1.1                          A bill for an act 
  1.2             relating to human services; providing medical 
  1.3             assistance and alternative care reimbursement for 
  1.4             certain employee travel costs in conjunction with 
  1.5             services provided in the recipient's home; 
  1.6             appropriating money; amending Minnesota Statutes 2000, 
  1.7             sections 256B.0625, by adding a subdivision; and 
  1.8             256B.0913, subdivision 5. 
  1.9   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.10     Section 1.  Minnesota Statutes 2000, section 256B.0625, is 
  1.11  amended by adding a subdivision to read: 
  1.12     Subd. 17b.  [TRANSPORTATION COSTS IN CONJUNCTION WITH HOME 
  1.13  CARE.] (a) Effective for services rendered on or after October 
  1.14  1, 2001, medical assistance covers transportation costs of an 
  1.15  employee for services provided to a recipient, if the following 
  1.16  conditions are satisfied: 
  1.17     (1) the services are provided by a home health aide, a 
  1.18  personal care assistant, or a homemaker; 
  1.19     (2) the services are provided at the recipient's place of 
  1.20  residence, provided the residence is not a nursing facility, a 
  1.21  boarding care home, a group residential housing facility, a 
  1.22  housing with services establishment, or an assisted living 
  1.23  facility; and 
  1.24     (3) the services are provided under medical assistance, the 
  1.25  elderly waiver, the community alternatives for disabled 
  1.26  individuals waiver, the community alternative care waiver, the 
  1.27  traumatic brain injury waiver, or the community-based services 
  2.1   waiver for persons with mental retardation or related conditions.
  2.2      (b) Transportation costs shall be reimbursed as follows:  
  2.3      (1) for workers traveling by private automobile, 
  2.4   reimbursement shall be at 100 percent of the standard mileage 
  2.5   rate deduction allowable under section 162 of the Internal 
  2.6   Revenue Code of 1986, as amended through December 31, 2000, for 
  2.7   actual mileage traveled; and 
  2.8      (2) for workers using public transportation, reimbursement 
  2.9   shall be 100 percent of actual costs, not to exceed the cost of 
  2.10  a monthly bus pass, if applicable. 
  2.11     (c) The employer shall record actual mileage; submit 
  2.12  expense reports to the commissioner on a form developed by the 
  2.13  commissioner; reimburse employees for mileage by no less than 
  2.14  the amount received from the commissioner for these costs; and 
  2.15  file an annual report of reimbursements received and payments 
  2.16  issued to employees on a form developed by the commissioner. 
  2.17     Sec. 2.  Minnesota Statutes 2000, section 256B.0913, 
  2.18  subdivision 5, is amended to read: 
  2.19     Subd. 5.  [SERVICES COVERED UNDER ALTERNATIVE CARE.] (a) 
  2.20  Alternative care funding may be used for payment of costs of: 
  2.21     (1) adult foster care; 
  2.22     (2) adult day care; 
  2.23     (3) home health aide; 
  2.24     (4) homemaker services; 
  2.25     (5) personal care; 
  2.26     (6) case management; 
  2.27     (7) respite care; 
  2.28     (8) assisted living; 
  2.29     (9) residential care services; 
  2.30     (10) care-related supplies and equipment; 
  2.31     (11) meals delivered to the home; 
  2.32     (12) transportation, including transportation expenses of 
  2.33  workers for providing services at the recipient's place of 
  2.34  residence, at the rate established in section 256B.0625, 
  2.35  subdivision 17b, provided the requirements of that subdivision 
  2.36  are satisfied; 
  3.1      (13) skilled nursing; 
  3.2      (14) chore services; 
  3.3      (15) companion services; 
  3.4      (16) nutrition services; 
  3.5      (17) training for direct informal caregivers; 
  3.6      (18) telemedicine devices to monitor recipients in their 
  3.7   own homes as an alternative to hospital care, nursing home care, 
  3.8   or home visits; and 
  3.9      (19) other services including direct cash payments to 
  3.10  clients, approved by the county agency, subject to the 
  3.11  provisions of paragraph (m).  Total annual payments for other 
  3.12  services for all clients within a county may not exceed either 
  3.13  ten percent of that county's annual alternative care program 
  3.14  base allocation or $5,000, whichever is greater.  In no case 
  3.15  shall this amount exceed the county's total annual alternative 
  3.16  care program base allocation. 
  3.17     (b) The county agency must ensure that the funds are used 
  3.18  only to supplement and not supplant services available through 
  3.19  other public assistance or services programs. 
  3.20     (c) Unless specified in statute, the service standards for 
  3.21  alternative care services shall be the same as the service 
  3.22  standards defined in the elderly waiver.  Except for the county 
  3.23  agencies' approval of direct cash payments to clients, persons 
  3.24  or agencies must be employed by or under a contract with the 
  3.25  county agency or the public health nursing agency of the local 
  3.26  board of health in order to receive funding under the 
  3.27  alternative care program. 
  3.28     (d) The adult foster care rate shall be considered a 
  3.29  difficulty of care payment and shall not include room and 
  3.30  board.  The adult foster care daily rate shall be negotiated 
  3.31  between the county agency and the foster care provider.  The 
  3.32  rate established under this section shall not exceed 75 percent 
  3.33  of the state average monthly nursing home payment for the case 
  3.34  mix classification to which the individual receiving foster care 
  3.35  is assigned, and it must allow for other alternative care 
  3.36  services to be authorized by the case manager. 
  4.1      (e) Personal care services may be provided by a personal 
  4.2   care provider organization.  A county agency may contract with a 
  4.3   relative of the client to provide personal care services, but 
  4.4   must ensure nursing supervision.  Covered personal care services 
  4.5   defined in section 256B.0627, subdivision 4, must meet 
  4.6   applicable standards in Minnesota Rules, part 9505.0335. 
  4.7      (f) A county may use alternative care funds to purchase 
  4.8   medical supplies and equipment without prior approval from the 
  4.9   commissioner when:  (1) there is no other funding source; (2) 
  4.10  the supplies and equipment are specified in the individual's 
  4.11  care plan as medically necessary to enable the individual to 
  4.12  remain in the community according to the criteria in Minnesota 
  4.13  Rules, part 9505.0210, item A; and (3) the supplies and 
  4.14  equipment represent an effective and appropriate use of 
  4.15  alternative care funds.  A county may use alternative care funds 
  4.16  to purchase supplies and equipment from a non-Medicaid certified 
  4.17  vendor if the cost for the items is less than that of a Medicaid 
  4.18  vendor.  A county is not required to contract with a provider of 
  4.19  supplies and equipment if the monthly cost of the supplies and 
  4.20  equipment is less than $250.  
  4.21     (g) For purposes of this section, residential care services 
  4.22  are services which are provided to individuals living in 
  4.23  residential care homes.  Residential care homes are currently 
  4.24  licensed as board and lodging establishments and are registered 
  4.25  with the department of health as providing special services.  
  4.26  Residential care services are defined as "supportive services" 
  4.27  and "health-related services."  "Supportive services" means the 
  4.28  provision of up to 24-hour supervision and oversight.  
  4.29  Supportive services includes:  (1) transportation, when provided 
  4.30  by the residential care center only; (2) socialization, when 
  4.31  socialization is part of the plan of care, has specific goals 
  4.32  and outcomes established, and is not diversional or recreational 
  4.33  in nature; (3) assisting clients in setting up meetings and 
  4.34  appointments; (4) assisting clients in setting up medical and 
  4.35  social services; (5) providing assistance with personal laundry, 
  4.36  such as carrying the client's laundry to the laundry room.  
  5.1   Assistance with personal laundry does not include any laundry, 
  5.2   such as bed linen, that is included in the room and board rate.  
  5.3   Health-related services are limited to minimal assistance with 
  5.4   dressing, grooming, and bathing and providing reminders to 
  5.5   residents to take medications that are self-administered or 
  5.6   providing storage for medications, if requested.  Individuals 
  5.7   receiving residential care services cannot receive homemaking 
  5.8   services.  
  5.9      (h) For the purposes of this section, "assisted living" 
  5.10  refers to supportive services provided by a single vendor to 
  5.11  clients who reside in the same apartment building of three or 
  5.12  more units which are not subject to registration under chapter 
  5.13  144D.  Assisted living services are defined as up to 24-hour 
  5.14  supervision, and oversight, supportive services as defined in 
  5.15  clause (1), individualized home care aide tasks as defined in 
  5.16  clause (2), and individualized home management tasks as defined 
  5.17  in clause (3) provided to residents of a residential center 
  5.18  living in their units or apartments with a full kitchen and 
  5.19  bathroom.  A full kitchen includes a stove, oven, refrigerator, 
  5.20  food preparation counter space, and a kitchen utensil storage 
  5.21  compartment.  Assisted living services must be provided by the 
  5.22  management of the residential center or by providers under 
  5.23  contract with the management or with the county. 
  5.24     (1) Supportive services include:  
  5.25     (i) socialization, when socialization is part of the plan 
  5.26  of care, has specific goals and outcomes established, and is not 
  5.27  diversional or recreational in nature; 
  5.28     (ii) assisting clients in setting up meetings and 
  5.29  appointments; and 
  5.30     (iii) providing transportation, when provided by the 
  5.31  residential center only.  
  5.32     Individuals receiving assisted living services will not 
  5.33  receive both assisted living services and homemaking services.  
  5.34  Individualized means services are chosen and designed 
  5.35  specifically for each resident's needs, rather than provided or 
  5.36  offered to all residents regardless of their illnesses, 
  6.1   disabilities, or physical conditions.  
  6.2      (2) Home care aide tasks means:  
  6.3      (i) preparing modified diets, such as diabetic or low 
  6.4   sodium diets; 
  6.5      (ii) reminding residents to take regularly scheduled 
  6.6   medications or to perform exercises; 
  6.7      (iii) household chores in the presence of technically 
  6.8   sophisticated medical equipment or episodes of acute illness or 
  6.9   infectious disease; 
  6.10     (iv) household chores when the resident's care requires the 
  6.11  prevention of exposure to infectious disease or containment of 
  6.12  infectious disease; and 
  6.13     (v) assisting with dressing, oral hygiene, hair care, 
  6.14  grooming, and bathing, if the resident is ambulatory, and if the 
  6.15  resident has no serious acute illness or infectious disease.  
  6.16  Oral hygiene means care of teeth, gums, and oral prosthetic 
  6.17  devices.  
  6.18     (3) Home management tasks means:  
  6.19     (i) housekeeping; 
  6.20     (ii) laundry; 
  6.21     (iii) preparation of regular snacks and meals; and 
  6.22     (iv) shopping.  
  6.23     Assisted living services as defined in this section shall 
  6.24  not be authorized in boarding and lodging establishments 
  6.25  licensed according to sections 157.011 and 157.15 to 157.22. 
  6.26     (i) For establishments registered under chapter 144D, 
  6.27  assisted living services under this section means the services 
  6.28  described and licensed under section 144A.4605. 
  6.29     (j) For the purposes of this section, reimbursement for 
  6.30  assisted living services and residential care services shall be 
  6.31  a monthly rate negotiated and authorized by the county agency 
  6.32  based on an individualized service plan for each resident.  The 
  6.33  rate shall not exceed the nonfederal share of the greater of 
  6.34  either the statewide or any of the geographic groups' weighted 
  6.35  average monthly medical assistance nursing facility payment rate 
  6.36  of the case mix resident class to which the 180-day eligible 
  7.1   client would be assigned under Minnesota Rules, parts 9549.0050 
  7.2   to 9549.0059, unless the services are provided by a home care 
  7.3   provider licensed by the department of health and are provided 
  7.4   in a building that is registered as a housing with services 
  7.5   establishment under chapter 144D and that provides 24-hour 
  7.6   supervision. 
  7.7      (k) For purposes of this section, companion services are 
  7.8   defined as nonmedical care, supervision and oversight, provided 
  7.9   to a functionally impaired adult.  Companions may assist the 
  7.10  individual with such tasks as meal preparation, laundry and 
  7.11  shopping, but do not perform these activities as discrete 
  7.12  services.  The provision of companion services does not entail 
  7.13  hands-on medical care.  Providers may also perform light 
  7.14  housekeeping tasks which are incidental to the care and 
  7.15  supervision of the recipient.  This service must be approved by 
  7.16  the case manager as part of the care plan.  Companion services 
  7.17  must be provided by individuals or organizations who are under 
  7.18  contract with the local agency to provide the service.  Any 
  7.19  person related to the waiver recipient by blood, marriage or 
  7.20  adoption cannot be reimbursed under this service.  Persons 
  7.21  providing companion services will be monitored by the case 
  7.22  manager. 
  7.23     (l) For purposes of this section, training for direct 
  7.24  informal caregivers is defined as a classroom or home course of 
  7.25  instruction which may include:  transfer and lifting skills, 
  7.26  nutrition, personal and physical cares, home safety in a home 
  7.27  environment, stress reduction and management, behavioral 
  7.28  management, long-term care decision making, care coordination 
  7.29  and family dynamics.  The training is provided to an informal 
  7.30  unpaid caregiver of a 180-day eligible client which enables the 
  7.31  caregiver to deliver care in a home setting with high levels of 
  7.32  quality.  The training must be approved by the case manager as 
  7.33  part of the individual care plan.  Individuals, agencies, and 
  7.34  educational facilities which provide caregiver training and 
  7.35  education will be monitored by the case manager. 
  7.36     (m) A county agency may make payment from their alternative 
  8.1   care program allocation for other services provided to an 
  8.2   alternative care program recipient if those services prevent, 
  8.3   shorten, or delay institutionalization.  These services may 
  8.4   include direct cash payments to the recipient for the purpose of 
  8.5   purchasing the recipient's services.  The following provisions 
  8.6   apply to payments under this paragraph: 
  8.7      (1) a cash payment to a client under this provision cannot 
  8.8   exceed 80 percent of the monthly payment limit for that client 
  8.9   as specified in subdivision 4, paragraph (a), clause (7); 
  8.10     (2) a county may not approve any cash payment for a client 
  8.11  who has been assessed as having a dependency in orientation, 
  8.12  unless the client has an authorized representative under section 
  8.13  256.476, subdivision 2, paragraph (g), or for a client who is 
  8.14  concurrently receiving adult foster care, residential care, or 
  8.15  assisted living services; 
  8.16     (3) any service approved under this section must be a 
  8.17  service which meets the purpose and goals of the program as 
  8.18  listed in subdivision 1; 
  8.19     (4) cash payments must also meet the criteria of and are 
  8.20  governed by the procedures and liability protection established 
  8.21  in section 256.476, subdivision 4, paragraphs (b) through (h), 
  8.22  and recipients of cash grants must meet the requirements in 
  8.23  section 256.476, subdivision 10; and 
  8.24     (5) the county shall report client outcomes, services, and 
  8.25  costs under this paragraph in a manner prescribed by the 
  8.26  commissioner. 
  8.27  Upon implementation of direct cash payments to clients under 
  8.28  this section, any person determined eligible for the alternative 
  8.29  care program who chooses a cash payment approved by the county 
  8.30  agency shall receive the cash payment under this section and not 
  8.31  under section 256.476 unless the person was receiving a consumer 
  8.32  support grant under section 256.476 before implementation of 
  8.33  direct cash payments under this section. 
  8.34     Sec. 3.  [APPROPRIATION.] 
  8.35     $....... is appropriated from the general fund to the 
  8.36  commissioner of human services for the biennium beginning July 
  9.1   1, 2001, for the purposes of sections 1 and 2.