1.1                          A bill for an act 
  1.2             relating to human services; making changes to 
  1.3             continuing care programs; amending Minnesota Statutes 
  1.4             2001 Supplement, sections 256B.0627, subdivision 10; 
  1.5             256B.0913, subdivision 5; 256B.0915, subdivision 3; 
  1.6             256B.0951, subdivisions 7, 8; 256B.437, subdivision 6. 
  1.7   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.8      Section 1.  Minnesota Statutes 2001 Supplement, section 
  1.9   256B.0627, subdivision 10, is amended to read: 
  1.10     Subd. 10.  [FISCAL INTERMEDIARY OPTION AVAILABLE FOR 
  1.11  PERSONAL CARE ASSISTANT SERVICES.] (a) The commissioner may 
  1.12  allow a recipient of personal care assistant services to use a 
  1.13  fiscal intermediary to assist the recipient in paying and 
  1.14  accounting for medically necessary covered personal care 
  1.15  assistant services authorized in subdivision 4 and within the 
  1.16  payment parameters of subdivision 5.  Unless otherwise provided 
  1.17  in this subdivision, all other statutory and regulatory 
  1.18  provisions relating to personal care assistant services apply to 
  1.19  a recipient using the fiscal intermediary option. 
  1.20     (b) The recipient or responsible party shall: 
  1.21     (1) recruit, hire, and terminate a qualified professional, 
  1.22  if a qualified professional is requested by the recipient or 
  1.23  responsible party; 
  1.24     (2) verify and document the credentials of the qualified 
  1.25  professional, if a qualified professional is requested by the 
  1.26  recipient or responsible party; 
  2.1      (3) develop a service plan based on physician orders and 
  2.2   public health nurse assessment with the assistance of a 
  2.3   qualified professional, if a qualified professional is requested 
  2.4   by the recipient or responsible party, that addresses the health 
  2.5   and safety of the recipient; 
  2.6      (4) recruit, hire, and terminate the personal care 
  2.7   assistant; 
  2.8      (5) orient and train the personal care assistant with 
  2.9   assistance as needed from the qualified professional; 
  2.10     (6) supervise and evaluate the personal care assistant with 
  2.11  assistance as needed from the recipient's physician or the 
  2.12  qualified professional; 
  2.13     (7) monitor and verify in writing and report to the fiscal 
  2.14  intermediary the number of hours worked by the personal care 
  2.15  assistant and the qualified professional; and 
  2.16     (8) enter into a written agreement, as specified in 
  2.17  paragraph (f). 
  2.18     (c) The duties of the fiscal intermediary shall be to: 
  2.19     (1) bill the medical assistance program for personal care 
  2.20  assistant and qualified professional services; 
  2.21     (2) request and secure background checks on personal care 
  2.22  assistants and qualified professionals according to section 
  2.23  245A.04; 
  2.24     (3) pay the personal care assistant and qualified 
  2.25  professional based on actual hours of services provided; 
  2.26     (4) withhold and pay all applicable federal and state 
  2.27  taxes; 
  2.28     (5) verify and keep records of hours worked by the personal 
  2.29  care assistant and qualified professional; 
  2.30     (6) make the arrangements and pay unemployment insurance, 
  2.31  taxes, workers' compensation, liability insurance, and other 
  2.32  benefits, if any; 
  2.33     (7) enroll in the medical assistance program as a fiscal 
  2.34  intermediary; and 
  2.35     (8) enter into a written agreement as specified in 
  2.36  paragraph (f) before services are provided. 
  3.1      (d) The fiscal intermediary: 
  3.2      (1) may not be related to the recipient, qualified 
  3.3   professional, or the personal care assistant; 
  3.4      (2) must ensure arm's length transactions with the 
  3.5   recipient and personal care assistant; and 
  3.6      (3) shall be considered a joint employer of the personal 
  3.7   care assistant and qualified professional to the extent 
  3.8   specified in this section. 
  3.9      The fiscal intermediary or owners of the entity that 
  3.10  provides fiscal intermediary services under this subdivision 
  3.11  must pass a criminal background check as required in section 
  3.12  256B.0627, subdivision 1, paragraph (e). 
  3.13     (e) If the recipient or responsible party requests a 
  3.14  qualified professional, the qualified professional providing 
  3.15  assistance to the recipient shall meet the qualifications 
  3.16  specified in section 256B.0625, subdivision 19c.  The qualified 
  3.17  professional shall assist the recipient in developing and 
  3.18  revising a plan to meet the recipient's needs, as assessed by 
  3.19  the public health nurse.  In performing this function, the 
  3.20  qualified professional must visit the recipient in the 
  3.21  recipient's home at least once annually.  The qualified 
  3.22  professional must report any suspected abuse, neglect, or 
  3.23  financial exploitation of the recipient to the appropriate 
  3.24  authorities.  
  3.25     (f) The fiscal intermediary, recipient or responsible 
  3.26  party, personal care assistant, and qualified professional shall 
  3.27  enter into a written agreement before services are started.  The 
  3.28  agreement shall include: 
  3.29     (1) the duties of the recipient, qualified professional, 
  3.30  personal care assistant, and fiscal agent based on paragraphs 
  3.31  (a) to (e); 
  3.32     (2) the salary and benefits for the personal care assistant 
  3.33  and the qualified professional; 
  3.34     (3) the administrative fee of the fiscal intermediary and 
  3.35  services paid for with that fee, including background check 
  3.36  fees; 
  4.1      (4) procedures to respond to billing or payment complaints; 
  4.2   and 
  4.3      (5) procedures for hiring and terminating the personal care 
  4.4   assistant and the qualified professional. 
  4.5      (g) The rates paid for personal care assistant 
  4.6   services, shared care services, qualified professional services, 
  4.7   and fiscal intermediary services under this subdivision shall be 
  4.8   the same rates paid for personal care assistant services and 
  4.9   qualified professional services under subdivision 2 
  4.10  respectively.  Except for the administrative fee of the fiscal 
  4.11  intermediary specified in paragraph (f), the remainder of the 
  4.12  rates paid to the fiscal intermediary must be used to pay for 
  4.13  the salary and benefits for the personal care assistant or the 
  4.14  qualified professional. 
  4.15     (h) As part of the assessment defined in subdivision 1, the 
  4.16  following conditions must be met to use or continue use of a 
  4.17  fiscal intermediary: 
  4.18     (1) the recipient must be able to direct the recipient's 
  4.19  own care, or the responsible party for the recipient must be 
  4.20  readily available to direct the care of the personal care 
  4.21  assistant; 
  4.22     (2) the recipient or responsible party must be 
  4.23  knowledgeable of the health care needs of the recipient and be 
  4.24  able to effectively communicate those needs; 
  4.25     (3) a face-to-face assessment must be conducted by the 
  4.26  local county public health nurse at least annually, or when 
  4.27  there is a significant change in the recipient's condition or 
  4.28  change in the need for personal care assistant services; 
  4.29     (4) recipients who choose to use the shared care option as 
  4.30  specified in subdivision 8 must utilize the same fiscal 
  4.31  intermediary; 
  4.32     (5) the recipient cannot select the shared services option 
  4.33  as specified in subdivision 8; and 
  4.34     (5) (6) parties must be in compliance with the written 
  4.35  agreement specified in paragraph (f). 
  4.36     (i) The commissioner shall deny, revoke, or suspend the 
  5.1   authorization to use the fiscal intermediary option if: 
  5.2      (1) it has been determined by the qualified professional or 
  5.3   local county public health nurse that the use of this option 
  5.4   jeopardizes the recipient's health and safety; 
  5.5      (2) the parties have failed to comply with the written 
  5.6   agreement specified in paragraph (f); or 
  5.7      (3) the use of the option has led to abusive or fraudulent 
  5.8   billing for personal care assistant services.  
  5.9      The recipient or responsible party may appeal the 
  5.10  commissioner's action according to section 256.045.  The denial, 
  5.11  revocation, or suspension to use the fiscal intermediary option 
  5.12  shall not affect the recipient's authorized level of personal 
  5.13  care assistant services as determined in subdivision 5. 
  5.14     Sec. 2.  Minnesota Statutes 2001 Supplement, section 
  5.15  256B.0913, subdivision 5, is amended to read: 
  5.16     Subd. 5.  [SERVICES COVERED UNDER ALTERNATIVE CARE.] (a) 
  5.17  Alternative care funding may be used for payment of costs of: 
  5.18     (1) adult foster care; 
  5.19     (2) adult day care; 
  5.20     (3) home health aide; 
  5.21     (4) homemaker services; 
  5.22     (5) personal care; 
  5.23     (6) case management; 
  5.24     (7) respite care; 
  5.25     (8) assisted living; 
  5.26     (9) residential care services; 
  5.27     (10) care-related supplies and equipment; 
  5.28     (11) meals delivered to the home; 
  5.29     (12) transportation; 
  5.30     (13) skilled nursing; 
  5.31     (14) chore services; 
  5.32     (15) companion services; 
  5.33     (16) nutrition services; 
  5.34     (17) training for direct informal caregivers; 
  5.35     (18) telemedicine devices to monitor recipients in their 
  5.36  own homes as an alternative to hospital care, nursing home care, 
  6.1   or home visits; 
  6.2      (19) other services which includes discretionary funds and 
  6.3   direct cash payments to clients, following approval by the 
  6.4   commissioner, subject to the provisions of paragraph (j).  Total 
  6.5   annual payments for "other services" for all clients within a 
  6.6   county may not exceed either ten 25 percent of that county's 
  6.7   annual alternative care program base allocation or $5,000, 
  6.8   whichever is greater.  In no case shall this amount exceed the 
  6.9   county's total annual alternative care program base allocation; 
  6.10  and 
  6.11     (20) environmental modifications. 
  6.12     (b) The county agency must ensure that the funds are not 
  6.13  used to supplant services available through other public 
  6.14  assistance or services programs. 
  6.15     (c) Unless specified in statute, the service definitions 
  6.16  and standards for alternative care services shall be the same as 
  6.17  the service definitions and standards specified in the federally 
  6.18  approved elderly waiver plan.  Except for the county agencies' 
  6.19  approval of direct cash payments to clients as described in 
  6.20  paragraph (j) or for a provider of supplies and equipment when 
  6.21  the monthly cost of the supplies and equipment is less than 
  6.22  $250, persons or agencies must be employed by or under a 
  6.23  contract with the county agency or the public health nursing 
  6.24  agency of the local board of health in order to receive funding 
  6.25  under the alternative care program.  Supplies and equipment may 
  6.26  be purchased from a vendor not certified to participate in the 
  6.27  Medicaid program if the cost for the item is less than that of a 
  6.28  Medicaid vendor.  
  6.29     (d) The adult foster care rate shall be considered a 
  6.30  difficulty of care payment and shall not include room and 
  6.31  board.  The adult foster care rate shall be negotiated between 
  6.32  the county agency and the foster care provider.  The alternative 
  6.33  care payment for the foster care service in combination with the 
  6.34  payment for other alternative care services, including case 
  6.35  management, must not exceed the limit specified in subdivision 
  6.36  4, paragraph (a), clause (6). 
  7.1      (e) Personal care services must meet the service standards 
  7.2   defined in the federally approved elderly waiver plan, except 
  7.3   that a county agency may contract with a client's relative who 
  7.4   meets the relative hardship waiver requirement as defined in 
  7.5   section 256B.0627, subdivision 4, paragraph (b), clause (10), to 
  7.6   provide personal care services if the county agency ensures 
  7.7   supervision of this service by a registered nurse or mental 
  7.8   health practitioner.  
  7.9      (f) For purposes of this section, residential care services 
  7.10  are services which are provided to individuals living in 
  7.11  residential care homes.  Residential care homes are currently 
  7.12  licensed as board and lodging establishments and are registered 
  7.13  with the department of health as providing special services 
  7.14  under section 157.17 and are not subject to registration under 
  7.15  chapter 144D.  Residential care services are defined as 
  7.16  "supportive services" and "health-related services."  
  7.17  "Supportive services" means the provision of up to 24-hour 
  7.18  supervision and oversight.  Supportive services includes:  (1) 
  7.19  transportation, when provided by the residential care home only; 
  7.20  (2) socialization, when socialization is part of the plan of 
  7.21  care, has specific goals and outcomes established, and is not 
  7.22  diversional or recreational in nature; (3) assisting clients in 
  7.23  setting up meetings and appointments; (4) assisting clients in 
  7.24  setting up medical and social services; (5) providing assistance 
  7.25  with personal laundry, such as carrying the client's laundry to 
  7.26  the laundry room.  Assistance with personal laundry does not 
  7.27  include any laundry, such as bed linen, that is included in the 
  7.28  room and board rate.  "Health-related services" are limited to 
  7.29  minimal assistance with dressing, grooming, and bathing and 
  7.30  providing reminders to residents to take medications that are 
  7.31  self-administered or providing storage for medications, if 
  7.32  requested.  Individuals receiving residential care services 
  7.33  cannot receive homemaking services funded under this section.  
  7.34     (g) For the purposes of this section, "assisted living" 
  7.35  refers to supportive services provided by a single vendor to 
  7.36  clients who reside in the same apartment building of three or 
  8.1   more units which are not subject to registration under chapter 
  8.2   144D and are licensed by the department of health as a class A 
  8.3   home care provider or a class E home care provider.  Assisted 
  8.4   living services are defined as up to 24-hour supervision, and 
  8.5   oversight, supportive services as defined in clause (1), 
  8.6   individualized home care aide tasks as defined in clause (2), 
  8.7   and individualized home management tasks as defined in clause 
  8.8   (3) provided to residents of a residential center living in 
  8.9   their units or apartments with a full kitchen and bathroom.  A 
  8.10  full kitchen includes a stove, oven, refrigerator, food 
  8.11  preparation counter space, and a kitchen utensil storage 
  8.12  compartment.  Assisted living services must be provided by the 
  8.13  management of the residential center or by providers under 
  8.14  contract with the management or with the county. 
  8.15     (1) Supportive services include:  
  8.16     (i) socialization, when socialization is part of the plan 
  8.17  of care, has specific goals and outcomes established, and is not 
  8.18  diversional or recreational in nature; 
  8.19     (ii) assisting clients in setting up meetings and 
  8.20  appointments; and 
  8.21     (iii) providing transportation, when provided by the 
  8.22  residential center only.  
  8.23     (2) Home care aide tasks means:  
  8.24     (i) preparing modified diets, such as diabetic or low 
  8.25  sodium diets; 
  8.26     (ii) reminding residents to take regularly scheduled 
  8.27  medications or to perform exercises; 
  8.28     (iii) household chores in the presence of technically 
  8.29  sophisticated medical equipment or episodes of acute illness or 
  8.30  infectious disease; 
  8.31     (iv) household chores when the resident's care requires the 
  8.32  prevention of exposure to infectious disease or containment of 
  8.33  infectious disease; and 
  8.34     (v) assisting with dressing, oral hygiene, hair care, 
  8.35  grooming, and bathing, if the resident is ambulatory, and if the 
  8.36  resident has no serious acute illness or infectious disease.  
  9.1   Oral hygiene means care of teeth, gums, and oral prosthetic 
  9.2   devices.  
  9.3      (3) Home management tasks means:  
  9.4      (i) housekeeping; 
  9.5      (ii) laundry; 
  9.6      (iii) preparation of regular snacks and meals; and 
  9.7      (iv) shopping.  
  9.8      Individuals receiving assisted living services shall not 
  9.9   receive both assisted living services and homemaking services.  
  9.10  Individualized means services are chosen and designed 
  9.11  specifically for each resident's needs, rather than provided or 
  9.12  offered to all residents regardless of their illnesses, 
  9.13  disabilities, or physical conditions.  Assisted living services 
  9.14  as defined in this section shall not be authorized in boarding 
  9.15  and lodging establishments licensed according to sections 
  9.16  157.011 and 157.15 to 157.22. 
  9.17     (h) For establishments registered under chapter 144D, 
  9.18  assisted living services under this section means either the 
  9.19  services described in paragraph (g) and delivered by a class E 
  9.20  home care provider licensed by the department of health or the 
  9.21  services described under section 144A.4605 and delivered by an 
  9.22  assisted living home care provider or a class A home care 
  9.23  provider licensed by the commissioner of health. 
  9.24     (i) Payment for assisted living services and residential 
  9.25  care services shall be a monthly rate negotiated and authorized 
  9.26  by the county agency based on an individualized service plan for 
  9.27  each resident and may not cover direct rent or food costs.  
  9.28     (1) The individualized monthly negotiated payment for 
  9.29  assisted living services as described in paragraph (g) or (h), 
  9.30  and residential care services as described in paragraph (f), 
  9.31  shall not exceed the nonfederal share in effect on July 1 of the 
  9.32  state fiscal year for which the rate limit is being calculated 
  9.33  of the greater of either the statewide or any of the geographic 
  9.34  groups' weighted average monthly nursing facility payment rate 
  9.35  of the case mix resident class to which the alternative care 
  9.36  eligible client would be assigned under Minnesota Rules, parts 
 10.1   9549.0050 to 9549.0059, less the maintenance needs allowance as 
 10.2   described in section 256B.0915, subdivision 1d, paragraph (a), 
 10.3   until the first day of the state fiscal year in which a resident 
 10.4   assessment system, under section 256B.437, of nursing home rate 
 10.5   determination is implemented.  Effective on the first day of the 
 10.6   state fiscal year in which a resident assessment system, under 
 10.7   section 256B.437, of nursing home rate determination is 
 10.8   implemented and the first day of each subsequent state fiscal 
 10.9   year, the individualized monthly negotiated payment for the 
 10.10  services described in this clause shall not exceed the limit 
 10.11  described in this clause which was in effect on the last day of 
 10.12  the previous state fiscal year and which has been adjusted by 
 10.13  the greater of any legislatively adopted home and 
 10.14  community-based services cost-of-living percentage increase or 
 10.15  any legislatively adopted statewide percent rate increase for 
 10.16  nursing facilities. 
 10.17     (2) The individualized monthly negotiated payment for 
 10.18  assisted living services described under section 144A.4605 and 
 10.19  delivered by a provider licensed by the department of health as 
 10.20  a class A home care provider or an assisted living home care 
 10.21  provider and provided in a building that is registered as a 
 10.22  housing with services establishment under chapter 144D and that 
 10.23  provides 24-hour supervision in combination with the payment for 
 10.24  other alternative care services, including case management, must 
 10.25  not exceed the limit specified in subdivision 4, paragraph (a), 
 10.26  clause (6). 
 10.27     (j) A county agency may make payment from their alternative 
 10.28  care program allocation for "other services" which include use 
 10.29  of "discretionary funds" for services that are not otherwise 
 10.30  defined in this section and direct cash payments to the client 
 10.31  for the purpose of purchasing the services.  The following 
 10.32  provisions apply to payments under this paragraph: 
 10.33     (1) a cash payment to a client under this provision cannot 
 10.34  exceed 80 percent of the monthly payment limit for that client 
 10.35  as specified in subdivision 4, paragraph (a), clause (6); 
 10.36     (2) a county may not approve any cash payment for a client 
 11.1   who meets either of the following: 
 11.2      (i) has been assessed as having a dependency in 
 11.3   orientation, unless the client has an authorized 
 11.4   representative.  An "authorized representative" means an 
 11.5   individual who is at least 18 years of age and is designated by 
 11.6   the person or the person's legal representative to act on the 
 11.7   person's behalf.  This individual may be a family member, 
 11.8   guardian, representative payee, or other individual designated 
 11.9   by the person or the person's legal representative, if any, to 
 11.10  assist in purchasing and arranging for supports; or 
 11.11     (ii) is concurrently receiving adult foster care, 
 11.12  residential care, or assisted living services; 
 11.13     (3) cash payments to a person or a person's family will be 
 11.14  provided through a monthly payment and be in the form of cash, 
 11.15  voucher, or direct county payment to a vendor.  Fees or premiums 
 11.16  assessed to the person for eligibility for health and human 
 11.17  services are not reimbursable through this service option.  
 11.18  Services and goods purchased through cash payments must be 
 11.19  identified in the person's individualized care plan and must 
 11.20  meet all of the following criteria: 
 11.21     (i) they must be over and above the normal cost of caring 
 11.22  for the person if the person did not have functional 
 11.23  limitations; 
 11.24     (ii) they must be directly attributable to the person's 
 11.25  functional limitations; 
 11.26     (iii) they must have the potential to be effective at 
 11.27  meeting the goals of the program; 
 11.28     (iv) they must be consistent with the needs identified in 
 11.29  the individualized service plan.  The service plan shall specify 
 11.30  the needs of the person and family, the form and amount of 
 11.31  payment, the items and services to be reimbursed, and the 
 11.32  arrangements for management of the individual grant; and 
 11.33     (v) the person, the person's family, or the legal 
 11.34  representative shall be provided sufficient information to 
 11.35  ensure an informed choice of alternatives.  The local agency 
 11.36  shall document this information in the person's care plan, 
 12.1   including the type and level of expenditures to be reimbursed; 
 12.2      (4) the county, lead agency under contract, or tribal 
 12.3   government under contract to administer the alternative care 
 12.4   program shall not be liable for damages, injuries, or 
 12.5   liabilities sustained through the purchase of direct supports or 
 12.6   goods by the person, the person's family, or the authorized 
 12.7   representative with funds received through the cash payments 
 12.8   under this section.  Liabilities include, but are not limited 
 12.9   to, workers' compensation, the Federal Insurance Contributions 
 12.10  Act (FICA), or the Federal Unemployment Tax Act (FUTA); 
 12.11     (5) persons receiving grants under this section shall have 
 12.12  the following responsibilities: 
 12.13     (i) spend the grant money in a manner consistent with their 
 12.14  individualized service plan with the local agency; 
 12.15     (ii) notify the local agency of any necessary changes in 
 12.16  the grant expenditures; 
 12.17     (iii) arrange and pay for supports; and 
 12.18     (iv) inform the local agency of areas where they have 
 12.19  experienced difficulty securing or maintaining supports; and 
 12.20     (6) the county shall report client outcomes, services, and 
 12.21  costs under this paragraph in a manner prescribed by the 
 12.22  commissioner. 
 12.23     (k) Upon implementation of direct cash payments to clients 
 12.24  under this section, any person determined eligible for the 
 12.25  alternative care program who chooses a cash payment approved by 
 12.26  the county agency shall receive the cash payment under this 
 12.27  section and not under section 256.476 unless the person was 
 12.28  receiving a consumer support grant under section 256.476 before 
 12.29  implementation of direct cash payments under this section. 
 12.30     Sec. 3.  Minnesota Statutes 2001 Supplement, section 
 12.31  256B.0915, subdivision 3, is amended to read: 
 12.32     Subd. 3.  [LIMITS OF CASES, RATES, PAYMENTS, AND 
 12.33  FORECASTING.] (a) The number of medical assistance waiver 
 12.34  recipients that a county may serve must be allocated according 
 12.35  to the number of medical assistance waiver cases open on July 1 
 12.36  of each fiscal year.  Additional recipients may be served with 
 13.1   the approval of the commissioner. 
 13.2      (b) The monthly limit for the cost of waivered services to 
 13.3   an individual elderly waiver client shall be the weighted 
 13.4   average monthly nursing facility rate of the case mix resident 
 13.5   class to which the elderly waiver client would be assigned under 
 13.6   Minnesota Rules, parts 9549.0050 to 9549.0059, less the 
 13.7   recipient's maintenance needs allowance as described in 
 13.8   subdivision 1d, paragraph (a), until the first day of the state 
 13.9   fiscal year in which the resident assessment system as described 
 13.10  in section 256B.437 for nursing home rate determination is 
 13.11  implemented.  Effective on the first day of the state fiscal 
 13.12  year in which the resident assessment system as described in 
 13.13  section 256B.437 for nursing home rate determination is 
 13.14  implemented and the first day of each subsequent state fiscal 
 13.15  year, the monthly limit for the cost of waivered services to an 
 13.16  individual elderly waiver client shall be the rate of the case 
 13.17  mix resident class to which the waiver client would be assigned 
 13.18  under Minnesota Rules, parts 9549.0050 to 9549.0059, in effect 
 13.19  on the last day of the previous state fiscal year, adjusted by 
 13.20  the greater of any legislatively adopted home and 
 13.21  community-based services cost-of-living percentage increase or 
 13.22  any legislatively adopted statewide percent rate increase for 
 13.23  nursing facilities. 
 13.24     (c) If extended medical supplies and equipment or 
 13.25  environmental modifications are or will be purchased for an 
 13.26  elderly waiver client, the costs may be prorated for up to 12 
 13.27  consecutive months beginning with the month of purchase.  If the 
 13.28  monthly cost of a recipient's waivered services exceeds the 
 13.29  monthly limit established in paragraph (b), the annual cost of 
 13.30  all waivered services shall be determined.  In this event, the 
 13.31  annual cost of all waivered services shall not exceed 12 times 
 13.32  the monthly limit of waivered services as described in paragraph 
 13.33  (b).  
 13.34     (d) For a person who is a nursing facility resident at the 
 13.35  time of requesting a determination of eligibility for elderly 
 13.36  waivered services, a monthly conversion limit for the cost of 
 14.1   elderly waivered services may be requested.  The monthly 
 14.2   conversion limit for the cost of elderly waiver services shall 
 14.3   be the resident class assigned under Minnesota Rules, parts 
 14.4   9549.0050 to 9549.0059, for that resident in the nursing 
 14.5   facility where the resident currently resides until July 1 of 
 14.6   the state fiscal year in which the resident assessment system as 
 14.7   described in section 256B.437 for nursing home rate 
 14.8   determination is implemented.  Effective on July 1 of the state 
 14.9   fiscal year in which the resident assessment system as described 
 14.10  in section 256B.437 for nursing home rate determination is 
 14.11  implemented, the monthly conversion limit for the cost of 
 14.12  elderly waiver services shall be the per diem nursing facility 
 14.13  rate as determined by the resident assessment system as 
 14.14  described in section 256B.437 for that resident in the nursing 
 14.15  facility where the resident currently resides multiplied by 365 
 14.16  and divided by 12, less the recipient's maintenance needs 
 14.17  allowance as described in subdivision 1d.  The initially 
 14.18  approved conversion rate may be adjusted by the greater of any 
 14.19  subsequent legislatively adopted home and community-based 
 14.20  services cost-of-living percentage increase or any subsequent 
 14.21  legislatively adopted statewide percentage rate increase for 
 14.22  nursing facilities.  The limit under this clause only applies to 
 14.23  persons discharged from a nursing facility after a minimum 
 14.24  30-day stay and found eligible for waivered services on or after 
 14.25  July 1, 1997.  The following costs must be included in 
 14.26  determining the total monthly costs for the waiver client: 
 14.27     (1) cost of all waivered services, including extended 
 14.28  medical supplies and equipment and environmental modifications; 
 14.29  and 
 14.30     (2) cost of skilled nursing, home health aide, and personal 
 14.31  care services reimbursable by medical assistance.  
 14.32     (e) Medical assistance funding for skilled nursing 
 14.33  services, private duty nursing, home health aide, and personal 
 14.34  care services for waiver recipients must be approved by the case 
 14.35  manager and included in the individual care plan. 
 14.36     (f) A county is not required to contract with a provider of 
 15.1   supplies and equipment if the monthly cost of the supplies and 
 15.2   equipment is less than $250.  
 15.3      (g) The adult foster care rate shall be considered a 
 15.4   difficulty of care payment and shall not include room and 
 15.5   board.  The adult foster care service rate shall be negotiated 
 15.6   between the county agency and the foster care provider.  The 
 15.7   elderly waiver payment for the foster care service in 
 15.8   combination with the payment for all other elderly waiver 
 15.9   services, including case management, must not exceed the limit 
 15.10  specified in paragraph (b). 
 15.11     (h) Payment for assisted living service shall be a monthly 
 15.12  rate negotiated and authorized by the county agency based on an 
 15.13  individualized service plan for each resident and may not cover 
 15.14  direct rent or food costs. 
 15.15     (1) The individualized monthly negotiated payment for 
 15.16  assisted living services as described in section 256B.0913, 
 15.17  subdivision 5, paragraph (g) or (h), and residential care 
 15.18  services as described in section 256B.0913, subdivision 5, 
 15.19  paragraph (f), shall not exceed the nonfederal share, in effect 
 15.20  on July 1 of the state fiscal year for which the rate limit is 
 15.21  being calculated, of the greater of either the statewide or any 
 15.22  of the geographic groups' weighted average monthly nursing 
 15.23  facility rate of the case mix resident class to which the 
 15.24  elderly waiver eligible client would be assigned under Minnesota 
 15.25  Rules, parts 9549.0050 to 9549.0059, less the maintenance needs 
 15.26  allowance as described in subdivision 1d, paragraph (a), until 
 15.27  the July 1 of the state fiscal year in which the resident 
 15.28  assessment system as described in section 256B.437 for nursing 
 15.29  home rate determination is implemented.  Effective on July 1 of 
 15.30  the state fiscal year in which the resident assessment system as 
 15.31  described in section 256B.437 for nursing home rate 
 15.32  determination is implemented and July 1 of each subsequent state 
 15.33  fiscal year, the individualized monthly negotiated payment for 
 15.34  the services described in this clause shall not exceed the limit 
 15.35  described in this clause which was in effect on June 30 of the 
 15.36  previous state fiscal year and which has been adjusted by the 
 16.1   greater of any legislatively adopted home and community-based 
 16.2   services cost-of-living percentage increase or any legislatively 
 16.3   adopted statewide percent rate increase for nursing facilities. 
 16.4      (2) The individualized monthly negotiated payment for 
 16.5   assisted living services described in section 144A.4605 and 
 16.6   delivered by a provider licensed by the department of health as 
 16.7   a class A home care provider or an assisted living home care 
 16.8   provider and provided in a building that is registered as a 
 16.9   housing with services establishment under chapter 144D and that 
 16.10  provides 24-hour supervision in combination with the payment for 
 16.11  other elderly waiver services, including case management, must 
 16.12  not exceed the limit specified in paragraph (b). 
 16.13     (i) The county shall negotiate individual service rates 
 16.14  with vendors and may authorize payment for actual costs up to 
 16.15  the county's current approved rate.  Persons or agencies must be 
 16.16  employed by or under a contract with the county agency or the 
 16.17  public health nursing agency of the local board of health in 
 16.18  order to receive funding under the elderly waiver program, 
 16.19  except as a provider of supplies and equipment when the monthly 
 16.20  cost of the supplies and equipment is less than $250.  
 16.21     (j) Reimbursement for the medical assistance recipients 
 16.22  under the approved waiver shall be made from the medical 
 16.23  assistance account through the invoice processing procedures of 
 16.24  the department's Medicaid Management Information System (MMIS), 
 16.25  only with the approval of the client's case manager.  The budget 
 16.26  for the state share of the Medicaid expenditures shall be 
 16.27  forecasted with the medical assistance budget, and shall be 
 16.28  consistent with the approved waiver.  
 16.29     (k) To improve access to community services and eliminate 
 16.30  payment disparities between the alternative care program and the 
 16.31  elderly waiver, the commissioner shall establish statewide 
 16.32  maximum service rate limits and eliminate county-specific 
 16.33  service rate limits. 
 16.34     (1) Effective July 1, 2001, for service rate limits, except 
 16.35  those described or defined in paragraphs (g) and (h), the rate 
 16.36  limit for each service shall be the greater of the alternative 
 17.1   care statewide maximum rate or the elderly waiver statewide 
 17.2   maximum rate. 
 17.3      (2) Counties may negotiate individual service rates with 
 17.4   vendors for actual costs up to the statewide maximum service 
 17.5   rate limit. 
 17.6      (l) Beginning July 1, 1991, the state shall reimburse 
 17.7   counties according to the payment schedule in section 256.025 
 17.8   for the county share of costs incurred under this subdivision on 
 17.9   or after January 1, 1991, for individuals who are receiving 
 17.10  medical assistance. 
 17.11     Sec. 4.  Minnesota Statutes 2001 Supplement, section 
 17.12  256B.0951, subdivision 7, is amended to read: 
 17.13     Subd. 7.  [WAIVER OF RULES.] If a federal waiver is 
 17.14  approved under subdivision 8, the commissioner of health may 
 17.15  exempt residents of intermediate care facilities for persons 
 17.16  with mental retardation (ICFs/MR) who participate in the 
 17.17  three-year alternative quality assurance pilot project 
 17.18  established in section 256B.095 from the requirements of 
 17.19  Minnesota Rules, chapter 4665, upon approval by the federal 
 17.20  government of a waiver of federal certification requirements for 
 17.21  ICFs/MR.  
 17.22     Sec. 5.  Minnesota Statutes 2001 Supplement, section 
 17.23  256B.0951, subdivision 8, is amended to read: 
 17.24     Subd. 8.  [FEDERAL WAIVER.] The commissioner of human 
 17.25  services shall seek federal authority to waive provisions of 
 17.26  intermediate care facilities for persons with mental retardation 
 17.27  (ICFs/MR) regulations to enable the demonstration and evaluation 
 17.28  of the alternative quality assurance system for ICFs/MR under 
 17.29  the project.  The commissioner of human services shall apply for 
 17.30  any necessary waivers as soon as practicable. a federal waiver 
 17.31  to allow intermediate care facilities for persons with mental 
 17.32  retardation (ICFs/MR) in Region 10 of Minnesota to participate 
 17.33  in the alternative licensing system.  If it is necessary for 
 17.34  purposes of participation in this alternative licensing system 
 17.35  for a facility to be decertified as an ICF/MR facility according 
 17.36  to the terms of the federal waiver, when the facility seeks 
 18.1   recertification under the provisions of ICF/MR regulations at 
 18.2   the end of the demonstration project, it will not be considered 
 18.3   a new ICF/MR as defined under section 252.291 provided the 
 18.4   licensed capacity of the facility did not increase during its 
 18.5   participation in the alternative licensing system.  The 
 18.6   provisions of section 252.292 will remain applicable for 
 18.7   counties in Region 10 of Minnesota and the ICFs/MR located 
 18.8   within those counties notwithstanding a county's participation 
 18.9   in the alternative licensing system. 
 18.10     Sec. 6.  Minnesota Statutes 2001 Supplement, section 
 18.11  256B.437, subdivision 6, is amended to read: 
 18.12     Subd. 6.  [PLANNED CLOSURE RATE ADJUSTMENT.] (a) The 
 18.13  commissioner of human services shall calculate the amount of the 
 18.14  planned closure rate adjustment available under subdivision 3, 
 18.15  paragraph (b), for up to 5,140 beds according to clauses (1) to 
 18.16  (4): 
 18.17     (1) the amount available is the net reduction of nursing 
 18.18  facility beds multiplied by $2,080; 
 18.19     (2) the total number of beds in the nursing facility or 
 18.20  facilities receiving the planned closure rate adjustment must be 
 18.21  identified; 
 18.22     (3) capacity days are determined by multiplying the number 
 18.23  determined under clause (2) by 365; and 
 18.24     (4) the planned closure rate adjustment is the amount 
 18.25  available in clause (1), divided by capacity days determined 
 18.26  under clause (3). 
 18.27     (b) A planned closure rate adjustment under this section is 
 18.28  effective on the first day of the month following completion of 
 18.29  closure of the facility designated for closure in the 
 18.30  application and becomes part of the nursing facility's total 
 18.31  operating payment rate. 
 18.32     (c) Applicants may use the planned closure rate adjustment 
 18.33  to allow for a property payment for a new nursing facility or an 
 18.34  addition to an existing nursing facility or as an operating 
 18.35  payment rate adjustment.  Applications approved under this 
 18.36  subdivision are exempt from other requirements for moratorium 
 19.1   exceptions under section 144A.073, subdivisions 2 and 3. 
 19.2      (d) Upon the request of a closing facility, the 
 19.3   commissioner must allow the facility a closure rate adjustment 
 19.4   as provided under section 144A.161, subdivision 10. 
 19.5      (e) A facility that has received a planned closure rate 
 19.6   adjustment may reassign it to another facility that is under the 
 19.7   same ownership at any time within three years of its effective 
 19.8   date.  The amount of the adjustment shall be computed according 
 19.9   to paragraph (a).