modifying provisions related to continuing care, the telephone
equipment program, chemical and mental health, and health care; reforming comprehensive
assessment and case management services; amending Minnesota Statutes 2010,
sections 237.50; 237.51; 237.52; 237.53; 237.54; 237.55; 237.56; 245.461, by
adding a subdivision; 245.462, subdivision 20; 245.487, by adding a
subdivision; 245.4871, subdivision 15; 245.4932, subdivision 1; 245A.11,
subdivision 2a; 246.53, by adding a subdivision; 256.9657, subdivision 1;
256B.04, subdivision 14; 256B.056, subdivision 3c; 256B.0595, subdivision 2;
256B.0625, subdivisions 13, 13d, 42; 256B.0659, subdivisions 1, 2, 3a, 4;
256B.0911, subdivisions 1, 2b, 2c, 3, 3b, 4c, 6; 256B.0913, subdivisions 7, 8;
256B.0915, subdivisions 1a, 1b, 3c, 6; 256B.092, subdivisions 1, 1a, 1b, 1e,
1g, 2, 3, 5, 7, 8, 8a, 9, 11; 256B.19, subdivision 1c; 256B.441, subdivisions
13, 31, 53; 256B.49, subdivision 13; 256B.69, subdivision 5; 256F.13,
subdivision 1; 256G.02, subdivision 6; 256L.05, subdivision 3; 514.982,
subdivision 1; Minnesota Statutes 2011 Supplement, sections 125A.21,
subdivision 7; 144A.071, subdivisions 3, 4a; 254B.04, subdivision 2a; 256B.056,
subdivision 3; 256B.057, subdivision 9; 256B.0625, subdivisions 13e, 13h, 14;
256B.0631, subdivisions 1, 2; 256B.0911, subdivisions 1a, 3a, 4a; 256B.0915,
subdivision 10; 256B.49, subdivisions 14, 15; 256B.69, subdivisions 5a, 28;
256L.15, subdivision 1; 626.557, subdivision 9; repealing Minnesota Statutes
2010, sections 256.01, subdivision 18b; 256B.431, subdivisions 2c, 2g, 2i, 2j,
2k, 2l, 2o, 3c, 11, 14, 17b, 17f, 19, 20, 25, 27, 29; 256B.434, subdivisions
4a, 4b, 4c, 4d, 4e, 4g, 4h, 7, 8; 256B.435; 256B.436; Minnesota Statutes 2011
Supplement, section 256B.431, subdivision 26; Minnesota Rules, part 9555.7700.
Reported the same back with the following amendments:
Delete everything after the enacting clause and insert:
"ARTICLE
1
CONTINUING
CARE
Section 1. Minnesota
Statutes 2011 Supplement, section 144A.071, subdivision 3, is amended to read:
Subd. 3. Exceptions authorizing increase in beds;
hardship areas. (a) The commissioner
of health, in coordination with the commissioner of human services, may approve
the addition of new licensed and Medicare and Medicaid certified nursing home
beds, using the criteria and process set forth in this subdivision.
(b) The commissioner, in cooperation with the commissioner
of human services, shall consider the following criteria when determining that
an area of the state is a hardship area with regard to access to nursing
facility services:
(1) a low number of beds per thousand in a specified area
using as a standard the beds per thousand people age 65 and older, in five year
age groups, using data from the most recent census and population projections,
weighted by each group's most recent nursing home utilization, of the county at
the 20th percentile, as determined by the commissioner of human services;
(2) a high level of out-migration for nursing facility
services associated with a described area from the county or counties of
residence to other Minnesota counties, as determined by the commissioner of
human services, using as a standard an amount greater than the out-migration of
the county ranked at the 50th percentile;
(3) an adequate level of availability of noninstitutional
long-term care services measured as public spending for home and
community-based long-term care services per individual age 65 and older, in
five year age groups, using data from the most recent census and population
projections, weighted by each group's most recent nursing home utilization, as
determined by the commissioner of human services using as a standard an amount
greater than the 50th percentile of counties;
(4) there must be a declaration of hardship resulting from
insufficient access to nursing home beds by local county agencies and area
agencies on aging; and
(5) other factors that may demonstrate the need to add new
nursing facility beds.
(c) On August 15 of odd-numbered years, the commissioner, in
cooperation with the commissioner of human services, may publish in the State
Register a request for information in which interested parties, using the data
provided under section 144A.351, along with any other relevant data,
demonstrate that a specified area is a hardship area with regard to access to
nursing facility services. For a
response to be considered, the commissioner must receive it by November 15. The commissioner shall make responses to the
request for information available to the public and shall allow 30 days for
comment. The commissioner shall review
responses and comments and determine if any areas of the state are to be declared
hardship areas.
(d) For each designated hardship area determined in
paragraph (c), the commissioner shall publish a request for proposals in
accordance with section 144A.073 and Minnesota Rules, parts 4655.1070 to
4655.1098. The request for proposals
must be published in the State Register by March 15 following receipt of
responses to the request for information.
The request for proposals must specify the number of new beds which may
be added in the designated hardship area, which must not exceed the number
which, if added to the existing number of beds in the area, including beds in
layaway status, would have prevented it from being determined to be a hardship
area under paragraph (b), clause (1). Beginning
July 1, 2011, the number of new beds approved must not exceed 200 beds
statewide per biennium. After June 30,
2019, the number of new beds that may be approved in a biennium must not exceed
300 statewide. For a proposal to be
considered, the commissioner must receive it within six months of the
publication of the request for proposals.
The commissioner shall review responses to the request for proposals and
shall approve or disapprove each proposal by the following July 15, in
accordance with section 144A.073 and Minnesota Rules, parts 4655.1070 to
4655.1098. The commissioner shall base
approvals or disapprovals on a comparison and ranking of proposals using only
the criteria in subdivision 4a. Approval
of a proposal expires after 18 months unless the facility has added the new
beds using existing space, subject to approval by the commissioner, or has
commenced construction as defined in section 144A.071, subdivision 1a,
paragraph (d). Operating If,
after the approved beds have been added, fewer than 50 percent of the beds in a
facility are newly licensed, the operating payment rates previously in effect
shall remain. If, after the approved
beds have been added, 50 percent or more of the beds in a facility are newly
licensed, operating payment rates shall be determined according to
Minnesota Rules, part 9549.0057, using the limits under section 256B.441. External fixed payment rates must be
determined according to section 256B.441, subdivision 53. Property payment rates for facilities with
beds added under this subdivision must be determined in the same manner as rate
determinations resulting from projects approved and completed under section
144A.073.
(e) The commissioner may:
(1) certify or license new beds in a new facility that is to
be operated by the commissioner of veterans affairs or when the costs of
constructing and operating the new beds are to be reimbursed by the
commissioner of veterans affairs or the United States Veterans Administration;
and
(2) license or certify beds in a facility that has been
involuntarily delicensed or decertified for participation in the medical
assistance program, provided that an application for relicensure or
recertification is submitted to the commissioner by an organization that is not
a related organization as defined in section 256B.441, subdivision 34, to the
prior licensee within 120 days after delicensure or decertification.
Sec. 2. Minnesota
Statutes 2011 Supplement, section 144A.071, subdivision 4a, is amended to read:
Subd. 4a. Exceptions for replacement beds. It is in the best interest of the state
to ensure that nursing homes and boarding care homes continue to meet the
physical plant licensing and certification requirements by permitting certain
construction projects. Facilities should
be maintained in condition to satisfy the physical and emotional needs of
residents while allowing the state to maintain control over nursing home
expenditure growth.
The commissioner of health in coordination with the
commissioner of human services, may approve the renovation, replacement, upgrading,
or relocation of a nursing home or boarding care home, under the following
conditions:
(a) to license or certify beds in a new facility constructed
to replace a facility or to make repairs in an existing facility that was
destroyed or damaged after June 30, 1987, by fire, lightning, or other hazard
provided:
(i) destruction was not caused by the intentional act of or
at the direction of a controlling person of the facility;
(ii) at the time the facility was destroyed or damaged the
controlling persons of the facility maintained insurance coverage for the type
of hazard that occurred in an amount that a reasonable person would conclude
was adequate;
(iii) the net proceeds from an insurance settlement for the
damages caused by the hazard are applied to the cost of the new facility or
repairs;
(iv) the number of licensed and certified beds in the new
facility does not exceed the number of licensed and certified beds in the
destroyed facility; and
(v) the commissioner determines that the replacement beds
are needed to prevent an inadequate supply of beds.
Project
construction costs incurred for repairs authorized under this clause shall not
be considered in the dollar threshold amount defined in subdivision 2;
(b) to license or certify beds that are moved from one
location to another within a nursing home facility, provided the total costs of
remodeling performed in conjunction with the relocation of beds does not exceed
$1,000,000;
(c) to license or certify beds in a project recommended for
approval under section 144A.073;
(d) to license or certify beds that are moved from an
existing state nursing home to a different state facility, provided there is no
net increase in the number of state nursing home beds;
(e) to certify and license as nursing home beds boarding
care beds in a certified boarding care facility if the beds meet the standards
for nursing home licensure, or in a facility that was granted an exception to
the moratorium under section 144A.073, and if the cost of any remodeling of the
facility does not exceed $1,000,000. If
boarding care beds are licensed as nursing home beds, the number of boarding
care beds in the facility must not increase beyond the number remaining at the
time of the upgrade in licensure. The
provisions contained in section 144A.073 regarding the upgrading of the
facilities do not apply to facilities that satisfy these requirements;
(f) to license and certify up to 40 beds
transferred from an existing facility owned and operated by the Amherst H. Wilder Foundation in
the city of St. Paul to a new unit at the same location as the existing
facility that will serve persons with Alzheimer's disease and other related
disorders. The transfer of beds may
occur gradually or in stages, provided the total number of beds transferred
does not exceed 40. At the time of
licensure and certification of a bed or beds in the new unit, the commissioner
of health shall delicense and decertify the same number of beds in the existing
facility. As a condition of receiving a
license or certification under this clause, the facility must make a written
commitment to the commissioner of human services that it will not seek to
receive an increase in its property-related payment rate as a result of the
transfers allowed under this paragraph;
(g) to license and certify nursing home beds to replace
currently licensed and certified boarding care beds which may be located either
in a remodeled or renovated boarding care or nursing home facility or in a
remodeled, renovated, newly constructed, or replacement nursing home facility
within the identifiable complex of health care facilities in which the
currently licensed boarding care beds are presently located, provided that the
number of boarding care beds in the facility or complex are decreased by the
number to be licensed as nursing home beds and further provided that, if the
total costs of new construction, replacement, remodeling, or renovation exceed
ten percent of the appraised value of the facility or $200,000, whichever is
less, the facility makes a written commitment to the commissioner of human
services that it will not seek to receive an increase in its property-related
payment rate by reason of the new construction, replacement, remodeling, or
renovation. The provisions contained in
section 144A.073 regarding the upgrading of facilities do not apply to
facilities that satisfy these requirements;
(h) to license as a nursing home and certify as a nursing
facility a facility that is licensed as a boarding care facility but not
certified under the medical assistance program, but only if the commissioner of
human services certifies to the commissioner of health that licensing the
facility as a nursing home and certifying the facility as a nursing facility
will result in a net annual savings to the state general fund of $200,000 or
more;
(i) to certify, after September 30, 1992, and prior to July
1, 1993, existing nursing home beds in a facility that was licensed and in
operation prior to January 1, 1992;
(j) to license and certify new nursing home beds to replace
beds in a facility acquired by the Minneapolis Community Development Agency as
part of redevelopment activities in a city of the first class, provided the new
facility is located within three miles of the site of the old facility. Operating and property costs for the new
facility must be determined and allowed under section 256B.431 or 256B.434;
(k) to license and certify up to 20 new nursing home beds in
a community-operated hospital and attached convalescent and nursing care facility
with 40 beds on April 21, 1991, that suspended operation of the hospital in
April 1986. The commissioner of human
services shall provide the facility with the same per diem property-related
payment rate for each additional licensed and certified bed as it will receive
for its existing 40 beds;
(l) to license or certify beds in renovation, replacement,
or upgrading projects as defined in section 144A.073, subdivision 1, so long as
the cumulative total costs of the facility's remodeling projects do not exceed
$1,000,000;
(m) to license and certify beds that are moved from one
location to another for the purposes of converting up to five four-bed wards to
single or double occupancy rooms in a nursing home that, as of January 1, 1993,
was county-owned and had a licensed capacity of 115 beds;
(n) to allow a facility that on April 16, 1993, was a
106-bed licensed and certified nursing facility located in Minneapolis to
layaway all of its licensed and certified nursing home beds. These beds may be relicensed and recertified
in a newly constructed teaching nursing home facility affiliated with a
teaching hospital upon approval by the legislature. The proposal must be developed in
consultation with the interagency committee on long-term care planning. The beds on layaway status shall have the
same status as voluntarily delicensed and decertified beds, except that beds on
layaway status remain subject to the surcharge in section 256.9657. This layaway provision expires July 1, 1998;
(o) to allow a project which will be completed in
conjunction with an approved moratorium exception project for a nursing home in
southern Cass County and which is directly related to that portion of the
facility that must be repaired, renovated, or replaced, to correct an emergency
plumbing problem for which a state correction order has been issued and which
must be corrected by August 31, 1993;
(p) to allow a facility that on April 16, 1993, was a
368-bed licensed and certified nursing facility located in Minneapolis to
layaway, upon 30 days prior written notice to the commissioner, up to 30 of the
facility's licensed and certified beds by converting three-bed wards to single
or double occupancy. Beds on layaway
status shall have the same status as voluntarily delicensed and decertified
beds except that beds on layaway status remain subject to the surcharge in
section 256.9657, remain subject to the license application and renewal fees
under section 144A.07 and shall be subject to a $100 per bed reactivation fee. In addition, at any time within three years
of the effective date of the layaway, the beds on layaway status may be:
(1) relicensed and recertified upon relocation and
reactivation of some or all of the beds to an existing licensed and certified
facility or facilities located in Pine River, Brainerd, or International Falls;
provided that the total project construction costs related to the relocation of
beds from layaway status for any facility receiving relocated beds may not
exceed the dollar threshold provided in subdivision 2 unless the construction
project has been approved through the moratorium exception process under
section 144A.073;
(2) relicensed and recertified, upon reactivation of some or
all of the beds within the facility which placed the beds in layaway status, if
the commissioner has determined a need for the reactivation of the beds on
layaway status.
The property-related payment rate of a facility placing beds
on layaway status must be adjusted by the incremental change in its rental per
diem after recalculating the rental per diem as provided in section 256B.431,
subdivision 3a, paragraph (c). The
property-related payment rate for a facility relicensing and recertifying beds
from layaway status must be adjusted by the incremental change in its rental
per diem after recalculating its rental per diem using the number of beds after
the relicensing to establish the facility's capacity day divisor, which shall
be effective the first day of the month following the month in which the
relicensing and recertification became effective. Any beds remaining on layaway status more
than three years after the date the layaway status became effective must be
removed from layaway status and immediately delicensed and decertified;
(q) to license and certify beds in a renovation
and remodeling project to convert 12 four-bed wards into 24 two-bed rooms, expand space,
and add improvements in a nursing home that, as of January 1, 1994, met the
following conditions: the nursing home
was located in Ramsey County; had a licensed capacity of 154 beds; and had been
ranked among the top 15 applicants by the 1993 moratorium exceptions advisory
review panel. The total project
construction cost estimate for this project must not exceed the cost estimate
submitted in connection with the 1993 moratorium exception process;
(r) to license and certify up to 117 beds that are relocated
from a licensed and certified 138-bed nursing facility located in St. Paul
to a hospital with 130 licensed hospital beds located in South St. Paul, provided
that the nursing facility and hospital are owned by the same or a related
organization and that prior to the date the relocation is completed the
hospital ceases operation of its inpatient hospital services at that hospital. After relocation, the nursing facility's
status under section 256B.431, subdivision 2j, shall be the same as it
was prior to relocation. The nursing
facility's property-related payment rate resulting from the project authorized
in this paragraph shall become effective no earlier than April 1, 1996. For purposes of calculating the incremental
change in the facility's rental per diem resulting from this project, the
allowable appraised value of the nursing facility portion of the existing
health care facility physical plant prior to the renovation and relocation may
not exceed $2,490,000;
(s) to license and certify two beds in a facility to replace
beds that were voluntarily delicensed and decertified on June 28, 1991;
(t) to allow 16 licensed and certified beds located on July
1, 1994, in a 142-bed nursing home and 21-bed boarding care home facility in
Minneapolis, notwithstanding the licensure and certification after July 1,
1995, of the Minneapolis facility as a 147-bed nursing home facility after
completion of a construction project approved in 1993 under section 144A.073,
to be laid away upon 30 days' prior written notice to the commissioner. Beds on layaway status shall have the same
status as voluntarily delicensed or decertified beds except that they shall
remain subject to the surcharge in section 256.9657. The 16 beds on layaway status may be
relicensed as nursing home beds and recertified at any time within five years
of the effective date of the layaway upon relocation of some or all of the beds
to a licensed and certified facility located in Watertown, provided that the
total project construction costs related to the relocation of beds from layaway
status for the Watertown facility may not exceed the dollar threshold provided
in subdivision 2 unless the construction project has been approved through the
moratorium exception process under section 144A.073.
The property-related payment rate of the facility placing
beds on layaway status must be adjusted by the incremental change in its rental
per diem after recalculating the rental per diem as provided in section
256B.431, subdivision 3a, paragraph (c).
The property-related payment rate for the facility relicensing and
recertifying beds from layaway status must be adjusted by the incremental
change in its rental per diem after recalculating its rental per diem using the
number of beds after the relicensing to establish the facility's capacity day
divisor, which shall be effective the first day of the month following the
month in which the relicensing and recertification became effective. Any beds remaining on layaway status more
than five years after the date the layaway status became effective must be
removed from layaway status and immediately delicensed and decertified;
(u) to license and certify beds that are moved within an
existing area of a facility or to a newly constructed addition which is built
for the purpose of eliminating three- and four-bed rooms and adding space for
dining, lounge areas, bathing rooms, and ancillary service areas in a nursing
home that, as of January 1, 1995, was located in Fridley and had a licensed
capacity of 129 beds;
(v) to relocate 36 beds in Crow Wing County and four beds
from Hennepin County to a 160-bed facility in Crow Wing County, provided all
the affected beds are under common ownership;
(w) to license and certify a total replacement project of up
to 49 beds located in Norman County that are relocated from a nursing home
destroyed by flood and whose residents were relocated to other nursing homes. The operating cost payment rates for the new
nursing facility shall be determined based on the interim and settle-up payment
provisions of Minnesota Rules, part 9549.0057, and the reimbursement provisions
of section 256B.431, except that subdivision 26, paragraphs (a) and (b),
shall not apply until the second rate year after the settle-up cost report is
filed. Property-related
reimbursement rates shall be determined under section 256B.431, taking into
account any federal or state flood-related loans or grants provided to the
facility;
(x) to license and certify a total replacement project of up
to 129 beds located in Polk County that are relocated from a nursing home
destroyed by flood and whose residents were relocated to other nursing homes. The operating cost payment rates for the new
nursing facility shall be determined based on the interim and settle-up payment
provisions of Minnesota Rules, part 9549.0057, and the reimbursement provisions
of section 256B.431, except that subdivision 26, paragraphs (a) and (b), shall
not apply until the second rate year after the settle-up cost report is filed. Property-related reimbursement rates shall be
determined under section 256B.431, taking into account any federal or state
flood-related loans or grants provided to the facility;
(y) to license and certify beds in a renovation and
remodeling project to convert 13 three-bed wards into 13 two-bed rooms and 13
single-bed rooms, expand space, and add improvements in a nursing home that, as
of January 1, 1994, met the following conditions: the nursing home was located in Ramsey
County, was not owned by a hospital corporation, had a licensed capacity of 64
beds, and had been ranked among the top 15 applicants by the 1993 moratorium
exceptions advisory review panel. The
total project construction cost estimate for this project must not exceed the
cost estimate submitted in connection with the 1993 moratorium exception
process;
(z) to license and certify up to 150 nursing home beds to
replace an existing 285 bed nursing facility located in St. Paul. The replacement project shall include both
the renovation of existing buildings and the construction of new facilities at
the existing site. The reduction in the
licensed capacity of the existing facility shall occur during the construction
project as beds are taken out of service due to the construction process. Prior to the start of the construction
process, the facility shall provide written information to the commissioner of
health describing the process for bed reduction, plans for the relocation of
residents, and the estimated construction schedule. The relocation of residents shall be in
accordance with the provisions of law and rule;
(aa) to allow the commissioner of human services to license
an additional 36 beds to provide residential services for the physically
disabled under Minnesota Rules, parts 9570.2000 to 9570.3400, in a 198-bed
nursing home located in Red Wing, provided that the total number of licensed
and certified beds at the facility does not increase;
(bb) to license and certify a new facility in St. Louis
County with 44 beds constructed to replace an existing facility in St. Louis
County with 31 beds, which has resident rooms on two separate floors and an
antiquated elevator that creates safety concerns for residents and prevents
nonambulatory residents from residing on the second floor. The project shall include the elimination of
three- and four-bed rooms;
(cc) to license and certify four beds in a 16-bed certified
boarding care home in Minneapolis to replace beds that were voluntarily
delicensed and decertified on or before March 31, 1992. The licensure and certification is
conditional upon the facility periodically assessing and adjusting its resident
mix and other factors which may contribute to a potential institution for
mental disease declaration. The
commissioner of human services shall retain the authority to audit the facility
at any time and shall require the facility to comply with any requirements
necessary to prevent an institution for mental disease declaration, including
delicensure and decertification of beds, if necessary;
(dd) to license and certify 72 beds in an existing facility
in Mille Lacs County with 80 beds as part of a renovation project. The renovation must include construction of
an addition to accommodate ten residents with beginning and midstage dementia
in a self-contained living unit; creation of three resident households where
dining, activities, and support spaces are located near resident living
quarters; designation of four beds for rehabilitation in a self-contained area;
designation of 30 private rooms; and other improvements;
(ee) to license and certify beds in a facility that has
undergone replacement or remodeling as part of a planned closure under section
256B.437;
(ff) to license and certify a total replacement project of
up to 124 beds located in Wilkin County that are in need of relocation from a
nursing home significantly damaged by flood.
The operating cost payment rates for the new nursing facility shall be
determined based on the interim and settle-up payment provisions of Minnesota
Rules, part 9549.0057, and the reimbursement provisions of section 256B.431,
except that section 256B.431, subdivision 26, paragraphs (a) and (b), shall not
apply until the second rate year after the settle-up cost report is filed. Property-related reimbursement rates shall be
determined under section 256B.431, taking into account any federal or state
flood-related loans or grants provided to the facility;
(gg) to allow the commissioner of human services to license
an additional nine beds to provide residential services for the physically
disabled under Minnesota Rules, parts 9570.2000 to 9570.3400, in a 240-bed
nursing home located in Duluth, provided that the total number of licensed and
certified beds at the facility does not increase;
(hh) to license and certify up to 120 new nursing facility
beds to replace beds in a facility in Anoka County, which was licensed for 98
beds as of July 1, 2000, provided the new facility is located within four miles
of the existing facility and is in Anoka County. Operating and property rates shall be
determined and allowed under section 256B.431 and Minnesota Rules, parts
9549.0010 to 9549.0080, or section 256B.434 or 256B.435. The provisions of section 256B.431,
subdivision 26, paragraphs (a) and (b), do not apply until the second rate year
following settle-up 256B.441; or
(ii) to transfer up to 98 beds of a 129-licensed bed
facility located in Anoka County that, as of March 25, 2001, is in the active
process of closing, to a 122-licensed bed nonprofit nursing facility located in
the city of Columbia Heights or its affiliate.
The transfer is effective when the receiving facility notifies the
commissioner in writing of the number of beds accepted. The commissioner shall place all transferred
beds on layaway status held in the name of the receiving facility. The layaway adjustment provisions of section
256B.431, subdivision 30, do not apply to this layaway. The receiving facility may only remove the
beds from layaway for recertification and relicensure at the receiving
facility's current site, or at a newly constructed facility located in Anoka
County. The receiving facility must
receive statutory authorization before removing these beds from layaway status,
or may remove these beds from layaway status if removal from layaway status is
part of a moratorium exception project approved by the commissioner under
section 144A.073.
Sec. 3. Minnesota
Statutes 2011 Supplement, section 245A.03, subdivision 7, is amended 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 May 15, 2009, 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, or restructuring of state-operated services that
limits the capacity of state-operated facilities;
(4) new foster care licenses determined to be needed by the
commissioner under paragraph (b) for persons requiring hospital level care; or
(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 in 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 the 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)
(c) The commissioner shall study the effects of the license moratorium
under this subdivision and shall report back to the legislature by January 15,
2011. This study shall include, but is
not limited to the following:
(1) the overall capacity and utilization of foster care beds
where the physical location is not the primary residence of the license holder
prior to and after implementation of the moratorium;
(2) the overall capacity and utilization of foster care beds
where the physical location is the primary residence of the license holder
prior to and after implementation of the moratorium; and
(3) the number of licensed and occupied ICF/MR beds prior to
and after implementation of the moratorium.
(e)
(d) When a foster care recipient moves out of a foster home that is not
the primary residence of the license holder according to section 256B.49,
subdivision 15, paragraph (f), the county shall immediately inform the
Department of Human Services Licensing Division, and the department shall
immediately decrease the licensed capacity for the home. A decreased licensed capacity according to
this paragraph is not subject to appeal under this chapter.
(e) At the time of application and reapplication for
licensure, the applicant and the license holder that are subject to the
moratorium or an exclusion established in paragraph (a) are required to inform
the commissioner whether the physical location where the foster care will be
provided is or will be the primary residence of the license holder for the
entire period of licensure. If the
primary residence of the applicant or license holder changes, the applicant or
license holder must notify the commissioner immediately. The commissioner shall print on the foster
care license certificate whether or not the physical location is the primary
residence of the license holder.
(f) License holders of foster care homes identified under
paragraph (e) that are not the primary residence of the license holder and that
also provide services in the foster care home that are covered by a federally
approved home and community-based services waiver, as authorized under section
256B.0915, 256B.092, or 256B.49 must inform the human services licensing
division that the license holder provides or intends to provide these
waiver-funded services. These license holders must be considered
registered under section 256B.092, subdivision 11, paragraph (c), and
this registration status must be identified on their license certificates.
Sec. 4. Minnesota
Statutes 2010, section 245A.11, subdivision 2a, is amended to read:
Subd. 2a. Adult foster care license capacity. (a) The commissioner shall issue adult
foster care licenses with a maximum licensed capacity of four beds, including
nonstaff roomers and boarders, except that the commissioner may issue a license
with a capacity of five beds, including roomers and boarders, according to
paragraphs (b) to (f).
(b) An adult foster care license holder may have a maximum
license capacity of five if all persons in care are age 55 or over and do not
have a serious and persistent mental illness or a developmental disability.
(c) The commissioner may grant variances to paragraph (b) to
allow a foster care provider with a licensed capacity of five persons to admit
an individual under the age of 55 if the variance complies with section
245A.04, subdivision 9, and approval of the variance is recommended by the
county in which the licensed foster care provider is located.
(d) The commissioner may grant variances to paragraph (b) to
allow the use of a fifth bed for emergency crisis services for a person with
serious and persistent mental illness or a developmental disability, regardless
of age, if the variance complies with section 245A.04, subdivision 9, and
approval of the variance is recommended by the county in which the licensed
foster care provider is located.
(e) If the 2009 legislature adopts a rate reduction that
impacts providers of adult foster care services, the commissioner may issue an
adult foster care license with a capacity of five adults if the fifth bed does
not increase the overall statewide capacity of licensed adult foster care beds
in homes that are not the primary residence of the license holder, over the
licensed capacity in such homes on July 1, 2009, as identified in a plan
submitted to the commissioner by the county, when the capacity is recommended
by the county licensing agency of the county in which the facility is located
and if the recommendation verifies that:
(1) the facility meets the physical environment requirements
in the adult foster care licensing rule;
(2) the five-bed living arrangement is specified for each
resident in the resident's:
(i) individualized plan of care;
(ii) individual service plan under section 256B.092,
subdivision 1b, if required; or
(iii) individual resident placement agreement under
Minnesota Rules, part 9555.5105, subpart 19, if required;
(3) the license holder obtains written and signed informed
consent from each resident or resident's legal representative documenting the
resident's informed choice to living in the home and that the resident's
refusal to consent would not have resulted in service termination; and
(4) the facility was licensed for adult foster care before
March 1, 2009.
(f) The commissioner shall not issue a
new adult foster care license under paragraph (e) after June 30, 2011 2014.
The commissioner shall allow a facility with an adult foster care
license issued under paragraph (e) before June 30, 2011 2014, to
continue with a capacity of five adults if the license holder continues to
comply with the requirements in paragraph (e).
Sec. 5. Minnesota
Statutes 2010, section 245A.11, subdivision 8, is amended 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 2012, as a
component of the quality outcome standards recommendations required by Laws
2010, chapter 352, article 1, section 24.
(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. 6. Minnesota
Statutes 2010, section 252.32, subdivision 1a, is amended to read:
Subd. 1a. Support grants. (a) Provision of support grants must be
limited to families who require support and whose
dependents are under the age of 21 and who have been certified disabled under
section 256B.055, subdivision 12, paragraphs (a), (b), (c), (d), and (e). Families who are receiving: home and community-based waivered
services for persons with developmental disabilities authorized under
section 256B.092 or 256B.49; personal care assistance under section 256B.0652;
or a consumer support grant under section 256.476 are not eligible for
support grants.
Families whose annual adjusted gross income is $60,000 or
more are not eligible for support grants except in cases where extreme hardship
is demonstrated. Beginning in state
fiscal year 1994, the commissioner shall adjust the income ceiling annually to
reflect the projected change in the average value in the United States
Department of Labor Bureau of Labor Statistics Consumer Price Index (all urban)
for that year.
(b) Support grants may be made available as monthly subsidy
grants and lump-sum grants.
(c) Support grants may be issued in the form of cash,
voucher, and direct county payment to a vendor.
(d) Applications for the support grant shall be made by the
legal guardian to the county social service agency. The application shall specify the needs of
the families, the form of the grant requested by the families, and the items
and services to be reimbursed.
Sec. 7. [252.34] REPORT BY COMMISSIONER OF HUMAN
SERVICES.
Beginning January 1, 2013, the commissioner of human
services shall provide a biennial report to the chairs of the legislative
committees with jurisdiction over health and human services policy and funding. The report must provide a summary of
overarching goals and priorities for persons with disabilities, including the
status of how each of the following programs administered by the commissioner
is supporting the overarching goals and priorities:
(1) home and community-based services waivers for persons
with disabilities under sections 256B.092 and 256B.49;
(2) home care services under section 256B.0652; and
(3) other relevant programs and services as determined by
the commissioner.
Sec. 8. Minnesota
Statutes 2010, section 252A.21, subdivision 2, is amended to read:
Subd. 2. Rules.
The commissioner shall adopt rules to implement this chapter. The rules must include standards for
performance of guardianship or conservatorship duties including, but not
limited to: twice a year visits with the
ward; quarterly reviews of records from day, residential, and support
services; a requirement that the duties of guardianship or conservatorship
and case management not be performed by the same person; specific standards for
action on "do not resuscitate" orders, sterilization requests, and
the use of psychotropic medication and aversive procedures.
Sec. 9. Minnesota
Statutes 2010, section 256.476, subdivision 11, is amended to read:
Subd. 11. Consumer support grant program after July
1, 2001. 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 50 percent of the average the
service authorization for each individual based on the individual's home
care rating assessment;
(ii) calculating the overall ratio of actual payments to
service authorizations by program;
(iii) applying the overall ratio to the average 50
percent of the service authorization level of each home care rating; and
(iv) adjusting the result for any authorized rate increases
changes provided by the legislature; and.
(v) adjusting the result for the average monthly utilization
per recipient.
(2) The commissioner may review and evaluate shall
ensure the methodology to reflect changes in is consistent with
the home care programs.
Sec. 10. Minnesota
Statutes 2010, section 256.9657, subdivision 1, is amended to read:
Subdivision 1. Nursing home license surcharge. (a) Effective July 1, 1993, each
non-state-operated nursing home licensed under chapter 144A shall pay to the
commissioner an annual surcharge according to the schedule in subdivision 4. The surcharge shall be calculated as $620 per
licensed bed. If the number of licensed
beds is reduced, the surcharge shall be based on the number of remaining
licensed beds the second month following the receipt of timely notice by the
commissioner of human services that beds have been delicensed. The nursing home must notify the commissioner
of health in writing when beds are delicensed.
The commissioner of health must notify the commissioner of human
services within ten working days after receiving written notification. If the notification is received by the commissioner
of human services by the 15th of the month, the invoice for the second
following month must be reduced to recognize the delicensing of beds. Beds on layaway status continue to be subject
to the surcharge. The commissioner of
human services must acknowledge a medical care surcharge appeal within 30 days
of receipt of the written appeal from the provider.
(b) Effective July 1, 1994, the surcharge in paragraph (a)
shall be increased to $625.
(c) Effective August 15, 2002, the surcharge under paragraph
(b) shall be increased to $990.
(d) Effective July 15, 2003, the surcharge under paragraph
(c) shall be increased to $2,815.
(e) The commissioner may reduce, and may subsequently
restore, the surcharge under paragraph (d) based on the commissioner's
determination of a permissible surcharge.
(f) Between April 1, 2002, and August 15, 2004, a facility
governed by this subdivision may elect to assume full participation in the
medical assistance program by agreeing to comply with all of the requirements
of the medical assistance program, including the rate equalization law in
section 256B.48, subdivision 1, paragraph (a), and all other requirements
established in law or rule, and to begin intake of new medical assistance
recipients. Rates will be determined
under Minnesota Rules, parts 9549.0010 to 9549.0080. Notwithstanding section 256B.431,
subdivision 27, paragraph (i), Rate calculations will be subject to limits
as prescribed in rule and law. Other
than the adjustments in sections 256B.431, subdivisions 30 and 32; 256B.437,
subdivision 3, paragraph (b), Minnesota Rules, part 9549.0057, and any other
applicable legislation enacted prior to the finalization of rates, facilities
assuming full participation in medical assistance under this paragraph are not
eligible for any rate adjustments until the July 1 following their settle-up
period.
Sec. 11. Minnesota
Statutes 2010, section 256B.0625, subdivision 19c, is amended to read:
Subd. 19c. Personal care. Medical assistance covers personal care
assistance services provided by an individual who is qualified to provide the
services according to subdivision 19a and sections 256B.0651 to 256B.0656,
provided in accordance with a plan, and supervised by a qualified professional.
"Qualified professional" means a mental health
professional as defined in section 245.462, subdivision 18, clauses (1) to
(6), or 245.4871, subdivision 27, clauses (1) to (6); or a
registered nurse as defined in sections 148.171 to 148.285, a licensed social
worker as defined in sections 148D.010 and 148D.055, or a qualified
developmental disabilities specialist under section 245B.07, subdivision 4. The qualified professional shall perform the
duties required in section 256B.0659.
Sec. 12. Minnesota
Statutes 2010, section 256B.0659, subdivision 1, is amended to read:
Subdivision 1. Definitions. (a) For the purposes of this section, the
terms defined in paragraphs (b) to (r) 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) "Extended personal care assistance service"
means personal care assistance services included in a service plan under one of
the home and community-based services waivers authorized under sections
256B.0915, 256B.092, subdivision 5, and 256B.49, which exceed the amount,
duration, and frequency of the state plan personal care assistance services for
participants who:
(1) need assistance provided periodically during a week, but
less than daily will not be able to remain in their homes without the
assistance, and other replacement services are more expensive or are not
available when personal care assistance services are to be terminated reduced;
or
(2) need additional personal care assistance services beyond
the amount authorized by the state plan personal care assistance assessment in
order to ensure that their safety, health, and welfare are provided for in
their homes.
(h) "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.
(i) "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.
(j) "Managing employee" has the same definition as
Code of Federal Regulations, title 42, section 455.
(k) "Qualified professional" means a professional
providing supervision of personal care assistance services and staff as defined
in section 256B.0625, subdivision 19c.
(l) "Personal care assistance provider agency"
means a medical assistance enrolled provider that provides or assists with
providing personal care assistance services and includes a personal care assistance
provider organization, personal care assistance choice agency, class A licensed
nursing agency, and Medicare-certified home health agency.
(m) "Personal care assistant" or "PCA"
means an individual employed by a personal care assistance agency who provides
personal care assistance services.
(n) "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.
(o) "Responsible party" means an individual who is
capable of providing the support necessary to assist the recipient to live in
the community.
(p) "Self-administered medication" means
medication taken orally, by injection or insertion, or applied topically
without the need for assistance.
(q) "Service plan" means a written summary of the
assessment and description of the services needed by the recipient.
(r) "Wages and benefits" means wages and salaries,
the employer's share of FICA taxes, Medicare taxes, state and federal unemployment
taxes, workers' compensation, mileage reimbursement, health and dental
insurance, life insurance, disability insurance, long-term care insurance,
uniform allowance, and contributions to employee retirement accounts.
Sec. 13. Minnesota
Statutes 2010, section 256B.0659, subdivision 3, is amended to read:
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.0652, subdivision 10, or responsible party;
(2) in lieu of other staffing options order to
meet staffing or license requirements 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, except when immediate attention is needed for health or
hygiene reasons integral to the personal care services and the need is listed
in the service plan by the assessor; and
(7) assessments for personal care assistance services by
personal care assistance provider agencies or by independently enrolled
registered nurses.
Sec. 14. Minnesota
Statutes 2010, section 256B.0659, subdivision 9, is amended to read:
Subd. 9. Responsible party; generally. (a) "Responsible party" 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) qualified professional;
(3)
home care provider agency owner or staff manager; or
(4) home care provider agency staff unless staff who are not
listed in clauses (1) to (3) are related to the recipient by blood, marriage,
or adoption; or
(3)
(5) 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 subdivision 3a 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.
Sec. 15. Minnesota
Statutes 2011 Supplement, section 256B.0659, subdivision 11, is amended to
read:
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:
(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. Except
as provided in subdivision 11a, 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. The training must be available in languages
other than English and to those who need accommodations due to disabilities. 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 275
hours per month, except that this limit shall be 275 hours per month for the
period July 1, 2009, through June 30, 2011, of personal care assistance
services regardless of the number of recipients being served or the number of
personal care assistance provider agencies enrolled with. The number of hours worked per day shall not
be disallowed by the department unless in violation of the law.
(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) Persons who do not qualify as a personal care assistant
include parents and, stepparents, and legal guardians of
minors,; spouses,; paid legal guardians, of
adults; family foster care providers, except as otherwise allowed in
section 256B.0625, subdivision 19a, or; and staff of a
residential setting. When the personal
care assistant is a relative of the recipient, the commissioner shall pay 80
percent of the provider rate. For
purposes of this section, relative means the parent or adoptive parent of an
adult child, a sibling aged 16 years or older, an adult child, a grandparent,
or a grandchild.
Sec. 16. Minnesota
Statutes 2010, section 256B.0659, subdivision 13, is amended to read:
Subd. 13. Qualified professional; qualifications. (a) The qualified professional must work
for 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.
(c) Effective July 1, 2010 2011, the qualified
professional shall complete the provider training with basic information about
the personal care assistance program approved by the commissioner. Newly hired qualified professionals must
complete the training within six months of the date hired by a personal
care assistance provider agency. Qualified
professionals who have completed the required training as a worker from a
personal care assistance provider agency do not need to repeat the required
training if they are hired by another agency, if they have completed the
training within the last three years. The
required training shall must be available in languages other
than English and to those who need accommodations due to disabilities,
with meaningful access according to title VI of the Civil Rights Act and
federal regulations adopted under that law or any guidance from the United
States Health and Human Services Department.
The required training must be available online, or by electronic
remote connection, and. The
required training must provide for competency testing to demonstrate an
understanding of the content without attending in-person training. A qualified professional is allowed to be
employed and is not subject to the training requirement until the training is
offered online or through remote electronic connection. A qualified professional employed by a
personal care assistance provider agency certified for participation in
Medicare as a home health agency is exempt from the training required in this
subdivision. When available, the
qualified professional working for a Medicare-certified home health agency must
successfully complete the competency test.
The commissioner shall ensure there is a mechanism in place to verify
the identity of persons completing the competency testing electronically.
EFFECTIVE DATE. This section is effective retroactively from July 1, 2011.
Sec. 17. Minnesota
Statutes 2010, section 256B.0659, subdivision 14, is amended to read:
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 regularly
scheduled services for a recipient, or sooner as determined by the qualified
professional, except for the personal care assistance choice option under
subdivision 19, paragraph (a), clause (4).
For the initial evaluation, the qualified professional shall evaluate
the personal care assistance services for a recipient through direct
observation of a personal care assistant's work. The qualified professional may conduct
additional training and evaluation visits, based upon the needs of the recipient
and the personal care assistant's ability to meet those needs. Subsequent visits to evaluate the personal
care assistance services provided to a recipient do not require direct
observation of each personal care assistant's work and shall occur:
(1) at least every 90 days thereafter for the first year of
a recipient's services;
(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; and
(3) after the first 180 days of a recipient's service,
supervisory visits may alternate between unscheduled phone or Internet
technology and in-person visits, unless the in-person visits are needed
according to the care plan.
(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:
(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 templates.
(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)
(2) agency administrative activities;
(4)
(3) training other than the individualized training required to provide
care for a recipient; and
(5)
(4) any other activity that is not described in this section.
Sec. 18. Minnesota
Statutes 2010, section 256B.0659, subdivision 19, is amended to read:
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 according to the terms of the written agreement required under
subdivision 20, paragraph (a);
(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;
(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.
Sec. 19. Minnesota
Statutes 2010, section 256B.0659, subdivision 21, is amended to read:
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:
(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) proof of liability insurance;
(6) 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;
(7) 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;
(8) 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 for the written agreement in subdivision 20 for recipients using the
personal care assistance choice option, if applicable;
(9) a list of all training and classes that the personal
care assistance provider agency requires of its staff providing personal care
assistance services;
(10) documentation that the personal care assistance
provider agency and staff have successfully completed all the training required
by this section;
(11) documentation of the agency's marketing practices;
(12) disclosure of ownership, leasing, or management of all
residential properties that is used or could be used for providing home care
services;
(13) 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; and
(14) effective May 15, 2010, documentation that the agency
does not burden recipients' free exercise of their right to choose service
providers by requiring personal care assistants to sign an agreement not to
work with any particular personal care assistance recipient or for another
personal care assistance provider agency after leaving the agency and that the
agency is not taking action on any such agreements or requirements regardless
of the date signed.
(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 July 1, 2009.
(c) All personal care assistance provider agencies shall
require all employees in management and supervisory positions and owners of the
agency who are active in the day-to-day management and operations of the agency
to complete mandatory training as determined by the commissioner before
enrollment of the agency as a provider. Employees
in management and supervisory positions and owners who are active in the
day-to-day operations of an agency who have completed the required training as
an employee with a personal care assistance provider agency do not need to
repeat the required training if they are hired by another agency, if they have
completed the training within the past three years. By September 1, 2010, the required training
must be available in languages other than English and to those who need
accommodations due to disabilities, with meaningful access according to
title VI of the Civil Rights Act and federal regulations adopted under that law
or any guidance from the United States Health and Human Services Department. The required training must be available
online, or by electronic remote connection, and. The required training must provide for
competency testing. Personal care
assistance provider agency billing staff shall complete training about personal
care assistance program financial management.
This training is effective July 1, 2009.
Any personal care assistance provider agency enrolled before that date
shall, if it has not already, complete the provider training within 18 months
of July 1, 2009. Any new owners or employees
in management and supervisory positions involved in the day-to-day operations
are required to complete mandatory training as a requisite of working for the
agency. Personal care assistance
provider agencies certified for participation in Medicare as home health
agencies are exempt from the training required in this subdivision. When available, Medicare-certified home
health agency owners, supervisors, or managers must successfully complete the
competency test.
Sec. 20. Minnesota
Statutes 2010, section 256B.0659, subdivision 30, is amended to read:
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 personal care
assistance 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; and
(3)
(2) a service agreement authorizing personal care assistance hours of
service at the previously authorized level, throughout the appeal process
period, when a recipient requests services pending an appeal.
EFFECTIVE DATE. This section is effective July 1, 2012.
Sec. 21. Minnesota
Statutes 2010, section 256B.0916, subdivision 7, is amended to read:
Subd. 7. Annual report by commissioner. (a) Beginning November 1, 2001,
and each November 1 thereafter, the commissioner shall issue an annual report
on county and state use of available resources for the home and community-based
waiver for persons with developmental disabilities. For each county or county partnership, the
report shall include:
(1) the amount of funds allocated but not used;
(2) the county specific allowed reserve amount approved and
used;
(3) the number, ages, and living situations of individuals screened
and waiting for services;
(4) the urgency of need for services to begin within one,
two, or more than two years for each individual;
(5) the services needed;
(6) the number of additional persons served by approval of
increased capacity within existing allocations;
(7) results of action by the commissioner to streamline
administrative requirements and improve county resource management; and
(8) additional action that would decrease the number of
those eligible and waiting for waivered services.
The
commissioner shall specify intended outcomes for the program and the degree to
which these specified outcomes are attained.
(b) This subdivision expires January 1, 2013.
Sec. 22. Minnesota
Statutes 2010, section 256B.092, subdivision 11, is amended to read:
Subd. 11. Residential support services. (a) Upon federal approval, there is
established a new service called residential support that is available on the
community alternative care, community alternatives for disabled individuals,
developmental disabilities, and traumatic brain injury waivers. Existing waiver service descriptions must be
modified to the extent necessary to ensure there is no duplication between
other services. Residential support
services must be provided by vendors licensed as a community residential
setting as defined in section 245A.11, subdivision 8.
(b) Residential support services must meet the following
criteria:
(1) providers of residential support services must own or
control the residential site;
(2) the residential site must not be the primary residence
of the license holder;
(3) the residential site must have a designated program
supervisor responsible for program oversight, development, and implementation
of policies and procedures;
(4) the provider of residential support services must
provide supervision, training, and assistance as described in the person's
community support plan; and
(5) the provider of residential support services must meet
the requirements of licensure and additional requirements of the person's
community support plan.
(c) Providers of residential support services that meet the
definition in paragraph (a) must be registered using a process determined by
the commissioner beginning July 1, 2009.
Providers licensed to provide child foster care under Minnesota
Rules, parts 2960.3000 to 2960.3340, or adult foster care licensed under
Minnesota Rules, parts 9555.5105 to 9555.6265, and that meet the requirements
in section 245A.03, subdivision 7, paragraph (e), are considered registered under
this section.
Sec. 23. Minnesota
Statutes 2010, section 256B.096, subdivision 5, is amended to read:
Subd. 5. Biennial report. (a) The commissioner shall provide
a biennial report to the chairs of the legislative committees with jurisdiction
over health and human services policy and funding beginning January 15, 2009,
on the development and activities of the quality management, assurance, and
improvement system designed to meet the federal requirements under the home and
community-based services waiver programs for persons with disabilities. By January 15, 2008, the commissioner shall
provide a preliminary report on priorities for meeting the federal
requirements, progress on development and field testing of the annual survey,
appropriations necessary to implement an annual survey of service recipients
once field testing is completed, recommendations for improvements in the
incident reporting system, and a plan for incorporating quality assurance
efforts under section 256B.095 and other regional efforts into the statewide
system.
(b) This subdivision expires January 1, 2013.
Sec. 24. Minnesota
Statutes 2010, section 256B.441, subdivision 13, is amended to read:
Subd. 13. External fixed costs. "External fixed costs" means
costs related to the nursing home surcharge under section 256.9657, subdivision
1; licensure fees under section 144.122; long-term care consultation fees under
section 256B.0911, subdivision 6; family advisory council fee under section
144A.33; scholarships under section 256B.431, subdivision 36; planned closure
rate adjustments under section 256B.436 or 256B.437; or single bed room
incentives under section 256B.431, subdivision 42; property taxes and property
insurance; and PERA.
Sec. 25. Minnesota
Statutes 2010, section 256B.441, subdivision 31, is amended to read:
Subd. 31. Prior system operating cost payment rate. "Prior system operating cost payment
rate" means the operating cost payment rate in effect on September 30,
2008, under Minnesota Rules and Minnesota Statutes, not including planned
closure rate adjustments under section 256B.436 or 256B.437, or single
bed room incentives under section 256B.431, subdivision 42.
Sec. 26. Minnesota
Statutes 2010, section 256B.441, subdivision 53, is amended to read:
Subd. 53. Calculation of payment rate for external
fixed costs. The commissioner shall
calculate a payment rate for external fixed costs.
(a) For a facility licensed as a nursing home, the portion
related to section 256.9657 shall be equal to $8.86. For a facility licensed as both a nursing
home and a boarding care home, the portion related to section 256.9657 shall be
equal to $8.86 multiplied by the result of
its number of nursing home beds divided by its total number of licensed beds.
(b) The portion related to the licensure fee under section
144.122, paragraph (d), shall be the amount of the fee divided by actual
resident days.
(c) The portion related to scholarships shall be determined
under section 256B.431, subdivision 36.
(d) The portion related to long-term care consultation shall
be determined according to section 256B.0911, subdivision 6.
(e) The portion related to development and education of
resident and family advisory councils under section 144A.33 shall be $5 divided
by 365.
(f) The portion related to planned closure rate adjustments
shall be as determined under sections 256B.436 and section
256B.437, subdivision 6, and Minnesota Statutes 2010, section 256B.436. Planned closure rate adjustments that take
effect before October 1, 2014, shall no longer be included in the payment rate
for external fixed costs beginning October 1, 2016. Planned closure rate adjustments that take
effect on or after October 1, 2014, shall no longer be included in the payment
rate for external fixed costs beginning on October 1 of the first year not less
than two years after their effective date.
(g) The portions related to property insurance, real estate
taxes, special assessments, and payments made in lieu of real estate taxes
directly identified or allocated to the nursing facility shall be the actual
amounts divided by actual resident days.
(h) The portion related to the Public
Employees Retirement Association shall be actual costs divided by resident
days.
(i) The single bed room incentives shall be as determined
under section 256B.431, subdivision 42. Single
bed room incentives that take effect before October 1, 2014, shall no longer be
included in the payment rate for external fixed costs beginning October 1, 2016. Single bed room incentives that take effect on
or after October 1, 2014, shall no longer be included in the payment rate for
external fixed costs beginning on October 1 of the first year not less than two
years after their effective date.
(j) The payment rate for external fixed costs shall be the sum
of the amounts in paragraphs (a) to (i).
Sec. 27. Minnesota
Statutes 2010, section 256B.49, subdivision 21, is amended to read:
Subd. 21. Report.
(a) The commissioner shall expand on the annual report
required under section 256B.0916, subdivision 7, to include information on the
county of residence and financial responsibility, age, and major diagnoses for
persons eligible for the home and community-based waivers authorized under
subdivision 11 who are:
(1) receiving those services;
(2) screened and waiting for waiver services; and
(3) residing in nursing facilities and are under age 65.
(b) This subdivision expires January 1, 2013.
Sec. 28. Minnesota
Statutes 2011 Supplement, section 626.557, subdivision 9, is amended to read:
Subd. 9. Common entry point designation. (a) Each county board shall designate a
common entry point for reports of suspected maltreatment. Two or more county boards may jointly
designate a single common entry point. The
common entry point is the unit responsible for receiving the report of
suspected maltreatment under this section.
(b) The common entry point must be available 24 hours per
day to take calls from reporters of suspected maltreatment. The common entry point shall use a standard
intake form that includes:
(1) the time and date of the report;
(2) the name, address, and telephone number of the person
reporting;
(3) the time, date, and location of the incident;
(4) the names of the persons involved, including but not
limited to, perpetrators, alleged victims, and witnesses;
(5) whether there was a risk of imminent danger to the
alleged victim;
(6) a description of the suspected maltreatment;
(7) the disability, if any, of the alleged victim;
(8) the relationship of the alleged perpetrator to the
alleged victim;
(9) whether a facility was involved and, if so, which agency
licenses the facility;
(10) any action taken by the common entry point;
(11) whether law enforcement has been notified;
(12) whether the reporter wishes to receive notification of
the initial and final reports; and
(13) if the report is from a facility with an internal
reporting procedure, the name, mailing address, and telephone number of the
person who initiated the report internally.
(c) The common entry point is not required to complete each
item on the form prior to dispatching the report to the appropriate lead
investigative agency.
(d) The common entry point shall immediately report to a law
enforcement agency any incident in which there is reason to believe a crime has
been committed.
(e) If a report is initially made to a law enforcement
agency or a lead investigative agency, those agencies shall take the report on
the appropriate common entry point intake forms and immediately forward a copy
to the common entry point.
(f) The common entry point staff must receive training on
how to screen and dispatch reports efficiently and in accordance with this
section.
(g) When a centralized database is available, the common
entry point has access to the centralized database and must log the reports
into the database. The
commissioner of human services shall maintain a centralized database for the
collection of common entry point data, lead investigative agency data including
maltreatment report disposition, and appeals data.
Sec. 29. Laws 2009, chapter 79, article 8, section 81,
as amended by Laws 2010, chapter 352, article 1, section 24, is amended to read:
Sec. 81. ESTABLISHING A SINGLE SET OF STANDARDS.
(a) The commissioner of human services shall consult with
disability service providers, advocates, counties, and consumer families to
develop a single set of standards, to be referred to as "quality outcome
standards," governing services for people with disabilities receiving
services under the home and community-based waiver services program, with
the exception of customized living services because the service license is
under the jurisdiction of the Department of Health, to replace all or
portions of existing laws and rules including, but not limited to, data
practices, licensure of facilities and providers, background studies, reporting
of maltreatment of minors, reporting of maltreatment of vulnerable adults, and the
psychotropic medication checklist. The
standards must:
(1) enable optimum consumer choice;
(2) be consumer driven;
(3) link services to individual needs and life goals;
(4) be based on quality assurance and individual outcomes;
(5) utilize the people closest to the recipient, who may
include family, friends, and health and service providers, in conjunction with
the recipient's risk management plan to assist the recipient or the recipient's
guardian in making decisions that meet the recipient's needs in a
cost-effective manner and assure the recipient's health and safety;
(6) utilize person-centered planning; and
(7) maximize federal financial participation.
(b) The commissioner may consult with existing stakeholder
groups convened under the commissioner's authority, including the home and
community-based expert services panel established by the commissioner in 2008,
to meet all or some of the requirements of this section.
(c) The commissioner shall provide the reports and plans
required by this section to the legislative committees and budget divisions
with jurisdiction over health and human services policy and finance by January
15, 2012.
Sec. 30. DISABILITY HOME AND COMMUNITY-BASED
WAIVER REQUEST.
By December 1, 2012, the commissioner shall request all
federal approvals and waiver amendments to the disability home and
community-based waivers to allow properly licensed adult foster care homes to
provide residential services for up to five individuals.
EFFECTIVE DATE. This section is effective July 1, 2012.
Sec. 31. HOURLY NURSING DETERMINATION MATRIX.
A service provider applying for medical assistance payments
for private duty nursing services under Minnesota Statutes, section 256B.0654,
must complete and submit to the commissioner of human services an hourly
nursing determination matrix for each recipient of private duty nursing
services. The commissioner of human
services will collect and analyze data from the hourly nursing determination
matrix.
Sec. 32. REPEALER.
(a) Minnesota Statutes 2010, sections 256B.431, subdivisions
2c, 2g, 2i, 2j, 2k, 2l, 2o, 3c, 11, 14, 17b, 17f, 19, 20, 25, 27, and 29;
256B.434, subdivisions 4a, 4b, 4c, 4d, 4e, 4g, 4h, 7, and 8; 256B.435; and
256B.436, are repealed.
(b) Minnesota Statutes 2011 Supplement, section 256B.431,
subdivision 26, is repealed.
(c) Minnesota Rules, part 9555.7700, is repealed.
ARTICLE 2
TELEPHONE
EQUIPMENT PROGRAM
Section 1. Minnesota
Statutes 2010, section 237.50, is amended to read:
237.50
DEFINITIONS.
Subdivision 1. Scope.
The terms used in sections 237.50 to 237.56 have the meanings given
them in this section.
Subd. 3. Communication impaired disability. "Communication impaired disability"
means certified as deaf, severely hearing impaired, hard-of-hearing having
a hearing loss, speech impaired, deaf and blind disability,
or mobility impaired if the mobility impairment significantly impedes the
ability physical disability that makes it difficult or impossible to
use standard customer premises telecommunications services and
equipment.
Subd. 4. Communication device. "Communication device" means a
device that when connected to a telephone enables a communication-impaired
person to communicate with another person utilizing the telephone system. A "communication device" includes a
ring signaler, an amplification device, a telephone device for the deaf, a
Brailling device for use with a telephone, and any other device the Department
of Human Services deems necessary.
Subd. 4a. Deaf.
"Deaf" means a hearing impairment loss of
such severity that the individual must depend primarily upon visual
communication such as writing, lip reading, manual communication sign
language, and gestures.
Subd. 4b. Deafblind. "Deafblind"
means any combination of vision and hearing loss which interferes with
acquiring information from the environment to the extent that compensatory
strategies and skills are necessary to access that or other information.
Subd. 5. Exchange.
"Exchange" means a unit area established and described by
the tariff of a telephone company for the administration of telephone service
in a specified geographical area, usually embracing a city, town, or village
and its environs, and served by one or more central offices, together with
associated facilities used in providing service within that area.
Subd. 6. Fund.
"Fund" means the telecommunications access Minnesota fund
established in section 237.52.
Subd. 6a. Hard-of-hearing. "Hard-of-hearing" means a
hearing impairment loss resulting in a functional loss limitation,
but not to the extent that the individual must depend primarily upon visual
communication.
Subd. 7. Interexchange service. "Interexchange service" means
telephone service between points in two or more exchanges.
Subd. 8. Inter-LATA interexchange service. "Inter-LATA interexchange
service" means interexchange service originating and terminating in
different LATAs.
Subd. 9. Local access and transport area. "Local access and transport area
(LATA)" means a geographical area designated by the Modification of Final
Judgment in U.S. v. Western Electric Co., Inc., 552 F. Supp. 131 (D.D.C. 1982),
including modifications in effect on the effective date of sections 237.51 to
237.54.
Subd. 10. Local exchange service. "Local exchange service" means telephone
service between points within an exchange.
Subd. 10a. Telecommunications device.
"Telecommunications device" means a device that (1)
allows a person with a communication disability to have access to
telecommunications services as defined in subdivision 13, and (2) is
specifically selected by the Department of Human Services for its capacity to
allow persons with communication disabilities to use telecommunications
services in a manner that is functionally equivalent to the ability of an individual
who does not have a communication disability.
A telecommunications device may include a ring signaler, an amplified
telephone, a hands-free telephone, a text telephone, a captioned telephone, a
wireless device, a device that produces Braille output for use with a
telephone, and any other device the Department of Human Services deems
appropriate.
Subd. 11. Telecommunication Telecommunications
Relay service Services. "Telecommunication
Telecommunications Relay service Services" or "TRS"
means a central statewide service through which a communication-impaired
person, using a communication device, may send and receive messages to and from
a non-communication-impaired person whose telephone is not equipped with a
communication device and through which a non-communication-impaired person may,
by using voice communication, send and receive messages to and from a
communication-impaired person the telecommunications transmission
services required under Federal Communications Commission (FCC) regulations at
Code of Federal Regulations, title 47, sections 64.604 to 64.606. TRS allows an individual who has a
communication disability to use telecommunications services in a manner that is
functionally equivalent to the ability of an individual who does not have a communication
disability.
Subd. 12. Telecommunications. "Telecommunications"
means the transmission, between or among points specified by the user, of
information of the user's choosing, without change in the form or content of
the information as sent and received.
Subd. 13. Telecommunications services.
"Telecommunications services" means the offering of
telecommunications for fee directly to the public, or to such classes of users
as to be effectively available to the public, regardless of the facilities
used.
Sec. 2. Minnesota
Statutes 2010, section 237.51, is amended to read:
237.51
TELECOMMUNICATIONS ACCESS MINNESOTA PROGRAM ADMINISTRATION.
Subdivision 1. Creation.
The commissioner of commerce shall:
(1) administer through interagency agreement with the
commissioner of human services a program to distribute communication telecommunications
devices to eligible communication-impaired persons who have
communication disabilities; and
(2) contract with a one or more qualified vendor
vendors that serves communication-impaired serve persons who
have communication disabilities to create and maintain a
telecommunication provide telecommunications relay service services.
For
purposes of sections 237.51 to 237.56, the Department of Commerce and any
organization with which it contracts pursuant to this section or section
237.54, subdivision 2, are not telephone companies or telecommunications
carriers as defined in section 237.01.
Subd. 5. Commissioner of commerce duties. In addition to any duties specified
elsewhere in sections 237.51 to 237.56, the commissioner of commerce shall:
(1) prepare the reports required by section 237.55;
(2) administer the fund created in section 237.52; and
(3) adopt rules under chapter 14 to implement the provisions
of sections 237.50 to 237.56.
Subd. 5a. Department Commissioner of
human services duties. (a) In
addition to any duties specified elsewhere in sections 237.51 to 237.56, the
commissioner of human services shall:
(1) define economic hardship, special needs, and household
criteria so as to determine the priority of eligible applicants for initial
distribution of devices and to determine circumstances necessitating provision
of more than one communication telecommunications device per
household;
(2) establish a method to verify eligibility requirements;
(3) establish specifications for communication telecommunications
devices to be purchased provided under section 237.53,
subdivision 3; and
(4) inform the public and specifically the community of
communication-impaired persons who have communication disabilities
of the program.; and
(5) provide devices based on the assessed need of eligible
applicants.
(b) The commissioner may establish an advisory board to
advise the department in carrying out the duties specified in this section and
to advise the commissioner of commerce in carrying out duties under section
237.54. If so established, the advisory
board must include, at a minimum, the following communication-impaired
persons:
(1) at least one member who is deaf;
(2) at least one member who is has a speech impaired
disability;
(3) at least one member who is mobility impaired has
a physical disability that makes it difficult or impossible for the person to
access telecommunications services; and
(4) at least one member who is hard-of-hearing.
The membership terms, compensation, and removal of members
and the filling of membership vacancies are governed by section 15.059. Advisory board meetings shall be held at the
discretion of the commissioner.
Sec. 3. Minnesota
Statutes 2010, section 237.52, is amended to read:
237.52
TELECOMMUNICATIONS ACCESS MINNESOTA FUND.
Subdivision 1. Fund established. A telecommunications access Minnesota
fund is established as an account in the state treasury. Earnings, such as interest, dividends, and
any other earnings arising from fund assets, must be credited to the fund.
Subd. 2. Assessment.
(a) The commissioner of commerce, the commissioner of employment and
economic development, and the commissioner of human services shall annually
recommend to the Public Utilities Commission (PUC) an adequate
and appropriate surcharge and budget to implement sections 237.50 to 237.56,
248.062, and 256C.30, respectively. The
maximum annual budget for section 248.062 must not exceed $100,000 and for
section 256C.30 must not exceed $300,000.
The Public Utilities Commission shall review the budgets for
reasonableness and may modify the budget to the extent it is unreasonable. The commission shall annually determine the
funding mechanism to be used within 60 days of receipt of the recommendation of
the departments and shall order the imposition of surcharges effective on the
earliest practicable date. The
commission shall establish a monthly charge no greater than 20 cents for each
customer access line, including trunk equivalents as designated by the
commission pursuant to section 403.11, subdivision 1.
(b) If the fund balance falls below a level capable of fully
supporting all programs eligible under subdivision 5 and sections 248.062 and
256C.30, expenditures under sections 248.062 and 256C.30 shall be reduced on a
pro rata basis and expenditures under sections 237.53 and 237.54 shall be fully
funded. Expenditures under sections
248.062 and 256C.30 shall resume at fully funded levels when the commissioner
of commerce determines there is a sufficient fund balance to fully fund those
expenditures.
Subd. 3. Collection.
Every telephone company or communications carrier that provides
service provider of services capable of originating a telecommunications
relay TRS call, including cellular communications and other nonwire
access services, in this state shall collect the charges established by the
commission under subdivision 2 and transfer amounts collected to the
commissioner of public safety in the same manner as provided in section 403.11,
subdivision 1, paragraph (d). The
commissioner of public safety must deposit the receipts in the fund established
in subdivision 1.
Subd. 4. Appropriation. Money in the fund is appropriated to the
commissioner of commerce to implement sections 237.51 to 237.56, to the
commissioner of employment and economic development to implement section
248.062, and to the commissioner of human services to implement section
256C.30.
Subd. 5. Expenditures. (a) Money in the fund may only be used
for:
(1) expenses of the Department of Commerce, including
personnel cost, public relations, advisory board members' expenses, preparation
of reports, and other reasonable expenses not to exceed ten percent of total
program expenditures;
(2) reimbursing the commissioner of human services for
purchases made or services provided pursuant to section 237.53;
(3) reimbursing telephone companies
for purchases made or services provided under section 237.53, subdivision 5;
and
(4) contracting for establishment and operation of the
telecommunication relay service the provision of TRS required by
section 237.54.
(b) All costs directly associated with the establishment of
the program, the purchase and distribution of communication telecommunications
devices, and the establishment and operation of the telecommunication relay
service provision of TRS are either reimbursable or directly payable
from the fund after authorization by the commissioner of commerce. The commissioner of commerce shall contract
with the message relay service operator one or more TRS providers
to indemnify the local exchange carriers of the relay telecommunications
service providers for any fines imposed by the Federal Communications
Commission related to the failure of the relay service to comply with federal
service standards. Notwithstanding
section 16A.41, the commissioner may advance money to the contractor of the
telecommunication relay service TRS providers if the contractor
establishes providers establish to the commissioner's satisfaction
that the advance payment is necessary for the operation provision
of the service. The advance payment may
be used only for working capital reserve for the operation of the service. The advance payment must be offset or repaid
by the end of the contract fiscal year together with interest accrued from the
date of payment.
Sec. 4. Minnesota
Statutes 2010, section 237.53, is amended to read:
237.53 COMMUNICATION
TELECOMMUNICATIONS DEVICE.
Subdivision 1. Application. A person applying for a communication
telecommunications device under this section must apply to the program
administrator on a form prescribed by the Department of Human Services.
Subd. 2. Eligibility. To be eligible to obtain a communication
telecommunications device under this section, a person must be:
(1) be able to benefit from and use the equipment for
its intended purpose;
(2) have a communication impaired disability;
(3) be a resident of the state;
(4) be a resident in a household that has a median
income at or below the applicable median household income in the state, except
a deaf and blind person who is deafblind applying for a telebraille
unit Braille device may reside in a household that has a median
income no more than 150 percent of the applicable median household income in
the state; and
(5) be a resident in a household that has telephone
telecommunications service or that has made application for service and
has been assigned a telephone number; or a resident in a residential care
facility, such as a nursing home or group home where telephone telecommunications
service is not included as part of overall service provision.
Subd. 3. Distribution. The commissioner of human services shall
purchase and distribute a sufficient number of communication telecommunications
devices so that each eligible household receives an appropriate device
devices as determined under section 237.51, subdivision 5a. The commissioner of human services shall
distribute the devices to eligible households in each service area free
of charge as determined under section 237.51, subdivision 5a.
Subd. 4. Training; maintenance. The commissioner of human services shall
maintain the communication telecommunications devices until the
warranty period expires, and provide training, without charge, to first-time
users of the devices.
Subd. 5. Wiring installation. If a communication-impaired person is not
served by telephone service and is subject to economic hardship as determined
by the Department of Human Services, the telephone company providing local
service shall at the direction of the administrator of the program install
necessary outside wiring without charge to the household.
Subd. 6. Ownership.
All communication Telecommunications devices purchased
pursuant to subdivision 3 will become are the property of the
state of Minnesota. Policies and
procedures for the return of devices from individuals who withdraw from the program
or whose eligibility status changes shall be determined by the commissioner of
human services.
Subd. 7. Standards.
The communication telecommunications devices
distributed under this section must comply with the electronic industries association
alliance standards and be approved by the Federal Communications
Commission. The commissioner of human
services must provide each eligible person a choice of several models of
devices, the retail value of which may not exceed $600 for a communication
device for the deaf text telephone, and a retail value of $7,000 for
a telebraille Braille device, or an amount authorized by the
Department of Human Services for a telephone device for the deaf with
auxiliary equipment all other telecommunications devices and auxiliary
equipment it deems cost-effective and appropriate to distribute according to
sections 237.51 to 237.56.
Sec. 5. Minnesota
Statutes 2010, section 237.54, is amended to read:
237.54 TELECOMMUNICATION
TELECOMMUNICATIONS RELAY SERVICE SERVICES (TRS).
Subd. 2. Operation.
(a) The commissioner of commerce shall contract with a one
or more qualified vendor vendors for the operation and
maintenance of the telecommunication relay system provision of
Telecommunications Relay Services (TRS).
(b) The telecommunication relay service provider TRS
providers shall operate the relay service within the state of Minnesota. The operator of the system TRS
providers shall keep all messages confidential, shall train personnel in
the unique needs of communication-impaired people, and shall inform
communication-impaired persons and the public of the availability and use of
the system. Except in the case of a
speech- or mobility-impaired person, the operator shall not relay a message
unless it originates or terminates through a communication device for the deaf
or a Brailling device for use with a telephone comply with all current
and subsequent FCC regulations at Code of Federal Regulations, title 47,
sections 64.601 to 64.606, and shall inform persons who have communication
disabilities and the public of the availability and use of TRS.
Sec. 6. Minnesota
Statutes 2010, section 237.55, is amended to read:
237.55 ANNUAL
REPORT ON COMMUNICATION TELECOMMUNICATIONS ACCESS.
The commissioner of commerce must prepare a report for
presentation to the Public Utilities Commission by January 31 of each
year. Each report must review the
accessibility of the telephone system to communication-impaired persons,
review the ability of non-communication-impaired persons to communicate with
communication-impaired persons via the telephone system telecommunications
services to persons who have communication disabilities, describe services
provided, account for money received and disbursed annually annual
revenues and expenditures for each aspect of the program fund
to date, and include predicted program future operation.
Sec. 7. Minnesota
Statutes 2010, section 237.56, is amended to read:
237.56 ADEQUATE
SERVICE ENFORCEMENT.
The services required to be provided under sections 237.50
to 237.55 may be enforced under section 237.081 upon a complaint of at least
two communication-impaired persons within the service area of any one telephone
company telecommunications service provider, provided that if only
one person within the service area of a company is receiving service under
sections 237.50 to 237.55, the commission Public Utilities Commission
may proceed upon a complaint from that person.
ARTICLE 3
COMPREHENSIVE
ASSESSMENT AND CASE MANAGEMENT REFORM
Section 1. Minnesota
Statutes 2011 Supplement, section 256B.0625, subdivision 56, is amended to
read:
Subd. 56. Medical service coordination. (a) Medical assistance covers in-reach
community-based service coordination that is performed in through
a hospital emergency department as an eligible procedure under a state
healthcare program or private insurance for a frequent user. A frequent user is defined as an individual
who has frequented the hospital emergency department for services three or more
times in the previous four consecutive months.
In-reach community-based service coordination includes navigating
services to address a client's mental health, chemical health, social,
economic, and housing needs, or any other activity targeted at reducing the
incidence of emergency room and other nonmedically necessary health care
utilization.
(b) Reimbursement must be made in 15-minute increments under
current Medicaid mental health social work reimbursement methodology and
allowed for up to 60 days posthospital discharge based upon the specific
identified emergency department visit or inpatient admitting event. A frequent user who is participating in
care coordination within a health care home framework is ineligible for
reimbursement under this subdivision.
In-reach community-based service coordination shall seek to connect
frequent users with existing covered services available to them, including, but
not limited to, targeted case management, waiver case management, or care
coordination in a health care home.
Eligible in-reach service coordinators must hold a minimum of a
bachelor's degree in social work, public health, corrections, or a related
field. The commissioner shall submit any
necessary application for waivers to the Centers for Medicare and Medicaid
Services to implement this subdivision.
(c) For the purposes of this subdivision, "in-reach
community-based service coordination" means the practice of a
community-based worker with training, knowledge, skills, and ability to access
a continuum of services, including housing, transportation, chemical and mental
health treatment, employment, and peer support services, by working with an
organization's staff to transition an individual back into the individual's
living environment. In-reach community-based
service coordination includes working with the individual during their
discharge and for up to a defined amount of time in the individual's living
environment, reducing the individual's need for readmittance.
Sec. 2. Minnesota
Statutes 2010, section 256B.0659, subdivision 1, is amended to read:
Subdivision 1. Definitions. (a) For the purposes of this section, the
terms defined in paragraphs (b) to (r) 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) "Extended personal care assistance service"
means personal care assistance services included in a service plan under one of
the home and community-based services waivers authorized under sections
256B.0915, 256B.092, subdivision 5, and 256B.49, which exceed the amount,
duration, and frequency of the state plan personal care assistance services for
participants who:
(1) need assistance provided periodically during a week, but
less than daily will not be able to remain in their homes without the
assistance, and other replacement services are more expensive or are not
available when personal care assistance services are to be terminated; or
(2) need additional personal care assistance services beyond
the amount authorized by the state plan personal care assistance assessment in
order to ensure that their safety, health, and welfare are provided for in
their homes.
(h) "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.
(i) "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.
(j) "Managing employee" has the same definition as
Code of Federal Regulations, title 42, section 455.
(k) "Qualified professional" means a professional
providing supervision of personal care assistance services and staff as defined
in section 256B.0625, subdivision 19c.
(l) "Personal care assistance provider agency"
means a medical assistance enrolled provider that provides or assists with
providing personal care assistance services and includes a personal care
assistance provider organization, personal care assistance choice agency, class
A licensed nursing agency, and Medicare-certified home health agency.
(m) "Personal care assistant" or "PCA"
means an individual employed by a personal care assistance agency who provides
personal care assistance services.
(n) "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.
(o) "Responsible party" means an individual who is
capable of providing the support necessary to assist the recipient to live in
the community.
(p) "Self-administered medication" means
medication taken orally, by injection, nebulizer, or insertion, or
applied topically without the need for assistance.
(q) "Service plan" means a written summary of the
assessment and description of the services needed by the recipient.
(r) "Wages and benefits" means wages and salaries,
the employer's share of FICA taxes, Medicare taxes, state and federal
unemployment taxes, workers' compensation, mileage reimbursement, health and
dental insurance, life insurance, disability insurance, long-term care
insurance, uniform allowance, and contributions to employee retirement
accounts.
Sec. 3. Minnesota
Statutes 2010, section 256B.0659, subdivision 2, is amended to read:
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;
(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, including medications given through a
nebulizer;
(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. A personal care
assistant must not determine the medication dose or time for medication.
(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 (i).
Sec. 4. Minnesota
Statutes 2010, section 256B.0659, subdivision 3a, is amended to read:
Subd. 3a. Assessment; defined. (a) "Assessment" means a
review and evaluation of a recipient's need for home personal
care assistance services conducted in person. Assessments for personal care assistance
services shall be conducted by the county public health nurse or a certified
public health nurse under contract with the county except when a long-term
care consultation assessment is being conducted for the purposes of determining
a person's eligibility for home and community-based waiver services including
personal care assistance services according to section 256B.0911. An in-person assessment must include: documentation of health status, determination
of need, evaluation of service effectiveness, 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 assistance 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. 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
assistance 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 assistance service. A service
update may be completed by telephone, used when there is no need for an
increase in personal care assistance 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 or reassessments 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.
(b) This subdivision expires when notification is given by
the commissioner as described in section 256B.0911, subdivision 3a.
Sec. 5. Minnesota
Statutes 2010, section 256B.0659, subdivision 4, is amended to read:
Subd. 4. Assessment for personal care assistance
services; limitations. (a) An
assessment as defined in subdivision 3a 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 daily need or need on the days during the
week the activity is completed for:
(i) cuing 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 or community support plan developed under
section 256B.0911, and found in the following:
(1) tube feedings requiring:
(i) a gastrojejunostomy 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 devices 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 intermittent catheterization, and including
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
(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) increased need for assistance for recipients who are
verbally aggressive and or resistive to care so that the time
needed to perform activities of daily living is increased.
Sec. 6. Minnesota
Statutes 2010, 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 support and service
options that meet their needs and reflect their preferences. The availability of, and access to,
information and other types of assistance, including assessment and support
planning, is also intended to prevent or delay certified nursing facility
institutional placements and to provide access to transition
assistance after admission. Further, the
goal of these services is to contain costs associated with unnecessary certified
nursing facility institutional admissions. Long-term consultation services must be
available to any person regardless of public program eligibility. The commissioner of human services 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 long-term care
options counseling provided under section 256.975, subdivision 7, and 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 lead 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. 7. Minnesota
Statutes 2011 Supplement, section 256B.0911, subdivision 1a, is amended to
read:
Subd. 1a. Definitions. For purposes of this section, the
following definitions apply:
(a) Until additional requirements apply under paragraph
(b), "long-term care consultation services" means:
(1) intake for and access to assistance in
identifying services needed to maintain an individual in the most inclusive
environment;
(2) providing recommendations on for and referrals
to cost-effective community services that are available to the individual;
(3) development of an individual's person-centered community
support plan;
(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;
(6) federally mandated preadmission screening to
determine the need for an institutional level of care under subdivision 4a activities
described under subdivisions 4a and 4b;
(7) determination of home and community-based waiver and
other service eligibility as required under sections 256B.0913,
256B.0915, and 256B.49, including level of care determination for
individuals who need an institutional level of care as determined under section
256B.0911, subdivision 4a, paragraph (d), or 256B.092, service eligibility
including state plan home care services identified in sections 256B.0625,
subdivisions 6, 7, and 19, paragraphs (a) and (c), and 256B.0657, based on
assessment and community support plan development with, appropriate
referrals to obtain necessary diagnostic information, and
including the option an eligibility determination for
consumer-directed community supports;
(8) providing recommendations for nursing facility institutional
placement when there are no cost-effective community services available; and
(9) providing access to assistance to transition
people back to community settings after facility institutional
admission.; and
(10) providing information about competitive employment,
with or without supports, for school-age youth and working-age adults and
referrals to the Disability Linkage Line and Disability Benefits 101 to ensure
that an informed choice about competitive employment can be made. For the purposes of this subdivision,
"competitive employment" means work in the competitive labor market
that is performed on a full-time or part-time basis in an integrated setting,
and for which an individual is compensated at or above the minimum wage, but
not less than the customary wage and level of benefits paid by the employer for
the same or similar work performed by individuals without disabilities.
(b) Upon statewide implementation of lead agency
requirements in subdivisions 2b, 2c, and 3a, "long-term care consultation
services" also means:
(1) service eligibility determination for state plan home
care services identified in:
(i) section 256B.0625, subdivisions 7, 19a, and 19c;
(ii) section 256B.0657; or
(iii) consumer support grants under section 256.476;
(2) notwithstanding provisions in Minnesota Rules, parts
9525.0004 to 9525.0024, determination of eligibility for case management
services available under sections 256B.0621, subdivision 2, paragraph (4), and
256B.0924 and Minnesota Rules, part 9525.0016;
(3) determination of institutional level of care, home and
community-based service waiver, and other service eligibility as required under
section 256B.092, determination of eligibility for family support grants under
section 252.32, semi-independent living services under section 252.275, and day
training and habilitation services under section 256B.092; and
(4) obtaining necessary diagnostic information to determine
eligibility under clauses (2) and (3).
(b)
(c) "Long-term care 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.
(c)
(d) "Minnesota health care programs" means the medical
assistance program under chapter 256B and the alternative care program under
section 256B.0913.
(d)
(e) "Lead agencies" means counties administering or a
collaboration of counties, tribes, and health plans administering
under contract with the commissioner to administer long-term care
consultation assessment and support planning services.
Sec. 8. Minnesota
Statutes 2010, section 256B.0911, subdivision 2b, is amended to read:
Subd. 2b. Certified assessors. (a) Beginning January 1, 2011, Each lead agency shall use certified
assessors who have completed training and the certification processes
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. A lead
agency may choose, according to departmental policies, to contract with a
qualified, certified assessor to conduct assessments and reassessments on
behalf of the lead agency.
(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 nurse without public health certification with at least three
two years of home and community-based experience that have has
received training and certification specific to assessment and consultation for
long-term care services in the state.
Sec. 9. Minnesota
Statutes 2010, section 256B.0911, subdivision 2c, is amended to read:
Subd. 2c. Assessor training and certification. The commissioner shall develop and
implement 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. within
timelines specified by the commissioner, but no sooner than six months after
statewide availability of the training and certification process. The commissioner must establish the timelines
for training and certification in a manner that allows lead agencies to most
efficiently adopt the automated process established in subdivision 5. 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. 10. Minnesota
Statutes 2010, 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) Certified assessors must be part of a
multidisciplinary long-term care consultation team of professionals that
includes public health nurses, social workers, and other professionals as
defined in subdivision 2b, paragraph (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.
(c) The commissioner shall allow arrangements and make
recommendations that encourage counties and tribes 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).
(d) Tribes and health plans under contract with the
commissioner must provide long-term care consultation services as specified in
the contract.
(e) The lead agency must provide the commissioner with an
administrative contact for communication purposes.
Sec. 11. Minnesota
Statutes 2011 Supplement, 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 15 20
calendar days after the date on which an assessment was requested or
recommended. After January 1, 2011,
these requirements also apply to Upon statewide implementation of
subdivisions 2b, 2c, and 5, this requirement also applies to an assessment of a
person requesting personal care assistance services, and
private duty nursing, and home health agency services, on timelines
established in subdivision 5. The
commissioner shall provide at least a 90-day notice to lead agencies prior to
the effective date of this requirement.
Face-to-face assessments must be conducted according to paragraphs (b)
to (i).
(b) The county lead agency may utilize a team
of either the social worker or public health nurse, or both. After January 1, 2011 Upon
implementation of subdivisions 2b, 2c, and 5, lead agencies shall use
certified assessors to conduct the assessment in a face-to-face interview
assessment. The consultation team
members must confer regarding the most appropriate care for each individual
screened or assessed. For a person
with complex health care needs, a public health or registered nurse from the
team must be consulted.
(c) The 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 community support plan that meets the consumers
needs, using an assessment form provided by the commissioner.
(d) The assessment must be conducted in a face-to-face
interview with the person being assessed and the person's legal representative,
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 community 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 person, or the person's legal representative, must
be provided with written recommendations for community-based services,
including consumer-directed options, or institutional care that include
documentation that the most cost-effective alternatives available were offered
to the individual, and alternatives to residential settings, including, but not
limited to, foster care settings that are not the primary residence of the
license holder. For purposes of this
requirement, "cost-effective alternatives" means community services
and living arrangements that cost the same as or less than institutional care.
(f)
(e) If the person chooses to use community-based services, the person or
the person's legal representative must be provided with a written community
support plan within 40 calendar days of the assessment visit, regardless
of whether the individual is eligible for Minnesota health care programs. The written community support plan must
include:
(1) a summary of assessed needs as defined in paragraphs (c)
and (d);
(2) the individual's options and choices to meet identified
needs, including all available options for case management services and
providers;
(3) identification of health and safety risks and how those
risks will be addressed, including personal risk management strategies;
(4) referral information; and
(5) informal caregiver supports, if applicable.
For a person determined eligible for state plan home care
under subdivision 1a, paragraph (b), clause (1), the person or person's
representative must also receive a copy of the home care service plan developed
by the certified assessor.
(f)
A person may request assistance in 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 long-term care options counseling
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 institutional placement and community placement after the
recommendations have been provided, except as provided in subdivision 4a,
paragraph (c).
(h) The team lead agency 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:
(1) written recommendations for community-based services
and consumer-directed options;
(2) documentation that the most cost-effective alternatives
available were offered to the individual.
For purposes of this clause, "cost-effective" means community
services and living arrangements that cost the same as or less than
institutional care. For an individual
found to meet eligibility criteria for home and community-based service
programs under section 256B.0915 or 256B.49, "cost effectiveness" has
the meaning found in the federally approved waiver plan for each program;
(3)
the need for and purpose of preadmission screening if the person selects
nursing facility placement;
(2)
(4) the role of the long-term care consultation assessment and
support planning in waiver and alternative care program eligibility
determination for waiver and alternative care programs, and state plan home
care, case management, and other services as defined in subdivision 1a,
paragraphs (a), clause (7), and (b);
(3)
(5) information about Minnesota health care programs;
(4)
(6) the person's freedom to accept or reject the recommendations of the
team;
(5)
(7) the person's right to confidentiality under the Minnesota Government
Data Practices Act, chapter 13;
(6)
(8) the long-term care consultant's certified assessor's
decision regarding the person's need for institutional level of care as
determined under criteria established in section 144.0724, subdivision 11,
or 256B.092 256B.0911, subdivision 4a, paragraph (d), and the certified
assessor's decision regarding eligibility for all services and programs as
defined in subdivision 1a, paragraphs (a), clause (7), and (b); and
(7)
(9) the person's right to appeal the certified assessor's decision
regarding eligibility for all services and programs as defined in subdivision
1a, paragraphs (a), clause (7), and (b), and incorporating the decision
regarding the need for nursing facility institutional level of
care or the county's lead agency'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.0913, 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.
(j)
The effective eligibility start date for these programs in paragraph
(i) 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). Notwithstanding retroactive
medical assistance coverage of state plan services, the effective date of program
eligibility in this case for programs included in paragraph (i) cannot
be prior to the date the most recent updated assessment is completed.
Sec. 12. Minnesota
Statutes 2010, section 256B.0911, subdivision 3b, is amended to read:
Subd. 3b. Transition assistance. (a) A long-term care consultation team
Lead agency certified assessors 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.975 256.975,
subdivision 10 7, for community support plan implementation and
to Minnesota health care programs, including home and community-based waiver
services and consumer-directed options through the waivers, 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, Disability
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 lead agency shall develop
transition processes with institutional social workers and discharge planners
to ensure that:
(1) referrals for in-person assessments are taken from
long-term care options counselors as provided for in section 256.975,
subdivision 7, paragraph (b), clause (11);
(2)
persons admitted to facilities assessed in institutions receive
information about transition assistance that is available;
(2)
(3) the assessment is completed for persons within ten working 20
calendar days of the date of request or recommendation for assessment; and
(3)
(4) there is a plan for transition and follow-up for the individual's
return to the community. The plan
must require, including notification of other local agencies when a
person who may require assistance is screened by one county for
admission to a facility from agencies located in another county.;
and
(5) relocation targeted case management as defined in
section 256B.0621, subdivision 2, clause (4), is authorized for an eligible
medical assistance recipient.
(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.
Sec. 13. Minnesota
Statutes 2011 Supplement, 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 lead agency must use forms and
criteria developed by the commissioner to identify persons who require referral
for further evaluation and determination of the need for specialized services;
and
(2) the evaluation and determination of the need for
specialized services must be done by:
(i) a qualified independent mental health professional, for
persons with a primary or secondary diagnosis of a serious mental illness; or
(ii) a qualified developmental disability professional, for
persons with a primary or secondary diagnosis of developmental disability. For purposes of this requirement, a qualified
developmental disability professional must meet the standards for a qualified
developmental disability professional under Code of Federal Regulations, title
42, section 483.430.
(c) The local county mental health authority or the state
developmental disability authority under Public Law Numbers 100-203 and 101-508
may prohibit admission to a nursing facility if the individual does not meet
the nursing facility level of care criteria or needs specialized services as
defined in Public Law Numbers 100-203 and 101-508. For purposes of this section,
"specialized services" for a person with developmental disability
means active treatment as that term is defined under Code of Federal
Regulations, title 42, section 483.440 (a)(1).
(d) The determination of the need for nursing facility level
of care must be made according to criteria developed by the commissioner, and
in section 256B.092, using forms developed by the commissioner. Effective no sooner than on or after July 1,
2012, for individuals age 21 and older, and on or after October 1, 2019, for
individuals under age 21, the determination of need for nursing facility level
of care shall be based on criteria in section 144.0724, subdivision 11. 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 lead agency.
Sec. 14. Minnesota
Statutes 2010, section 256B.0911, subdivision 4c, is amended to read:
Subd. 4c. Screening requirements. (a) A person may be screened for nursing
facility admission by telephone or in a face-to-face screening interview. Consultation team members Certified
assessors shall identify each individual's needs using the following
categories:
(1) the person needs no face-to-face screening interview to
determine the need for nursing facility level of care based on information
obtained from other health care professionals;
(2) the person needs an immediate face-to-face screening
interview to determine the need for nursing facility level of care and complete
activities required under subdivision 4a; or
(3) the person may be exempt from screening requirements as
outlined in subdivision 4b, but will need transitional assistance after
admission or in-person follow-along after a return home.
(b) Persons admitted on a nonemergency basis to a
Medicaid-certified nursing facility must be screened prior to admission.
(c) The county lead agency screening or intake
activity must include processes to identify persons who may require transition
assistance as described in subdivision 3b.
Sec. 15. Minnesota
Statutes 2010, 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), or 256B.441.
(c) In the event of the layaway, delicensure and
decertification, or removal from layaway of 25 percent or more of the beds in a
facility, the commissioner may adjust the per diem payment amount in paragraph
(b) and may adjust the monthly payment amount in paragraph (a). The effective date of an adjustment made
under this paragraph shall be on or after the first day of the month following
the effective date of the layaway, delicensure and decertification, or removal
from layaway.
(d) Payments for long-term care consultation services are
available to the county or counties to cover staff salaries and expenses to
provide the services described in subdivision 1a. The county shall employ, or contract with
other agencies to employ, within the limits of available funding, sufficient
personnel to provide long-term care consultation services while meeting the
state's long-term care outcomes and objectives as defined in section
256B.0917, subdivision 1. The county
shall be accountable for meeting local objectives as approved by the
commissioner in the biennial home and community-based services quality
assurance plan on a form provided by the commissioner.
(e) Notwithstanding section 256B.0641, overpayments
attributable to payment of the screening costs under the medical assistance
program may not be recovered from a facility.
(f) The commissioner of human services shall amend the
Minnesota medical assistance plan to include reimbursement for the local
consultation teams.
(g) Until the alternative payment methodology in
paragraph (h) is implemented, 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 other funding sources,
including federal funding, for this all long-term care
consultation and preadmission screening activity.
Sec. 16. Minnesota
Statutes 2010, section 256B.0913, subdivision 7, is amended to read:
Subd. 7. Case management. (a) The provision of case management
under the alternative care program is governed by requirements in section
256B.0915, subdivisions 1a and 1b.
(b)
The case manager must not approve alternative care funding for a client in any
setting in which the case manager cannot reasonably ensure the client's health
and safety.
(c)
The case manager is responsible for the cost-effectiveness of the alternative
care individual care coordinated service and support plan and
must not approve any care plan in which the cost of services funded by
alternative care and client contributions exceeds the limit specified in
section 256B.0915, subdivision 3 3a, paragraph (b).
(d) Case manager responsibilities include those in section
256B.0915, subdivision 1a, paragraph (g).
Sec. 17. Minnesota
Statutes 2010, section 256B.0913, subdivision 8, is amended to read:
Subd. 8. Requirements for individual care coordinated
service and support plan. (a)
The case manager shall implement the coordinated service and support
plan of care for each alternative care client and ensure that a client's
service needs and eligibility are reassessed at least every 12 months. The coordinated service and support plan
must meet the requirements in section 256B.0915, subdivision 6. The plan shall include any services
prescribed by the individual's attending physician as necessary to allow the
individual to remain in a community setting.
In developing the individual's care plan, the case manager should
include the use of volunteers from families and neighbors, religious
organizations, social clubs, and civic and service organizations to support the
formal home care services. The lead
agency shall be held harmless for damages or injuries sustained through the use
of volunteers under this subdivision including workers' compensation liability. The case manager shall provide documentation
in each individual's plan of care and, if requested, to the commissioner
that the most cost-effective alternatives available have been offered to the
individual and that the individual was free to choose among available qualified
providers, both public and private, including qualified case management or
service coordination providers other than those employed by any county;
however, the county or tribe maintains responsibility for prior authorizing
services in accordance with statutory and administrative requirements. The case manager must give the individual a
ten-day written notice of any denial, termination, or reduction of alternative
care services.
(b) The county of service or tribe must provide access to
and arrange for case management services, including assuring implementation of
the coordinated service and support plan. "County of service" has the meaning
given it in Minnesota Rules, part 9505.0015, subpart 11. The county of service must notify the county
of financial responsibility of the approved care plan and the amount of
encumbered funds.
Sec. 18. Minnesota
Statutes 2010, section 256B.0915, subdivision 1a, is amended to read:
Subd. 1a. Elderly waiver case management services. (a) Elderly Except as provided
to individuals under prepaid medical assistance programs as described in
paragraph (h), case management services under the home and community-based
services waiver for elderly individuals are available from providers meeting
qualification requirements and the standards specified in subdivision 1b. Eligible recipients may choose any qualified
provider of elderly case management services.
(b) Case management services assist individuals who receive
waiver services in gaining access to needed waiver and other state plan
services, and assist individuals in appeals under section 256.045,
as well as needed medical, social, educational, and other services regardless
of the funding source for the services to which access is gained. Case managers shall collaborate with
consumers, families, legal representatives, and relevant medical experts and
service providers in the development and periodic review of the coordinated
service and support plan.
(c) A case aide shall provide assistance to the case manager
in carrying out administrative activities of the case management function. The case aide may not assume responsibilities
that require professional judgment including assessments, reassessments, and
care plan development. The case manager
is responsible for providing oversight of the case aide.
(d) Case managers shall be responsible for ongoing
monitoring of the provision of services included in the individual's plan of
care. Case managers shall initiate and
oversee the process of assessment and reassessment of the
individual's care coordinated service and support plan and review
the plan of care at intervals specified in the federally approved
waiver plan.
(e) The county of service or tribe must provide access to
and arrange for case management services.
County of service has the meaning given it in Minnesota Rules, part
9505.0015, subpart 11.
(f) Except as described in paragraph (h), case management
services must be provided by a public or private agency that is enrolled as a
medical assistance provider determined by the commissioner to meet all of the
requirements in subdivision 1b. Case
management services must not be provided to a recipient by a private agency
that has a financial interest in the provision of any other services included
in the recipient's coordinated service and support plan. For purposes of this section, "private
agency" means any agency that is not identified as a lead agency under
section 256B.0911, subdivision 1a, paragraph (e).
(g) Case management service activities provided to or
arranged for a person include:
(1) development of the coordinated service and support plan
under subdivision 6;
(2) informing the individual or the individual's legal
guardian or conservator of service options, and options for case management
services and providers;
(3) consulting with relevant medical experts or service
providers;
(4) assisting the person in the identification of potential
providers;
(5) assisting the person to access services;
(6) coordination of services; and
(7) evaluation and monitoring of the services identified in
the plan, which must incorporate at least one annual face-to-face visit by the
case manager with each person.
(h) Notwithstanding any requirements in this section, for
individuals enrolled in prepaid medical assistance programs under section
256B.69, subdivisions 6b and 23, the health plan shall provide or arrange to
provide elderly waiver case management services in paragraph (g), in accordance
with contract requirements established by the commissioner.
Sec. 19. Minnesota
Statutes 2010, section 256B.0915, subdivision 1b, is amended to read:
Subd. 1b. Provider qualifications and standards. (a) The commissioner must enroll
qualified providers of elderly case management services under the home
and community-based waiver for the elderly under section 1915(c) of the Social
Security Act. The enrollment process
shall ensure the provider's ability to meet the qualification requirements and
standards in this subdivision and other federal and state requirements of this
service. An elderly A case
management provider is an enrolled medical assistance provider who is
determined by the commissioner to have all of the following characteristics:
(1) the demonstrated capacity and experience to provide the
components of case management to coordinate and link community resources needed
by the eligible population;
(2) administrative capacity and experience in serving the
target population for whom it will provide services and in ensuring quality of
services under state and federal requirements;
(3) a financial management system that provides accurate
documentation of services and costs under state and federal requirements;
(4) the capacity to document and maintain individual case records
under state and federal requirements; and
(5) the lead agency may allow a case manager employed by the
lead agency to delegate certain aspects of the case management activity to
another individual employed by the lead agency provided there is oversight of
the individual by the case manager. The
case manager may not delegate those aspects which require professional judgment
including assessments, reassessments, and care coordinated service
and support plan development. Lead
agencies include counties, health plans, and federally recognized tribes who
authorize services under this section.
(b) A health plan shall provide or arrange to provide
elderly waiver case management services in subdivision 1a, paragraph (g), as
part of an integrated delivery system in accordance with contract requirements
established by the commissioner related to provider standards and
qualifications.
Sec. 20. Minnesota
Statutes 2010, section 256B.0915, subdivision 3c, is amended to read:
Subd. 3c. Service approval and contracting provisions. (a) Medical assistance funding for
skilled nursing services, private duty nursing, home health aide, and personal
care services for waiver recipients must be approved by the case manager and
included in the individual care coordinated service and support
plan.
(b) A lead agency is not required to contract with a
provider of supplies and equipment if the monthly cost of the supplies and
equipment is less than $250.
Sec. 21. Minnesota
Statutes 2010, section 256B.0915, subdivision 6, is amended to read:
Subd. 6. Implementation of care coordinated
service and support plan. (a)
Each elderly waiver client shall be provided a copy of a written care coordinated
service and support plan that meets the requirements outlined in section
256B.0913, subdivision 8. The care plan
must be implemented by the county of service when it is different than the
county of financial responsibility. The
county of service administering waivered services must notify the county of
financial responsibility of the approved care plan. which:
(1) is developed and signed by the recipient within ten
working days after the case manager receives the assessment information and
written community support plan as described in section 256B.0911, subdivision
3a, from the certified assessor;
(2) includes the person's need for service and
identification of service needs that will be or that are met by the person's
relatives, friends, and others, as well as community services used by the
general public;
(3) reasonably ensures the health and safety of the
recipient;
(4) identifies the person's preferences for services as
stated by the person or the person's legal guardian or conservator;
(5) reflects the person's informed choice between
institutional and community-based services, as well as choice of services,
supports, and providers, including available case manager providers;
(6) identifies long and short-range goals for the person;
(7) identifies specific services and the amount, frequency,
duration, and cost of the services to be provided to the person based on
assessed needs, preferences, and available resources;
(8) includes information about the right to appeal decisions
under section 256.045; and
(9) includes the authorized annual and monthly amounts for
the services.
(b) In developing the coordinated service and support plan,
the case manager should also include the use of volunteers, religious
organizations, social clubs, and civic and service organizations to support the
individual in the community. The lead
agency must be held harmless for damages or injuries sustained through the use
of volunteers and agencies under this paragraph, including workers'
compensation liability.
Sec. 22. Minnesota
Statutes 2011 Supplement, section 256B.0915, subdivision 10, is amended 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 6b and 23, to reflect the maximum service
rate limits for customized living services and 24-hour customized living
services under subdivisions 3e and 3h. Medical
assistance rates paid to customized living providers by managed care
organizations under this section shall not exceed the maximum service rate
limits and component rates as determined by the commissioner under subdivisions
3e and 3h.
Sec. 23. Minnesota
Statutes 2010, section 256B.092, subdivision 1, is amended to read:
Subdivision 1. County of financial responsibility; duties. Before any services shall be rendered to
persons with developmental disabilities who are in need of social service and
medical assistance, the county of financial responsibility shall conduct or
arrange for a diagnostic evaluation in order to determine whether the person
has or may have a developmental disability or has or may have a related
condition. If the county of financial
responsibility determines that the person has a developmental disability, the
county shall inform the person of case management services available under this
section. Except as provided in
subdivision 1g or 4b, if a person is diagnosed as having a developmental
disability, the county of financial responsibility shall conduct or arrange for
a needs assessment by a certified assessor, and develop or
arrange for an individual service a community support plan according
to section 256B.0911, provide or arrange for ongoing case management
services at the level identified in the individual service plan, provide or
arrange for case management administration, and authorize services
identified in the person's individual service coordinated service and
support plan developed according to subdivision 1b. Diagnostic information, obtained by other
providers or agencies, may be used by the county agency in determining
eligibility for case management. Nothing
in this section shall be construed as requiring: (1) assessment in areas agreed to as
unnecessary by the case manager a certified assessor and the
person, or the person's legal guardian or conservator, or the parent if the
person is a minor, or (2) assessments in areas where there has been a
functional assessment completed in the previous 12 months for which the case
manager certified assessor and the person or person's guardian or
conservator, or the parent if the person is a minor, agree that further
assessment is not necessary. For persons
under state guardianship, the case manager certified assessor
shall seek authorization from the public guardianship office for waiving any
assessment requirements. Assessments
related to health, safety, and protection of the person for the purpose of
identifying service type, amount, and frequency or assessments required to
authorize services may not be waived. To
the extent possible, for wards of the commissioner the county shall consider
the opinions of the parent of the person with a developmental disability when
developing the person's individual service community support plan
and coordinated service and support plan.
Sec. 24. Minnesota
Statutes 2010, section 256B.092, subdivision 1a, is amended to read:
Subd. 1a. Case management administration and
services. (a) The administrative
functions of case management provided to or arranged for a person include: Each
recipient of a home and community-based waiver shall be provided case
management services by qualified vendors as described in the federally approved
waiver application.
(1) review of eligibility for services;
(2) screening;
(3) intake;
(4) diagnosis;
(5) the review and authorization of services based upon an
individualized service plan; and
(6) responding to requests for conciliation conferences and
appeals according to section 256.045 made by the person, the person's legal
guardian or conservator, or the parent if the person is a minor.
(b) Case management service activities provided to or
arranged for a person include:
(1) development of the individual service coordinated
service and support plan under subdivision 1b;
(2) informing the individual or the individual's legal
guardian or conservator, or parent if the person is a minor, of service
options;
(3) consulting with relevant medical experts or service
providers;
(4) assisting the person in the identification of potential
providers;
(5) assisting the person to access services and assisting
in appeals under section 256.045;
(6) coordination of services, if coordination is not
provided by another service provider;
(7) evaluation and monitoring of the services identified in
the coordinated service and support plan, which must incorporate at
least one annual face-to-face visit by the case manager with each person;
and
(8) annual reviews of service plans and services provided
reviewing coordinated service and support plans and providing the lead
agency with recommendations for service authorization based upon the
individual's needs identified in the coordinated service and support plan.
(c) Case management administration and service
activities that are provided to the person with a developmental disability
shall be provided directly by county agencies or under contract. Case management services must be provided
by a public or private agency that is enrolled as a medical assistance provider
determined by the commissioner to meet all of the requirements in the approved
federal waiver plans. Case management
services must not be provided to a recipient by a private agency that has a
financial interest in the provision of any other services included in the
recipient's coordinated service and support plan. For purposes of this section, "private
agency" means any agency that is not identified as a lead agency under
section 256B.0911, subdivision 1a, paragraph (e).
(d) Case managers are responsible for the administrative
duties and service provisions listed in paragraphs (a) and (b). Case managers shall collaborate with
consumers, families, legal representatives, and relevant medical experts and
service providers in the development and annual review of the individualized
service coordinated service and support plan and habilitation plans
plan.
(e) The Department of Human Services shall offer ongoing
education in case management to case managers.
Case managers shall receive no less than ten hours of case management
education and disability-related training each year.
Sec. 25. Minnesota
Statutes 2010, section 256B.092, subdivision 1b, is amended to read:
Subd. 1b. Individual Coordinated
service and support plan. The
individual service plan must (a) Each recipient of home and community-based
waivered services shall be provided a copy of the written coordinated service
and support plan which:
(1) is developed and signed by the recipient within ten
working days after the case manager receives the assessment information and
written community support plan as described in section 256B.0911, subdivision
3a, from the certified assessor;
(1) include the results of the assessment information on (2) includes the
person's need for service, including identification of service needs that will
be or that are met by the person's relatives, friends, and others, as well as
community services used by the general public;
(3) reasonably ensures the health and safety of the
recipient;
(2) identify (4) identifies the person's preferences for services
as stated by the person, the person's legal guardian or conservator, or the
parent if the person is a minor, including the person's choices made on
self-directed options and on services and supports to achieve employment goals;
(5) provides for an informed choice, as defined in section
256B.77, subdivision 2, paragraph (o), of service and support providers, and
identifies all available options for case management services and providers;
(3) identify (6) identifies long- and short-range goals for the
person;
(4) identify (7) identifies specific services and the amount and
frequency of the services to be provided to the person based on assessed needs,
preferences, and available resources. The
individual service coordinated service and support plan shall
also specify other services the person needs that are not available;
(5) identify (8) identifies the need for an individual program
plan to be developed by the provider according to the respective state and
federal licensing and certification standards, and additional assessments to be
completed or arranged by the provider after service initiation;
(6) identify (9) identifies provider responsibilities to
implement and make recommendations for modification to the individual
service coordinated service and support plan;
(7) include (10) includes notice of the right to request a
conciliation conference or a hearing under section 256.045;
(8) be
(11) is agreed upon and signed by the person, the person's legal
guardian or conservator, or the parent if the person is a minor, and the
authorized county representative; and
(9) be
(12) is reviewed by a health professional if the person has overriding
medical needs that impact the delivery of services.; and
(13) includes the authorized annual and monthly amounts for
the services.
Service planning formats developed for interagency planning
such as transition, vocational, and individual family service plans may be
substituted for service planning formats developed by county agencies.
(b) In developing the coordinated service and support plan,
the case manager is encouraged to include the use of volunteers, religious
organizations, social clubs, and civic and service organizations to support the
individual in the community. The lead
agency must be held harmless for damages or injuries sustained through the use
of volunteers and agencies under this paragraph, including workers'
compensation liability.
Sec. 26. Minnesota
Statutes 2010, section 256B.092, subdivision 1e, is amended to read:
Subd. 1e. Coordination, evaluation, and monitoring of
services. (a) If the individual
service coordinated service and support plan identifies the need for
individual program plans for authorized services, the case manager shall assure
that individual program plans are developed by the providers according to
clauses (2) to (5). The providers shall
assure that the individual program plans:
(1) are developed according to the respective state and
federal licensing and certification requirements;
(2) are designed to achieve the goals of the individual
service coordinated service and support plan;
(3) are consistent with other aspects of the individual
service coordinated service and support plan;
(4) assure the health and safety of the person; and
(5) are developed with consistent and coordinated approaches
to services among the various service providers.
(b) The case manager shall monitor the provision of
services:
(1) to assure that the individual service coordinated
service and support plan is being followed according to paragraph (a);
(2) to identify any changes or modifications that might be
needed in the individual service coordinated service and support
plan, including changes resulting from recommendations of current service
providers;
(3) to determine if the person's legal rights are protected,
and if not, notify the person's legal guardian or conservator, or the parent if
the person is a minor, protection services, or licensing agencies as
appropriate; and
(4) to determine if the person, the person's legal guardian
or conservator, or the parent if the person is a minor, is satisfied with the
services provided.
(c) If the provider fails to develop or carry out the individual
program plan according to paragraph (a), the case manager shall notify the
person's legal guardian or conservator, or the parent if the person is a minor,
the provider, the respective licensing and certification agencies, and the
county board where the services are being provided. In addition, the case manager shall identify
other steps needed to assure the person receives the services identified in the
individual service coordinated service and support plan.
Sec. 27. Minnesota
Statutes 2010, section 256B.092, subdivision 1g, is amended to read:
Subd. 1g. Conditions not requiring development of individual
service coordinated service and support plan. Unless otherwise required by federal law,
the county agency is not required to complete an individual service a
coordinated service and support plan as defined in subdivision 1b for:
(1) persons whose families are requesting respite care for
their family member who resides with them, or whose families are requesting a
family support grant and are not requesting purchase or arrangement of
habilitative services; and
(2) persons with developmental disabilities, living
independently without authorized services or receiving funding for services at
a rehabilitation facility as defined in section 268A.01, subdivision 6, and not
in need of or requesting additional services.
Sec. 28. Minnesota
Statutes 2010, section 256B.092, subdivision 2, is amended to read:
Subd. 2. Medical assistance. To assure quality case management to
those persons who are eligible for medical assistance, the commissioner shall,
upon request:
(1) provide consultation on the case management process;
(2) assist county agencies in the screening and
annual reviews of clients review process to assure that appropriate levels of service
are provided to persons;
(3) provide consultation on service planning and development
of services with appropriate options;
(4) provide training and technical assistance to county case
managers; and
(5) authorize payment for medical assistance services
according to this chapter and rules implementing it.
Sec. 29. Minnesota
Statutes 2010, section 256B.092, subdivision 3, is amended to read:
Subd. 3. Authorization and termination of services. County agency case managers, under rules
of the commissioner, shall authorize and terminate services of community and
regional treatment center providers according to individual service support
plans. Services provided to persons with
developmental disabilities may only be authorized and terminated by case
managers or certified assessors according to (1) rules of the
commissioner and (2) the individual service coordinated service and
support plan as defined in subdivision 1b.
Medical assistance services not needed shall not be authorized by county
agencies or funded by the commissioner. When
purchasing or arranging for unlicensed respite care services for persons with
overriding health needs, the county agency shall seek the advice of a health
care professional in assessing provider staff training needs and skills
necessary to meet the medical needs of the person.
Sec. 30. Minnesota
Statutes 2010, section 256B.092, subdivision 5, is amended to read:
Subd. 5. Federal waivers. (a) The commissioner shall apply for any
federal waivers necessary to secure, to the extent allowed by law, federal
financial participation under United States Code, title 42, sections 1396 et
seq., as amended, for the provision of services to persons who, in the absence
of the services, would need the level of care provided in a regional treatment
center or a community intermediate care facility for persons with developmental
disabilities. The commissioner may seek
amendments to the waivers or apply for additional waivers under United States
Code, title 42, sections 1396 et seq., as amended, to contain costs. The commissioner shall ensure that payment
for the cost of providing home and community-based alternative services under
the federal waiver plan shall not exceed the cost of intermediate care services
including day training and habilitation services that would have been provided
without the waivered services.
The commissioner shall seek an amendment to the 1915c home
and community-based waiver to allow properly licensed adult foster care homes
to provide residential services to up to five individuals with developmental
disabilities. If the amendment to the
waiver is approved, adult foster care providers that can accommodate five
individuals shall increase their capacity to five beds, provided the providers
continue to meet all applicable licensing requirements.
(b) The commissioner, in administering home and
community-based waivers for persons with developmental disabilities, shall
ensure that day services for eligible persons are not provided by the person's
residential service provider, unless the person or the person's legal
representative is offered a choice of providers and agrees in writing to
provision of day services by the residential service provider. The individual service coordinated
service and support plan for individuals who choose to have their
residential service provider provide their day services must describe how
health, safety, protection, and habilitation needs will be met, including how
frequent and regular contact with persons other than the residential service
provider will occur. The individualized
service coordinated service and support plan must address the
provision of services during the day outside the residence on weekdays.
(c) When a county lead agency is evaluating
denials, reductions, or terminations of home and community-based services under
section 256B.0916 for an individual, the case manager lead agency
shall offer to meet with the individual or the individual's guardian in order
to discuss the prioritization of service needs within the individualized
service coordinated service and support plan. The reduction in the authorized services for
an individual due to changes in funding for waivered services may not exceed
the amount needed to ensure medically necessary services to meet the
individual's health, safety, and welfare.
Sec. 31. Minnesota
Statutes 2010, section 256B.092, subdivision 7, is amended to read:
Subd. 7. Screening teams Assessments. (a) Assessments and reassessments
shall be conducted by certified assessors according to section 256B.0911, and
must incorporate appropriate referrals to determine eligibility for case
management under subdivision 1a.
(b) For persons with developmental
disabilities, screening teams shall be established which a certified
assessor shall evaluate the need for the an institutional
level of care. provided by
residential-based habilitation services, residential services, training and
habilitation services, and nursing facility services. The evaluation assessment shall
address whether home and community-based services are appropriate for persons
who are at risk of placement in an intermediate care facility for persons with
developmental disabilities, or for whom there is reasonable indication that
they might require this level of care. The
screening team certified assessor shall make an evaluation of
need within 60 working days of a request for service by a person with a
developmental disability, and within five working days of an emergency
admission of a person to an intermediate care facility for persons with
developmental disabilities. The
screening team shall consist of the case manager for persons with developmental
disabilities, the person, the person's legal guardian or conservator, or the
parent if the person is a minor, and a qualified developmental disability
professional, as defined in the Code of Federal Regulations, title 42, section
483.430, as amended through June 3, 1988.
The case manager may also act as the qualified developmental disability
professional if the case manager meets the federal definition. County social service agencies may contract
with a public or private agency or individual who is not a service provider for
the person for the public guardianship representation required by the screening
or individual service planning process. The
contract shall be limited to public guardianship representation for the
screening and individual service planning activities. The contract shall require compliance with
the commissioner's instructions and may be for paid or voluntary services. For persons determined to have overriding
health care needs and are seeking admission to a nursing facility or an ICF/MR,
or seeking access to home and community-based waivered services, a registered
nurse must be designated as either the case manager or the qualified
developmental disability professional. For
persons under the jurisdiction of a correctional agency, the case manager must
consult with the corrections administrator regarding additional health, safety,
and supervision needs. The case manager,
with the concurrence of the person, the person's legal guardian or conservator,
or the parent if the person is a minor, may invite other individuals to attend
meetings of the screening team. No
member of the screening team shall have any direct or indirect service provider
interest in the case. Nothing in this
section shall be construed as requiring the screening team meeting to be
separate from the service planning meeting.
Sec. 32. Minnesota Statutes 2010, section 256B.092,
subdivision 8, is amended to read:
Subd. 8. Screening
team Additional certified assessor duties. In addition to the responsibilities of
certified assessors described in section 256B.0911, for persons with
developmental disabilities, the screening team certified assessor
shall:
(1)
review diagnostic data;
(2)
review health, social, and developmental assessment data using a uniform
screening tool specified by the commissioner;
(3)
identify the level of services appropriate to maintain the person in the most
normal and least restrictive setting that is consistent with the person's
treatment needs;
(4) (1) identify other
noninstitutional public assistance or social service that may prevent or delay
long-term residential placement;
(5) (2) assess whether a
person is in need of long-term residential care;
(6) (3) make recommendations
regarding placement and payment for:
(i)
social service or public assistance support, or both, to maintain a person in
the person's own home or other place of residence;
(ii)
training and habilitation service, vocational rehabilitation, and employment
training activities;
(iii) community residential service placement;
(iv) regional treatment center placement; or
(v) a home and community-based service alternative to
community residential placement service or regional treatment
center placement including self-directed service options;
(7)
(4) evaluate the availability, location, and quality of the services
listed in clause (6) (3), including the impact of placement
alternatives on the person's ability to maintain or improve existing patterns
of contact and involvement with parents and other family members;
(8)
(5) identify the cost implications of recommendations in clause (6)
(3); and
(9)
(6) make recommendations to a court as may be needed to assist the court
in making decisions regarding commitment of persons with developmental
disabilities; and.
(10) inform the person and the person's legal guardian or
conservator, or the parent if the person is a minor, that appeal may be made to
the commissioner pursuant to section 256.045.
Sec. 33. Minnesota
Statutes 2010, section 256B.092, subdivision 8a, is amended to read:
Subd. 8a. County concurrence notification. (a) If the county of financial
responsibility wishes to place a person in another county for services, the
county of financial responsibility shall seek concurrence from notify
the proposed county of service and the placement shall be made cooperatively
between the two counties. Arrangements
shall be made between the two counties for ongoing social service, including
annual reviews of the person's individual service coordinated service
and support plan. The county where
services are provided may not make changes in the person's service coordinated
service and support plan without approval by the county of financial
responsibility.
(b) When a person has been screened and authorized for
services in an intermediate care facility for persons with developmental
disabilities or for home and community-based services for persons with
developmental disabilities, the case manager shall assist that person in
identifying a service provider who is able to meet the needs of the person
according to the person's individual service plan. If the identified service is to be provided
in a county other than the county of financial responsibility, the county of
financial responsibility shall request concurrence of the county where the
person is requesting to receive the identified services. The county of service may refuse to concur
shall notify the county of financial responsibility if:
(1) it can demonstrate that the provider is unable to
provide the services identified in the person's individual service plan as
services that are needed and are to be provided; or
(2), in the case of an intermediate
care facility for persons with developmental disabilities, there has been no
authorization for admission by the admission review team as required in section
256B.0926.
(c) The county of service shall notify the county of
financial responsibility of concurrence or refusal to concur any
concerns about the chosen provider's capacity to meet the needs of the person
seeking to move to residential services in another county no later than 20
working days following receipt of the written request notification. Unless other mutually acceptable arrangements
are made by the involved county agencies, the county of financial
responsibility is responsible for costs of social services and the costs
associated with the development and maintenance of the placement. The county of service may request that the
county of financial responsibility purchase case management services from the
county of service or from a contracted provider of case management when the
county of financial responsibility is not providing case management as defined
in this section and rules adopted under this section, unless other mutually
acceptable arrangements are made by the involved county agencies. Standards for payment limits under this
section may be established by the commissioner.
Financial disputes between counties shall be resolved as provided in
section 256G.09. This subdivision
also applies to home and community-based waiver services provided under section
256B.49.
Sec. 34. Minnesota
Statutes 2010, section 256B.092, subdivision 9, is amended to read:
Subd. 9. Reimbursement. Payment for services shall not be provided
to a service provider for any person placed in an intermediate care facility
for persons with developmental disabilities prior to the person being
screened by the screening team receiving an assessment by a certified
assessor. The commissioner shall not
deny reimbursement for: (1) a person
admitted to an intermediate care facility for persons with developmental
disabilities who is assessed to need long-term supportive services, if
long-term supportive services other than intermediate care are not available in
that community; (2) any person admitted to an intermediate care facility for
persons with developmental disabilities under emergency circumstances; (3) any
eligible person placed in the intermediate care facility for persons with
developmental disabilities pending an appeal of the screening team's certified
assessor's decision; or (4) any medical assistance recipient when, after
full discussion of all appropriate alternatives including those that are
expected to be less costly than intermediate care for persons with
developmental disabilities, the person or the person's legal guardian or
conservator, or the parent if the person is a minor, insists on intermediate
care placement. The screening team
certified assessor shall provide documentation that the most
cost-effective alternatives available were offered to this individual or the
individual's legal guardian or conservator.
Sec. 35. Minnesota
Statutes 2010, section 256B.092, subdivision 11, is amended to read:
Subd. 11. Residential support services. (a) Upon federal approval, there is
established a new service called residential support that is available on the
community alternative care, community alternatives for disabled individuals,
developmental disabilities, and traumatic brain injury waivers. Existing waiver service descriptions must be
modified to the extent necessary to ensure there is no duplication between
other services. Residential support
services must be provided by vendors licensed as a community residential
setting as defined in section 245A.11, subdivision 8.
(b) Residential support services must meet the following
criteria:
(1) providers of residential support services must own or
control the residential site;
(2) the residential site must not be the primary residence
of the license holder;
(3) the residential site must have a designated program
supervisor responsible for program oversight, development, and implementation
of policies and procedures;
(4) the provider of residential support services must
provide supervision, training, and assistance as described in the person's community
coordinated service and support plan; and
(5) the provider of residential support services must meet
the requirements of licensure and additional requirements of the person's community
coordinated service and support plan.
(c) Providers of residential support services that meet the
definition in paragraph (a) must be registered using a process determined by
the commissioner beginning July 1, 2009.
Sec. 36. Minnesota
Statutes 2010, section 256B.15, subdivision 1c, is amended to read:
Subd. 1c. Notice of potential claim. (a) A state agency with a claim or
potential claim under this section may file a notice of potential claim under
this subdivision anytime before or within one year after a medical assistance
recipient dies. The claimant shall be
the state agency. A notice filed prior
to the recipient's death shall not take effect and shall not be effective as
notice until the recipient dies. A
notice filed after a recipient dies shall be effective from the time of filing.
(b) The notice of claim shall be filed or recorded in the
real estate records in the office of the county recorder or registrar of titles
for each county in which any part of the property is located. The recorder shall accept the notice for
recording or filing. The registrar of
titles shall accept the notice for filing if the recipient has a recorded
interest in the property. The registrar
of titles shall not carry forward to a new certificate of title any notice
filed more than one year from the date of the recipient's death.
(c) The notice must be dated, state the name of the
claimant, the medical assistance recipient's name and last four digits of
the Social Security number if filed before their death and their date of
death if filed after they die, the name and date of death of any predeceased
spouse of the medical assistance recipient for whom a claim may exist, a
statement that the claimant may have a claim arising under this section,
generally identify the recipient's interest in the property, contain a legal
description for the property and whether it is abstract or registered property,
a statement of when the notice becomes effective and the effect of the notice,
be signed by an authorized representative of the state agency, and may include
such other contents as the state agency may deem appropriate.
Sec. 37. Minnesota
Statutes 2010, section 256B.15, subdivision 1f, is amended to read:
Subd. 1f. Agency lien. (a) The notice shall constitute a lien in
favor of the Department of Human Services against the recipient's interests in
the real estate it describes for a period of 20 years from the date of filing
or the date of the recipient's death, whichever is later. Notwithstanding any law or rule to the
contrary, a recipient's life estate and joint tenancy interests shall not end
upon the recipient's death but shall continue according to subdivisions 1h, 1i,
and 1j. The amount of the lien shall be
equal to the total amount of the claims that could be presented in the
recipient's estate under this section.
(b) If no estate has been opened for the deceased recipient,
any holder of an interest in the property may apply to the lienholder for a
statement of the amount of the lien or for a full or partial release of the
lien. The application shall include the
applicant's name, current mailing address, current home and work telephone
numbers, and a description of their interest in the property, a legal
description of the recipient's interest in the property, and the deceased
recipient's name, date of birth, and last four digits of the Social
Security number. The lienholder shall
send the applicant by certified mail, return receipt requested, a written
statement showing the amount of the lien, whether the lienholder is willing to
release the lien and under what conditions, and inform them of the right to a
hearing under section 256.045. The
lienholder shall have the discretion to compromise and settle the lien upon any
terms and conditions the lienholder deems appropriate.
(c) Any holder of an interest in property subject to the
lien has a right to request a hearing under section 256.045 to determine the
validity, extent, or amount of the lien.
The request must be in writing, and must include the names, current
addresses, and home and business telephone numbers for all other parties
holding an interest in the property. A
request for a hearing by any holder of an interest in the property shall be
deemed to be a request for a hearing by all parties owning interests in the
property. Notice of the hearing shall be
given to the lienholder, the party filing the appeal, and all of the other
holders of interests in the property at the addresses listed in the appeal by
certified mail, return receipt requested, or by ordinary mail. Any owner of an interest in the property to
whom notice of the hearing is mailed shall be deemed to have waived any and all
claims or defenses in respect to the lien unless they appear and assert any
claims or defenses at the hearing.
(d) If the claim the lien secures could be filed under
subdivision 1h, the lienholder may collect, compromise, settle, or release the
lien upon any terms and conditions it deems appropriate. If the claim the lien secures could be filed
under subdivision 1i or 1j, the lien may be adjusted or enforced to the same
extent had it been filed under subdivisions 1i and 1j, and the provisions of
subdivisions 1i, clause (f), and 1j, clause (d), shall apply to voluntary
payment, settlement, or satisfaction of the lien.
(e) If no probate proceedings have been commenced for the
recipient as of the date the lien holder executes a release of the lien on a
recipient's life estate or joint tenancy interest, created for purposes of this
section, the release shall terminate the life estate or joint tenancy interest
created under this section as of the date it is recorded or filed to the extent
of the release. If the claimant executes
a release for purposes of extinguishing a life estate or a joint tenancy
interest created under this section to remove a cloud on title to real
property, the release shall have the effect of extinguishing any life estate or
joint tenancy interests in the property it describes which may have been
continued by reason of this section retroactive to the date of death of the
deceased life tenant or joint tenant except as provided for in section 514.981,
subdivision 6.
(f) If the deceased recipient's estate is probated, a claim
shall be filed under this section. The
amount of the lien shall be limited to the amount of the claim as finally
allowed. If the claim the lien secures
is filed under subdivision 1h, the lien may be released in full after any
allowance of the claim becomes final or according to any agreement to settle
and satisfy the claim. The release shall
release the lien but shall not extinguish or terminate the interest being
released. If the claim the lien secures
is filed under subdivision 1i or 1j, the lien shall be released after the lien
under subdivision 1i or 1j is filed or recorded, or settled according to any
agreement to settle and satisfy the claim.
The release shall not extinguish or terminate the interest being
released. If the claim is finally
disallowed in full, the claimant shall release the claimant's lien at the
claimant's expense.
Sec. 38. Minnesota
Statutes 2010, section 256B.49, subdivision 13, is amended to read:
Subd. 13. Case management. (a) Each recipient of a home and
community-based waiver shall be provided case management services by qualified
vendors as described in the federally approved waiver application. The case management service activities
provided will must include:
(1) assessing the needs of the individual within 20 working
days of a recipient's request;
(2) developing (1) finalizing the written individual service
coordinated service and support plan within ten working days after the assessment
is completed case manager receives the plan from the certified assessor;
(3)
(2) informing the recipient or the recipient's legal guardian or
conservator of service options;
(4)
(3) assisting the recipient in the identification of potential service
providers and available options for case management service and providers;
(5)
(4) assisting the recipient to access services and assisting with
appeals under section 256.045; and
(6)
(5) coordinating, evaluating, and monitoring of the services identified
in the service plan;.
(7) completing the annual reviews of the service plan; and
(8) informing the recipient or legal representative of the
right to have assessments completed and service plans developed within
specified time periods, and to appeal county action or inaction under section
256.045, subdivision 3, including the determination of nursing facility level
of care.
(b) The case manager may delegate certain aspects of the
case management service activities to another individual provided there is
oversight by the case manager. The case
manager may not delegate those aspects which require professional judgment
including assessments, reassessments, and care plan development.:
(1) finalizing the coordinated service and support plan;
(2) ongoing assessment and monitoring of the person's needs
and adequacy of the approved coordinated service and support plan; and
(3) adjustments to the coordinated service and support plan.
(c) Case management services must be provided by a public or
private agency that is enrolled as a medical assistance provider determined by
the commissioner to meet all of the requirements in the approved federal waiver
plans. Case management services must not
be provided to a recipient by a private agency that has any financial interest
in the provision of any other services included in the recipient's coordinated
service and support plan. For purposes
of this section, "private agency" means any agency that is not
identified as a lead agency under section 256B.0911, subdivision 1a, paragraph
(e).
Sec. 39. Minnesota
Statutes 2011 Supplement, section 256B.49, subdivision 14, is amended to read:
Subd. 14. Assessment and reassessment. (a) Assessments of each recipient's
strengths, informal support systems, and need for services shall be completed
within 20 working days of the recipient's request as provided in section
256B.0911. Reassessment of each
recipient's strengths, support systems, and need for services shall be
conducted at least every 12 months and at other times when there has been a
significant change in the recipient's functioning and reassessments shall be conducted by
certified assessors according to section 256B.0911, subdivision 2b.
(b) There must be a determination that the client requires a
hospital level of care or a nursing facility level of care as defined in
section 256B.0911, subdivision 4a, paragraph (d), at initial and subsequent
assessments to initiate and maintain participation in the waiver program.
(c) 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, 3b, and 4d, that result in a hospital level of care
determination or a nursing facility level of care determination must be
accepted for purposes of initial and ongoing access to waiver services payment.
(d) Persons with developmental disabilities who apply for
services under the nursing facility level waiver programs shall be screened for
the appropriate level of care according to section 256B.092.
(e)
(d) Recipients who are found eligible for home and community-based
services under this section before their 65th birthday may remain eligible for
these services after their 65th birthday if they continue to meet all other
eligibility factors.
(f)
(e) The commissioner shall develop criteria to identify recipients whose
level of functioning is reasonably expected to improve and reassess these
recipients to establish a baseline assessment.
Recipients who meet these criteria must have a comprehensive transitional
service plan developed under subdivision 15, paragraphs (b) and (c), and be
reassessed every six months until there has been no significant change in the
recipient's functioning for at least 12 months.
After there has been no significant change in the recipient's
functioning for at least 12 months, reassessments of the recipient's strengths,
informal support systems, and need for services shall be conducted at least
every 12 months and at other times when there has been a significant change in
the recipient's functioning. Counties,
case managers, and service providers are responsible for conducting these
reassessments and shall complete the reassessments out of existing funds.
Sec. 40. Minnesota
Statutes 2011 Supplement, section 256B.49, subdivision 15, is amended to read:
Subd. 15. Individualized service Coordinated
service and support plan; comprehensive transitional service plan;
maintenance service plan. (a) Each
recipient of home and community-based waivered services shall be provided a
copy of the written coordinated service and support plan which:
meets the requirements in section 256B.092, subdivision 1b.
(1) is developed and signed by the recipient within ten
working days of the completion of the assessment;
(2) meets the assessed needs of the recipient;
(3) reasonably ensures the health and safety of the
recipient;
(4) promotes independence;
(5) allows for services to be provided in the most
integrated settings; and
(6) provides for an informed choice, as defined in section
256B.77, subdivision 2, paragraph (p), of service and support providers.
(b) In developing the comprehensive transitional service
plan, the individual receiving services, the case manager, and the guardian, if
applicable, will identify the transitional service plan fundamental service
outcome and anticipated timeline to achieve this outcome. Within the first 20 days following a
recipient's request for an assessment or reassessment, the transitional service
planning team must be identified. A team
leader must be identified who will be responsible for assigning responsibility
and communicating with team members to ensure implementation of the transition
plan and ongoing assessment and communication process. The team leader should be an individual, such
as the case manager or guardian, who has the opportunity to follow the
recipient to the next level of service.
Within ten days following an assessment, a comprehensive
transitional service plan must be developed incorporating elements of a
comprehensive functional assessment and including short-term measurable
outcomes and timelines for achievement of and reporting on these outcomes. Functional milestones must also be identified
and reported according to the timelines agreed upon by the transitional service
planning team. In addition, the
comprehensive transitional service plan must identify additional supports that
may assist in the achievement of the fundamental service outcome such as the
development of greater natural community support, increased collaboration among
agencies, and technological supports.
The timelines for reporting on functional milestones will
prompt a reassessment of services provided, the units of services, rates, and
appropriate service providers. It is the
responsibility of the transitional service planning team leader to review
functional milestone reporting to determine if the milestones are consistent
with observable skills and that milestone achievement prompts any needed
changes to the comprehensive transitional service plan.
For those whose fundamental transitional service outcome
involves the need to procure housing, a plan for the recipient to seek the
resources necessary to secure the least restrictive housing possible should be
incorporated into the plan, including employment and public supports such as
housing access and shelter needy funding.
(c) Counties and other agencies responsible for funding
community placement and ongoing community supportive services are responsible
for the implementation of the comprehensive transitional service plans. Oversight responsibilities include both
ensuring effective transitional service delivery and efficient utilization of
funding resources.
(d) Following one year of transitional services, the
transitional services planning team will make a determination as to whether or
not the individual receiving services requires the current level of continuous
and consistent support in order to maintain the recipient's current level of
functioning. Recipients who are
determined to have not had a significant change in functioning for 12 months
must move from a transitional to a maintenance service plan. Recipients on a maintenance service plan must
be reassessed to determine if the recipient would benefit from a transitional
service plan at least every 12 months and at other times when there has been a
significant change in the recipient's functioning. This assessment should consider any changes
to technological or natural community supports.
(e) When a county is evaluating denials, reductions, or
terminations of home and community-based services under section 256B.49 for an
individual, the case manager shall offer to meet with the individual or the
individual's guardian in order to discuss the prioritization of service needs
within the individualized coordinated service and support
plan, comprehensive transitional service plan, or maintenance service plan. The reduction in the authorized services for
an individual due to changes in funding for waivered services may not exceed
the amount needed to ensure medically necessary services to meet the
individual's health, safety, and welfare.
(f) At the time of reassessment, local agency case managers
shall assess each recipient of community alternatives for disabled individuals
or traumatic brain injury waivered services currently residing in a licensed
adult foster home that is not the primary residence of the license holder, or
in which the license holder is not the primary caregiver, to determine if that
recipient could appropriately be served in a community-living setting. If appropriate for the recipient, the case
manager shall offer the recipient, through a person-centered planning process,
the option to receive alternative housing and service options. In the event that the recipient chooses to
transfer from the adult foster home, the vacated bed shall not be filled with
another recipient of waiver services and group residential housing, unless
provided under section 245A.03, subdivision 7, paragraph (a), clauses (3) and
(4), and the licensed capacity shall be reduced accordingly. If the adult foster home becomes no longer
viable due to these transfers, the county agency, with the assistance of the
department, shall facilitate a consolidation of settings or closure. This reassessment process shall be completed
by June 30, 2012.
Sec. 41. Minnesota
Statutes 2010, section 256G.02, subdivision 6, is amended to read:
Subd. 6. Excluded time. "Excluded time" means:
(a)
(1) 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)
(2) 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 assistance services pursuant to
section 256B.0659; semi-independent living services provided under section
252.275, and Minnesota Rules, parts 9525.0500 to 9525.0660; or day
training and habilitation programs and assisted living services; and
(c)
(3) any placement for a person with an indeterminate commitment,
including independent living.
Sec. 42. RECOMMENDATIONS FOR FURTHER CASE
MANAGEMENT REDESIGN AND STUDY OF COUNTY AND TRIBAL ADMINISTRATIVE FUNCTIONS.
(a) By February 1, 2013, the commissioner of human services
shall develop a legislative report with specific recommendations and language
for proposed legislation for the following:
(1) definitions of service and consolidation of standards
and rates to the extent appropriate for all types of medical assistance case
management service services, including targeted case management under Minnesota
Statutes, sections 256B.0621, 256B.0924, and 256B.094, and all types of home
and community-based waiver case management and case management under Minnesota
Rules, parts 9525.0004 to 9525.0036. This
work must be completed in collaboration with efforts under Minnesota Statutes,
section 256B.4912;
(2) recommendations on county of financial responsibility
requirements and quality assurance measures for case management; and
(3) identification of county administrative functions that
may remain entwined in case management service delivery models.
(b) The commissioner of human services shall evaluate county
and tribal administrative functions, processes, and reimbursement methodologies
for the purposes of administration of home and community-based services, and
compliance and oversight functions. The
commissioner shall work with county, tribal, and stakeholder representatives in
the evaluation process and develop a plan for the delegation of commissioner
duties to county and tribal entities after the elimination of county contracts
under Minnesota Statutes, section 256B.4912, for waiver service provision and
the creation of quality outcome standards under Laws 2009, chapter 79, article
8, section 81, and residential support services under Minnesota Statutes,
sections 256B.092, subdivision 11, and 245A.11, subdivision 8. The commissioner shall present findings and
recommendations to the chairs and ranking minority members of the legislative
committees with jurisdiction over health and human services finance and policy
by February 1, 2013, with any specific
recommendations and language for proposed legislation to be effective July 1,
2013.
ARTICLE 4
CHEMICAL
AND MENTAL HEALTH
Section 1. Minnesota
Statutes 2010, section 245.461, is amended by adding a subdivision to read:
Subd. 6. Diagnostic codes list. By
July 1, 2013, the commissioner of human services shall develop a list of
diagnostic codes to define the range of child and adult mental illnesses for
the statewide mental health system. The
commissioner may use the International Classification of Diseases (ICD); the
American Psychiatric Association's Diagnostic and Statistical Manual (DSM); or
a combination of both to develop the list.
The commissioner shall establish an advisory committee, comprising
mental health professional associations, counties, tribes, managed care
organizations, state agencies, and consumer organizations that shall advise the
commissioner regarding development of the diagnostic codes list. The commissioner shall annually notify
providers of changes to the list.
Sec. 2. Minnesota
Statutes 2010, section 245.462, subdivision 20, is amended to read:
Subd. 20. Mental illness. (a) "Mental illness" means an
organic disorder of the brain or a clinically significant disorder of thought,
mood, perception, orientation, memory, or behavior that is listed in the
clinical manual of the International Classification of Diseases (ICD-9-CM),
current edition, code range 290.0 to 302.99 or 306.0 to 316.0 or the
corresponding code in the American Psychiatric Association's Diagnostic and
Statistical Manual of Mental Disorders (DSM-MD), current edition, Axes I, II,
or III detailed in a diagnostic codes list published by the commissioner,
and that seriously limits a person's capacity to function in primary aspects of
daily living such as personal relations, living arrangements, work, and
recreation.
(b) An "adult with acute mental illness" means an
adult who has a mental illness that is serious enough to require prompt
intervention.
(c) For purposes of case management and community support
services, a "person with serious and persistent mental illness" means
an adult who has a mental illness and meets at least one of the following
criteria:
(1) the adult has undergone two or more episodes of
inpatient care for a mental illness within the preceding 24 months;
(2) the adult has experienced a continuous psychiatric
hospitalization or residential treatment exceeding six months' duration within
the preceding 12 months;
(3) the adult has been treated by a crisis team two or more
times within the preceding 24 months;
(4) the adult:
(i) has a diagnosis of schizophrenia, bipolar disorder,
major depression, or borderline personality disorder;
(ii) indicates a significant impairment in functioning; and
(iii) has a written opinion from a mental health
professional, in the last three years, stating that the adult is reasonably
likely to have future episodes requiring inpatient or residential treatment, of
a frequency described in clause (1) or (2), unless ongoing case management or
community support services are provided;
(5) the adult has, in the last three years, been committed
by a court as a person who is mentally ill under chapter 253B, or the adult's
commitment has been stayed or continued; or
(6) the adult (i) was eligible under clauses (1) to (5), but
the specified time period has expired or the adult was eligible as a child
under section 245.4871, subdivision 6; and (ii) has a written opinion from a
mental health professional, in the last three years, stating that the adult is
reasonably likely to have future episodes requiring inpatient or residential
treatment, of a frequency described in clause (1) or (2), unless ongoing case
management or community support services are provided.
Sec. 3. Minnesota
Statutes 2010, section 245.487, is amended by adding a subdivision to read:
Subd. 7. Diagnostic codes list. By
July 1, 2013, the commissioner of human services shall develop a list of
diagnostic codes to define the range of child and adult mental illnesses for
the statewide mental health system. The
commissioner may use the International Classification of Diseases (ICD); the
American Psychiatric Association's Diagnostic and Statistical Manual (DSM); or
a combination of both to develop the list.
The commissioner shall establish a time-limited advisory committee,
comprising mental health professional associations, counties, tribes, managed
care organizations, state agencies, and consumer organizations that shall
advise the commissioner regarding development of the diagnostic codes list. The commissioner shall annually notify
providers of changes to the list.
Sec. 4. Minnesota
Statutes 2010, section 245.4871, subdivision 15, is amended to read:
Subd. 15. Emotional disturbance. "Emotional disturbance" means
an organic disorder of the brain or a clinically significant disorder of
thought, mood, perception, orientation, memory, or behavior that:
(1) is listed in the clinical manual of the International
Classification of Diseases (ICD-9-CM), current edition, code range 290.0 to
302.99 or 306.0 to 316.0 or the corresponding code in the American Psychiatric
Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-MD),
current edition, Axes I, II, or III detailed in a diagnostic codes list
published by the commissioner; and
(2) seriously limits a child's capacity to function in
primary aspects of daily living such as personal relations, living
arrangements, work, school, and recreation.
"Emotional disturbance" is a generic term and is
intended to reflect all categories of disorder described in DSM-MD, current
edition the clinical code list published by the commissioner as
"usually first evident in childhood or adolescence."
Sec. 5. Minnesota
Statutes 2010, section 245.4932, subdivision 1, is amended to read:
Subdivision 1. Collaborative responsibilities. The children's mental health
collaborative shall have the following authority and responsibilities regarding
federal revenue enhancement:
(1) the collaborative must establish an integrated fund;
(2) the collaborative shall designate a lead county or other
qualified entity as the fiscal agency for reporting, claiming, and receiving
payments;
(3) the collaborative or lead county may enter into
subcontracts with other counties, school districts, special education
cooperatives, municipalities, and other public and nonprofit entities for
purposes of identifying and claiming eligible expenditures to enhance federal
reimbursement;
(4) the collaborative shall use any enhanced revenue
attributable to the activities of the collaborative, including administrative
and service revenue, solely to provide mental health services or to expand the
operational target population. The lead
county or other qualified entity may not use enhanced federal revenue for any
other purpose;
(5) the members of the collaborative must continue the base
level of expenditures, as defined in section 245.492, subdivision 2, for
services for children with emotional or behavioral disturbances and their
families from any state, county, federal, or other public or private funding
source which, in the absence of the new federal reimbursement earned under
sections 245.491 to 245.495, would have been available for those services. The base year for purposes of this
subdivision shall be the accounting period closest to state fiscal year 1993;
(6)
(5) the collaborative or lead county must develop and maintain an
accounting and financial management system adequate to support all claims for
federal reimbursement, including a clear audit trail and any provisions
specified in the contract with the commissioner of human services;
(7)
(6) the collaborative or its members may elect to pay the nonfederal
share of the medical assistance costs for services designated by the
collaborative; and
(8)
(7) the lead county or other qualified entity may not use federal funds
or local funds designated as matching for other federal funds to provide the
nonfederal share of medical assistance.
Sec. 6. Minnesota
Statutes 2010, section 246.53, is amended by adding a subdivision to read:
Subd. 4. Exception from statute of limitations. Any statute of limitations that limits
the commissioner in recovering the cost of care obligation incurred by a client
or former client shall not apply to any claim against an estate made under this
section to recover the cost of care.
Sec. 7. Minnesota
Statutes 2011 Supplement, section 254B.04, subdivision 2a, is amended to read:
Subd. 2a. Eligibility for treatment in residential
settings. Notwithstanding provisions
of Minnesota Rules, part 9530.6622, subparts 5 and 6, related to an assessor's
discretion in making placements to residential treatment settings, a person
eligible for services under this section must score at level 4 on assessment
dimensions related to relapse, continued use, and or recovery
environment in order to be assigned to services with a room and board component
reimbursed under this section.
Sec. 8. Minnesota
Statutes 2010, 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, clauses (5) and (1) to (6); or 245.4871, subdivision 27,
clauses (5) and (1) to (6), for the purpose of this section and
Minnesota Rules, parts 9505.0170 to 9505.0475.
Sec. 9. Minnesota
Statutes 2010, section 256F.13, subdivision 1, is amended to read:
Subdivision 1. Federal revenue enhancement. (a) The commissioner of human services
may enter into an agreement with one or more family services collaboratives to
enhance federal reimbursement under title IV-E of the Social Security Act and federal
administrative reimbursement under title XIX of the Social Security Act. The commissioner may contract with the
Department of Education for purposes of transferring the federal reimbursement
to the commissioner of education to be distributed to the collaboratives
according to clause (2). The
commissioner shall have the following authority and responsibilities regarding
family services collaboratives:
(1) the commissioner shall submit amendments to state plans
and seek waivers as necessary to implement the provisions of this section;
(2) the commissioner shall pay the federal reimbursement
earned under this subdivision to each collaborative based on their earnings. Payments to collaboratives for expenditures
under this subdivision will only be made of federal earnings from services
provided by the collaborative;
(3) the commissioner shall review expenditures of family
services collaboratives using reports specified in the agreement with the
collaborative to ensure that the base level of expenditures is continued and
new federal reimbursement is used to expand education, social, health, or
health-related services to young children and their families;
(4) the commissioner may reduce, suspend, or eliminate a
family services collaborative's obligations to continue the base level of
expenditures or expansion of services if the commissioner determines that one
or more of the following conditions apply:
(i) imposition of levy limits that significantly reduce
available funds for social, health, or health-related services to families and
children;
(ii) reduction in the net tax capacity of the taxable
property eligible to be taxed by the lead county or subcontractor that
significantly reduces available funds for education, social, health, or
health-related services to families and children;
(iii) reduction in the number of children under age 19 in
the county, collaborative service delivery area, subcontractor's district, or
catchment area when compared to the number in the base year using the most
recent data provided by the State Demographer's Office; or
(iv) termination of the federal revenue earned under the
family services collaborative agreement;
(5)
(4) the commissioner shall not use the federal reimbursement earned
under this subdivision in determining the allocation or distribution of other
funds to counties or collaboratives;
(6)
(5) the commissioner may suspend, reduce, or terminate the federal reimbursement
to a provider that does not meet the reporting or other requirements of this
subdivision;
(7)
(6) the commissioner shall recover from the family services
collaborative any federal fiscal disallowances or sanctions for audit
exceptions directly attributable to the family services collaborative's actions
in the integrated fund, or the proportional
share if federal fiscal disallowances or sanctions are based on a statewide
random sample; and
(8)
(7) the commissioner shall establish criteria for the family services
collaborative for the accounting and financial management system that will
support claims for federal reimbursement.
(b) The family services collaborative shall have the
following authority and responsibilities regarding federal revenue enhancement:
(1) the family services collaborative shall be the party
with which the commissioner contracts. A
lead county shall be designated as the fiscal agency for reporting, claiming,
and receiving payments;
(2) the family services collaboratives may enter into
subcontracts with other counties, school districts, special education
cooperatives, municipalities, and other public and nonprofit entities for
purposes of identifying and claiming eligible expenditures to enhance federal
reimbursement, or to expand education, social, health, or health-related
services to families and children;
(3) the family services collaborative must use all new
federal reimbursement resulting from federal revenue enhancement to expand
expenditures for education, social, health, or health-related services to
families and children beyond the base level, except as provided in paragraph
(a), clause (4);
(4) the family services collaborative must ensure that
expenditures submitted for federal reimbursement are not made from federal funds or funds used to match
other federal funds. Notwithstanding
section 256B.19, subdivision 1, for the purposes of family services
collaborative expenditures under agreement with the department, the nonfederal
share of costs shall be provided by the family services collaborative from
sources other than federal funds or funds used to match other federal funds;
(5) the family services collaborative must develop and
maintain an accounting and financial management system adequate to support all
claims for federal reimbursement, including a clear audit trail and any
provisions specified in the agreement; and
(6) the family services collaborative shall submit an annual
report to the commissioner as specified in the agreement.
Sec. 10. TERMINOLOGY AUDIT.
The commissioner of human services shall collaborate with
individuals with disabilities, families, advocates, and other governmental
agencies to solicit feedback and identify inappropriate and insensitive
terminology relating to individuals with disabilities, conduct a comprehensive
audit of the placement of this terminology in Minnesota Statutes and Minnesota
Rules, and make recommendations for changes to the 2013 legislature on the
repeal and replacement of this terminology with more appropriate and sensitive
terminology.
ARTICLE 5
HEALTH
CARE
Section 1. Minnesota
Statutes 2011 Supplement, section 125A.21, subdivision 7, is amended to read:
Subd. 7. District disclosure of information. A school district may disclose
information contained in a student's individualized education program,
consistent with section 13.32, subdivision 3, paragraph (a), and Code of
Federal Regulations, title 34, parts 99 and 300; including records of the
student's diagnosis and treatment, to a health plan company only with the
signed and dated consent of the student's parent, or other legally authorized
individual, including consent that the parent or legal representative gave
as part of the application process for MinnesotaCare or medical assistance
under section 256B.08, subdivision 1.
The school district shall disclose only that information necessary for
the health plan company to decide matters of coverage and payment. A health plan company may use the information
only for making decisions regarding coverage and payment, and for any other use
permitted by law.
Sec. 2. Minnesota
Statutes 2010, section 256B.04, subdivision 14, is amended to read:
Subd. 14. Competitive bidding. (a) When determined to be effective,
economical, and feasible, the commissioner may utilize volume purchase through
competitive bidding and negotiation under the provisions of chapter 16C, to provide
items under the medical assistance program including but not limited to the
following:
(1) eyeglasses;
(2) oxygen. The
commissioner shall provide for oxygen needed in an emergency situation on a
short-term basis, until the vendor can obtain the necessary supply from the
contract dealer;
(3) hearing aids and supplies; and
(4) durable medical equipment, including but not limited to:
(i) hospital beds;
(ii) commodes;
(iii) glide-about chairs;
(iv) patient lift apparatus;
(v) wheelchairs and accessories;
(vi) oxygen administration equipment;
(vii) respiratory therapy equipment;
(viii) electronic diagnostic, therapeutic and life-support
systems;
(5) nonemergency medical transportation level of need
determinations, disbursement of public transportation passes and tokens, and
volunteer and recipient mileage and parking reimbursements; and
(6) drugs.
(b) Rate changes and recipient cost-sharing under
this chapter and chapters 256D and 256L do not affect contract payments under
this subdivision unless specifically identified.
(c) The commissioner may not utilize volume purchase through
competitive bidding and negotiation for special transportation services under
the provisions of chapter 16C.
Sec. 3. Minnesota
Statutes 2011 Supplement, section 256B.056, subdivision 3, is amended to read:
Subd. 3. Asset limitations for individuals and
families. (a) To be eligible for
medical assistance, a person must not individually own more than $3,000 in
assets, or if a member of a household with two family members, husband and
wife, or parent and child, the household must not own more than $6,000 in
assets, plus $200 for each additional legal dependent. In addition to these maximum amounts, an
eligible individual or family may accrue interest on these amounts, but they
must be reduced to the maximum at the time of an eligibility redetermination. The accumulation of the clothing and personal
needs allowance according to section 256B.35 must also be reduced to the
maximum at the time of the eligibility redetermination. The value of assets that are not considered
in determining eligibility for medical assistance is the value of those assets
excluded under the supplemental security income program for aged, blind, and
disabled persons, with the following exceptions:
(1) household goods and personal effects are not considered;
(2) capital and operating assets of a trade or business that
the local agency determines are necessary to the person's ability to earn an
income are not considered;
(3) motor vehicles are excluded to the same extent excluded
by the supplemental security income program;
(4) assets designated as burial expenses are excluded to the
same extent excluded by the supplemental security income program. Burial expenses funded by annuity contracts
or life insurance policies must irrevocably designate the individual's estate
as contingent beneficiary to the extent proceeds are not used for payment of
selected burial expenses; and
(5) for a person who no longer qualifies as an employed
person with a disability due to loss of earnings, assets allowed while eligible
for medical assistance under section 256B.057, subdivision 9, are not
considered for 12 months, beginning with the first month of ineligibility as an
employed person with a disability, to the extent that the person's total assets
remain within the allowed limits of section 256B.057, subdivision 9, paragraph
(d).; and
(6) effective July 1, 2009, certain assets owned by American
Indians are excluded as required by section 5006 of the American Recovery and
Reinvestment Act of 2009, Public Law 111-5.
For purposes of this clause, an American Indian is any person who meets the definition of Indian according to
Code of Federal Regulations, title 42, section 447.50.
(b) No asset limit shall apply to persons eligible under
section 256B.055, subdivision 15.
EFFECTIVE DATE. This section is effective retroactively from July 1, 2009.
Sec. 4. Minnesota
Statutes 2010, section 256B.056, subdivision 3c, is amended to read:
Subd. 3c. Asset limitations for families and children. A household of two or more persons must
not own more than $20,000 in total net assets, and a household of one person
must not own more than $10,000 in total net assets. In addition to these maximum amounts, an
eligible individual or family may accrue interest on these amounts, but they
must be reduced to the maximum at the time of an eligibility redetermination. The value of assets that are not considered
in determining eligibility for medical assistance for families and children is
the value of those assets excluded under the AFDC state plan as of July 16,
1996, as required by the Personal Responsibility and Work Opportunity
Reconciliation Act of 1996 (PRWORA), Public Law 104-193, with the following
exceptions:
(1) household goods and personal effects are not considered;
(2) capital and operating assets of a trade or business up
to $200,000 are not considered, except that a bank account that contains
personal income or assets, or is used to pay personal expenses, is not
considered a capital or operating asset of a trade or business;
(3) one motor vehicle is excluded for each person of legal
driving age who is employed or seeking employment;
(4) assets designated as burial expenses are excluded to the
same extent they are excluded by the Supplemental Security Income program;
(5) court-ordered settlements up to $10,000 are not
considered;
(6) individual retirement accounts and funds are not
considered; and
(7) assets owned by children are not considered.;
and
(8) effective July 1, 2009, certain assets owned by American
Indians are excluded, as required by section 5006 of the American Recovery and
Reinvestment Act of 2009, Public Law 111-5.
For purposes of this clause, an American
Indian is any person who meets the definition of Indian according to Code of
Federal Regulations, title 42, section 447.50.
The
assets specified in clause (2) must be disclosed to the local agency at the
time of application and at the time of an eligibility redetermination, and must
be verified upon request of the local agency.
EFFECTIVE DATE. This section is effective retroactively from July 1, 2009.
Sec. 5. Minnesota
Statutes 2011 Supplement, section 256B.057, subdivision 9, is amended to read:
Subd. 9. Employed persons with disabilities. (a) Medical assistance may be paid for a
person who is employed and who:
(1) but for excess earnings or assets, meets the definition
of disabled under the Supplemental Security Income program;
(2) is at least 16 but less than 65 years of age;
(3) meets the asset limits in paragraph (d); and
(4) pays a premium and other obligations under paragraph
(e).
(b) For purposes of eligibility, there is a $65 earned
income disregard. To be eligible for
medical assistance under this subdivision, a person must have more than $65 of
earned income. Earned income must have
Medicare, Social Security, and applicable state and federal taxes withheld. The person must document earned income tax
withholding. Any spousal income or
assets shall be disregarded for purposes of eligibility and premium
determinations.
(c) After the month of enrollment, a person enrolled in
medical assistance under this subdivision who:
(1) is temporarily unable to work and without receipt of
earned income due to a medical condition, as verified by a physician; or
(2) loses employment for reasons not attributable to the
enrollee, and is without receipt of earned income may retain eligibility for up
to four consecutive months after the month of job loss. To receive a four-month extension, enrollees
must verify the medical condition or provide notification of job loss. All other eligibility requirements must be
met and the enrollee must pay all calculated premium costs for continued
eligibility.
(d) For purposes of determining eligibility under this
subdivision, a person's assets must not exceed $20,000, excluding:
(1) all assets excluded under section 256B.056;
(2) retirement accounts, including individual accounts,
401(k) plans, 403(b) plans, Keogh plans, and pension plans;
(3) medical expense accounts set up through the person's
employer; and
(4) spousal assets, including spouse's share of jointly held
assets.
(e) All enrollees must pay a premium to be eligible for
medical assistance under this subdivision, except as provided under section
256.01, subdivision 18b clause (5).
(1) An enrollee must pay the greater of a $65 premium or the
premium calculated based on the person's gross earned and unearned income and
the applicable family size using a sliding fee scale established by the
commissioner, which begins at one percent of income at 100 percent of the
federal poverty guidelines and increases to 7.5 percent of income for those
with incomes at or above 300 percent of the federal poverty guidelines.
(2) Annual adjustments in the premium schedule based upon
changes in the federal poverty guidelines shall be effective for premiums due
in July of each year.
(3) All enrollees who receive unearned income must pay five
percent of unearned income in addition to the premium amount, except as
provided under section 256.01, subdivision 18b clause (5).
(4) Increases in benefits under title II of the Social
Security Act shall not be counted as income for purposes of this subdivision
until July 1 of each year.
(5) Effective July 1, 2009, American Indians are exempt from
paying premiums as required by section 5006 of the American Recovery and
Reinvestment Act of 2009, Public Law 111-5.
For purposes of this clause, an American Indian is any person who meets the definition of Indian according to
Code of Federal Regulations, title 42, section 447.50.
(f) A person's eligibility and premium shall be determined
by the local county agency. Premiums
must be paid to the commissioner. All
premiums are dedicated to the commissioner.
(g) Any required premium shall be determined at application
and redetermined at the enrollee's six-month income review or when a change in
income or household size is reported. Enrollees
must report any change in income or household size within ten days of when the
change occurs. A decreased premium
resulting from a reported change in income or household size shall be effective
the first day of the next available billing month after the change is reported. Except for changes occurring from annual
cost-of-living increases, a change resulting in an increased premium shall not
affect the premium amount until the next six-month review.
(h) Premium payment is due upon notification from the
commissioner of the premium amount required.
Premiums may be paid in installments at the discretion of the
commissioner.
(i) Nonpayment of the premium shall result in denial or
termination of medical assistance unless the person demonstrates good cause for
nonpayment. Good cause exists if the
requirements specified in Minnesota Rules, part 9506.0040, subpart 7, items B
to D, are met. Except when an
installment agreement is accepted by the commissioner, all persons disenrolled
for nonpayment of a premium must pay any past due premiums as well as current
premiums due prior to being reenrolled. Nonpayment
shall include payment with a returned, refused, or dishonored instrument. The commissioner may require a guaranteed form
of payment as the only means to replace a returned, refused, or dishonored
instrument.
(j) The commissioner shall notify enrollees annually
beginning at least 24 months before the person's 65th birthday of the medical
assistance eligibility rules affecting income, assets, and treatment of a
spouse's income and assets that will be applied upon reaching age 65.
(k) For enrollees whose income does not exceed 200 percent
of the federal poverty guidelines and who are also enrolled in Medicare, the
commissioner shall reimburse the enrollee for Medicare part B premiums under
section 256B.0625, subdivision 15, paragraph (a).
EFFECTIVE DATE. This section is effective retroactively from July 1, 2009.
Sec. 6. Minnesota
Statutes 2010, section 256B.0595, subdivision 2, is amended to read:
Subd. 2. Period of ineligibility for long-term care
services. (a) For any uncompensated
transfer occurring on or before August 10, 1993, the number of months of
ineligibility for long-term care services shall be the lesser of 30 months, or
the uncompensated transfer amount divided by the average medical assistance
rate for nursing facility services in the state in effect on the date of
application. The amount used to
calculate the average medical assistance payment rate shall be adjusted each
July 1 to reflect payment rates for the previous calendar year. The period of ineligibility begins with the
month in which the assets were transferred.
If the transfer was not reported to the local agency at the time of
application, and the applicant received long-term care services during what
would have been the period of ineligibility if the transfer had been reported,
a cause of action exists against the transferee for the cost of long-term care
services provided during the period of ineligibility, or for the uncompensated
amount of the transfer, whichever is less.
The uncompensated transfer amount is the fair market value of the asset
at the time it was given away, sold, or disposed of, less the amount of
compensation received.
(b) For uncompensated transfers made after August 10, 1993,
the number of months of ineligibility for long-term care services shall be the
total uncompensated value of the resources transferred divided by the average
medical assistance rate for nursing facility services in the state in effect on
the date of application. The amount used
to calculate the average medical assistance payment rate shall be adjusted each
July 1 to reflect payment rates for the previous calendar year. The period of ineligibility begins with the
first day of the month after the month in which the assets were transferred
except that if one or more uncompensated transfers are made during a period of
ineligibility, the total assets transferred during the ineligibility period shall
be combined and a penalty period calculated to begin on the first day of the
month after the month in which the first uncompensated transfer was made. If the transfer was reported to the local
agency after the date that advance notice of a period of ineligibility that
affects the next month could be provided to the recipient and the recipient
received medical assistance services or the transfer was not reported to the
local agency, and the applicant or recipient received medical assistance
services during what would have been the period of ineligibility if the
transfer had been reported, a cause of action exists against the transferee for
that portion of long-term care services provided during the period of
ineligibility, or for the uncompensated amount of the transfer, whichever is
less. The uncompensated transfer amount
is the fair market value of the asset at the time it was given away, sold, or
disposed of, less the amount of compensation received. Effective for transfers made on or after
March 1, 1996, involving persons who apply for medical assistance on or after
April 13, 1996, no cause of action exists for a transfer unless:
(1) the transferee knew or should have known that the
transfer was being made by a person who was a resident of a long-term care
facility or was receiving that level of care in the community at the time of
the transfer;
(2) the transferee knew or should have known that the
transfer was being made to assist the person to qualify for or retain medical
assistance eligibility; or
(3) the transferee actively solicited the transfer with
intent to assist the person to qualify for or retain eligibility for medical
assistance.
(c) For uncompensated transfers made on or after February 8,
2006, the period of ineligibility:
(1) for uncompensated transfers by or on behalf of
individuals receiving medical assistance payment of long-term care services,
begins the first day of the month following advance notice of the period of
ineligibility, but no later than the first day of the month that follows three
full calendar months from the date of the report or discovery of the transfer;
or
(2) for uncompensated transfers by individuals requesting
medical assistance payment of long-term care services, begins the date on which
the individual is eligible for medical assistance under the Medicaid state plan
and would otherwise be receiving long-term care services based on an approved
application for such care but for the period of ineligibility resulting from
the uncompensated transfer; and
(3) cannot begin during any other period of ineligibility.
(d) If a calculation of a period of ineligibility results in
a partial month, payments for long-term care services shall be reduced in an
amount equal to the fraction.
(e) In the case of multiple fractional transfers of assets
in more than one month for less than fair market value on or after February 8,
2006, the period of ineligibility is calculated by treating the total,
cumulative, uncompensated value of all assets transferred during all months on
or after February 8, 2006, as one transfer.
(f) A period of ineligibility established under paragraph
(c) may be eliminated if all of the assets transferred for less than fair
market value used to calculate the period of ineligibility, or cash equal to
the value of the assets at the time of the transfer, are returned within 12
months after the date the period of ineligibility began. A period of ineligibility must not be
adjusted if less than the full amount of the transferred assets or the full
cash value of the transferred assets are returned.
Sec. 7. Minnesota
Statutes 2010, section 256B.0625, subdivision 13, is amended to read:
Subd. 13. Drugs.
(a) Medical assistance covers drugs, except for fertility drugs when
specifically used to enhance fertility, if prescribed by a licensed
practitioner and dispensed by a licensed pharmacist, by a physician enrolled in
the medical assistance program as a dispensing physician, or by a physician,
physician assistant, or a nurse practitioner employed by or under contract with
a community health board as defined in section 145A.02, subdivision 5, for the
purposes of communicable disease control.
(b) The dispensed quantity of a prescription drug must not
exceed a 34-day supply, unless authorized by the commissioner.
(c) For the purpose of this subdivision and subdivision 13d,
an "active pharmaceutical ingredient" is defined as a substance that
is represented for use in a drug and when used in the manufacturing,
processing, or packaging of a drug, becomes an active ingredient of the drug
product. An "excipient" is
defined as an inert substance used as a diluent or vehicle for a drug. The commissioner shall establish a list of
active pharmaceutical ingredients and excipients which are included in the
medical assistance formulary. Medical
assistance covers selected active pharmaceutical ingredients and excipients
used in compounded prescriptions when the compounded combination is
specifically approved by the commissioner or when a commercially available
product:
(1) is not a therapeutic option for the patient;
(2) does not exist in the same combination of active
ingredients in the same strengths as the compounded prescription; and
(3) cannot be used in place of the active pharmaceutical
ingredient in the compounded prescription.
(c)
(d) Medical assistance covers the following over-the-counter drugs when
prescribed by a licensed practitioner or by a licensed pharmacist who meets
standards established by the commissioner, in consultation with the board of pharmacy: antacids, acetaminophen, family planning
products, aspirin, insulin, products for the treatment of lice, vitamins for
adults with documented vitamin deficiencies, vitamins for children under the
age of seven and pregnant or nursing women, and any other over-the-counter drug
identified by the commissioner, in consultation with the formulary committee,
as necessary, appropriate, and cost-effective for the treatment of certain
specified chronic diseases, conditions, or disorders, and this determination
shall not be subject to the requirements of chapter 14. A pharmacist may prescribe over-the-counter
medications as provided under this paragraph for purposes of receiving
reimbursement under Medicaid. When
prescribing over-the-counter drugs under this paragraph, licensed pharmacists
must consult with the recipient to determine necessity, provide drug
counseling, review drug therapy for potential adverse interactions, and make
referrals as needed to other health care professionals. Over-the-counter medications must be
dispensed in a quantity that is the lower of:
(1) the number of dosage units contained in the manufacturer's original
package; and (2) the number of dosage units required to complete the patient's
course of therapy.
(d)
(e) Effective January 1, 2006, medical assistance shall not cover drugs
that are coverable under Medicare Part D as defined in the Medicare
Prescription Drug, Improvement, and Modernization Act of 2003, Public Law
108-173, section 1860D-2(e), for individuals eligible for drug coverage as
defined in the Medicare Prescription Drug, Improvement, and Modernization Act
of 2003, Public Law 108-173, section 1860D-1(a)(3)(A). For these individuals, medical assistance may
cover drugs from the drug classes listed in United States Code, title 42,
section 1396r-8(d)(2), subject to this subdivision and subdivisions 13a to 13g,
except that drugs listed in United States Code, title 42, section
1396r-8(d)(2)(E), shall not be covered.
Sec. 8. Minnesota
Statutes 2010, section 256B.0625, subdivision 13d, is amended to read:
Subd. 13d. Drug formulary. (a) The commissioner shall establish a
drug formulary. Its establishment and
publication shall not be subject to the requirements of the Administrative
Procedure Act, but the Formulary Committee shall review and comment on the
formulary contents.
(b) The formulary shall not include:
(1) drugs, active pharmaceutical ingredients, or
products for which there is no federal funding;
(2) over-the-counter drugs, except as provided in subdivision
13;
(3) drugs or active pharmaceutical ingredients used
for weight loss, except that medically necessary lipase inhibitors may be
covered for a recipient with type II diabetes;
(4) drugs or active pharmaceutical ingredients when
used for the treatment of impotence or erectile dysfunction;
(5) drugs or active pharmaceutical ingredients for
which medical value has not been established; and
(6) drugs from manufacturers who have not signed a rebate
agreement with the Department of Health and Human Services pursuant to section
1927 of title XIX of the Social Security Act.
(c) If a single-source drug used by at least two percent of
the fee-for-service medical assistance recipients is removed from the formulary
due to the failure of the manufacturer to sign a rebate agreement with the
Department of Health and Human Services, the commissioner shall notify
prescribing practitioners within 30 days of receiving notification from the
Centers for Medicare and Medicaid Services (CMS) that a rebate agreement was not
signed.
Sec. 9. Minnesota
Statutes 2011 Supplement, section 256B.0625, subdivision 13e, is amended to
read:
Subd. 13e. Payment rates. (a) The basis for determining the amount
of payment shall be the lower of the actual acquisition costs of the drugs or
the maximum allowable cost by the commissioner plus the fixed dispensing fee;
or the usual and customary price charged to the public. The amount of payment basis must be reduced
to reflect all discount amounts applied to the charge by any provider/insurer
agreement or contract for submitted charges to medical assistance programs. The net submitted charge may not be greater
than the patient liability for the service.
The pharmacy dispensing fee shall be $3.65, except that the dispensing
fee for intravenous solutions which must be compounded by the pharmacist shall
be $8 per bag, $14 per bag for cancer chemotherapy products, and $30 per bag
for total parenteral nutritional products dispensed in one liter quantities, or
$44 per bag for total parenteral nutritional products dispensed in quantities
greater than one liter. Actual
acquisition cost includes quantity and other special discounts except time and
cash discounts. The actual acquisition
cost of a drug shall be estimated by the commissioner at wholesale acquisition
cost plus four percent for independently owned pharmacies located in a
designated rural area within Minnesota, and at wholesale acquisition cost plus
two percent for all other pharmacies. A
pharmacy is "independently owned" if it is one of four or fewer
pharmacies under the same ownership nationally.
A "designated rural area" means an area defined as a small
rural area or isolated rural area according to the four-category classification
of the Rural Urban Commuting Area system developed for the United States Health
Resources and Services Administration. Wholesale
acquisition cost is defined as the manufacturer's list price for a drug or
biological to wholesalers or direct purchasers in the United States, not
including prompt pay or other discounts, rebates, or reductions in price, for
the most recent month for which information is available, as reported in
wholesale price guides or other publications of drug or biological pricing data. The maximum allowable cost of a multisource
drug may be set by the commissioner and it shall be comparable to, but no
higher than, the maximum amount paid by other third-party payors in this state
who have maximum allowable cost programs.
Establishment of the amount of payment for drugs shall not be subject to
the requirements of the Administrative Procedure Act.
(b) An additional dispensing fee of $.30 may be added to the
dispensing fee paid to pharmacists for legend drug prescriptions dispensed to
residents of long-term care facilities when a unit dose blister card system,
approved by the department, is used. Under
this type of dispensing system, the pharmacist must dispense a 30-day supply of
drug. The National Drug Code (NDC) from
the drug container used to fill the blister card must be identified on the
claim to the department. The unit dose
blister card containing the drug must meet the packaging standards set forth in
Minnesota Rules, part 6800.2700, that govern the return of unused drugs to the
pharmacy for reuse. The pharmacy provider will be required to credit the department
for the actual acquisition cost of all unused drugs that are eligible
for reuse. Over-the-counter
medications must be dispensed in the manufacturer's unopened package. The commissioner may permit the drug
clozapine to be dispensed in a quantity that is less than a 30-day supply.
(c) Whenever a maximum allowable cost has been set for a
multisource drug, payment shall be the lower of the usual and customary price
charged to the public or the maximum allowable cost established by the
commissioner unless prior authorization for the brand name product has been
granted according to the criteria established by the Drug Formulary Committee
as required by subdivision 13f, paragraph (a), and the prescriber has indicated
"dispense as written" on the prescription in a manner consistent with
section 151.21, subdivision 2.
(d) The basis for determining the amount of payment for
drugs administered in an outpatient setting shall be the lower of the usual and
customary cost submitted by the provider or 106 percent of the average sales
price as determined by the United States Department of Health and Human
Services pursuant to title XVIII, section 1847a of the federal Social Security
Act. If average sales price is
unavailable, the amount of payment must be lower of the usual and customary
cost submitted by the provider or the wholesale acquisition cost.
(e) The commissioner may negotiate lower reimbursement rates
for specialty pharmacy products than the rates specified in paragraph (a). The commissioner may require individuals
enrolled in the health care programs administered by the department to obtain
specialty pharmacy products from providers with whom the commissioner has
negotiated lower reimbursement rates. Specialty
pharmacy products are defined as those used by a small number of recipients or
recipients with complex and chronic diseases that require expensive and
challenging drug regimens. Examples of
these conditions include, but are not limited to: multiple sclerosis, HIV/AIDS, transplantation,
hepatitis C, growth hormone deficiency, Crohn's Disease, rheumatoid arthritis,
and certain forms of cancer. Specialty
pharmaceutical products include injectable and infusion therapies,
biotechnology drugs, antihemophilic factor products, high-cost therapies, and
therapies that require complex care. The
commissioner shall consult with the formulary committee to develop a list of
specialty pharmacy products subject to this paragraph. In consulting with the formulary committee in
developing this list, the commissioner shall take into consideration the
population served by specialty pharmacy products, the current delivery system
and standard of care in the state, and access to care issues. The commissioner shall have the discretion to
adjust the reimbursement rate to prevent access to care issues.
(f) Home infusion therapy services provided by home infusion
therapy pharmacies must be paid at rates according to subdivision 8d.
Sec. 10. Minnesota
Statutes 2011 Supplement, section 256B.0625, subdivision 13h, is amended to
read:
Subd. 13h. Medication therapy management services. (a) Medical assistance and general
assistance medical care cover medication therapy management services for a
recipient taking three or more prescriptions to treat or prevent one or more
chronic medical conditions; a recipient with a drug therapy problem that is
identified by the commissioner or identified by a pharmacist and approved by
the commissioner; or prior authorized by the commissioner that has resulted or
is likely to result in significant nondrug program costs. The commissioner may cover medical therapy
management services under MinnesotaCare if the commissioner determines this is
cost-effective. For purposes of this
subdivision, "medication therapy management" means the provision of
the following pharmaceutical care services by a licensed pharmacist to optimize
the therapeutic outcomes of the patient's medications:
(1) performing or obtaining necessary assessments of the
patient's health status;
(2) formulating a medication treatment plan;
(3) monitoring and evaluating the patient's response to
therapy, including safety and effectiveness;
(4) performing a comprehensive medication review to
identify, resolve, and prevent medication-related problems, including adverse
drug events;
(5) documenting the care delivered and communicating
essential information to the patient's other primary care providers;
(6) providing verbal education and training designed to
enhance patient understanding and appropriate use of the patient's medications;
(7) providing information, support services, and resources
designed to enhance patient adherence with the patient's therapeutic regimens;
and
(8) coordinating and integrating medication therapy
management services within the broader health care management services being
provided to the patient.
Nothing
in this subdivision shall be construed to expand or modify the scope of
practice of the pharmacist as defined in section 151.01, subdivision 27.
(b) To be eligible for reimbursement for services under this
subdivision, a pharmacist must meet the following requirements:
(1) have a valid license issued under chapter 151 by
the Board of Pharmacy of the state in which the medication therapy management
service is being performed;
(2) have graduated from an accredited college of pharmacy on
or after May 1996, or completed a structured and comprehensive education
program approved by the Board of Pharmacy and the American Council of
Pharmaceutical Education for the provision and documentation of pharmaceutical
care management services that has both clinical and didactic elements;
(3) be practicing in an ambulatory care setting as part of a
multidisciplinary team or have developed a structured patient care process that
is offered in a private or semiprivate patient care area that is separate from
the commercial business that also occurs in the setting, or in home settings,
including long-term care settings, group homes, and facilities providing
assisted living services, but excluding skilled nursing facilities; and
(4) make use of an electronic patient record system that
meets state standards.
(c) For purposes of reimbursement for medication therapy
management services, the commissioner may enroll individual pharmacists as
medical assistance and general assistance medical care providers. The commissioner may also establish contact
requirements between the pharmacist and recipient, including limiting the
number of reimbursable consultations per recipient.
(d) If there are no pharmacists who meet the requirements of
paragraph (b) practicing within a reasonable geographic distance of the
patient, a pharmacist who meets the requirements may provide the services via
two-way interactive video. Reimbursement
shall be at the same rates and under the same conditions that would otherwise
apply to the services provided. To
qualify for reimbursement under this paragraph, the pharmacist providing the
services must meet the requirements of paragraph (b), and must be located
within an ambulatory care setting approved by the commissioner. The patient must also be located within an
ambulatory care setting approved by the commissioner. Services provided under this paragraph may
not be transmitted into the patient's residence.
(e) The commissioner shall establish a pilot project for an
intensive medication therapy management program for patients identified by the
commissioner with multiple chronic conditions and a high number of medications
who are at high risk of preventable hospitalizations, emergency room use,
medication complications, and suboptimal treatment outcomes due to
medication-related problems. For
purposes of the pilot project, medication therapy management services may be
provided in a patient's home or community setting, in addition to other
authorized settings. The commissioner
may waive existing payment policies and establish special payment rates for the
pilot project. The pilot project must be
designed to produce a net savings to the state compared to the estimated costs
that would otherwise be incurred for similar
patients without the program. The pilot
project must begin by January 1, 2010, and end June 30, 2012.
Sec. 11. Minnesota
Statutes 2011 Supplement, section 256B.0625, subdivision 14, is amended to
read:
Subd. 14. Diagnostic, screening, and preventive
services. (a) Medical assistance
covers diagnostic, screening, and preventive services.
(b) "Preventive services" include services related
to pregnancy, including:
(1) services for those conditions which may complicate a
pregnancy and which may be available to a pregnant woman determined to be at
risk of poor pregnancy outcome;
(2) prenatal HIV risk assessment, education, counseling, and
testing; and
(3) alcohol abuse assessment, education, and counseling on
the effects of alcohol usage while pregnant.
Preventive services available to a woman at risk of poor pregnancy
outcome may differ in an amount, duration, or scope from those available to
other individuals eligible for medical assistance.
(c) "Screening services" include, but are not
limited to, blood lead tests.
(d) The commissioner shall encourage, at the time of the
child and teen checkup or at an episodic care visit, the primary care health
care provider to perform primary caries preventive services. Primary caries preventive services include,
at a minimum:
(1) a general visual examination of the child's mouth
without using probes or other dental equipment or taking radiographs;
(2) a risk assessment using the factors established by the
American Academies of Pediatrics and Pediatric Dentistry; and
(3) the application of a fluoride varnish beginning at age
one to those children assessed by the provider as being high risk in accordance
with best practices as defined by the Department of Human Services. The provider must obtain parental or legal
guardian consent before a fluoride treatment varnish is applied
to a minor child's teeth.
At
each checkup, if primary caries preventive services are provided, the provider
must provide to the child's parent or legal guardian: information on caries etiology and
prevention; and information on the importance of finding a dental home for
their child by the age of one. The
provider must also advise the parent or legal guardian to contact the child's
managed care plan or the Department of Human Services in order to secure a
dental appointment with a dentist. The
provider must indicate in the child's medical record that the parent or legal
guardian was provided with this information and document any primary caries
prevention services provided to the child.
Sec. 12. Minnesota
Statutes 2011 Supplement, section 256B.0631, subdivision 1, is amended to read:
Subdivision 1. Cost-sharing. (a) Except as provided in subdivision 2,
the medical assistance benefit plan shall include the following cost-sharing
for all recipients, effective for services provided on or after September 1,
2011:
(1) $3 per nonpreventive visit, except as provided in
paragraph (b). For purposes of this
subdivision, a visit means an episode of service which is required because of a
recipient's symptoms, diagnosis, or established illness, and which is delivered
in an ambulatory setting by a physician or physician ancillary, chiropractor,
podiatrist, nurse midwife, advanced practice nurse, audiologist, optician, or
optometrist;
(2) $3 for eyeglasses;
(3)
(2) $3.50 for nonemergency visits to a hospital-based emergency room,
except that this co-payment shall be increased to $20 upon federal approval;
(4)
(3) $3 per brand-name drug prescription and $1 per generic drug
prescription, subject to a $12 per month maximum for prescription drug
co-payments. No co-payments shall apply
to antipsychotic drugs when used for the treatment of mental illness;
(5)
(4) effective January 1, 2012, a family deductible equal to the maximum
amount allowed under Code of Federal Regulations, title 42, part 447.54; and
(6)
(5) for individuals identified by the commissioner with income at or
below 100 percent of the federal poverty guidelines, total monthly cost-sharing
must not exceed five percent of family income.
For purposes of this paragraph, family income is the total earned and
unearned income of the individual and the individual's spouse, if the spouse is
enrolled in medical assistance and also subject to the five percent limit on
cost-sharing.
(b) Recipients of medical assistance are responsible for all
co-payments and deductibles in this subdivision.
Sec. 13. Minnesota
Statutes 2011 Supplement, section 256B.0631, subdivision 2, is amended to read:
Subd. 2. Exceptions.
Co-payments and deductibles shall be subject to the following
exceptions:
(1) children under the age of 21;
(2) pregnant women for services that relate to the pregnancy
or any other medical condition that may complicate the pregnancy;
(3) recipients expected to reside for at least 30 days in a
hospital, nursing home, or intermediate care facility for the developmentally
disabled;
(4) recipients receiving hospice care;
(5) 100 percent federally funded services provided by an
Indian health service;
(6) emergency services;
(7) family planning services;
(8) services that are paid by Medicare, resulting in the
medical assistance program paying for the coinsurance and deductible; and
(9) co-payments that exceed one per day per provider for nonpreventive
visits, eyeglasses, and nonemergency visits to a hospital-based emergency room.;
and
(10) services, fee-for-service payments subject to volume
purchase through competitive bidding.
Sec. 14. Minnesota
Statutes 2010, section 256B.19, subdivision 1c, is amended to read:
Subd. 1c. Additional portion of nonfederal share. (a) Hennepin County shall be responsible
for a monthly transfer payment of $1,500,000, due before noon on the 15th of
each month and the University of Minnesota shall be responsible for a monthly
transfer payment of $500,000 due before noon on the 15th of each month,
beginning July 15, 1995. These sums
shall be part of the designated governmental unit's portion of the nonfederal
share of medical assistance costs.
(b) Beginning July 1, 2001, Hennepin County's payment under
paragraph (a) shall be $2,066,000 each month.
(c) Beginning July 1, 2001, the commissioner shall increase
annual capitation payments to the metropolitan health plan a
demonstration provider serving eligible individuals in Hennepin County
under section 256B.69 for the prepaid medical assistance program by
approximately $6,800,000 to recognize higher than average medical education
costs.
(d) Effective August 1, 2005, Hennepin County's payment
under paragraphs (a) and (b) shall be reduced to $566,000, and the University
of Minnesota's payment under paragraph (a) shall be reduced to zero. Effective October 1, 2008, to December 31,
2010, Hennepin County's payment under paragraphs (a) and (b) shall be $434,688. Effective January 1, 2011, Hennepin County's
payment under paragraphs (a) and (b) shall be $566,000.
(e) Notwithstanding paragraph (d), upon federal enactment of
an extension to June 30, 2011, of the enhanced federal medical assistance
percentage (FMAP) originally provided under Public Law 111-5, for the six-month
period from January 1, 2011, to June 30, 2011, Hennepin County's payment under
paragraphs (a) and (b) shall be $434,688.
Sec. 15. Minnesota
Statutes 2010, section 256B.69, subdivision 5, is amended to read:
Subd. 5. Prospective per capita payment. The commissioner shall establish the
method and amount of payments for services.
The commissioner shall annually contract with demonstration providers to
provide services consistent with these established methods and amounts for
payment.
If allowed by the commissioner, a demonstration provider may
contract with an insurer, health care provider, nonprofit health service plan
corporation, or the commissioner, to provide insurance or similar protection
against the cost of care provided by the demonstration provider or to provide
coverage against the risks incurred by demonstration providers under this
section. The recipients enrolled with a
demonstration provider are a permissible group under group insurance laws and
chapter 62C, the Nonprofit Health Service Plan Corporations Act. Under this type of contract, the insurer or
corporation may make benefit payments to a demonstration provider for services
rendered or to be rendered to a recipient.
Any insurer or nonprofit health service plan corporation licensed to do
business in this state is authorized to provide this insurance or similar
protection.
Payments to providers participating in the project are
exempt from the requirements of sections 256.966 and 256B.03, subdivision 2. The commissioner shall complete development
of capitation rates for payments before delivery of services under this section
is begun. For payments made during
calendar year 1990 and later years, the commissioner shall contract with an
independent actuary to establish prepayment rates.
By January 15, 1996, the commissioner shall report to the
legislature on the methodology used to allocate to participating counties
available administrative reimbursement for advocacy and enrollment costs. The report shall reflect the commissioner's
judgment as to the adequacy of the funds made available and of the methodology
for equitable distribution of the funds.
The commissioner must involve participating counties in the development
of the report.
Beginning July 1, 2004, the commissioner may include
payments for elderly waiver services and 180 days of nursing home care in
capitation payments for the prepaid medical assistance program for recipients
age 65 and older. Payments for elderly
waiver services shall be made no earlier than the month following the month in
which services were received.
Sec. 16. Minnesota
Statutes 2011 Supplement, section 256B.69, subdivision 5a, is amended to read:
Subd. 5a. Managed care contracts. (a) Managed care contracts under this
section and section 256L.12 shall be entered into or renewed on a calendar year
basis beginning January 1, 1996. Managed
care contracts which were in effect on June 30, 1995, and set to renew on July
1, 1995, shall be renewed for the period July 1, 1995 through December 31, 1995
at the same terms that were in effect on June 30, 1995. The commissioner may issue separate contracts
with requirements specific to services to medical assistance recipients age 65
and older.
(b) A prepaid health plan providing covered health services
for eligible persons pursuant to chapters 256B and 256L is responsible for
complying with the terms of its contract with the commissioner. Requirements applicable to managed care
programs under chapters 256B and 256L established after the effective date of a
contract with the commissioner take effect when the contract is next issued or
renewed.
(c) Effective for services rendered on or after January 1,
2003, the commissioner shall withhold five percent of managed care plan
payments under this section and county-based purchasing plan payments under
section 256B.692 for the prepaid medical assistance program pending completion
of performance targets. Each performance
target must be quantifiable, objective, measurable, and reasonably attainable,
except in the case of a performance target based on a federal or state law or
rule. Criteria for assessment of each
performance target must be outlined in writing prior to the contract effective
date. Clinical or utilization
performance targets and their related criteria must consider evidence-based
research and reasonable interventions when available or applicable to the
populations served, and must be developed with input from external clinical
experts and stakeholders, including managed care and county-based purchasing
plans and providers. The managed
care plan must demonstrate, to the commissioner's satisfaction, that the data
submitted regarding attainment of the performance target is accurate. The commissioner shall periodically change
the administrative measures used as performance targets in order to improve
plan performance across a broader range of administrative services. The performance targets must include
measurement of plan efforts to contain spending on health care services and
administrative activities. The
commissioner may adopt plan-specific performance targets that take into account
factors affecting only one plan, including characteristics of the plan's
enrollee population. The withheld funds
must be returned no sooner than July of the following year if performance
targets in the contract are achieved. The
commissioner may exclude special demonstration projects under subdivision 23.
(d) Effective for services rendered on or after January 1,
2009, through December 31, 2009, the commissioner shall withhold three percent
of managed care plan payments under this section and county-based purchasing
plan payments under section 256B.692 for the prepaid medical assistance program. The withheld funds must be returned no sooner
than July 1 and no later than July 31 of the following year. The commissioner may exclude special
demonstration projects under subdivision 23.
(e) Effective for services provided on or after January 1,
2010, the commissioner shall require that managed care plans use the assessment
and authorization processes, forms, timelines, standards, documentation, and
data reporting requirements, protocols, billing processes, and policies
consistent with medical assistance fee-for-service or the Department of Human
Services contract requirements consistent with medical assistance
fee-for-service or the Department of Human Services contract requirements for
all personal care assistance services under section 256B.0659.
(f) Effective for services rendered on or after January 1,
2010, through December 31, 2010, the commissioner shall withhold 4.5 percent of
managed care plan payments under this section and county-based purchasing plan
payments under section 256B.692 for the prepaid medical assistance program. The withheld funds must be returned no sooner
than July 1 and no later than July 31 of the following year. The commissioner may exclude special
demonstration projects under subdivision 23.
(g) Effective for services rendered on or after January 1,
2011, through December 31, 2011, the commissioner shall include as part of the
performance targets described in paragraph (c) a reduction in the health plan's
emergency room utilization rate for state health care program enrollees by a
measurable rate of five percent from the plan's utilization rate for state
health care program enrollees for the previous calendar year. Effective for services rendered on or after
January 1, 2012, the commissioner shall include as part of the performance
targets described in paragraph (c) a reduction in the health plan's emergency
department utilization rate for medical assistance and MinnesotaCare enrollees,
as determined by the commissioner. For
2012, the reduction shall be based on the health plan's utilization in 2009. To earn the return of the withhold each year,
the managed care plan or county-based purchasing plan must achieve a qualifying
reduction of no less than ten percent of the plan's emergency department
utilization rate for medical assistance and MinnesotaCare enrollees, excluding Medicare
enrollees in programs described in subdivisions 23 and 28, compared to
the previous calendar measurement year until the final
performance target is reached. When
measuring performance, the commissioner must consider the difference in health
risk in a plan's membership in the baseline year compared to the measurement
year, and work with the managed care or county-based purchasing plan to account
for differences that they agree are significant.
The withheld funds must be returned no sooner than July 1
and no later than July 31 of the following calendar year if the managed care
plan or county-based purchasing plan demonstrates to the satisfaction of the
commissioner that a reduction in the utilization rate was achieved.
The withhold described in this paragraph shall continue for
each consecutive contract period until the plan's emergency room utilization
rate for state health care program enrollees is reduced by 25 percent of the
plan's emergency room utilization rate for medical assistance and MinnesotaCare
enrollees for calendar year 2011 2009. Hospitals shall cooperate with the health
plans in meeting this performance target and shall accept payment withholds
that may be returned to the hospitals if the performance target is achieved.
(h) Effective for services rendered on or after January 1,
2012, the commissioner shall include as part of the performance targets
described in paragraph (c) a reduction in the plan's hospitalization admission rate
for medical assistance and MinnesotaCare enrollees, as determined by the
commissioner. To earn the return of the
withhold each year, the managed care plan or county-based purchasing plan must
achieve a qualifying reduction of no less than five percent of the plan's
hospital admission rate for medical assistance and MinnesotaCare enrollees,
excluding Medicare enrollees in programs described in subdivisions 23
and 28, compared to the previous calendar year until the final performance
target is reached. When measuring
performance, the commissioner must evaluate the difference in health risk in a
plan's membership in the baseline year compared to the measurement year, and
work with the managed care or county-based purchasing plan to account for
differences that they agree are significant.
The withheld funds must be returned no sooner than July 1
and no later than July 31 of the following calendar year if the managed care
plan or county-based purchasing plan demonstrates to the satisfaction of the
commissioner that this reduction in the hospitalization rate was achieved.
The withhold described in this paragraph shall continue
until there is a 25 percent reduction in the hospital admission rate compared
to the hospital admission rates in calendar year 2011, as determined by the
commissioner. The hospital admissions in
this performance target do not include the admissions applicable to the
subsequent hospital admission performance target under paragraph (i). Hospitals shall cooperate with the plans in
meeting this performance target and shall accept payment withholds that may be
returned to the hospitals if the performance target is achieved.
(i) Effective for services rendered on or after January 1,
2012, the commissioner shall include as part of the performance targets
described in paragraph (c) a reduction in the plan's hospitalization admission
rates for subsequent hospitalizations within 30 days of a previous
hospitalization of a patient regardless of the reason, for medical assistance
and MinnesotaCare enrollees, as determined by the commissioner. To earn the return of the withhold each year,
the managed care plan or county-based purchasing plan must achieve a qualifying
reduction of the subsequent hospitalization rate for medical assistance and
MinnesotaCare enrollees, excluding Medicare enrollees in programs
described in subdivisions 23 and 28, of no less than five percent compared
to the previous calendar year until the final performance target is reached.
The withheld funds must be returned no sooner than July 1
and no later than July 31 of the following calendar year if the managed care
plan or county-based purchasing plan demonstrates to the satisfaction of the
commissioner that a qualifying reduction in the subsequent hospitalization rate
was achieved.
The withhold described in this paragraph must continue for
each consecutive contract period until the plan's subsequent hospitalization
rate for medical assistance and MinnesotaCare enrollees, excluding Medicare
enrollees in programs described in subdivisions 23 and 28, is reduced by
25 percent of the plan's subsequent hospitalization rate for calendar year 2011. Hospitals shall cooperate with the plans in
meeting this performance target and shall accept payment withholds that must be
returned to the hospitals if the performance target is achieved.
(j) Effective for services rendered on or after January 1,
2011, through December 31, 2011, the commissioner shall withhold 4.5 percent of
managed care plan payments under this section and county-based purchasing plan
payments under section 256B.692 for the prepaid medical assistance program. The withheld funds must be returned no sooner
than July 1 and no later than July 31 of the following year. The commissioner may exclude special
demonstration projects under subdivision 23.
(k) Effective for services rendered on or after January 1,
2012, through December 31, 2012, the commissioner shall withhold 4.5 percent of
managed care plan payments under this section and county-based purchasing plan
payments under section 256B.692 for the prepaid medical assistance program. The withheld funds must be returned no sooner
than July 1 and no later than July 31 of the following year. The commissioner may exclude special
demonstration projects under subdivision 23.
(l) Effective for services rendered on or after January 1,
2013, through December 31, 2013, the commissioner shall withhold 4.5 percent of
managed care plan payments under this section and county-based purchasing plan
payments under section 256B.692 for the prepaid medical assistance program. The withheld funds must be returned no sooner
than July 1 and no later than July 31 of the following year. The commissioner may exclude special
demonstration projects under subdivision 23.
(m) Effective for services rendered on or after January 1,
2014, the commissioner shall withhold three percent of managed care plan
payments under this section and county-based purchasing plan payments under
section 256B.692 for the prepaid medical assistance program. The withheld funds must be returned no sooner
than July 1 and no later than July 31 of the following year. The commissioner may exclude special
demonstration projects under subdivision 23.
(n) A managed care plan or a county-based purchasing plan
under section 256B.692 may include as admitted assets under section 62D.044 any
amount withheld under this section that is reasonably expected to be returned.
(o) Contracts between the commissioner and a prepaid health
plan are exempt from the set-aside and preference provisions of section 16C.16,
subdivisions 6, paragraph (a), and 7.
(p) The return of the withhold under paragraphs (d), (f),
and (j) to (m) is not subject to the requirements of paragraph (c).
Sec. 17. Minnesota
Statutes 2011 Supplement, section 256B.69, subdivision 28, is amended to read:
Subd. 28. Medicare special needs plans; medical
assistance basic health care. (a)
The commissioner may contract with demonstration providers and current or
former sponsors of qualified Medicare-approved special needs plans, to
provide medical assistance basic health care services to persons with
disabilities, including those with developmental disabilities. Basic health care services include:
(1) those services covered by the medical assistance state
plan except for ICF/MR services, home and community-based waiver services, case
management for persons with developmental disabilities under section 256B.0625,
subdivision 20a, and personal care and certain home care services defined by
the commissioner in consultation with the stakeholder group established under
paragraph (d); and
(2) basic health care services may also include risk for up
to 100 days of nursing facility services for persons who reside in a
noninstitutional setting and home health services related to rehabilitation as
defined by the commissioner after consultation with the stakeholder group.
The commissioner may exclude other medical assistance
services from the basic health care benefit set. Enrollees in these plans can access any
excluded services on the same basis as other medical assistance recipients who
have not enrolled.
(b) Beginning January 1, 2007, the commissioner may contract
with demonstration providers and current and former sponsors of
qualified Medicare special needs plans, to provide basic health care
services under medical assistance to persons who are dually eligible for both
Medicare and Medicaid and those Social Security beneficiaries eligible for
Medicaid but in the waiting period for Medicare. The commissioner shall consult with the
stakeholder group under paragraph (d) in developing program specifications for
these services. The commissioner shall
report to the chairs of the house of representatives and senate committees with
jurisdiction over health and human services policy and finance by February 1,
2007, on implementation of these programs and the need for increased funding
for the ombudsman for managed care and other consumer assistance and
protections needed due to enrollment in managed care of persons with
disabilities. Payment for Medicaid
services provided under this subdivision for the months of May and June will be
made no earlier than July 1 of the same calendar year.
(c) Notwithstanding subdivision 4, beginning January 1,
2012, the commissioner shall enroll persons with disabilities in managed care
under this section, unless the individual chooses to opt out of enrollment. The commissioner shall establish enrollment
and opt out procedures consistent with applicable enrollment procedures under
this subdivision section.
(d) The commissioner shall establish a state-level
stakeholder group to provide advice on managed care programs for persons with
disabilities, including both MnDHO and contracts with special needs plans that
provide basic health care services as described in paragraphs (a) and (b). The stakeholder group shall provide advice on
program expansions under this subdivision and subdivision 23, including:
(1) implementation efforts;
(2) consumer protections; and
(3) program specifications such as quality assurance
measures, data collection and reporting, and evaluation of costs, quality, and
results.
(e) Each plan under contract to provide medical assistance
basic health care services shall establish a local or regional stakeholder
group, including representatives of the counties covered by the plan, members,
consumer advocates, and providers, for advice on issues that arise in the local
or regional area.
(f) The commissioner is prohibited from providing the names
of potential enrollees to health plans for marketing purposes. The commissioner shall mail no more than two
sets of marketing materials per contract year to potential enrollees on behalf
of health plans, at the health plan's request.
The marketing materials shall be mailed by the commissioner within 30
days of receipt of these materials from the health plan. The health plans shall cover any costs
incurred by the commissioner for mailing marketing materials.
Sec. 18. Minnesota
Statutes 2010, section 256L.05, subdivision 3, is amended to read:
Subd. 3. Effective date of coverage. (a) The effective date of coverage is the
first day of the month following the month in which eligibility is approved and
the first premium payment has been received.
As provided in section 256B.057, coverage for newborns is automatic from
the date of birth and must be coordinated with other health coverage. The effective date of coverage for eligible
newly adoptive children added to a family receiving covered health services is
the month of placement. The effective
date of coverage for other new members added to the family is the first day of
the month following the month in which the change is reported. All eligibility criteria must be met by the
family at the time the new family member is added. The income of the new family member is included with the family's gross income and the
adjusted premium begins in the month the new family member is added.
(b) The initial premium must be received by the last working
day of the month for coverage to begin the first day of the following month.
(c) Benefits are not available until the day following
discharge if an enrollee is hospitalized on the first day of coverage.
(d) Notwithstanding any other law to the contrary, benefits
under sections 256L.01 to 256L.18 are secondary to a plan of insurance or
benefit program under which an eligible person may have coverage and the
commissioner shall use cost avoidance techniques to ensure coordination of any
other health coverage for eligible persons.
The commissioner shall identify eligible persons who may have coverage
or benefits under other plans of insurance or who become eligible for medical
assistance.
(e) The effective date of coverage for individuals or
families who are exempt from paying premiums under section 256L.15, subdivision
1, paragraph (d), is the first day of the month following the month in which
verification of American Indian status is received or eligibility is approved,
whichever is later.
Sec. 19. Minnesota
Statutes 2011 Supplement, section 256L.12, subdivision 9, is amended to read:
Subd. 9. Rate setting; performance withholds. (a) Rates will be prospective, per
capita, where possible. The commissioner
may allow health plans to arrange for inpatient hospital services on a risk or
nonrisk basis. The commissioner shall
consult with an independent actuary to determine appropriate rates.
(b) For services rendered on or after January 1, 2004, the
commissioner shall withhold five percent of managed care plan payments and
county-based purchasing plan payments under this section pending completion of
performance targets. Each performance
target must be quantifiable, objective, measurable, and reasonably attainable,
except in the case of a performance target based on a federal or state law or
rule. Criteria for assessment of each
performance target must be outlined in writing prior to the contract effective
date. Clinical or utilization
performance targets and their related criteria must consider evidence-based
research and reasonable interventions, when available or applicable to the
populations served, and must be developed with input from external clinical
experts and stakeholders, including managed care and county-based purchasing
plans and providers. The managed
care plan must demonstrate, to the commissioner's satisfaction, that the data
submitted regarding attainment of the performance target is accurate. The commissioner shall periodically change
the administrative measures used as performance targets in order to improve
plan performance across a broader range of administrative services. The performance targets must include
measurement of plan efforts to contain spending on health care services and
administrative activities. The
commissioner may adopt plan-specific performance targets that take into account
factors affecting only one plan, such as characteristics of the plan's enrollee
population. The withheld funds must be
returned no sooner than July 1 and no later than July 31 of the following calendar
year if performance targets in the contract are achieved.
(c) For services rendered on or after January 1, 2011, the
commissioner shall withhold an additional three percent of managed care plan or
county-based purchasing plan payments under this section. The withheld funds must be returned no sooner
than July 1 and no later than July 31 of the following calendar year. The return of the withhold under this
paragraph is not subject to the requirements of paragraph (b).
(d) Effective for services rendered on or after January 1,
2011, through December 31, 2011, the commissioner shall include as part of the
performance targets described in paragraph (b) a reduction in the plan's
emergency room utilization rate for state health care program enrollees by a
measurable rate of five percent from the plan's utilization rate for the
previous calendar year. Effective for
services rendered on or after January 1, 2012, the commissioner shall include
as part of the performance targets described in paragraph (b) a reduction in
the health plan's emergency department utilization rate for medical assistance
and MinnesotaCare enrollees, as determined by the commissioner. For 2012, the reduction shall be based on
the health plan's utilization in 2009.
To earn the return of the withhold each year, the managed care plan or
county-based purchasing plan must achieve a qualifying reduction of no less
than ten percent of the plan's utilization rate for medical assistance and
MinnesotaCare enrollees, excluding Medicare enrollees in programs
described in section 256B.69, subdivisions 23 and 28, compared to the
previous calendar measurement year, until the final performance
target is reached. When measuring
performance, the commissioner must evaluate the difference in health risk in a
plan's membership in the baseline year compared to the measurement year, and
work with the managed care or county-based purchasing plan to account for
differences that they agree are significant.
The withheld funds must be returned no sooner than July 1
and no later than July 31 of the following calendar year if the managed care
plan or county-based purchasing plan demonstrates to the satisfaction of the
commissioner that a reduction in the utilization rate was achieved.
The withhold described in this paragraph shall continue for
each consecutive contract period until the plan's emergency room utilization
rate for state health care program enrollees is reduced by 25 percent of the
plan's emergency room utilization rate for medical assistance and MinnesotaCare
enrollees for calendar year 2011. Hospitals
shall cooperate with the health plans in meeting this performance target and
shall accept payment withholds that may be returned to the hospitals if the
performance target is achieved.
(e) Effective for services rendered on or after January 1,
2012, the commissioner shall include as part of the performance targets
described in paragraph (b) a reduction in the plan's hospitalization admission
rate for medical assistance and MinnesotaCare enrollees, as determined by the
commissioner. To earn the return of the
withhold each year, the managed care plan or county-based purchasing plan must
achieve a qualifying reduction of no less than five percent of the plan's
hospital admission rate for medical assistance and MinnesotaCare enrollees,
excluding Medicare enrollees in programs described in section
256B.69, subdivisions 23 and 28, compared to the previous calendar year,
until the final performance target is reached.
When measuring performance, the commissioner must evaluate the
difference in health risk in a plan's membership in the baseline year compared
to the measurement year, and work with the managed care or county-based
purchasing plan to account for differences that they agree are significant.
The withheld funds must be returned no sooner than July 1
and no later than July 31 of the following calendar year if the managed care
plan or county-based purchasing plan demonstrates to the satisfaction of the
commissioner that this reduction in the hospitalization rate was achieved.
The withhold described in this paragraph shall continue
until there is a 25 percent reduction in the hospitals admission rate compared
to the hospital admission rate for calendar year 2011 as determined by the
commissioner. Hospitals shall cooperate
with the plans in meeting this performance target and shall accept payment
withholds that may be returned to the hospitals if the performance target is
achieved. The hospital admissions in
this performance target do not include the admissions applicable to the
subsequent hospital admission performance target under paragraph (f).
(f) Effective for services provided on or after January 1,
2012, the commissioner shall include as part of the performance targets
described in paragraph (b) a reduction in the plan's hospitalization rate for a
subsequent hospitalization within 30 days of a previous hospitalization of a
patient regardless of the reason, for medical assistance and MinnesotaCare
enrollees, as determined by the commissioner.
To earn the return of the withhold each year, the managed care plan or
county-based purchasing plan must achieve a qualifying reduction of the
subsequent hospital admissions rate for medical assistance and MinnesotaCare
enrollees, excluding Medicare enrollees described in section 256B.69,
subdivisions 23 and 28, of no less than five percent compared to the
previous calendar year until the final performance target is reached.
The withheld funds must be returned no sooner than July 1
and no later than July 31 of the following calendar year if the managed care
plan or county-based purchasing plan demonstrates to the satisfaction of the
commissioner that a reduction in the subsequent hospitalization rate was
achieved.
The withhold described in this paragraph must continue for
each consecutive contract period until the plan's subsequent hospitalization
rate for medical assistance and MinnesotaCare enrollees is reduced by 25
percent of the plan's subsequent hospitalization rate for calendar year 2011. Hospitals shall cooperate with the plans in
meeting this performance target and shall accept payment withholds that must be
returned to the hospitals if the performance target is achieved.
(g) A managed care plan or a county-based purchasing plan
under section 256B.692 may include as admitted assets under section 62D.044 any
amount withheld under this section that is reasonably expected to be returned.
Sec. 20. Minnesota
Statutes 2011 Supplement, section 256L.15, subdivision 1, is amended to read:
Subdivision 1. Premium determination. (a) Families with children and
individuals shall pay a premium determined according to subdivision 2.
(b) Pregnant women and children under
age two are exempt from the provisions of section 256L.06, subdivision 3, paragraph (b), clause (3),
requiring disenrollment for failure to pay premiums. For pregnant women, this exemption continues
until the first day of the month following the 60th day postpartum. Women who remain enrolled during pregnancy or
the postpartum period, despite nonpayment of premiums, shall be disenrolled on
the first of the month following the 60th day postpartum for the penalty period
that otherwise applies under section 256L.06, unless they begin paying
premiums.
(c) Members of the military and their families who meet the
eligibility criteria for MinnesotaCare upon eligibility approval made within 24
months following the end of the member's tour of active duty shall have their
premiums paid by the commissioner. The
effective date of coverage for an individual or family who meets the criteria
of this paragraph shall be the first day of the month following the month in
which eligibility is approved. This
exemption applies for 12 months.
(d) Beginning July 1, 2009, American Indians enrolled in
MinnesotaCare and their families shall have their premiums waived by the
commissioner in accordance with section 5006 of the American Recovery and
Reinvestment Act of 2009, Public Law 111-5.
An individual must document status as an American Indian, as defined
under Code of Federal Regulations, title 42, section 447.50, to qualify for the
waiver of premiums.
EFFECTIVE DATE. This section is effective retroactively from July 1, 2009.
Sec. 21. Minnesota
Statutes 2010, section 514.982, subdivision 1, is amended to read:
Subdivision 1. Contents.
A medical assistance lien notice must be dated and must contain:
(1) the full name, last known address, and last four
digits of the Social Security number of the medical assistance recipient;
(2) a statement that medical assistance payments have been
made to or for the benefit of the medical assistance recipient named in the
notice, specifying the first date of eligibility for benefits;
(3) a statement that all interests in real property owned by
the persons named in the notice may be subject to or affected by the rights of
the agency to be reimbursed for medical assistance benefits; and
(4) the legal description of the real property upon which
the lien attaches, and whether the property is registered property.
Sec. 22. HEALTH SERVICES ADVISORY COUNCIL.
The Health Services Advisory Council shall review currently
available literature regarding the efficacy of various treatments for autism
spectrum disorder, including an evaluation of age-based variation in the
appropriateness of existing medical and behavioral interventions. The council shall recommend to the
commissioner of human services authorization criteria for services based on
existing evidence. The council may
recommend coverage with ongoing collection of outcomes evidence in
circumstances where evidence is currently unavailable, or where the strength of
the evidence is low. The council shall
make this recommendation by December 31, 2012.
Sec. 23. REPEALER.
Minnesota Statutes 2010, section 256.01, subdivision 18b, is
repealed.
ARTICLE 6
TECHNICAL
Section 1. Minnesota
Statutes 2010, section 144A.071, subdivision 5a, is amended to read:
Subd. 5a. Cost estimate of a moratorium exception
project. (a) For the purposes of
this section and section 144A.073, the cost estimate of a moratorium exception
project shall include the effects of the proposed project on the costs of the
state subsidy for community-based services, nursing services, and housing in
institutional and noninstitutional settings.
The commissioner of health, in cooperation with the commissioner of
human services, shall define the method for estimating these costs in the
permanent rule implementing section 144A.073.
The commissioner of human services shall prepare an estimate of the
total state annual long-term costs of each moratorium exception proposal.
(b) The interest rate to be used for estimating the cost of
each moratorium exception project proposal shall be the lesser of either the
prime rate plus two percentage points, or the posted yield for standard
conventional fixed rate mortgages of the Federal Home Loan Mortgage Corporation
plus two percentage points as published in the Wall Street Journal and in
effect 56 days prior to the application deadline. If the applicant's proposal uses this
interest rate, the commissioner of human services, in determining the
facility's actual property-related payment rate to be established upon
completion of the project must use the actual interest rate obtained by the
facility for the project's permanent financing up to the maximum permitted
under subdivision 6 Minnesota Rules, part 9549.0060, subpart 6.
The applicant may choose an alternate interest rate for
estimating the project's cost. If the
applicant makes this election, the commissioner of human services, in
determining the facility's actual property-related payment rate to be
established upon completion of the project, must use the lesser of the actual
interest rate obtained for the project's permanent financing or the interest
rate which was used to estimate the proposal's project cost. For succeeding rate years, the applicant is
at risk for financing costs in excess of the interest rate selected.
Sec. 2. REVISOR'S INSTRUCTION.
(a) In Minnesota Statutes, sections 256B.038, 256B.0911,
256B.0918, 256B.092, 256B.097, 256B.49, and 256B.765, the revisor of statutes
shall delete the word "traumatic" when it comes before the word
"brain."
(b) In Minnesota Statutes, section 256B.093, subdivision 1,
clauses (4) and (5), and subdivision 3, clause (2), the revisor of statutes
shall delete the word "traumatic" when it comes before the word
"brain."
(c) In Minnesota Statutes, sections 144.0724 and 144G.05,
the revisor of statutes shall delete "TBI" and replace it with
"BI.""
Delete the title and insert:
"A bill for an act relating to state government; making
changes to health and human services policy provisions; modifying provisions
related to continuing care, the telephone equipment program, chemical and
mental health, and health care; reforming comprehensive assessment and case
management services; making technical changes; requiring reports; amending
Minnesota Statutes 2010, sections 144A.071, subdivision 5a; 237.50; 237.51;
237.52; 237.53; 237.54; 237.55; 237.56; 245.461, by adding a subdivision;
245.462, subdivision 20; 245.487, by adding a subdivision; 245.4871,
subdivision 15; 245.4932, subdivision 1; 245A.11, subdivisions 2a, 8; 246.53,
by adding a subdivision; 252.32, subdivision 1a; 252A.21, subdivision 2;
256.476, subdivision 11; 256.9657, subdivision 1; 256B.04, subdivision 14;
256B.056, subdivision 3c; 256B.0595, subdivision 2; 256B.0625, subdivisions 13,
13d, 19c, 42; 256B.0659, subdivisions 1, 2, 3, 3a, 4, 9, 13, 14, 19, 21, 30; 256B.0911,
subdivisions 1, 2b, 2c, 3, 3b, 4c, 6; 256B.0913, subdivisions 7, 8; 256B.0915,
subdivisions 1a, 1b, 3c, 6; 256B.0916, subdivision 7; 256B.092, subdivisions 1,
1a, 1b, 1e, 1g, 2, 3, 5, 7, 8, 8a, 9, 11; 256B.096, subdivision 5; 256B.15,
subdivisions 1c, 1f; 256B.19, subdivision 1c; 256B.441, subdivisions 13, 31,
53; 256B.49, subdivisions 13, 21; 256B.69, subdivision 5; 256F.13, subdivision
1; 256G.02, subdivision 6; 256L.05, subdivision 3; 514.982, subdivision 1;
Minnesota Statutes 2011 Supplement, sections 125A.21, subdivision 7; 144A.071,
subdivisions 3, 4a; 245A.03, subdivision 7; 254B.04, subdivision 2a; 256B.056,
subdivision 3; 256B.057, subdivision 9; 256B.0625, subdivisions 13e, 13h, 14,
56; 256B.0631, subdivisions 1, 2; 256B.0659, subdivision 11; 256B.0911,
subdivisions 1a, 3a, 4a; 256B.0915, subdivision 10; 256B.49, subdivisions 14,
15; 256B.69, subdivisions 5a, 28; 256L.12, subdivision 9; 256L.15, subdivision
1; 626.557, subdivision 9; Laws 2009, chapter 79, article 8, section 81, as
amended; proposing coding for new law in Minnesota Statutes, chapter 252;
repealing Minnesota Statutes 2010, sections 256.01, subdivision 18b; 256B.431,
subdivisions 2c, 2g, 2i, 2j, 2k, 2l, 2o, 3c, 11, 14, 17b, 17f, 19, 20, 25, 27,
29; 256B.434, subdivisions 4a, 4b, 4c, 4d, 4e, 4g, 4h, 7, 8; 256B.435;
256B.436; Minnesota Statutes 2011 Supplement, section 256B.431, subdivision 26;
Minnesota Rules, part 9555.7700."
With the recommendation that when so amended the bill pass
and be re-referred to the Committee on Civil Law.
The
report was adopted.
Gottwalt from the Committee on Health
and Human Services Reform to which was referred:
H. F. No. 2009, A bill for an act relating to
human services; changing human services legal provisions; modifying provisions
related to human services licensing, licensing data, and the Office of
Inspector General; amending the Human Services Background Studies Act; amending
Minnesota Statutes 2010, sections 13.46, subdivision 4; 245A.02, by adding
subdivisions; 245A.04, subdivisions 1, 5, 7, 11, by adding a subdivision;
245A.05; 245A.07, subdivision 3; 245A.08, subdivision 2a; 245A.14, subdivision
11, by adding a subdivision; 245A.146, subdivisions 2, 3; 245A.16, subdivision
4, by adding a subdivision; 245A.18, subdivision 1; 245A.22, subdivision 2;
245A.66, subdivisions 2, 3; 245C.03, subdivision 1; 245C.04, subdivision 1;
245C.05, subdivisions 2, 4, 6, 7, by adding a subdivision; 245C.07; 245C.08,
subdivisions 1, 2, 3, by adding a subdivision; 245C.14, subdivision 2; 245C.15;
245C.16, subdivision 1; 245C.17, subdivision 2; 245C.22, subdivision 5;
245C.23, subdivision 2; 245C.24, subdivision 2; 245C.28, subdivisions 1, 3;
245C.29, subdivision 2; 256.045, subdivision 3b; Minnesota Statutes 2011
Supplement, section 256B.04, subdivision 21; proposing coding for new law in
Minnesota Statutes, chapter 245A; repealing Minnesota Rules, part 9503.0150,
item E.
Reported the same back with the following amendments:
Delete everything after the enacting clause and insert:
"ARTICLE
1
DATA
PRACTICES
Section 1. Minnesota
Statutes 2010, section 13.46, subdivision 2, is amended to read:
Subd. 2. General.
(a) Unless the data is summary data or a statute specifically
provides a different classification, data on individuals collected, maintained,
used, or disseminated by the welfare system is private data on individuals, and
shall not be disclosed except:
(1) according to section 13.05;
(2) according to court order;
(3) according to a statute specifically authorizing access
to the private data;
(4) to an agent of the welfare system and an investigator
acting on behalf of a county, the state, or the federal government,
including a law enforcement person, or attorney, or
investigator acting for it in the investigation or prosecution of a
criminal or, civil, or administrative proceeding relating
to the administration of a program;
(5) to personnel of the welfare system who require the data
to verify an individual's identity; determine eligibility, amount of
assistance, and the need to provide services to an individual or family across
programs; evaluate the effectiveness of programs; assess parental contribution
amounts; and investigate suspected fraud;
(6) to administer federal funds or programs;
(7) between personnel of the welfare system working in the
same program;
(8) to the Department of Revenue to assess parental
contribution amounts for purposes of section 252.27, subdivision 2a, administer
and evaluate tax refund or tax credit programs and to identify individuals who
may benefit from these programs. The
following information may be disclosed under this paragraph: an individual's and their dependent's names,
dates of birth, Social Security numbers, income, addresses, and other data as
required, upon request by the Department of Revenue. Disclosures by the commissioner of revenue to
the commissioner of human services for the purposes described in this clause
are governed by section 270B.14, subdivision 1.
Tax refund or tax credit programs include, but are not limited to, the
dependent care credit under section 290.067, the Minnesota working family
credit under section 290.0671, the property tax refund and rental credit under
section 290A.04, and the Minnesota education credit under section 290.0674;
(9) between the Department of Human Services, the Department
of Employment and Economic Development, and when applicable, the Department of
Education, for the following purposes:
(i) to monitor the eligibility of the data subject for
unemployment benefits, for any employment or training program administered,
supervised, or certified by that agency;
(ii) to administer any rehabilitation program or child care
assistance program, whether alone or in conjunction with the welfare system;
(iii) to monitor and evaluate the Minnesota family
investment program or the child care assistance program by exchanging data on
recipients and former recipients of food support, cash assistance under chapter
256, 256D, 256J, or 256K, child care assistance under chapter 119B, or medical
programs under chapter 256B, 256D, or 256L; and
(iv) to analyze public assistance employment services and
program utilization, cost, effectiveness, and outcomes as implemented under the
authority established in Title II, Sections 201-204 of the Ticket to Work and
Work Incentives Improvement Act of 1999.
Health records governed by sections 144.291 to 144.298 and
"protected health information" as defined in Code of Federal
Regulations, title 45, section 160.103, and governed by Code of Federal
Regulations, title 45, parts 160-164, including health care claims utilization
information, must not be exchanged under this clause;
(10) to appropriate parties in connection with an emergency
if knowledge of the information is necessary to protect the health or safety of
the individual or other individuals or persons;
(11) data maintained by residential programs as defined in
section 245A.02 may be disclosed to the protection and advocacy system
established in this state according to Part C of Public Law 98-527 to protect
the legal and human rights of persons with developmental disabilities or other
related conditions who live in residential facilities for these persons if the protection
and advocacy system receives a complaint by or on behalf of that person and the
person does not have a legal guardian or the state or a designee of the state
is the legal guardian of the person;
(12) to the county medical examiner or the county coroner
for identifying or locating relatives or friends of a deceased person;
(13) data on a child support obligor who makes payments to
the public agency may be disclosed to the Minnesota Office of Higher Education
to the extent necessary to determine eligibility under section 136A.121,
subdivision 2, clause (5);
(14) participant Social Security numbers and names collected
by the telephone assistance program may be disclosed to the Department of
Revenue to conduct an electronic data match with the property tax refund
database to determine eligibility under section 237.70, subdivision 4a;
(15) the current address of a Minnesota family investment
program participant may be disclosed to law enforcement officers who provide
the name of the participant and notify the agency that:
(i) the participant:
(A) is a fugitive felon fleeing to avoid prosecution, or
custody or confinement after conviction, for a crime or attempt to commit a
crime that is a felony under the laws of the jurisdiction from which the individual
is fleeing; or
(B) is violating a condition of probation or parole imposed
under state or federal law;
(ii) the location or apprehension of the felon is within the
law enforcement officer's official duties; and
(iii) the request is made in writing and in the proper
exercise of those duties;
(16) the current address of a recipient of general
assistance or general assistance medical care may be disclosed to probation
officers and corrections agents who are supervising the recipient and to law
enforcement officers who are investigating the recipient in connection with a
felony level offense;
(17) information obtained from food support applicant or
recipient households may be disclosed to local, state, or federal law
enforcement officials, upon their written request, for the purpose of
investigating an alleged violation of the Food Stamp Act, according to Code of
Federal Regulations, title 7, section 272.1 (c);
(18) the address, Social Security number, and, if available,
photograph of any member of a household receiving food support shall be made
available, on request, to a local, state, or federal law enforcement officer if
the officer furnishes the agency with the name of the member and notifies the
agency that:
(i) the member:
(A) is fleeing to avoid prosecution, or custody or
confinement after conviction, for a crime or attempt to commit a crime that is
a felony in the jurisdiction the member is fleeing;
(B) is violating a condition of probation or parole imposed
under state or federal law; or
(C) has information that is necessary for the officer to
conduct an official duty related to conduct described in subitem (A) or (B);
(ii) locating or apprehending the member is within the
officer's official duties; and
(iii) the request is made in writing and in the proper
exercise of the officer's official duty;
(19) the current address of a recipient of Minnesota family
investment program, general assistance, general assistance medical care, or
food support may be disclosed to law enforcement officers who, in writing,
provide the name of the recipient and notify the agency that the recipient is a
person required to register under section 243.166, but is not residing at the
address at which the recipient is registered under section 243.166;
(20) certain information regarding child support obligors
who are in arrears may be made public according to section 518A.74;
(21) data on child support payments made by a child support
obligor and data on the distribution of those payments excluding identifying information
on obligees may be disclosed to all obligees to whom the obligor owes support,
and data on the enforcement actions undertaken by the public authority, the
status of those actions, and data on the income of the obligor or obligee may
be disclosed to the other party;
(22) data in the work reporting system may be disclosed
under section 256.998, subdivision 7;
(23) to the Department of Education for the purpose of
matching Department of Education student data with public assistance data to
determine students eligible for free and reduced-price meals, meal supplements,
and free milk according to United States Code, title 42, sections 1758, 1761,
1766, 1766a, 1772, and 1773; to allocate federal and state funds that are
distributed based on income of the student's family; and to verify receipt of
energy assistance for the telephone assistance plan;
(24) the current address and telephone number of program
recipients and emergency contacts may be released to the commissioner of health
or a local board of health as defined in section 145A.02, subdivision 2, when
the commissioner or local board of health has reason to believe that a program
recipient is a disease case, carrier, suspect case, or at risk of illness, and
the data are necessary to locate the person;
(25) to other state agencies, statewide systems, and
political subdivisions of this state, including the attorney general, and
agencies of other states, interstate information networks, federal agencies,
and other entities as required by federal regulation or law for the
administration of the child support enforcement program;
(26) to personnel of public assistance programs as defined
in section 256.741, for access to the child support system database for the
purpose of administration, including monitoring and evaluation of those public
assistance programs;
(27) to monitor and evaluate the Minnesota family investment
program by exchanging data between the Departments of Human Services and
Education, on recipients and former recipients of food support, cash assistance
under chapter 256, 256D, 256J, or 256K, child care assistance under chapter
119B, or medical programs under chapter 256B, 256D, or 256L;
(28) to evaluate child support program performance and to
identify and prevent fraud in the child support program by exchanging data
between the Department of Human Services, Department of Revenue under section
270B.14, subdivision 1, paragraphs (a) and (b), without regard to the
limitation of use in paragraph (c), Department of Health, Department of Employment
and Economic Development, and other state agencies as is reasonably necessary
to perform these functions;
(29) counties operating child care assistance programs under
chapter 119B may disseminate data on program participants, applicants, and providers
to the commissioner of education; or
(30) child support data on the parents and the child may be
disclosed to agencies administering programs under titles IV-B and IV-E of the
Social Security Act, as provided by federal law. Data may be disclosed only to the extent
necessary for the purpose of establishing parentage or for determining who has
or may have parental rights with respect to a child, which could be related to
permanency planning.
(b) Information on persons who have been treated for drug or
alcohol abuse may only be disclosed according to the requirements of Code of
Federal Regulations, title 42, sections 2.1 to 2.67.
(c) Data provided to law enforcement agencies under
paragraph (a), clause (15), (16), (17), or (18), or paragraph (b), are
investigative data and are confidential or protected nonpublic while the
investigation is active. The data are
private after the investigation becomes inactive under section 13.82,
subdivision 5, paragraph (a) or (b).
(d) Mental health data shall be treated as provided in
subdivisions 7, 8, and 9, but is not subject to the access provisions of
subdivision 10, paragraph (b).
For the purposes of this subdivision, a request will be
deemed to be made in writing if made through a computer interface system.
Sec. 2. Minnesota
Statutes 2010, section 13.46, subdivision 3, is amended to read:
Subd. 3. Investigative data. (a) Data on persons, including data on
vendors of services, licensees, and applicants that is collected, maintained,
used, or disseminated by the welfare system in an investigation, authorized by
statute, and relating to the enforcement of rules or law is confidential data
on individuals pursuant to section 13.02, subdivision 3, or protected nonpublic
data not on individuals pursuant to section 13.02, subdivision 13, and shall
not be disclosed except:
(1) pursuant to section 13.05;
(2) pursuant to statute or valid court order;
(3) to a party named in a civil or criminal proceeding,
administrative or judicial, for preparation of defense; or
(4) to provide notices required or permitted by statute.
The data referred to in this subdivision shall be classified
as public data upon its submission to an administrative law judge or court in
an administrative or judicial proceeding.
Inactive welfare investigative data shall be treated as provided in
section 13.39, subdivision 3.
(b) Notwithstanding any other provision in law, the
commissioner of human services shall provide all active and inactive
investigative data, including the name of the reporter of alleged maltreatment
under section 626.556 or 626.557, to the ombudsman for mental health and
developmental disabilities upon the request of the ombudsman.
(c) Notwithstanding paragraph (a) and section 13.39, the
existence and status of an investigation by the commissioner of possible
overpayments of public funds to a service provider are public data during an
investigation.
Sec. 3. Minnesota
Statutes 2010, section 13.46, subdivision 4, is amended to read:
Subd. 4. Licensing data. (a) As used in this subdivision:
(1) "licensing data" means all data collected,
maintained, used, or disseminated by the welfare system pertaining to persons
licensed or registered or who apply for licensure or registration or who
formerly were licensed or registered under the authority of the commissioner of
human services;