1.1                          A bill for an act 
  1.2             relating to human services; establishing level of care 
  1.3             for nursing home placement; allowing alternative care 
  1.4             funds for certain individuals; requesting federal 
  1.5             waivers for long-term care demonstration projects; 
  1.6             amending Minnesota Statutes 1994, sections 144.0721, 
  1.7             by adding a subdivision; 256B.0911, subdivision 4; and 
  1.8             256B.0913, by adding a subdivision; proposing coding 
  1.9             for new law in Minnesota Statutes, chapter 256B. 
  1.10  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.11     Section 1.  Minnesota Statutes 1994, section 144.0721, is 
  1.12  amended by adding a subdivision to read: 
  1.13     Subd. 3.  [LEVEL OF CARE CRITERIA; MODIFICATIONS.] The 
  1.14  commissioner shall seek appropriate federal waivers to implement 
  1.15  this subdivision.  Notwithstanding any laws or rules to the 
  1.16  contrary, effective July 1, 1996, Minnesota's level of care 
  1.17  criteria for admission of any person to a nursing home licensed 
  1.18  under chapter 144A, or a boarding care home licensed under 
  1.19  sections 144.50 to 144.56, is modified as follows: 
  1.20     (1) the resident reimbursement classifications and 
  1.21  terminology established by rule under sections 256B.41 to 
  1.22  256B.48 are the basis for applying the level of care criteria 
  1.23  changes; 
  1.24     (2) an applicant to a nursing home or boarding care home 
  1.25  who is dependent in two or fewer case mix activities of daily 
  1.26  living, and who is independent in orientation and 
  1.27  self-preservation, is classified as a high function class A 
  2.1   person and is not eligible for admission to Minnesota nursing 
  2.2   facilities; 
  2.3      (3) applicants in clause (2) are eligible for a service 
  2.4   allowance under section 256B.0913, subdivision 15, and are not 
  2.5   eligible for services under sections 256B.0913, subdivisions 1 
  2.6   to 14, and 256B.0915, and personal care attendant and home 
  2.7   health aide services under section 256B.0625.  Applicants in 
  2.8   clause (2) will have the option of residing in community 
  2.9   settings under sections 256I.01 to 256I.06, if otherwise 
  2.10  eligible, or receiving the services allowance option under 
  2.11  section 256B.0913, subdivision 15, but not both; 
  2.12     (4) residents of a nursing home or boarding care home who 
  2.13  were admitted before July 1, 1996, are not subject to the new 
  2.14  level of care criteria unless the resident is discharged home or 
  2.15  to another service setting other than a nursing home or boarding 
  2.16  care home and applies for admission to a nursing home or 
  2.17  boarding care home after June 30, 1996; 
  2.18     (5) the commissioner of health, in cooperation with the 
  2.19  commissioner of human services, shall adopt emergency rules for 
  2.20  admission exceptions criteria and an appeals process which takes 
  2.21  into account extraordinary circumstances including but not 
  2.22  limited to the absence or inaccessibility of suitable 
  2.23  alternatives, contravening family circumstances, and protective 
  2.24  service issues; 
  2.25     (6) the local screening teams under section 256B.0911 shall 
  2.26  make preliminary determinations concerning the existence of 
  2.27  extraordinary circumstances and may authorize an admission for a 
  2.28  short-term stay at a nursing home or boarding care home in 
  2.29  accordance with a treatment and discharge plan for up to 30 
  2.30  days; and 
  2.31     (7) an individual deemed ineligible for admission to 
  2.32  Minnesota nursing facilities or for services under sections 
  2.33  256B.0913, subdivisions 1 to 14, and 256B.0915 is entitled to an 
  2.34  appeal under section 256.045. 
  2.35     Sec. 2.  Minnesota Statutes 1994, section 256B.0911, 
  2.36  subdivision 4, is amended to read: 
  3.1      Subd. 4.  [RESPONSIBILITIES OF THE COUNTY AND THE SCREENING 
  3.2   TEAM.] (a) The county shall: 
  3.3      (1) provide information and education to the general public 
  3.4   regarding availability of the preadmission screening program; 
  3.5      (2) accept referrals from individuals, families, human 
  3.6   service and health professionals, and hospital and nursing 
  3.7   facility personnel; 
  3.8      (3) assess the health, psychological, and social needs of 
  3.9   referred individuals and identify services needed to maintain 
  3.10  these persons in the least restrictive environments; 
  3.11     (4) determine if the individual screened needs nursing 
  3.12  facility level of care; 
  3.13     (5) assess specialized service needs based upon an 
  3.14  evaluation by: 
  3.15     (i) a qualified independent mental health professional for 
  3.16  persons with a primary or secondary diagnosis of a serious 
  3.17  mental illness; and 
  3.18     (ii) a qualified mental retardation professional for 
  3.19  persons with a primary or secondary diagnosis of mental 
  3.20  retardation or related conditions.  For purposes of this clause, 
  3.21  a qualified mental retardation professional must meet the 
  3.22  standards for a qualified mental retardation professional in 
  3.23  Code of Federal Regulations, title 42, section 483.430; 
  3.24     (6) make recommendations for individuals screened regarding 
  3.25  cost-effective community services which are available to the 
  3.26  individual; 
  3.27     (7) make recommendations for individuals screened regarding 
  3.28  nursing home placement when there are no cost-effective 
  3.29  community services available; 
  3.30     (8) develop an individual's community care plan and provide 
  3.31  follow-up services as needed; and 
  3.32     (9) prepare and submit reports that may be required by the 
  3.33  commissioner of human services. 
  3.34     (b) The screener shall document that the most 
  3.35  cost-effective alternatives available were offered to the 
  3.36  individual or the individual's legal representative.  For 
  4.1   purposes of this section, "cost-effective alternatives" means 
  4.2   community services and living arrangements that cost the same or 
  4.3   less than nursing facility care. 
  4.4      (c) Screeners shall adhere to the level of care criteria 
  4.5   for admission to a nursing facility established under section 
  4.6   144.0721.  
  4.7      (d) For persons who are eligible for medical assistance or 
  4.8   who would be eligible within 180 days of admission to a nursing 
  4.9   facility and who are admitted to a nursing facility, the nursing 
  4.10  facility must include a screener or the case manager in the 
  4.11  discharge planning process for those individuals who the team 
  4.12  has determined have discharge potential.  The screener or the 
  4.13  case manager must ensure a smooth transition and follow-up for 
  4.14  the individual's return to the community. 
  4.15     Screeners shall cooperate with other public and private 
  4.16  agencies in the community, in order to offer a variety of 
  4.17  cost-effective services to the disabled and elderly.  The 
  4.18  screeners shall encourage the use of volunteers from families, 
  4.19  religious organizations, social clubs, and similar civic and 
  4.20  service organizations to provide services. 
  4.21     Sec. 3.  Minnesota Statutes 1994, section 256B.0913, is 
  4.22  amended by adding a subdivision to read: 
  4.23     Subd. 15.  [ALTERNATIVE CARE FUND AVAILABILITY.] Effective 
  4.24  July 1, 1996, the commissioner may make alternative care funds 
  4.25  available to high function class A persons as defined in section 
  4.26  144.0721, subdivision 3, clause (2).  Clients choosing the 
  4.27  service allowance option are not eligible for other alternative 
  4.28  care services or options and are exempt from the requirements 
  4.29  listed in subdivision 12.  Funding available under the service 
  4.30  allowance option is exempt from the standards defined in 
  4.31  subdivision 5, paragraphs (c) and (f).  While individual monthly 
  4.32  grants under the service allowance option are permitted to be 
  4.33  either greater or less than the amount of $225 per month based 
  4.34  on individual need, the average monthly cost per individual 
  4.35  expended by the state must not exceed $225. 
  4.36     Sec. 4.  [256B.4211] [LONG-TERM CARE DEMONSTRATION 
  5.1   PROJECTS.] 
  5.2      Subdivision 1.  [WAIVER APPLICATION.] The commissioner 
  5.3   shall apply for applicable federal waivers for long-term care 
  5.4   demonstration projects that would increase options for consumers 
  5.5   and providers in seeking and developing long-term care services. 
  5.6      Subd. 2.  [REQUEST FOR PROPOSALS.] The commissioner will 
  5.7   develop a request for proposal process that will be used to 
  5.8   select long-term care demonstration projects.  An advisory 
  5.9   committee consisting of consumers, advocates, long-term care 
  5.10  providers, and appropriate state and county agencies will be 
  5.11  formed by the commissioner.  The advisory committee will assist 
  5.12  the commissioner in developing goals, project guidelines and 
  5.13  priorities, and analyzing outcomes of the long-term care 
  5.14  demonstration projects. 
  5.15     Subd. 3.  [DEMONSTRATION PROJECT CRITERIA.] In the 
  5.16  development of the long-term care demonstration projects request 
  5.17  for proposals and consideration of provider selection the 
  5.18  commissioner shall consider whether the proposal: 
  5.19     (1) adapts to changing consumer needs, market place 
  5.20  demands, and payment sources; 
  5.21     (2) recognizes the various standards for quality from 
  5.22  consumers payors and providers; 
  5.23     (3) provides for maximum diversity, innovation, and 
  5.24  flexibility within the continuum of long-term care from acute 
  5.25  services to home-based services by expanding consumer choice for 
  5.26  payment and service provision; 
  5.27     (4) is based on principles of fiscal responsibility to 
  5.28  include incentives for efficiency for consumers, providers, and 
  5.29  payors while allowing for the greatest amount of access to 
  5.30  services possible; 
  5.31     (5) accommodates a multitude of public and private funding 
  5.32  sources, yet be predictable for consumers, providers, and payors 
  5.33  both in the short term and long term; 
  5.34     (6) tests reimbursement strategies that establish a link 
  5.35  between long-term care and the managed care marketplace; 
  5.36     (7) encourages long-term care providers to diversify their 
  6.1   service provision to community home care programs including 
  6.2   adult foster care and independent living services; and 
  6.3      (8) considers other areas as determined by the commissioner 
  6.4   and long-term care demonstration project advisory committee. 
  6.5      Subd. 4.  [DEMONSTRATION PROJECT PARAMETERS.] In addition 
  6.6   to meeting the guidelines established in subdivision 3, in 
  6.7   making their recommendations for selection of demonstration 
  6.8   projects to the commissioner, the advisory committee must 
  6.9   consider the following: 
  6.10     (1) length of the project; 
  6.11     (2) consideration of both rural and urban participation; 
  6.12     (3) projects that include enrollment of diverse populations 
  6.13  including elderly and disabled; 
  6.14     (4) consideration of a variety of services and providers; 
  6.15     (5) extent to which there is a public/private partnership; 
  6.16  and 
  6.17     (6) inclusion of multiple systems. 
  6.18     Subd. 5.  [FUNDING.] When applicable, the commissioner 
  6.19  shall seek private and federal funding to implement 
  6.20  demonstration projects.