1.1                          A bill for an act 
  1.2             relating to human services; requiring a reduction in 
  1.3             the waiting list for home and community-based waivered 
  1.4             services for persons with mental retardation and 
  1.5             related conditions; allowing counties to form 
  1.6             partnerships to deliver waivered services; 
  1.7             appropriating money for increased home and 
  1.8             community-based waiver services; amending Minnesota 
  1.9             Statutes 1998, section 256B.0916; repealing Laws 1997, 
  1.10            chapter 203, article 7, section 27. 
  1.11  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.12     Section 1.  Minnesota Statutes 1998, section 256B.0916, is 
  1.13  amended to read: 
  1.14     256B.0916 [EXPANSION OF HOME AND COMMUNITY-BASED SERVICES; 
  1.15  MANAGEMENT AND ALLOCATION RESPONSIBILITIES.] 
  1.16     ~~(a) The commissioner shall expand availability of home and~~ 
  1.17  ~~community-based services for persons with mental retardation and~~ 
  1.18  ~~related conditions to the extent allowed by federal law and~~ 
  1.19  ~~regulation and shall assist counties in transferring persons~~ 
  1.20  ~~from semi-independent living services to home and~~ 
  1.21  ~~community-based services.  The commissioner may transfer funds~~ 
  1.22  ~~from the state semi-independent living services account~~ 
  1.23  ~~available under section 252.275, subdivision 8, and state~~ 
  1.24  ~~community social services aids available under section 256E.15~~ 
  1.25  ~~to the medical assistance account to pay for the nonfederal~~ 
  1.26  ~~share of nonresidential and residential home and community-based~~ 
  1.27  ~~services authorized under section 256B.092 for persons~~ 
  1.28  ~~transferring from semi-independent living services.~~ 
  2.1      ~~(b) Upon federal approval, county boards are not~~ 
  2.2   ~~responsible for funding semi-independent living services as a~~ 
  2.3   ~~social service for those persons who have transferred to the~~ 
  2.4   ~~home and community-based waiver program as a result of the~~ 
  2.5   ~~expansion under this subdivision.  The county responsibility for~~ 
  2.6   ~~those persons transferred shall be assumed under section~~ 
  2.7   ~~256B.092.  Notwithstanding the provisions of section 252.275,~~ 
  2.8   ~~the commissioner shall continue to allocate funds under that~~ 
  2.9   ~~section for semi-independent living services and county boards~~ 
  2.10  ~~shall continue to fund services under sections 256E.06 and~~ 
  2.11  ~~256E.14 for those persons who cannot access home and~~ 
  2.12  ~~community-based services under section 256B.092.~~ 
  2.13     ~~(c) Eighty percent of the state funds made available to the~~ 
  2.14  ~~commissioner under section 252.275 as a result of persons~~ 
  2.15  ~~transferring from the semi-independent living services program~~ 
  2.16  ~~to the home and community-based services program shall be used~~ 
  2.17  ~~to fund additional persons in the semi-independent living~~ 
  2.18  ~~services program.~~ 
  2.19     ~~(d) Beginning August 1, 1998, the commissioner shall issue~~ 
  2.20  ~~an annual report on the home and community-based waiver for~~ 
  2.21  ~~persons with mental retardation or related conditions, that~~ 
  2.22  ~~includes a list of the counties in which less than 95 percent of~~ 
  2.23  ~~the allocation provided, excluding the county waivered services~~ 
  2.24  ~~reserve, has been committed for two or more quarters during the~~ 
  2.25  ~~previous state fiscal year.  For each listed county, the report~~ 
  2.26  ~~shall include the amount of funds allocated but not used, the~~ 
  2.27  ~~number and ages of individuals screened and waiting for~~ 
  2.28  ~~services, the services needed, a description of the technical~~ 
  2.29  ~~assistance provided by the commissioner to assist the counties~~ 
  2.30  ~~in jointly planning with other counties in order to serve more~~ 
  2.31  ~~persons, and additional actions which will be taken to serve~~ 
  2.32  ~~those screened and waiting for services.~~ 
  2.33     Subdivision 1.  [REDUCTION OF WAITING LIST.] (a) The 
  2.34  legislature recognizes that as of January 1, 1999, 3,300 persons 
  2.35  with mental retardation or related conditions have been screened 
  2.36  and determined eligible for the home and community-based waiver 
  3.1   services program for persons with mental retardation or related 
  3.2   conditions.  Many wait for several years before receiving 
  3.3   service. 
  3.4      (b) The waiting list for this program shall be reduced or 
  3.5   eliminated by June 30, 2003.  In order to reduce the number of 
  3.6   eligible persons waiting for identified services provided 
  3.7   through the home and community-based waiver for persons with 
  3.8   mental retardation or related conditions, funding shall be 
  3.9   increased to add 500 additional eligible persons each year 
  3.10  beyond the November 1998 medical assistance forecast for the 
  3.11  period July 1, 1999, to June 30, 2003. 
  3.12     Subd. 2.  [DISTRIBUTION OF FUNDS; PARTNERSHIPS.] (a) 
  3.13  Beginning with fiscal year 2000, the commissioner shall 
  3.14  distribute all funding available for home and community-based 
  3.15  waiver services for persons with mental retardation or related 
  3.16  conditions to individual counties or to groups of counties that 
  3.17  form partnerships to jointly plan, administer, and authorize 
  3.18  funding for eligible individuals.  The commissioner shall 
  3.19  encourage counties to form partnerships that have a sufficient 
  3.20  number of recipients and funding to adequately manage the risk 
  3.21  and maximize use of available resources.  
  3.22     (b) Counties must submit a request for funds and a plan for 
  3.23  administering the program as required by the commissioner.  The 
  3.24  plan must identify the number of clients to be served, their 
  3.25  ages, and their priority listing based on: 
  3.26     (1) requirements in Minnesota Rules, part 9525.1880; 
  3.27     (2) unstable living situations due to the age or incapacity 
  3.28  of the primary caregiver; and 
  3.29     (3) the need for services to avoid out-of-home placement of 
  3.30  children.  
  3.31  The plan must also identify changes made to improve services to 
  3.32  eligible persons and to improve program management. 
  3.33     (c) In allocating resources to counties, priority must be 
  3.34  given to groups of counties that form partnerships to jointly 
  3.35  plan, administer, and authorize funding for eligible individuals 
  3.36  and to counties determined by the commissioner to have 
  4.1   sufficient waiver capacity to maximize resource use. 
  4.2      (d) Within 30 days after receiving the county request for 
  4.3   funds and plans, the commissioner shall provide a written 
  4.4   response to the plan that includes the level of resources 
  4.5   available to serve additional persons. 
  4.6      (e) Counties determined to have sufficient capacity and 
  4.7   groups of counties managing funds in partnership are eligible to 
  4.8   receive medical assistance administrative reimbursement for 
  4.9   administrative costs under criteria established by the 
  4.10  commissioner.  
  4.11     Subd. 3.  [FAILURE TO DEVELOP PARTNERSHIPS OR SUBMIT A 
  4.12  PLAN.] (a) By October 1 of each year the commissioner shall 
  4.13  notify the county board if any county determined by the 
  4.14  commissioner to have insufficient capacity to maximize use of 
  4.15  available resources fails to develop a partnership with other 
  4.16  counties or fails to submit a plan as required in subdivision 
  4.17  2.  The commissioner shall provide needed technical assistance 
  4.18  to a county or group of counties that fails to form a 
  4.19  partnership or submit a plan.  If a county has not joined a 
  4.20  county partnership or submitted a plan within 30 days following 
  4.21  the notice by the commissioner of its failure, the commissioner 
  4.22  shall require and assist that county to develop a plan or 
  4.23  contract with another county or group of counties to plan and 
  4.24  administer the waiver services program in that county. 
  4.25     (b) Counties may request technical assistance, management 
  4.26  information, and administrative support from the commissioner at 
  4.27  any time.  The commissioner shall respond to county requests 
  4.28  within 30 days.  Priority shall be given to activities that 
  4.29  support the administrative needs of newly formed county 
  4.30  partnerships. 
  4.31     Subd. 4.  [RESERVE ACCOUNT.] Counties or groups of counties 
  4.32  participating in partnerships that have submitted a plan under 
  4.33  this section may develop a reserve account to meet crises and 
  4.34  other unmet needs of current home and community-based waiver 
  4.35  recipients.  The amount of the allowed reserve shall be a county 
  4.36  specific amount based upon documented past experience and 
  5.1   projected need for the coming year described in a reserve 
  5.2   account plan submitted for approval to the commissioner with the 
  5.3   allocation request for the fiscal year.  Any funds remaining in 
  5.4   a reserve account at the end of the fiscal year do not cancel, 
  5.5   but shall carry forward and be used by counties or groups of 
  5.6   counties that have developed partnerships for home and 
  5.7   community-based services for the next fiscal year, unless 
  5.8   reallocated to other counties. 
  5.9      Subd. 5.  [PRIORITIES FOR REASSIGNMENT OF RESOURCES AND 
  5.10  APPROVAL OF INCREASED CAPACITY.] In order to maximize the number 
  5.11  of persons served with waiver funds, the commissioner shall 
  5.12  monitor county utilization of allocated resources and, as 
  5.13  appropriate, reassign resources not utilized and approve 
  5.14  increased capacity within available county allocations.  
  5.15  Priority consideration for reassignment of resources and 
  5.16  approval of increased capacity shall be given to counties with 
  5.17  sufficient capacity and counties that form partnerships.  In 
  5.18  addition to the priorities listed in Minnesota Rules, part 
  5.19  9525.1880, the commissioner shall also give priority 
  5.20  consideration to persons whose living situations are unstable 
  5.21  due to the age or incapacity of the primary caregiver and to 
  5.22  children to avoid out-of-home placement. 
  5.23     Subd. 6.  [WAIVER REQUEST.] (a) The commissioner shall 
  5.24  submit to the federal Health Care Financing Administration by 
  5.25  September 1, 1999, a request for a demonstration waiver to 
  5.26  include an option that would allow waiver service recipients to 
  5.27  directly receive 95 percent of the funds that would be allocated 
  5.28  to individuals based on written county criteria and procedures 
  5.29  approved by the commissioner for the purchase of services to 
  5.30  meet their long-term care needs.  The waiver request must 
  5.31  include a provision requiring recipients who receive funds 
  5.32  directly to provide to the commissioner annually, a description 
  5.33  of the type of services used, the amount paid for the services 
  5.34  purchased, and the amount of unspent funds. 
  5.35     (b) The commissioner, in cooperation with county 
  5.36  representatives, waiver service providers, recipients, 
  6.1   recipients' families, legal guardians, and advocacy groups, 
  6.2   </u>
  6.3   shall develop criteria for: 
  6.4      (1) eligibility to receive funding directly; 
  6.5      (2) determination of the amount of funds made available to 
  6.6   each eligible person based on need; and 
  6.7      (3) the accountability required of persons directly 
  6.8   receiving funds. 
  6.9      (c) If this waiver is approved and implemented, any unspent 
  6.10  money from the waiver services allocation, including the five 
  6.11  percent not directly allocated to recipients and any unspent 
  6.12  portion of the money that is directly allocated, shall be used 
  6.13  to meet the needs of other eligible persons waiting for services 
  6.14  funded through the waiver.  Any portion of the allocation 
  6.15  remaining unspent at the end of a fiscal year shall not cancel 
  6.16  but shall be carried forward to the next fiscal year for this 
  6.17  purpose. 
  6.18     (d) The commissioner, in consultation with county social 
  6.19  services agencies, waiver services providers, recipients, 
  6.20  recipients' families, legal guardians, and advocacy groups shall 
  6.21  evaluate the effectiveness of this option within two years of 
  6.22  its implementation. 
  6.23     Subd. 7.  [ANNUAL REPORT BY COMMISSIONER.] Beginning 
  6.24  October 1, 1999, and each October 1 thereafter, the commissioner 
  6.25  shall issue an annual report on county and state use of 
  6.26  available resources for the home and community-based waiver for 
  6.27  persons with mental retardation or related conditions.  For each 
  6.28  county or county partnership, the report shall include: 
  6.29     (1) the amount of funds allocated but not used; 
  6.30     (2) the county specific reserve amount approved and used; 
  6.31     (3) the number, ages and living situations of individuals 
  6.32  screened and waiting for services; 
  6.33     (4) the urgency of need for services to begin within one, 
  6.34  two, or more than two years for each individual; 
  6.35     (5) the services needed; 
  6.36     (6) the number of additional persons served by approval of 
  6.37  increased capacity within existing allocations; 
  7.1      (7) results of action by the commissioner to streamline 
  7.2   administrative requirements and improve county resource 
  7.3   management; and 
  7.4      (8) additional action that would decrease the number of 
  7.5   those eligible and waiting for waivered services. 
  7.6   The commissioner shall specify intended outcomes for the program 
  7.7   and the degree to which these specified outcomes are attained. 
  7.8      ~~(e)~~ Subd. 8.  [FINANCIAL INFORMATION BY COUNTY.] The 
  7.9   commissioner shall make available to interested parties, upon 
  7.10  request, financial information by county including the amount of 
  7.11  resources allocated for the home and community-based waiver for 
  7.12  persons with mental retardation and related conditions, the 
  7.13  resources committed, the number of persons screened and waiting 
  7.14  for services, the type of services requested by those waiting, 
  7.15  and the amount of allocated resources not committed. 
  7.16     Sec. 2.  [REPORT ON ALTERNATIVE RESOURCE ALLOCATION 
  7.17  METHODS.] 
  7.18     The commissioner of human services shall consider and 
  7.19  evaluate administrative methods other than the current resource 
  7.20  allocation system for the home and community-based waiver for 
  7.21  persons with mental retardation and related conditions.  In 
  7.22  developing the alternatives, the commissioner shall consult with 
  7.23  county commissioners from large and small counties, county 
  7.24  agencies, consumers, advocates, and providers.  The commissioner 
  7.25  shall report to the chairs of the senate health and family 
  7.26  security budget division and house health and human services 
  7.27  finance committee by February 1, 2000. 
  7.28     Sec. 3.  [APPROPRIATION.] 
  7.29     (a) $....... is appropriated from the general fund to the 
  7.30  commissioner of human services for the biennium beginning July 
  7.31  1, 1999, for increased home and community-based waiver services 
  7.32  for persons with mental retardation or a related condition.  
  7.33     (b) $2,000,000 is appropriated from the general fund to the 
  7.34  commissioner of human services for each year of the biennium 
  7.35  beginning July 1, 1999, for semi-independent living services 
  7.36  under Minnesota Statutes, section 252.275. 
  8.1      (c) $3,000,000 is appropriated from the general fund to the 
  8.2   commissioner of human services for each year of the biennium 
  8.3   beginning July 1, 1999, for family support grants under 
  8.4   Minnesota Statutes, section 252.32. 
  8.5      (d) $....... is appropriated from the general fund to the 
  8.6   commissioner of human services for the biennium beginning July 
  8.7   1, 1999, to reimburse county administrative costs under 
  8.8   Minnesota Statutes, section 256B.0916, subdivision 2. 
  8.9      (e) $250,000 is appropriated from the general fund to the 
  8.10  commissioner of human services for the biennium beginning July 
  8.11  1, 1999, for technical assistance to counties to improve county 
  8.12  management of the waiver services program and to assist counties 
  8.13  in forming joint partnerships. 
  8.14     (f) Any unspent portion of the appropriations in this 
  8.15  section for fiscal year 2000 does not cancel but shall be 
  8.16  available for the same purpose for fiscal year 2001. 
  8.17     (g) The appropriations in this section shall become part of 
  8.18  the base-level funding for the commissioner of human services. 
  8.19     Sec. 4.  [REPEALER.] 
  8.20     Laws 1997, chapter 203, article 7, section 27, is repealed.