1.1.................... moves to amend H.F. No. 1114 as follows:
1.2Delete everything after the enacting clause and insert:

1.3    "Section 1. Minnesota Statutes 2008, section 245A.11, subdivision 2a, is amended to
1.5    Subd. 2a. Adult foster care license capacity. The commissioner shall issue adult
1.6foster care licenses with a maximum licensed capacity of four beds, including nonstaff
1.7roomers and boarders, but may issue a license with a capacity of five beds, including
1.8roomers and boarders, only according to paragraph (a) through (e).
1.9(a) An adult foster care license holder may have a maximum license capacity of five
1.10if all persons in care are age 55 or over and do not have a serious and persistent mental
1.11illness or a developmental disability.
1.12(b) The commissioner may grant variances to paragraph (a) to allow a foster care
1.13provider with a licensed capacity of five persons to admit an individual under the age of 55
1.14if the variance complies with section 245A.04, subdivision 9, and approval of the variance
1.15is recommended by the county in which the licensed foster care provider is located.
1.16(c) The commissioner may grant variances to paragraph (a) to allow the use of a fifth
1.17bed for emergency crisis services for a person with serious and persistent mental illness
1.18or a developmental disability, regardless of age, if the variance complies with section
1.19245A.04, subdivision 9 , and approval of the variance is recommended by the county in
1.20which the licensed foster care provider is located.
1.21(d) Notwithstanding paragraph (a), the commissioner may issue an adult foster
1.22care license with a capacity of five adults if the fifth bed does not increase the overall
1.23statewide capacity of licensed adult foster care beds in homes which are not the primary
1.24residence of the license holder, over the licensed capacity in such homes on July 1, 2009,
1.25as identified in a plan submitted to the commissioner by the county, when the capacity is
1.26recommended by the county licensing agency of the county in which the facility is located
1.27and if the recommendation verifies that:
2.1(1) the facility meets the physical environment requirements in the adult foster
2.2care licensing rule;
2.3(2) the five-bed living arrangement is specified for each resident in the resident's:
2.4(i) individualized plan of care;
2.5(ii) individual service plan under section 256B.092, subdivision 1b, if required; or
2.6(iii) individual resident placement agreement under Minnesota Rules, part
2.79555.5105, subpart 19, if required;
2.8(3) the license holder obtains written and signed informed consent from each
2.9resident or resident's legal representative documenting the resident's informed choice to
2.10living in the home and that the resident's refusal to consent would not have resulted in
2.11service termination; and
2.12(4) the facility was licensed for adult foster care before March 1, 2003 2009.
2.13(e) The commissioner shall not issue a new adult foster care license under paragraph
2.14(d) after June 30, 2005 2011. The commissioner shall allow a facility with an adult foster
2.15care license issued under paragraph (d) before June 30, 2005 2011, to continue with a
2.16capacity of five adults if the license holder continues to comply with the requirements in
2.17paragraph (d).

2.18    Sec. 2. Minnesota Statutes 2008, section 256B.092, subdivision 5a, is amended to read:
2.19    Subd. 5a. Increasing adult foster care capacity to serve five persons. (a) When
2.20an a licensed adult foster care provider increases the capacity of an existing four-bed home
2.21licensed to serve four persons and obtains a license to serve a fifth person under this
2.22section, the county agency shall reduce the contracted negotiate per diem cost for room
2.23and board and the developmental disability waiver services of the existing foster care
2.24home by an average of 14 percent for all individuals living in that home. A county agency
2.25may average the required per diem rate reductions across several adult foster care homes
2.26that expand capacity under this section to achieve the necessary overall per diem reduction
2.27with the provider to manage a legislated rate reduction. The revised per diem costs must
2.28demonstrate an overall reduction in the payment to the provider for the persons receiving
2.29services affected by the occupancy change.
2.30(b) Following the contract changes in paragraph (a), the commissioner shall adjust:
2.31(1) individual county allocations for developmental disability waivered services by
2.32the amount of savings that results from the changes made for developmental disability
2.33waiver recipients for whom the county is financially responsible; and
2.34(2) group residential housing rate payments to the adult foster care home by the
2.35amount of savings that results from the changes made.
3.1(c) Effective July 1, 2003, when a new five-person adult foster care home is licensed
3.2under this section, county agencies shall not establish group residential housing room
3.3and board rates and developmental disability waiver service rates for the new home that
3.4exceed 86 percent of the average per diem room and board and developmental disability
3.5waiver services costs of four-person homes serving persons with comparable needs and in
3.6the same geographic area. A county agency developing more than one new five-person
3.7adult foster care home may average the required per diem rates across the homes to
3.8achieve the necessary overall per diem reductions.
3.9(d) The commissioner shall reduce the individual county allocations for
3.10developmental disability waivered services by the savings resulting from the per diem
3.11limits on adult foster care recipients for whom the county is financially responsible, and
3.12shall limit the group residential housing rate for a new five-person adult foster care home.

3.13    Sec. 3. Minnesota Statutes 2008, section 256B.49, subdivision 17, is amended to read:
3.14    Subd. 17. Cost of services and supports. (a) The commissioner shall ensure
3.15that the average per capita expenditures estimated in any fiscal year for home and
3.16community-based waiver recipients does not exceed the average per capita expenditures
3.17that would have been made to provide institutional services for recipients in the absence
3.18of the waiver.
3.19(b) The commissioner shall implement on January 1, 2002, one or more aggregate,
3.20need-based methods for allocating to local agencies the home and community-based
3.21waivered service resources available to support recipients with disabilities in need of
3.22the level of care provided in a nursing facility or a hospital. The commissioner shall
3.23allocate resources to single counties and county partnerships in a manner that reflects
3.24consideration of:
3.25(1) an incentive-based payment process for achieving outcomes;
3.26(2) the need for a state-level risk pool;
3.27(3) the need for retention of management responsibility at the state agency level; and
3.28(4) a phase-in strategy as appropriate.
3.29(c) Until the allocation methods described in paragraph (b) are implemented, the
3.30annual allowable reimbursement level of home and community-based waiver services
3.31shall be the greater of:
3.32(1) the statewide average payment amount which the recipient is assigned under the
3.33waiver reimbursement system in place on June 30, 2001, modified by the percentage of
3.34any provider rate increase appropriated for home and community-based services; or
4.1(2) an amount approved by the commissioner based on the recipient's extraordinary
4.2needs that cannot be met within the current allowable reimbursement level. The
4.3increased reimbursement level must be necessary to allow the recipient to be discharged
4.4from an institution or to prevent imminent placement in an institution. The additional
4.5reimbursement may be used to secure environmental modifications; assistive technology
4.6and equipment; and increased costs for supervision, training, and support services
4.7necessary to address the recipient's extraordinary needs. The commissioner may approve
4.8an increased reimbursement level for up to one year of the recipient's relocation from an
4.9institution or up to six months of a determination that a current waiver recipient is at
4.10imminent risk of being placed in an institution.
4.11(d) Beginning July 1, 2001, medically necessary private duty nursing services will be
4.12authorized under this section as complex and regular care according to sections 256B.0651
4.13and 256B.0653 to 256B.0656. The rate established by the commissioner for registered
4.14nurse or licensed practical nurse services under any home and community-based waiver as
4.15of January 1, 2001, shall not be reduced.
4.16(e) When a licensed adult foster care provider seeks to increase the capacity of an
4.17existing four-bed home to be licensed to serve a fifth person under section 245A.11,
4.18subdivision 2a, the county agency shall negotiate the per diem cost for room and board and
4.19the waiver services with the provider to manage a legislatively required rate reduction.
4.20The revised per diem costs must demonstrate an overall reduction in the payment to the
4.21provider for the persons receiving services affected by the occupancy change.

4.24Minnesota Statutes, section 252.28, subdivision 3, paragraph (d), shall not be in
4.25effect from July 1, 2009, to June 30, 2011, to allow the commissioner to issue licenses
4.26for residential programs with a capacity of five adults under the conditions specified in
4.27section 245A.11, subdivision 2a.

4.28    Sec. 5. WAIVER.
4.29By December 1, 2009, the commissioner shall request all federal approvals and
4.30waiver amendments to the disability home and community-based waivers to allow properly
4.31licensed adult foster care homes to provide residential services for up to five individuals.

4.32    Sec. 6. EFFECTIVE DATE.
4.33Sections 1 to 5 are effective July 1, 2009."
4.34Amend the title accordingly