1.1                          A bill for an act 
  1.2             relating to human services; modifying provisions for 
  1.3             long-term care; amending Minnesota Statutes 2000, 
  1.4             sections 144A.31, subdivision 2a; 256.975, by adding a 
  1.5             subdivision; 256B.0911, subdivisions 1, 3, 5, 6, 7, 
  1.6             and by adding subdivisions; 256B.0913, subdivisions 1, 
  1.7             2, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, and 14; 
  1.8             256B.0915, subdivisions 1d, 3, and 5; 256B.0917, by 
  1.9             adding a subdivision; 256B.431, by adding a 
  1.10            subdivision; 256B.435, subdivisions 1, 1a, 2, 3, 5, 6, 
  1.11            7, 8, and by adding subdivisions; 256B.436, 
  1.12            subdivisions 1, 2, 4, 7, and by adding subdivisions; 
  1.13            proposing coding for new law in Minnesota Statutes, 
  1.14            chapter 144A; repealing Minnesota Statutes 2000, 
  1.15            sections 144A.16; 256B.0911, subdivisions 2, 2a, 4, 8, 
  1.16            and 9; 256B.0913, subdivisions 3, 15a, 15b, and 16; 
  1.17            256B.0915, subdivisions 3a, 3b, and 3c; and 256B.436, 
  1.18            subdivisions 3, 5, 6, and 8; Minnesota Rules, parts 
  1.19            4655.6810; 4655.6820; 4655.6830; 4658.1600; 4658.1605; 
  1.20            4658.1610; 4658.1690; 9505.2390; 9505.2395; 9505.2396; 
  1.21            9505.2400; 9505.2405; 9505.2410; 9505.2413; 9505.2415; 
  1.22            9505.2420; 9505.2425; 9505.2426; 9505.2430; 9505.2435; 
  1.23            9505.2440; 9505.2445; 9505.2450; 9505.2455; 9505.2458; 
  1.24            9505.2460; 9505.2465; 9505.2470; 9505.2473; 9505.2475; 
  1.25            9505.2480; 9505.2485; 9505.2486; 9505.2490; 9505.2495; 
  1.26            9505.2496; 9505.2500; 9546.0010; 9546.0020; 9546.0030; 
  1.27            9546.0040; 9546.0050; and 9546.0060. 
  1.28  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.29     Section 1.  [144A.161] [NURSING FACILITY RESIDENT 
  1.30  RELOCATION.] 
  1.31     Subdivision 1.  [DEFINITIONS.] The definitions in this 
  1.32  subdivision apply to subdivisions 2 to 9. 
  1.33     (a) "Closure" means the cessation of operations of a 
  1.34  nursing home and the delicensure and decertification of all beds 
  1.35  within the facility. 
  1.36     (b) "Curtailment," "reduction," or "change" refers to any 
  2.1   change in operations which would result in or encourage the 
  2.2   relocation of residents. 
  2.3      (c) "Facility" means a nursing home licensed pursuant to 
  2.4   this chapter, or a certified boarding care home licensed 
  2.5   pursuant to sections 144.50 to 144.56. 
  2.6      (d) "Licensee" means the facility that is proposing a 
  2.7   closure, curtailment, reduction, or change in operations which 
  2.8   may result in the relocation of residents. 
  2.9      (e) "Local agency" means the county or multicounty social 
  2.10  service agency authorized under sections 393.01 and 393.07, as 
  2.11  the agency responsible for providing social services for the 
  2.12  county in which the nursing home is located. 
  2.13     (f) "Plan" means a process developed under subdivision 3, 
  2.14  paragraph (b), for the closure, curtailment, reduction, or 
  2.15  change in operations in a facility and the subsequent relocation 
  2.16  of residents. 
  2.17     (g) "Relocation" means the discharge of a resident and 
  2.18  movement of the resident to another facility or living 
  2.19  arrangement as a result of the closing, curtailment, reduction, 
  2.20  or change in operations of a nursing home or boarding care home. 
  2.21     Subd. 2.  [INITIAL NOTICE FROM LICENSEE.] (a) The licensee 
  2.22  of the facility shall notify the following parties in writing 
  2.23  when there is an intent to close, curtail, reduce, or change 
  2.24  operations or services which would result in the relocation of 
  2.25  residents:  the department of health, the department of human 
  2.26  services, the local agency, the office of ombudsman for older 
  2.27  Minnesotans, and the ombudsman for mental health/mental 
  2.28  retardation. 
  2.29     (b) The written notice shall include the names, telephone 
  2.30  numbers, facsimile numbers, and e-mail addresses of the persons 
  2.31  responsible for coordinating the licensee's efforts in the 
  2.32  planning process, and the number of residents potentially 
  2.33  affected by the closure, curtailment, reduction, or change in 
  2.34  operations. 
  2.35     Subd. 3.  [PLANNING PROCESS.] (a) The local agency shall, 
  2.36  within five working days of receiving initial notice of the 
  3.1   licensee's intent to close, curtail, reduce, or change 
  3.2   operations, provide the licensee and all parties identified in 
  3.3   subdivision 2, paragraph (a), with the names, telephone numbers, 
  3.4   facsimile numbers, and e-mail addresses of those persons 
  3.5   responsible for coordinating local agency efforts in the 
  3.6   planning process. 
  3.7      (b) The licensee shall convene a meeting of representatives 
  3.8   from the department of health, the department of human services, 
  3.9   and the local agency to jointly develop a plan regarding the 
  3.10  closure, curtailment, or change in facility operations.  The 
  3.11  plan shall: 
  3.12     (1) identify the expected date of closure, curtailment, 
  3.13  reduction, or change in operations; 
  3.14     (2) outline the process for public notification of the 
  3.15  closure, curtailment, reduction, or change in operations; 
  3.16     (3) identify and make efforts to include other stakeholders 
  3.17  in the planning process; 
  3.18     (4) outline the process to ensure 60-day advance written 
  3.19  notice to residents, family members, and designated 
  3.20  representatives; 
  3.21     (5) present an aggregate description of the resident 
  3.22  population remaining to be relocated and their needs; 
  3.23     (6) outline the individual resident assessment process to 
  3.24  be utilized; 
  3.25     (7) identify an inventory of available relocation options, 
  3.26  including home and community-based services; 
  3.27     (8) identify a timeline for submission of the list 
  3.28  identified in subdivision 5, paragraph (h); 
  3.29     (9) identify a schedule for the timely completion of each 
  3.30  element of the plan; 
  3.31     (10) provide an estimate of the relocation costs to the 
  3.32  local agency; and 
  3.33     (11) be finalized within a period not to exceed 45 days 
  3.34  from the receipt of the initial notice of closure, curtailment, 
  3.35  reduction, or change in operations or services. 
  3.36     Subd. 4.  [RESPONSIBILITIES OF LICENSEE FOR RESIDENT 
  4.1   RELOCATIONS.] The licensee shall provide for the safe, orderly, 
  4.2   and appropriate relocation of residents.  The licensee and 
  4.3   facility staff shall cooperate with representatives from the 
  4.4   local agency, the department of health, the department of human 
  4.5   services, the office of ombudsman for older Minnesotans, and 
  4.6   ombudsman for mental health/mental retardation, in planning for 
  4.7   and implementing the relocation of residents.  The discharge and 
  4.8   relocation of residents must comply with all applicable state 
  4.9   and federal requirements. 
  4.10     Subd. 5.  [RESPONSIBILITIES PRIOR TO RELOCATION.] (a) The 
  4.11  licensee shall provide an initial notice as described in 
  4.12  subdivision 2, when there is an intent to close, curtail, 
  4.13  reduce, or change in operations which would result in the 
  4.14  relocation of residents. 
  4.15     (b) The licensee shall establish an interdisciplinary team 
  4.16  responsible for coordinating and implementing the plan as 
  4.17  outlined in subdivision 3, paragraph (b).  The interdisciplinary 
  4.18  team shall include representatives from the local agency, the 
  4.19  office of ombudsman for older Minnesotans, facility staff that 
  4.20  provide direct care services to the residents, and facility 
  4.21  administration. 
  4.22     (c) The licensee shall provide a list to the local agency 
  4.23  that includes the following information on each resident to be 
  4.24  relocated: 
  4.25     (1) the resident's name; 
  4.26     (2) date of birth; 
  4.27     (3) social security number; 
  4.28     (4) medical assistance identification number; 
  4.29     (5) all diagnoses; and 
  4.30     (6) the name and contact information for the resident's 
  4.31  family or other designated representative. 
  4.32     (d) The licensee shall consult with the local agency on the 
  4.33  availability and development of available resources, and on the 
  4.34  resident relocation process. 
  4.35     (e) At least 60 days before the proposed date of closing, 
  4.36  curtailment, reduction, or change in operations as agreed to in 
  5.1   the plan, the licensee shall send a written notice of closure, 
  5.2   curtailment, reduction, or change in operations to each resident 
  5.3   being relocated, the resident's family member or designated 
  5.4   representative, and the resident's attending physician.  The 
  5.5   notice must include the following: 
  5.6      (1) the date of the proposed closure, curtailment, 
  5.7   reduction, or change in operations; 
  5.8      (2) the name, address, telephone number, facsimile number, 
  5.9   and e-mail address of the individual or individuals in the 
  5.10  facility responsible for providing assistance and information; 
  5.11     (3) notification of upcoming meetings for individuals, 
  5.12  families, and resident councils to discuss the relocation of 
  5.13  residents; 
  5.14     (4) the name, address, and telephone number of the local 
  5.15  agency contact person; 
  5.16     (5) the name, address, and telephone number of the office 
  5.17  of ombudsman for older Minnesotans and the ombudsman for mental 
  5.18  health/mental retardation; and 
  5.19     (6) a notice of resident rights during discharge and 
  5.20  relocation, in a form approved by the office of ombudsman for 
  5.21  older Minnesotans. 
  5.22     The notice must comply with all applicable state and 
  5.23  federal requirements for notice of transfer or discharge of 
  5.24  nursing home residents. 
  5.25     (f) The licensee shall request the attending physician 
  5.26  provide or arrange for the release of medical information needed 
  5.27  to update resident medical records and prepare all required 
  5.28  forms and discharge summaries. 
  5.29     (g) The licensee shall provide sufficient preparation to 
  5.30  residents to ensure safe, orderly and appropriate discharge, and 
  5.31  relocation.  The licensee shall assist residents in finding a 
  5.32  placement that satisfies personal preferences such as desired 
  5.33  geographic location.  
  5.34     (h) The licensee shall prepare a resource list with several 
  5.35  relocation options for each resident.  The list must contain the 
  5.36  following information for each relocation option, when 
  6.1   applicable: 
  6.2      (1) the name, address, telephone, and fax numbers of each 
  6.3   facility with appropriate, available beds or services; 
  6.4      (2) the certification level of the available beds; 
  6.5      (3) the types of services available; 
  6.6      (4) the name, address, telephone, and fax numbers of 
  6.7   appropriate available home and community-based placements, 
  6.8   services and settings, or other options for individuals with 
  6.9   special needs.  
  6.10  The list shall be made available to residents and their families 
  6.11  or designated representatives, and upon request to the office of 
  6.12  ombudsman for older Minnesotans and ombudsman for mental 
  6.13  health/mental retardation, and the local agency. 
  6.14     (i) Following the establishment of the plan under 
  6.15  subdivision 3, paragraph (b), the licensee shall conduct 
  6.16  meetings with residents, designated representatives, and 
  6.17  resident and family councils to notify them of the process for 
  6.18  resident relocation.  Representatives from the local county 
  6.19  social services agency and the office of ombudsman for older 
  6.20  Minnesotans and the ombudsman for mental health/mental 
  6.21  retardation shall receive advance notice of the meetings.  
  6.22     (j) The licensee shall assist residents in making site 
  6.23  visits to facilities with available beds or other appropriate 
  6.24  living options to which the resident may relocate, unless it is 
  6.25  medically inadvisable, as documented by the attending physician 
  6.26  in the resident's care record.  The licensee shall provide 
  6.27  transportation for site visits to facilities or other living 
  6.28  options within a 50-mile radius to which the resident may 
  6.29  relocate.  The licensee shall provide available written 
  6.30  materials to residents on a potential new facility or living 
  6.31  option. 
  6.32     (k) The licensee shall complete an inventory of resident 
  6.33  personal possessions and provide a copy of the final inventory 
  6.34  to the resident and the resident's designated representative 
  6.35  prior to relocation.  The licensee shall be responsible for the 
  6.36  transfer of the resident's possessions for all relocations 
  7.1   within a 50-mile radius of the facility.  The licensee shall 
  7.2   complete the transfer of resident possessions in a timely 
  7.3   manner, but no later than the date of the actual physical 
  7.4   relocation of the resident. 
  7.5      (l) The licensee shall complete a final accounting of 
  7.6   personal funds held in trust by the facility and provide a copy 
  7.7   of this accounting to the resident and the resident's family or 
  7.8   the resident's designated representative.  The licensee shall be 
  7.9   responsible for the transfer of all personal funds held in trust 
  7.10  by the facility.  The licensee shall complete the transfer of 
  7.11  all personal funds in a timely manner. 
  7.12     (m) The licensee shall assist residents with the transfer 
  7.13  and reconnection of service for telephones or other personal 
  7.14  communication devices or services.  The licensee shall pay the 
  7.15  costs associated with reestablishing service for telephones or 
  7.16  other personal communication devices or services, such as 
  7.17  connection fees or other one-time charges.  The transfer or 
  7.18  reconnection of personal communication devices or services shall 
  7.19  be completed in a timely manner. 
  7.20     (n) The licensee shall provide the resident, the resident's 
  7.21  family or designated representative, and the resident's 
  7.22  attending physician final written notice prior to the relocation 
  7.23  of the resident.  The notice must: 
  7.24     (1) be provided seven days prior to the actual relocation, 
  7.25  unless the resident agrees to waive the right to advance notice; 
  7.26  and 
  7.27     (2) identify the date of the anticipated relocation and the 
  7.28  destination to which the resident is being relocated. 
  7.29     (o) The licensee shall provide the receiving facility or 
  7.30  other health, housing, or care entity with complete and accurate 
  7.31  resident records including information on family members, 
  7.32  designated representatives, guardians, social service 
  7.33  caseworkers, or other contact information.  These records must 
  7.34  also include all information necessary to provide appropriate 
  7.35  medical care and social services.  This includes, but is not 
  7.36  limited to information on preadmission screening, Level I and 
  8.1   Level II screening, Minimum Data Set (MDS) and all other 
  8.2   assessments, resident diagnoses, social, behavioral, and 
  8.3   medication information. 
  8.4      Subd. 6.  [RESPONSIBILITIES DURING RELOCATION.] (a) The 
  8.5   licensee shall arrange for the safe transport of residents to 
  8.6   the new facility or placement. 
  8.7      (b) The licensee must ensure that there is no disruption in 
  8.8   the provision of meals, medications, or treatments of the 
  8.9   resident during the relocation process. 
  8.10     Subd. 7.  [RESPONSIBILITIES FOLLOWING RELOCATION.] (a) 
  8.11  Beginning the week following development of the initial 
  8.12  relocation plan, the licensee shall submit biweekly status 
  8.13  reports to the commissioners of the department of health and the 
  8.14  department of human services or their designees, and to the 
  8.15  local agency.  The initial status report must identify: 
  8.16     (1) the relocation plan developed; 
  8.17     (2) the interdisciplinary team members; and 
  8.18     (3) the number of residents to be relocated. 
  8.19     (b) Subsequent status reports must identify: 
  8.20     (1) any modifications to the plan; 
  8.21     (2) any change of interdisciplinary team members; 
  8.22     (3) the number of residents relocated; 
  8.23     (4) the destination to which residents have been relocated; 
  8.24     (5) the number of residents remaining to be relocated; and 
  8.25     (6) issues or problems encountered during the process and 
  8.26  resolution of these issues. 
  8.27     (c) The licensee shall retain or make arrangements for the 
  8.28  retention of all remaining resident records, for the period 
  8.29  required by law.  The licensee shall provide the department of 
  8.30  health access to these records.  The licensee shall notify the 
  8.31  department of health of the location of any resident records 
  8.32  that have not been transferred to the new facility or other 
  8.33  health care entity. 
  8.34     Subd. 8.  [RESPONSIBILITIES OF THE LOCAL AGENCY.] (a) The 
  8.35  local agency shall participate in the meeting as outlined in 
  8.36  subdivision 3, paragraph (b), to develop a relocation plan. 
  9.1      (b) The local agency shall designate a representative to 
  9.2   the interdisciplinary team established by the licensee 
  9.3   responsible for coordinating the relocation efforts. 
  9.4      (c) The local agency shall serve as a resource in the 
  9.5   relocation process. 
  9.6      (d) Concurrent with the notice sent to residents from the 
  9.7   licensee as provided in subdivision 5, paragraph (e), the local 
  9.8   agency shall provide written notice to residents, family, or 
  9.9   designated representatives describing: 
  9.10     (1) the county's role in the relocation process and in the 
  9.11  follow-up to relocations; 
  9.12     (2) a local agency contact name, address, and telephone 
  9.13  number; and 
  9.14     (3) the name, address, and telephone number of the office 
  9.15  of ombudsman for older Minnesotans and the ombudsman for mental 
  9.16  health/mental retardation. 
  9.17     (e) The local agency designee shall meet with appropriate 
  9.18  facility staff to coordinate any assistance in the relocation 
  9.19  process.  This coordination shall include participating in group 
  9.20  meetings with residents, families, and designated 
  9.21  representatives to explain the relocation process. 
  9.22     (f) The local agency shall monitor compliance with all 
  9.23  components of the plan.  If the licensee is not in compliance, 
  9.24  the local agency shall notify the commissioners of the 
  9.25  department of health and the department of human services. 
  9.26     (g) The local agency shall report to the commissioners of 
  9.27  health and human services, any relocations that endanger the 
  9.28  health, safety, or well-being of residents.  The local agency 
  9.29  shall pursue remedies to protect the resident during the 
  9.30  relocation process, including, but not limited to, assisting the 
  9.31  resident with filing an appeal of transfer or discharge, 
  9.32  notification of all appropriate licensing boards and agencies, 
  9.33  and other remedies available to the county under section 
  9.34  626.557, subdivision 10. 
  9.35     (h) A member of the local agency staff shall visit the 
  9.36  resident within 30 days after the relocation.  Local agency 
 10.1   staff shall interview the resident and family or designated 
 10.2   representative, observe the resident on site, and review and 
 10.3   discuss pertinent medical or social records with facility staff 
 10.4   to: 
 10.5      (1) assess the adjustment of the resident to the new 
 10.6   placement; 
 10.7      (2) recommend services or methods to meet any special needs 
 10.8   of the resident; and 
 10.9      (3) identify residents at risk. 
 10.10     (i) The local agency shall have the authority to conduct 
 10.11  subsequent follow-up visits in cases where the adjustment of the 
 10.12  resident to the new placement is in question. 
 10.13     (j) Within 60 days of the completion of the follow-up 
 10.14  visits, the local agency shall submit a written summary of the 
 10.15  follow-up work to the department of health and the department of 
 10.16  human services, in a manner approved by the commissioners. 
 10.17     (k) The local agency shall submit to the department of 
 10.18  health and the department of human services a report of any 
 10.19  issues that may require further review or monitoring. 
 10.20     (l) The local agency shall be responsible for the safe and 
 10.21  orderly relocation of residents in cases where an emergent need 
 10.22  arises or when the licensee has abrogated their responsibilities 
 10.23  under the plan. 
 10.24     Subd. 9.  [FUNDING.] The commissioner of human services 
 10.25  shall negotiate with the local agency to determine an amount of 
 10.26  administrative funding within appropriations specified for this 
 10.27  purpose to make available to the local agency for the costs of 
 10.28  work related to the relocation process. 
 10.29     Subd. 10.  [PENALTIES.] According to sections 144.653 and 
 10.30  144A.10, the licensee shall be subject to correction orders and 
 10.31  civil monetary penalties of up to $500 per day for each 
 10.32  violation of this statute. 
 10.33     Sec. 2.  [144A.162] [NURSING FACILITY DELICENSURE.] 
 10.34     Subdivision 1.  [DELICENSURE.] By no later than June 30, 
 10.35  2002, all licensed nursing facilities except for veterans homes 
 10.36  established under chapter 198, shall delicense third and fourth 
 11.1   beds in nursing facility bedrooms.  Reducing the number of 
 11.2   residents occupying rooms with three or four beds shall take 
 11.3   place through attrition.  Nursing facilities shall not discharge 
 11.4   residents to accomplish this downsizing.  Third and fourth beds 
 11.5   that are on layaway at the time of enactment shall be deemed 
 11.6   permanently delicensed.  Resident room transfers within 
 11.7   facilities shall be conducted in compliance with all applicable 
 11.8   state and federal regulations regarding notice and resident 
 11.9   rights. 
 11.10     Subd. 2.  [REPORTING.] By August 15, 2001, all nursing 
 11.11  facilities shall report to the commissioner of health on their 
 11.12  bed composition, as of July 1, 2001, in a manner to be 
 11.13  established by the commissioner.  This report shall provide 
 11.14  counts of the number of rooms in the facility with one, two, 
 11.15  three, or four beds.  Nursing facilities with rooms with three 
 11.16  or four beds shall report within two weeks of the end of each 
 11.17  calendar quarter on their progress, during the prior quarter, in 
 11.18  reducing the number of residents occupying third and fourth 
 11.19  beds, the number of discharges that took place during the 
 11.20  quarter, and any issues which have arisen.  When the occupancy 
 11.21  of all rooms with three or four licensed beds is reduced to two 
 11.22  or less, the nursing facility shall report to the commissioner 
 11.23  the effective date of the delicensure of these beds. 
 11.24     Subd. 3.  [EXTENSIONS.] In the event the number of 
 11.25  residents in rooms with three or four beds cannot be reduced to 
 11.26  two or less within one year because of a low number of 
 11.27  discharges or concerns that moves within the facility may 
 11.28  endanger the health or safety of residents, the commissioner of 
 11.29  health may grant the nursing facility extensions of up to three 
 11.30  months in order to reduce their occupancy.  Nursing facilities 
 11.31  may request extensions in progress reports filed with the 
 11.32  commissioner for quarters ending on or after June 30, 2002. 
 11.33     Subd. 4.  [WAIVERS.] The commissioner of health, in 
 11.34  consultation with the commissioner of human services, may waive 
 11.35  the requirement to delicense third and fourth beds in nursing 
 11.36  facility bedrooms for up to ten percent of the beds identified 
 12.1   in the initial reports in subdivision 2 where their elimination 
 12.2   would cause severe financial hardship to those facilities, or 
 12.3   where other mitigating conditions exist.  Requests for waiver 
 12.4   must be submitted to the commissioner of health within three 
 12.5   months of enactment of this section and must specify the nature 
 12.6   and extent of the hardship to the facility of the delicensure of 
 12.7   the third and fourth bed and the minimum number that must be 
 12.8   retained to minimize this hardship.  In granting such waivers 
 12.9   the commissioner shall consider recommendations from the 
 12.10  interagency long-term care planning committee, established in 
 12.11  section 144A.31, taking into consideration information in the 
 12.12  waiver request and the number of nursing facilities beds 
 12.13  available in the county and in contiguous counties. 
 12.14     Subd. 5.  [RATE ADJUSTMENTS.] Within ten working days of 
 12.15  notification by the nursing facility of the effective date of 
 12.16  delicensure, the commissioner shall notify the commissioner of 
 12.17  human services.  Effective the first day of the month following 
 12.18  the delicensure of the third and fourth beds, the commissioner 
 12.19  of human services shall provide a rate adjustment to nursing 
 12.20  facilities that have rates established under sections 256B.431, 
 12.21  256B.434, or 256B.435, as provided under section 256B.431, 
 12.22  subdivision 30. 
 12.23     Sec. 3.  Minnesota Statutes 2000, section 144A.31, 
 12.24  subdivision 2a, is amended to read: 
 12.25     Subd. 2a.  [DUTIES.] (a) The interagency committee shall 
 12.26  manage and implement the moratorium exception process in 
 12.27  accordance with sections 144A.071 and 144A.073. 
 12.28     (b) The interagency committee shall manage and implement 
 12.29  the waiver process for the delicensure of third and fourth beds 
 12.30  in nursing facility bedrooms, according to section 144A.162. 
 12.31     Sec. 4.  Minnesota Statutes 2000, section 256.975, is 
 12.32  amended by adding a subdivision to read: 
 12.33     Subd. 7.  [CONSUMER INFORMATION AND ASSISTANCE; SENIOR 
 12.34  LINKAGE.] (a) The Minnesota board on aging shall operate 
 12.35  directly or through contracts, an expanded statewide information 
 12.36  and assistance service to help elder Minnesotans and their 
 13.1   families make informed choices about long-term care options and 
 13.2   health care benefits.  This service, known as senior linkage, 
 13.3   shall be available on a daily basis by telephone, including 
 13.4   evening and weekend hours, and through the Internet.  Language 
 13.5   services to limited English-speaking people shall be available. 
 13.6      (b) The expanded service shall be regionally based with a 
 13.7   statewide toll-free number, utilizing a statewide database and 
 13.8   client tracking. 
 13.9      (c) The expanded service shall assist older adults and 
 13.10  their caregivers by providing assistance in gaining access to 
 13.11  services by: 
 13.12     (1) helping older adults or their caregivers complete 
 13.13  program applications to enroll in appropriate programs; 
 13.14     (2) developing a database that includes long-term care 
 13.15  resource listings that are consumer- and provider-oriented 
 13.16  through multiple points of entry including print, telephone, 
 13.17  Internet, and other communication methods; 
 13.18     (3) conducting outreach and developing community education 
 13.19  materials with a focus on planning for long-term care, options 
 13.20  for independent living, and how to access related information 
 13.21  over the Internet; 
 13.22     (4) providing health insurance counseling assistance with 
 13.23  comparative information on health care supplements, providers, 
 13.24  and health care choices statewide; 
 13.25     (5) coordinating with county human services to assist older 
 13.26  adults in making choices about health care and housing options 
 13.27  and directly transferring callers to county social service 
 13.28  intake staff for long-term care consultation, assessment, 
 13.29  screening, and program enrollment; and 
 13.30     (6) providing access to services by linking with providers, 
 13.31  including county human services, to recommend alternatives such 
 13.32  as home and community-based long-term care options. 
 13.33     (d) Senior linkage shall provide information in the form of 
 13.34  aggregate data on unmet needs, current services, or other 
 13.35  information related to long-term care to the department of human 
 13.36  services, local regional planning entities, and county human 
 14.1   services agencies to assist in community planning for 
 14.2   alternative long-term care options. 
 14.3      Sec. 5.  Minnesota Statutes 2000, section 256B.0911, 
 14.4   subdivision 1, is amended to read: 
 14.5      Subdivision 1.  [PURPOSE AND GOAL.] The purpose of ~~the~~ 
 14.6   ~~preadmission screening program~~ long-term care consultation 
 14.7   services is to assist persons with long term or chronic care 
 14.8   needs in making decisions and selecting options that meet their 
 14.9   needs and reflect their preferences.  The availability of, and 
 14.10  access to, information and other types of assistance is also 
 14.11  intended to prevent or delay certified nursing facility 
 14.12  placements ~~by assessing applicants and residents and offering~~ 
 14.13  ~~cost-effective alternatives appropriate for the person's needs~~, 
 14.14  and to provide transition assistance after admission.  Further, 
 14.15  the goal of ~~the program~~ these services is to contain costs 
 14.16  associated with unnecessary certified nursing facility 
 14.17  admissions.  The commissioners of human services and health 
 14.18  shall seek to maximize use of available federal and state funds 
 14.19  and establish the broadest program possible within the funding 
 14.20  available. 
 14.21     These services shall be coordinated with those provided 
 14.22  under sections 256.975, subdivision 7, and 256.9772, and with 
 14.23  the services provided by other public and private agencies in 
 14.24  the community, in order to offer a variety of cost-effective 
 14.25  alternatives to people with disabilities and elderly people.  
 14.26  The county agency providing long-term care consultation services 
 14.27  shall encourage the use of volunteers from families, religious 
 14.28  organizations, social clubs, and similar civic and service 
 14.29  organizations to provide community-based services. 
 14.30     Sec. 6.  Minnesota Statutes 2000, section 256B.0911, is 
 14.31  amended by adding a subdivision to read: 
 14.32     Subd. 1a.  [DEFINITIONS.] For purposes of this section, the 
 14.33  following terms have the meanings given: 
 14.34     (a) "Long-term care consultation services" means: 
 14.35     (1) the provision of information and education to the 
 14.36  general public regarding availability of the services authorized 
 15.1   under this section; 
 15.2      (2) an intake process that provides any person seeking 
 15.3   long-term care consultation services access to the services 
 15.4   described in this section, regardless of eligibility for 
 15.5   Minnesota health care programs; 
 15.6      (3) assessment of the health, psychological, and social 
 15.7   needs of referred individuals; 
 15.8      (4) assistance in identifying services needed to maintain 
 15.9   an individual in the least restrictive environments; 
 15.10     (5) providing recommendations on cost-effective community 
 15.11  services that are available to the individual; 
 15.12     (6) development of an individual's community support plan 
 15.13  and provision of follow-up services as needed; 
 15.14     (7) provision of information regarding eligibility for 
 15.15  Minnesota health care programs; 
 15.16     (8) preadmission screening to determine the need for a 
 15.17  nursing facility level of care; 
 15.18     (9) preliminary determination of Minnesota health care 
 15.19  programs eligibility for individuals who need a nursing facility 
 15.20  level of care, with appropriate referrals for final 
 15.21  determination; 
 15.22     (10) providing recommendations for nursing facility 
 15.23  placement when there are no cost-effective community services 
 15.24  available; and 
 15.25     (11) assistance to help transition people back to community 
 15.26  settings after facility admission.  
 15.27     (b) "Minnesota health care programs" means the medical 
 15.28  assistance program under this chapter, the alternative care 
 15.29  program under section 256B.0913, and the prescription drug 
 15.30  program under section 256.955.  
 15.31     Sec. 7.  Minnesota Statutes 2000, section 256B.0911, 
 15.32  subdivision 3, is amended to read: 
 15.33     Subd. 3.  [~~PERSONS RESPONSIBLE FOR CONDUCTING THE~~ 
 15.34  ~~PREADMISSION SCREENING~~ LONG-TERM CARE CONSULTATION TEAM.] (a) A 
 15.35  ~~local screening~~ long-term care consultation team shall be 
 15.36  established by the county board of commissioners.  Each local 
 16.1   ~~screening~~ consultation team shall consist of ~~screeners who are a~~ 
 16.2   at least one social worker and ~~a~~ at least one public health 
 16.3   nurse from their respective county agencies.  The board may 
 16.4   designate public health or social services as the lead agency 
 16.5   for long-term care consultation services.  If a county does not 
 16.6   have a public health nurse available, it may request approval 
 16.7   from the commissioner to assign a county registered nurse with 
 16.8   at least one year experience in home care to participate on the 
 16.9   team.  ~~The screening team members must confer regarding the most~~ 
 16.10  ~~appropriate care for each individual screened.~~  Two or more 
 16.11  counties may collaborate to establish a joint local 
 16.12  ~~screening~~ consultation team ~~or teams~~. 
 16.13     (b) ~~In assessing a person's needs, screeners shall have a~~ 
 16.14  ~~physician available for consultation and shall consider the~~ 
 16.15  ~~assessment of the individual's attending physician, if any.  The~~ 
 16.16  ~~individual's physician shall be included if the physician~~ 
 16.17  ~~chooses to participate.  Other personnel may be included on the~~ 
 16.18  ~~team as deemed appropriate by the county agencies~~ The team shall 
 16.19  be responsible to provide long-term care consultative services 
 16.20  to persons located in their county as described in subdivision 
 16.21  1a, paragraph (a), clauses (2) to (11). 
 16.22     Sec. 8.  Minnesota Statutes 2000, section 256B.0911, is 
 16.23  amended by adding a subdivision to read: 
 16.24     Subd. 3a.  [ASSESSMENT AND SUPPORT PLANNING.] (a) Persons 
 16.25  requesting assessment, services planning, or other assistance 
 16.26  intended to support community-based living must be visited 
 16.27  within ten working days after the date of referral.  Assessments 
 16.28  shall be conducted according to the provisions listed in 
 16.29  paragraphs (b) to (g).  
 16.30     (b) The lead agency may utilize a team consisting of either 
 16.31  the social worker or public health nurse or both to conduct the 
 16.32  assessment in a face-to-face interview.  The consultation team 
 16.33  members must confer regarding the most appropriate care for each 
 16.34  individual screened or assessed. 
 16.35     (c) The long-term care consultation team must assess the 
 16.36  health and social needs of the person, using an assessment form 
 17.1   provided by the commissioner. 
 17.2      (d) The team must conduct the assessment in a face-to-face 
 17.3   interview with the person being assessed, and the person's legal 
 17.4   representative, if any. 
 17.5      (e) The team must provide the person, or the person's legal 
 17.6   representative, with written recommendations for facility or 
 17.7   community-based services.  The team shall document that the most 
 17.8   cost-effective alternatives available were offered to the 
 17.9   individual.  For purposes of this requirement, "cost-effective 
 17.10  alternatives" means community services and living arrangements 
 17.11  that cost the same or less than nursing facility care. 
 17.12     (f) The team must provide the person or the person's legal 
 17.13  representative with a written community support plan if the 
 17.14  person chooses to use community-based services, regardless of 
 17.15  whether the individual is eligible for Minnesota health care 
 17.16  programs.  The person may request assistance in developing a 
 17.17  community support plan without participating in a complete 
 17.18  assessment. 
 17.19     (g) The team must give the person receiving assessment or 
 17.20  support planning, or the person's legal representative, 
 17.21  materials supplied by the commissioner containing the following 
 17.22  information: 
 17.23     (1) the purpose of preadmission screening and assessment; 
 17.24     (2) information about Minnesota health care programs; 
 17.25     (3) the person's freedom to accept or reject the 
 17.26  recommendations of the team; 
 17.27     (4) the person's right to confidentiality under chapter 13, 
 17.28  the Minnesota Government Data Practices Act; and 
 17.29     (5) the person's right to appeal under section 256.045, 
 17.30  subdivision 3, the following:  the team's recommendations, the 
 17.31  decision regarding the need for nursing facility level of care, 
 17.32  or the county's final decision regarding public program 
 17.33  eligibility. 
 17.34     Sec. 9.  Minnesota Statutes 2000, section 256B.0911, is 
 17.35  amended by adding a subdivision to read: 
 17.36     Subd. 3b.  [TRANSITION ASSISTANCE.] (a) A long-term care 
 18.1   consultation team shall provide assistance to persons residing 
 18.2   in a nursing facility, hospital, regional treatment center, or 
 18.3   intermediate care facility for persons with mental retardation 
 18.4   who request or are referred for assistance.  Transition 
 18.5   assistance must include assessment, community support plan 
 18.6   development, referrals to Minnesota health care programs, and 
 18.7   referrals to programs that provide assistance with housing. 
 18.8      (b) The lead agency shall develop transition processes with 
 18.9   institutional social workers and discharge planners to assure 
 18.10  that: 
 18.11     (1) persons with discharge potential are identified; 
 18.12     (2) persons admitted to facilities receive information 
 18.13  about assistance that is available; 
 18.14     (3) assessment is completed for persons within ten working 
 18.15  days of the date of referral; and 
 18.16     (4) there is a plan for transition and follow-up for the 
 18.17  individual's return to the community.  This includes 
 18.18  notification to other counties when a person who may require 
 18.19  assistance is screened by one county for admission to a facility 
 18.20  located in another county. 
 18.21     (c) If a person who is eligible for a Minnesota health care 
 18.22  program is admitted to a nursing facility, and has been 
 18.23  determined to have discharge potential by a long-term care 
 18.24  consultation team, the nursing facility must include a 
 18.25  consultation team member in the discharge planning process. 
 18.26     Sec. 10.  Minnesota Statutes 2000, section 256B.0911, is 
 18.27  amended by adding a subdivision to read: 
 18.28     Subd. 3c.  [ACCESS DEMONSTRATIONS.] (a) The demonstration 
 18.29  project is intended to target critical areas for improvement in 
 18.30  long-term care consultation services, and to organize resources 
 18.31  in a more efficient, effective, and preferred way.  The 
 18.32  demonstrations may include: 
 18.33     (1) development and implementation of strategies to 
 18.34  increase the number of people who leave nursing facilities, 
 18.35  hospitals, regional treatment centers, and intermediate care 
 18.36  facilities for persons with mental retardation and return to 
 19.1   community living, based on demonstration proposals that: 
 19.2      (i) focus on transitional planning between care settings; 
 19.3      (ii) engage a variety of providers and care settings; 
 19.4      (iii) include participants from both greater Minnesota and 
 19.5   metro communities; 
 19.6      (iv) emphasize regional or other cooperative approaches; 
 19.7   and 
 19.8      (v) identify potential obstacles to individuals returning 
 19.9   to community settings and propose recommendations to address 
 19.10  those obstacles and ways to improve the identification of people 
 19.11  who need transitional assistance; 
 19.12     (2) improve access to and expand the availability of 
 19.13  long-term care consultation services, and improve the 
 19.14  integration of these services with other local activities 
 19.15  designed to support people in community living; 
 19.16     (3) identify activities that increase public awareness of 
 19.17  and information about the various forms of long-term care 
 19.18  assistance available, and develop and implement replicable 
 19.19  training efforts; and 
 19.20     (4) select sites based on outcome and other performance 
 19.21  criteria outlined in an application process.  Projects can be 
 19.22  single-county or multicounty managed.  Project budgets may 
 19.23  include payments to increase the amount and encourage innovation 
 19.24  in the development of transitional services within demonstration 
 19.25  sites.  Payments for increased assessments, support plan 
 19.26  development, and other activities, as approved in the budget 
 19.27  proposal for selected project sites, shall be incorporated into 
 19.28  the reimbursement for long-term care consultation services as 
 19.29  described in subdivision 6.  Projected transition assessments 
 19.30  included as part of selected demonstration sites shall be 
 19.31  calculated at the rate for county case management services.  
 19.32     (b) The commissioner of human services shall submit a 
 19.33  report to the legislature describing demonstration models, 
 19.34  implementation activities, and projected outcomes by February 
 19.35  15, 2002.  A final report on the performance of the models and 
 19.36  recommendations for strategies to address relocation or 
 20.1   transitional assistance shall be completed by December 15, 2003. 
 20.2      Sec. 11.  Minnesota Statutes 2000, section 256B.0911, is 
 20.3   amended by adding a subdivision to read: 
 20.4      Subd. 3d.  [INTEGRATED SERVICE ACCESS STUDY.] The 
 20.5   commissioner of human services shall submit to the legislature 
 20.6   by February 15, 2002, a feasibility study for creating 
 20.7   integrated service access at the county agency level for both 
 20.8   publicly subsidized and nonsubsidized long-term care services 
 20.9   and housing options.  The report shall include a plan to: 
 20.10     (1) integrate public funding streams, with and without 
 20.11  eligibility requirements, to allow low-income, private pay 
 20.12  consumers to purchase services through a sliding fee scale; and 
 20.13     (2) include an evaluation that covers, at a minimum, the 
 20.14  public cost, consumer preferences and satisfaction, and 
 20.15  feasibility of statewide implementation. 
 20.16     Sec. 12.  Minnesota Statutes 2000, section 256B.0911, is 
 20.17  amended by adding a subdivision to read: 
 20.18     Subd. 4a.  [PREADMISSION SCREENING ACTIVITIES RELATED TO 
 20.19  NURSING FACILITY ADMISSIONS.] (a) All applicants to Medicaid 
 20.20  certified nursing facilities, including certified boarding care 
 20.21  facilities, must be screened prior to admission, regardless of 
 20.22  income, assets, or funding sources for nursing facility care, 
 20.23  except as described in subdivision 4b.  The purpose of the 
 20.24  screening activity is to determine the need for nursing facility 
 20.25  level of care described in paragraph (e), and to complete 
 20.26  activities required under federal law related to mental illness 
 20.27  and mental retardation as outlined in paragraph (b). 
 20.28     (b) A person who has a diagnosis or possible diagnosis of 
 20.29  mental illness, mental retardation, or a related condition must 
 20.30  receive a preadmission screening before admission, regardless of 
 20.31  the exemptions outlined in subdivision 4b, paragraph (b), to 
 20.32  identify the need for further evaluation or specialized 
 20.33  services, unless an admission prior to screening is authorized 
 20.34  by the local mental health authority, or the local developmental 
 20.35  disabilities case manager, or is authorized by the county agency 
 20.36  according to Public Law Number 100-508. 
 21.1      (c) The following criteria apply to the preadmission 
 21.2   screening: 
 21.3      (1) the lead agency must use forms and criteria developed 
 21.4   by the commissioner to identify people who require referral for 
 21.5   further evaluation and determination of the need for specialized 
 21.6   services; and 
 21.7      (2) the evaluation and determination of the need for 
 21.8   service needs must be done by: 
 21.9      (i) a qualified independent mental health professional, for 
 21.10  persons with a primary or secondary diagnosis of a serious 
 21.11  mental illness; or 
 21.12     (ii) a qualified mental retardation professional, for 
 21.13  persons with a primary or secondary diagnosis of mental 
 21.14  retardation or related conditions.  For purposes of this 
 21.15  requirement, a qualified mental retardation professional must 
 21.16  meet the standards for a qualified mental retardation 
 21.17  professional in the Code of Federal Regulations, title 42, 
 21.18  section 483.430. 
 21.19     (d) The local county mental health authority or the state 
 21.20  mental retardation authority under Public Law Numbers 100-203 
 21.21  and 101-508 may prohibit admission to a nursing facility if the 
 21.22  individual does not meet the nursing facility level of care 
 21.23  criteria or needs specialized services as defined in Public Law 
 21.24  Numbers 100-203 and 101-508.  For purposes of this section, 
 21.25  "specialized services" for a person with mental retardation or a 
 21.26  related condition means "active treatment" as that term is 
 21.27  defined in Code of Federal Regulations, title 42, section 
 21.28  483.440(a)(1). 
 21.29     (e) The determination of the need for nursing facility 
 21.30  level of care shall be made according to criteria developed by 
 21.31  the commissioner.  In assessing a person's needs, consultation 
 21.32  team members shall have a physician available for consultation 
 21.33  and shall consider the assessment of the individual's attending 
 21.34  physician, if any.  The individual's physician shall be included 
 21.35  if the physician chooses to participate.  Other personnel may be 
 21.36  included on the team as deemed appropriate by the county 
 22.1   agencies. 
 22.2      Sec. 13.  Minnesota Statutes 2000, section 256B.0911, is 
 22.3   amended by adding a subdivision to read: 
 22.4      Subd. 4b.  [EXEMPTIONS AND EMERGENCY ADMISSIONS.] (a) 
 22.5   Persons who are exempt from the federal screening requirements 
 22.6   outlined in subdivision 4a are: 
 22.7      (1) a person who, having entered an acute care facility 
 22.8   from a certified nursing facility, is returning to a certified 
 22.9   nursing facility; and 
 22.10     (2) a person transferring from one certified nursing 
 22.11  facility in Minnesota to another certified nursing facility in 
 22.12  Minnesota. 
 22.13     (b) Persons who are exempt from preadmission screening for 
 22.14  purposes of determining the level of care include: 
 22.15     (1) a person described in paragraph (a); 
 22.16     (2) a person who has a contractual right to have nursing 
 22.17  facility care paid for indefinitely by the veteran's 
 22.18  administration; 
 22.19     (3) a person who is enrolled in a demonstration project 
 22.20  under section 256B.69, subdivision 8, at the time of application 
 22.21  to a nursing facility; 
 22.22     (4) a person currently being served under the alternative 
 22.23  care program or under a home and community-based services waiver 
 22.24  authorized under section 1915(c) of the Social Security Act; or 
 22.25     (5) a person who is admitted to a certified nursing 
 22.26  facility for a short-term stay, which, based upon a physician's 
 22.27  certification, is expected to be 14 days or less in duration, 
 22.28  and who has been assessed and approved for nursing facility 
 22.29  admission within the previous six months.  This exemption 
 22.30  applies only if the team determines at the time of the initial 
 22.31  assessment of the six-month period that it is appropriate to use 
 22.32  the nursing facility for short-term stays and that there is an 
 22.33  adequate plan of care for return to the home or community-based 
 22.34  setting.  If a stay exceeds 14 days, the person must be referred 
 22.35  for a screening, which must be completed within five working 
 22.36  days of the referral, no later than the first county business 
 23.1   day following the 14th resident day.  Payment limitations in 
 23.2   subdivision 7 will apply to a person found at screening who does 
 23.3   not meet the level of care criteria for admission to a certified 
 23.4   nursing facility. 
 23.5      (c) Persons admitted to the Medicaid certified nursing 
 23.6   facility from the community on an emergency basis as described 
 23.7   in paragraph (d), or from an acute care facility on a nonworking 
 23.8   day, must be screened the first working day after admission. 
 23.9      (d) Emergency admission to a nursing facility prior to 
 23.10  screening is permitted when:  
 23.11     (1) a person is admitted from the community to a certified 
 23.12  nursing or certified boarding care facility during county 
 23.13  nonworking hours; 
 23.14     (2) a physician has determined that delaying admission 
 23.15  until preadmission screening is completed would adversely affect 
 23.16  the person's health and safety; 
 23.17     (3) there is a recent precipitating event that precludes 
 23.18  the person from living safely in the community, such as 
 23.19  sustaining an injury, sudden onset of acute illness, or a 
 23.20  caregiver is unable to continue to provide care; 
 23.21     (4) the attending physician has authorized the emergency 
 23.22  placement and has documented the reason that emergency placement 
 23.23  is recommended; and 
 23.24     (5) the county is contacted on the first working day 
 23.25  following the emergency admission. 
 23.26     (e) Transfer of a patient from an acute care hospital to a 
 23.27  nursing facility is not considered an emergency except for a 
 23.28  person who has received hospital services in the following 
 23.29  situations:  hospital admission for observation; care in an 
 23.30  emergency room without hospital admission; or following hospital 
 23.31  24-hour bed care. 
 23.32     Sec. 14.  Minnesota Statutes 2000, section 256B.0911, is 
 23.33  amended by adding a subdivision to read: 
 23.34     Subd. 4c.  [SCREENING REQUIREMENTS.] (a) A person may be 
 23.35  screened for nursing facility admission by telephone or in a 
 23.36  face-to-face consultation.  Consultation team members shall 
 24.1   identify each individual's needs using the following categories: 
 24.2      (1) needs no face-to-face screening in order to determine 
 24.3   the need for nursing facility level of care based on information 
 24.4   obtained from other health care professionals; 
 24.5      (2) needs an immediate face-to-face screening interview in 
 24.6   order to determine the need for nursing facility level of care 
 24.7   and complete activities required under subdivision 4a; or 
 24.8      (3) the person may be exempt from screening requirements as 
 24.9   outlined in subdivision 4b but will need transitional assistance 
 24.10  after admission or in-person follow-up after a return home. 
 24.11     (b) Persons admitted on a nonemergency basis to a Medicaid 
 24.12  certified nursing facility must be screened prior to the 
 24.13  admission. 
 24.14     (c) The team shall recommend a case mix classification for 
 24.15  persons admitted to a certified nursing facility when sufficient 
 24.16  information is received to make that classification.  The 
 24.17  nursing facility is authorized to conduct all case mix 
 24.18  assessments for persons who have been screened prior to 
 24.19  admission for whom the county did not recommend a case mix 
 24.20  classification.  The nursing facility is authorized to conduct 
 24.21  all case mix assessments for persons admitted to the facility 
 24.22  prior to a preadmission screening.  The county retains the 
 24.23  responsibility of distributing appropriate case mix forms to the 
 24.24  nursing facility. 
 24.25     (d) The county screening or intake activity will include 
 24.26  processes to identify persons who may require transition 
 24.27  assistance as described in subdivision 3b. 
 24.28     Sec. 15.  Minnesota Statutes 2000, section 256B.0911, 
 24.29  subdivision 5, is amended to read: 
 24.30     Subd. 5.  [~~SIMPLIFICATION OF FORMS~~ ADMINISTRATIVE 
 24.31  ACTIVITY.] The commissioner shall minimize the number of forms 
 24.32  required in the ~~preadmission screening process~~ provision of 
 24.33  long-term care consultation services and shall limit the 
 24.34  screening document to items necessary for ~~care~~ community support 
 24.35  plan approval, reimbursement, program planning, evaluation, and 
 24.36  policy development. 
 25.1      Sec. 16.  Minnesota Statutes 2000, section 256B.0911, 
 25.2   subdivision 6, is amended to read: 
 25.3      Subd. 6.  [PAYMENT FOR ~~PREADMISSION SCREENING~~ LONG-TERM 
 25.4   CARE CONSULTATION SERVICES.] (a) The total ~~screening~~ payment for 
 25.5   each county must be paid monthly by certified nursing facilities 
 25.6   in the county.  The monthly amount to be paid by each nursing 
 25.7   facility for each fiscal year must be determined by dividing the 
 25.8   county's annual allocation for ~~screenings~~ long-term care 
 25.9   consultation services by 12 to determine the monthly payment and 
 25.10  allocating the monthly payment to each nursing facility based on 
 25.11  the number of licensed beds in the nursing facility.  Payments 
 25.12  to counties in which there is no certified nursing facility as a 
 25.13  result of closures made according to provisions in section 
 25.14  256B.436 shall be made by increasing the payment rate of the two 
 25.15  facilities located nearest to the county.  The commissioner 
 25.16  shall exclude these rate increases when applying any rate limits 
 25.17  in section 256B.431.  
 25.18     (b) The commissioner shall include the total annual payment 
 25.19  ~~for screening~~ determined under paragraph (a) for each nursing 
 25.20  facility according to section 256B.431, subdivision 2b, 
 25.21  paragraph (g), or 256B.435. 
 25.22     (c) Payments for ~~screening activities~~ long-term care 
 25.23  consultation services are available to the county or counties to 
 25.24  cover staff salaries and expenses to provide the ~~screening~~ 
 25.25  ~~function~~ services described in subdivision 1a.  The lead agency 
 25.26  shall employ, or contract with other agencies to employ, within 
 25.27  the limits of available funding, sufficient personnel to ~~conduct~~ 
 25.28  ~~the preadmission screening activity~~ provide long-term care 
 25.29  consultation services while meeting the state's long-term care 
 25.30  outcomes and objectives as defined in section 256B.0917, 
 25.31  subdivision 1.  The ~~local~~ lead agency shall be accountable for 
 25.32  meeting local objectives as approved by the commissioner in the 
 25.33  CSSA biennial plan. 
 25.34     (d) Notwithstanding section 256B.0641, overpayments 
 25.35  attributable to payment of the screening costs under the medical 
 25.36  assistance program may not be recovered from a facility.  
 26.1      (e) The commissioner of human services shall amend the 
 26.2   Minnesota medical assistance plan to include reimbursement for 
 26.3   the local ~~screening~~ consultation teams. 
 26.4      (f) The lead agency may bill, as case management services, 
 26.5   assessments, support planning, and follow-up provided to persons 
 26.6   determined to be eligible for case management under Minnesota 
 26.7   health care programs.  No individual or family member shall be 
 26.8   charged for any service described in subdivision 1a. 
 26.9      Sec. 17.  Minnesota Statutes 2000, section 256B.0911, 
 26.10  subdivision 7, is amended to read: 
 26.11     Subd. 7.  [REIMBURSEMENT FOR CERTIFIED NURSING FACILITIES.] 
 26.12  (a) Medical assistance reimbursement for nursing facilities 
 26.13  shall be authorized for a medical assistance recipient only if a 
 26.14  preadmission screening has been conducted prior to admission or 
 26.15  the ~~local county~~ lead agency has authorized an exemption.  
 26.16  Medical assistance reimbursement for nursing facilities shall 
 26.17  not be provided for any recipient who the local screener has 
 26.18  determined does not meet the level of care criteria for nursing 
 26.19  facility placement or, if indicated, has not had a level 
 26.20  II ~~PASARR~~ evaluation as required under the Omnibus 
 26.21  Reconciliation Act of 1987 completed unless an admission for a 
 26.22  recipient with mental illness is approved by the local mental 
 26.23  health authority or an admission for a recipient with mental 
 26.24  retardation or related condition is approved by the state mental 
 26.25  retardation authority.  
 26.26     (b) The nursing facility shall not bill a person who is not 
 26.27  a medical assistance recipient for resident days that preceded 
 26.28  the date of completion of screening activities as required under 
 26.29  subdivisions 4a, 4b, and 4d.  The nursing facility must include 
 26.30  unreimbursed resident days in the nursing facility resident day 
 26.31  totals reported to the department. 
 26.32     (c) The commissioner shall make a request to the health 
 26.33  care financing administration for a waiver allowing ~~screening~~ 
 26.34  team approval of Medicaid payments for certified nursing 
 26.35  facility care.  An individual has a choice and makes the final 
 26.36  decision between nursing facility placement and community 
 27.1   placement after the screening team's recommendation, except as 
 27.2   provided in ~~paragraphs (b) and (c~~) subdivision 4a, paragraph (d).
 27.3      ~~(c) The local county mental health authority or the state~~ 
 27.4   ~~mental retardation authority under Public Law Numbers 100-203~~ 
 27.5   ~~and 101-508 may prohibit admission to a nursing facility, if the~~ 
 27.6   ~~individual does not meet the nursing facility level of care~~ 
 27.7   ~~criteria or needs specialized services as defined in Public Law~~ 
 27.8   ~~Numbers 100-203 and 101-508.  For purposes of this section,~~ 
 27.9   ~~"specialized services" for a person with mental retardation or a~~ 
 27.10  ~~related condition means "active treatment" as that term is~~ 
 27.11  ~~defined in Code of Federal Regulations, title 42, section~~ 
 27.12  ~~483.440(a)(1).~~ 
 27.13     (~~e) Appeals from the screening team's recommendation or the~~ 
 27.14  ~~county agency's final decision shall be made according to~~ 
 27.15  ~~section 256.045, subdivision 3.~~ 
 27.16     Sec. 18.  Minnesota Statutes 2000, section 256B.0913, 
 27.17  subdivision 1, is amended to read: 
 27.18     Subdivision 1.  [PURPOSE AND GOALS.] The purpose of the 
 27.19  alternative care program is to provide funding for ~~or access to~~ 
 27.20  home and community-based services for ~~frail~~ elderly persons, in 
 27.21  order to limit nursing facility placements.  The program is 
 27.22  designed to support ~~frail~~ elderly persons in their desire to 
 27.23  remain in the community as independently and as long as possible 
 27.24  and to support informal caregivers in their efforts to provide 
 27.25  care for ~~frail~~ elderly people.  Further, the goals of the 
 27.26  program are: 
 27.27     (1) to contain medical assistance expenditures by ~~providing~~ 
 27.28  funding care in the community ~~at a cost the same or less than~~ 
 27.29  ~~nursing facility costs~~; and 
 27.30     (2) to maintain the moratorium on new construction of 
 27.31  nursing home beds. 
 27.32     Sec. 19.  Minnesota Statutes 2000, section 256B.0913, 
 27.33  subdivision 2, is amended to read: 
 27.34     Subd. 2.  [ELIGIBILITY FOR SERVICES.] Alternative care 
 27.35  services are available to ~~all frail older~~ Minnesotans~~.  This~~ 
 27.36  ~~includes:~~ 
 28.1      ~~(1) persons who are receiving medical assistance and served~~ 
 28.2   ~~under the medical assistance program or the Medicaid waiver~~ 
 28.3   ~~program;~~ 
 28.4      ~~(2) persons~~ age 65 or older who are not eligible for 
 28.5   medical assistance without a spenddown or waiver obligation but 
 28.6   who would be eligible for medical assistance within 180 days of 
 28.7   admission to a nursing facility and ~~served under~~ subject to 
 28.8   subdivisions 4 to 13~~; and~~ 
 28.9      ~~(3) persons who are paying for their services out-of-pocket~~.
 28.10     Sec. 20.  Minnesota Statutes 2000, section 256B.0913, 
 28.11  subdivision 4, is amended to read: 
 28.12     Subd. 4.  [ELIGIBILITY FOR FUNDING FOR SERVICES FOR 
 28.13  NONMEDICAL ASSISTANCE RECIPIENTS.] (a) Funding for services 
 28.14  under the alternative care program is available to persons who 
 28.15  meet the following criteria: 
 28.16     (1) the person has been ~~screened by the county screening~~ 
 28.17  ~~team or, if previously screened and served under the alternative~~ 
 28.18  ~~care program, assessed by the local county social worker or~~ 
 28.19  ~~public health nurse~~ determined by a community assessment under 
 28.20  section 256B.0911, to be a person who would require the level of 
 28.21  care provided in a nursing facility, but for the provision of 
 28.22  services under the alternative care program; 
 28.23     (2) the person is age 65 or older; 
 28.24     (3) the person would be ~~financially~~ eligible for medical 
 28.25  assistance within 180 days of admission to a nursing facility; 
 28.26     (4) the person ~~meets the asset transfer requirements of~~ is 
 28.27  not ineligible for the medical assistance program due to an 
 28.28  asset transfer penalty; 
 28.29     (5) ~~the screening team would recommend nursing facility~~ 
 28.30  ~~admission or continued stay for the person if alternative care~~ 
 28.31  ~~services were not available;~~ 
 28.32     ~~(6)~~ the person needs services that are not ~~available at~~ 
 28.33  ~~that time in the county~~ funded through other ~~county,~~ state~~,~~ or 
 28.34  federal funding ~~sources~~; and 
 28.35     ~~(7)~~ (6) the monthly cost of the alternative care services 
 28.36  funded by the program for this person does not exceed 75 percent 
 29.1   of the statewide ~~average monthly medical assistance payment for~~ 
 29.2   ~~nursing facility care at the individual's case mix~~ 
 29.3   ~~classification~~ weighted average monthly nursing facility rate of 
 29.4   the case mix resident class to which the individual alternative 
 29.5   care client would be assigned under Minnesota Rules, parts 
 29.6   9549.0050 to 9549.0059, less the recipient's maintenance needs 
 29.7   allowance as described in section 256B.0915, subdivision 1d, 
 29.8   paragraph (a), until the first day of the state fiscal year in 
 29.9   which the resident assessment system, under section 256B.437, 
 29.10  for nursing home rate determination is implemented.  Effective 
 29.11  on the first day of the state fiscal year in which a resident 
 29.12  assessment system, under section 256B.437, for nursing home rate 
 29.13  determination is implemented and the first day of each 
 29.14  subsequent state fiscal year, the monthly cost of alternative 
 29.15  care services for this person shall not exceed the alternative 
 29.16  care monthly cap for the case mix resident class to which the 
 29.17  alternative care client would be assigned under Minnesota Rules, 
 29.18  parts 9549.0050 to 9549.0059, which was in effect on the last 
 29.19  day of the previous state fiscal year, and adjusted by the 
 29.20  greater of any legislatively adopted home and community-based 
 29.21  services cost-of-living percentage increase or any legislatively 
 29.22  adopted statewide percent rate increase for nursing facilities.  
 29.23  This monthly limit does not prohibit the alternative care client 
 29.24  from payment for additional services, but in no case may the 
 29.25  cost of additional services purchased under this section exceed 
 29.26  the difference between the client's monthly service limit 
 29.27  defined under section 256B.0915, subdivision 3, and the 
 29.28  alternative care program monthly service limit defined in this 
 29.29  paragraph.  If medical supplies and equipment or ~~adaptations~~ 
 29.30  environmental modifications are or will be purchased for an 
 29.31  alternative care services recipient, the costs may be prorated 
 29.32  on a monthly basis ~~throughout the year in which they are~~ 
 29.33  ~~purchased~~ for up to 12 consecutive months beginning with the 
 29.34  month of purchase.  If the monthly cost of a recipient's other 
 29.35  alternative care services exceeds the monthly limit established 
 29.36  in this paragraph, the annual cost of the alternative care 
 30.1   services shall be determined.  In this event, the annual cost of 
 30.2   alternative care services shall not exceed 12 times the monthly 
 30.3   limit ~~calculated~~ described in this paragraph. 
 30.4      (b) ~~Individuals who meet the criteria in paragraph (a) and~~ 
 30.5   ~~who have been approved for alternative care funding are called~~ 
 30.6   ~~180-day eligible clients.~~ 
 30.7      ~~(c) The statewide average payment for nursing facility care~~ 
 30.8   ~~is the statewide average monthly nursing facility rate in effect~~ 
 30.9   ~~on July 1 of the fiscal year in which the cost is incurred, less~~ 
 30.10  ~~the statewide average monthly income of nursing facility~~ 
 30.11  ~~residents who are age 65 or older and who are medical assistance~~ 
 30.12  ~~recipients in the month of March of the previous fiscal year.~~  
 30.13  ~~This monthly limit does not prohibit the 180-day eligible client~~ 
 30.14  ~~from paying for additional services needed or desired.~~  
 30.15     ~~(d) In determining the total costs of alternative care~~ 
 30.16  ~~services for one month, the costs of all services funded by the~~ 
 30.17  ~~alternative care program, including supplies and equipment, must~~ 
 30.18  ~~be included.~~ 
 30.19     ~~(e)~~ Alternative care funding under this subdivision is not 
 30.20  available for a person who is a medical assistance recipient or 
 30.21  who would be eligible for medical assistance without a 
 30.22  spenddown~~, unless authorized by the commissioner~~ or waiver 
 30.23  obligation.  A person whose initial application for medical 
 30.24  assistance is being processed may be served under the 
 30.25  alternative care program for a period up to 60 days.  If the 
 30.26  individual is found to be eligible for medical assistance, ~~the~~ 
 30.27  ~~county must bill~~ medical assistance must be billed for services 
 30.28  payable under the federally approved elderly waiver plan and 
 30.29  delivered from the date the individual was found eligible 
 30.30  for ~~services reimbursable under~~ the federally approved elderly 
 30.31  waiver ~~program~~ plan.  Notwithstanding this provision, 
 30.32  alternative care funds may not be used to pay for any service 
 30.33  the cost of which is payable by medical assistance or which is 
 30.34  used by a recipient to meet a medical assistance income 
 30.35  spenddown or waiver obligation.  
 30.36     ~~(f)~~ (c) Alternative care funding is not available for a 
 31.1   person who resides in a licensed nursing home ~~or~~, certified 
 31.2   boarding care home, hospital, or intermediate care facility, 
 31.3   except for case management services which are ~~being~~ provided in 
 31.4   support of the discharge planning process to a nursing home 
 31.5   resident or certified boarding care home resident who is 
 31.6   ineligible for case management funded by medical assistance. 
 31.7      Sec. 21.  Minnesota Statutes 2000, section 256B.0913, 
 31.8   subdivision 5, is amended to read: 
 31.9      Subd. 5.  [SERVICES COVERED UNDER ALTERNATIVE CARE.] (a) 
 31.10  Alternative care funding may be used for payment of costs of: 
 31.11     (1) adult foster care; 
 31.12     (2) adult day care; 
 31.13     (3) home health aide; 
 31.14     (4) homemaker services; 
 31.15     (5) personal care; 
 31.16     (6) case management; 
 31.17     (7) respite care; 
 31.18     (8) assisted living; 
 31.19     (9) residential care services; 
 31.20     (10) care-related supplies and equipment; 
 31.21     (11) meals delivered to the home; 
 31.22     (12) transportation; 
 31.23     (13) skilled nursing; 
 31.24     (14) chore services; 
 31.25     (15) companion services; 
 31.26     (16) nutrition services; 
 31.27     (17) training for direct informal caregivers; 
 31.28     (18) telemedicine devices to monitor recipients in their 
 31.29  own homes as an alternative to hospital care, nursing home care, 
 31.30  or home visits; ~~and~~ 
 31.31     (19) "other services" ~~including~~ includes discretionary 
 31.32  funds and direct cash payments to clients, ~~approved by the~~ 
 31.33  ~~county agency~~ following approval by the commissioner, subject to 
 31.34  the provisions of paragraph ~~(m)~~ (j).  Total annual payments for "
 31.35  other services" for all clients within a county may not exceed 
 31.36  either ten percent of that county's annual alternative care 
 32.1   program base allocation or $5,000, whichever is greater.  In no 
 32.2   case shall this amount exceed the county's total annual 
 32.3   alternative care program base allocation; and 
 32.4      (20) environmental modifications. 
 32.5      (b) The county agency must ensure that the funds are not 
 32.6   used ~~only to supplement and not~~ to supplant services available 
 32.7   through other public assistance or services programs. 
 32.8      (c) Unless specified in statute, the service definitions 
 32.9   and standards for alternative care services shall be the same as 
 32.10  the service definitions and standards ~~defined~~ specified in the 
 32.11  federally approved elderly waiver plan.  Except for the county 
 32.12  agencies' approval of direct cash payments to clients as 
 32.13  described in paragraph (j) or for a provider of supplies and 
 32.14  equipment when the monthly cost of the supplies and equipment is 
 32.15  less than $250, persons or agencies must be employed by or under 
 32.16  a contract with the county agency or the public health nursing 
 32.17  agency of the local board of health in order to receive funding 
 32.18  under the alternative care program.  Supplies and equipment may 
 32.19  be purchased from a non-Medicaid certified vendor if the cost 
 32.20  for the item is less than that of a Medicaid vendor.  
 32.21     (d) The adult foster care rate shall be considered a 
 32.22  difficulty of care payment and shall not include room and 
 32.23  board.  The adult foster care ~~daily~~ rate shall be negotiated 
 32.24  between the county agency and the foster care provider.  ~~The~~ 
 32.25  ~~rate established under this section shall not exceed 75 percent~~ 
 32.26  ~~of the state average monthly nursing home payment for the case~~ 
 32.27  ~~mix classification to which the individual receiving foster care~~ 
 32.28  ~~is assigned, and it must allow for other alternative care~~ 
 32.29  ~~services to be authorized by the case manager.~~  The alternative 
 32.30  care payment for the foster care service in combination with the 
 32.31  payment for other alternative care services, including case 
 32.32  management, must not exceed the limit specified in subdivision 
 32.33  4, paragraph (a), clause (6). 
 32.34     (e) Personal care services ~~may~~ must meet the service 
 32.35  standards defined in the federally approved elderly waiver plan 
 32.36  and be provided by a personal care provider organization~~.~~  or a 
 33.1   home health agency, except that a county agency may contract 
 33.2   with a client's relative ~~of the client~~ who meets the relative 
 33.3   hardship waiver requirement as defined in section 256B.0627, 
 33.4   subdivision 4, paragraph (b), clause (10), to provide personal 
 33.5   care services~~, but must ensure nursing~~ if the county agency 
 33.6   ensures supervision of this service by a registered nurse or 
 33.7   mental health professional.  ~~Covered personal care services~~ 
 33.8   ~~defined in section 256B.0627, subdivision 4, must meet~~ 
 33.9   ~~applicable standards in Minnesota Rules, part 9505.0335.~~ 
 33.10     (f) ~~A county may use alternative care funds to purchase~~ 
 33.11  ~~medical supplies and equipment without prior approval from the~~ 
 33.12  ~~commissioner when:  (1) there is no other funding source; (2)~~ 
 33.13  ~~the supplies and equipment are specified in the individual's~~ 
 33.14  ~~care plan as medically necessary to enable the individual to~~ 
 33.15  ~~remain in the community according to the criteria in Minnesota~~ 
 33.16  ~~Rules, part 9505.0210, item A; and (3) the supplies and~~ 
 33.17  ~~equipment represent an effective and appropriate use of~~ 
 33.18  ~~alternative care funds.  A county may use alternative care funds~~ 
 33.19  ~~to purchase supplies and equipment from a non-Medicaid certified~~ 
 33.20  ~~vendor if the cost for the items is less than that of a Medicaid~~ 
 33.21  ~~vendor.  A county is not required to contract with a provider of~~ 
 33.22  ~~supplies and equipment if the monthly cost of the supplies and~~ 
 33.23  ~~equipment is less than $250.~~  
 33.24     ~~(g)~~ For purposes of this section, residential care services 
 33.25  are services which are provided to individuals living in 
 33.26  residential care homes.  Residential care homes are currently 
 33.27  licensed as board and lodging establishments and are registered 
 33.28  with the department of health as providing special 
 33.29  services under section 157.17 and are not subject to 
 33.30  registration under chapter 144D.  Residential care services are 
 33.31  defined as "supportive services" and "health-related services."  
 33.32  "Supportive services" means the provision of up to 24-hour 
 33.33  supervision and oversight.  Supportive services includes:  (1) 
 33.34  transportation, when provided by the residential care ~~center~~ 
 33.35  home only; (2) socialization, when socialization is part of the 
 33.36  plan of care, has specific goals and outcomes established, and 
 34.1   is not diversional or recreational in nature; (3) assisting 
 34.2   clients in setting up meetings and appointments; (4) assisting 
 34.3   clients in setting up medical and social services; (5) providing 
 34.4   assistance with personal laundry, such as carrying the client's 
 34.5   laundry to the laundry room.  Assistance with personal laundry 
 34.6   does not include any laundry, such as bed linen, that is 
 34.7   included in the room and board rate.  "Health-related services" 
 34.8   are limited to minimal assistance with dressing, grooming, and 
 34.9   bathing and providing reminders to residents to take medications 
 34.10  that are self-administered or providing storage for medications, 
 34.11  if requested.  Individuals receiving residential care services 
 34.12  cannot receive homemaking services funded under this section.  
 34.13     ~~(h)~~ (g) For the purposes of this section, "assisted living" 
 34.14  refers to supportive services provided by a single vendor to 
 34.15  clients who reside in the same apartment building of three or 
 34.16  more units which are not subject to registration under chapter 
 34.17  144D and are licensed by the department of health as a class A 
 34.18  home care provider or a class E home care provider.  Assisted 
 34.19  living services are defined as up to 24-hour supervision, and 
 34.20  oversight, supportive services as defined in clause (1), 
 34.21  individualized home care aide tasks as defined in clause (2), 
 34.22  and individualized home management tasks as defined in clause 
 34.23  (3) provided to residents of a residential center living in 
 34.24  their units or apartments with a full kitchen and bathroom.  A 
 34.25  full kitchen includes a stove, oven, refrigerator, food 
 34.26  preparation counter space, and a kitchen utensil storage 
 34.27  compartment.  Assisted living services must be provided by the 
 34.28  management of the residential center or by providers under 
 34.29  contract with the management or with the county. 
 34.30     (1) Supportive services include:  
 34.31     (i) socialization, when socialization is part of the plan 
 34.32  of care, has specific goals and outcomes established, and is not 
 34.33  diversional or recreational in nature; 
 34.34     (ii) assisting clients in setting up meetings and 
 34.35  appointments; and 
 34.36     (iii) providing transportation, when provided by the 
 35.1   residential center only.  
 35.2      ~~Individuals receiving assisted living services will not~~ 
 35.3   ~~receive both assisted living services and homemaking services.~~  
 35.4   ~~Individualized means services are chosen and designed~~ 
 35.5   ~~specifically for each resident's needs, rather than provided or~~ 
 35.6   ~~offered to all residents regardless of their illnesses,~~ 
 35.7   ~~disabilities, or physical conditions.~~  
 35.8      (2) Home care aide tasks means:  
 35.9      (i) preparing modified diets, such as diabetic or low 
 35.10  sodium diets; 
 35.11     (ii) reminding residents to take regularly scheduled 
 35.12  medications or to perform exercises; 
 35.13     (iii) household chores in the presence of technically 
 35.14  sophisticated medical equipment or episodes of acute illness or 
 35.15  infectious disease; 
 35.16     (iv) household chores when the resident's care requires the 
 35.17  prevention of exposure to infectious disease or containment of 
 35.18  infectious disease; and 
 35.19     (v) assisting with dressing, oral hygiene, hair care, 
 35.20  grooming, and bathing, if the resident is ambulatory, and if the 
 35.21  resident has no serious acute illness or infectious disease.  
 35.22  Oral hygiene means care of teeth, gums, and oral prosthetic 
 35.23  devices.  
 35.24     (3) Home management tasks means:  
 35.25     (i) housekeeping; 
 35.26     (ii) laundry; 
 35.27     (iii) preparation of regular snacks and meals; and 
 35.28     (iv) shopping.  
 35.29     Individuals receiving assisted living services will not 
 35.30  receive both assisted living services and homemaking services.  
 35.31  Individualized means services are chosen and designed 
 35.32  specifically for each resident's needs, rather than provided or 
 35.33  offered to all residents regardless of their illnesses, 
 35.34  disabilities, or physical conditions.  Assisted living services 
 35.35  as defined in this section shall not be authorized in boarding 
 35.36  and lodging establishments licensed according to sections 
 36.1   157.011 and 157.15 to 157.22. 
 36.2      ~~(i)~~ (h) For establishments registered under chapter 144D, 
 36.3   assisted living services under this section means either the 
 36.4   services described ~~and licensed~~ in paragraph (g) and delivered 
 36.5   by a class E home care provider licensed by the department of 
 36.6   health or the services described under section 144A.4605 and 
 36.7   delivered by an assisted living home care provider or a class A 
 36.8   home care provider licensed by the department of health. 
 36.9      ~~(j) For the purposes of this section, reimbursement~~ (i) 
 36.10  Payment for assisted living services and residential care 
 36.11  services shall be a monthly rate negotiated and authorized by 
 36.12  the county agency based on an individualized service plan for 
 36.13  each resident and may not cover direct rent or food costs.  ~~The~~ 
 36.14  ~~rate~~ 
 36.15     (1) The individualized monthly negotiated payment for 
 36.16  assisted living services as described in subdivision 5, 
 36.17  paragraph (g) or (h), and residential care services as described 
 36.18  in subdivision 5, paragraph (f), and shall not exceed the 
 36.19  nonfederal share (in effect on July 1 of the state fiscal year 
 36.20  for which the rate limit is being calculated) of the greater of 
 36.21  either the statewide or any of the geographic groups' weighted 
 36.22  average monthly ~~medical assistance~~ nursing facility ~~payment~~ rate 
 36.23  of the case mix resident class to which the ~~180-day~~ elderly 
 36.24  waiver or alternative care eligible client would be assigned 
 36.25  under Minnesota Rules, parts 9549.0050 to 9549.0059, ~~unless the~~ 
 36.26  less the maintenance needs allowance as described in subdivision 
 36.27  1d, paragraph (a), until the first day of the state fiscal year 
 36.28  in which a resident assessment system, under section 256B.437, 
 36.29  of nursing home rate determination is implemented.  Effective on 
 36.30  the first day of the state fiscal year in which a resident 
 36.31  assessment system, under section 256B.437, of nursing home rate 
 36.32  determination is implemented and the first day of each 
 36.33  subsequent state fiscal year, the individualized monthly 
 36.34  negotiated payment for the services described in this clause 
 36.35  shall not exceed the limit described in this clause which was in 
 36.36  effect on the last day of the previous state fiscal year and 
 37.1   which has been adjusted by the greater of any legislatively 
 37.2   adopted home and community-based services cost-of-living 
 37.3   percentage increase or any legislatively adopted statewide 
 37.4   percent rate increase for nursing facilities. 
 37.5      (2) The individualized monthly negotiated payment for 
 37.6   assisted living services ~~are provided by a home care~~ described 
 37.7   under section 144A.4605 and delivered by a provider licensed by 
 37.8   the department of health as a class A home care provider or an 
 37.9   assisted living home care provider and ~~are~~ provided in a 
 37.10  building that is registered as a housing with services 
 37.11  establishment under chapter 144D and that provides 24-hour 
 37.12  supervision in combination with the payment for other 
 37.13  alternative care services, including case management, must not 
 37.14  exceed the limit specified in subdivision 4, paragraph (a), 
 37.15  clause (6). 
 37.16     ~~(k) For purposes of this section, companion services are~~ 
 37.17  ~~defined as nonmedical care, supervision and oversight, provided~~ 
 37.18  ~~to a functionally impaired adult.  Companions may assist the~~ 
 37.19  ~~individual with such tasks as meal preparation, laundry and~~ 
 37.20  ~~shopping, but do not perform these activities as discrete~~ 
 37.21  ~~services.  The provision of companion services does not entail~~ 
 37.22  ~~hands-on medical care.  Providers may also perform light~~ 
 37.23  ~~housekeeping tasks which are incidental to the care and~~ 
 37.24  ~~supervision of the recipient.  This service must be approved by~~ 
 37.25  ~~the case manager as part of the care plan.  Companion services~~ 
 37.26  ~~must be provided by individuals or organizations who are under~~ 
 37.27  ~~contract with the local agency to provide the service.  Any~~ 
 37.28  ~~person related to the waiver recipient by blood, marriage or~~ 
 37.29  ~~adoption cannot be reimbursed under this service.  Persons~~ 
 37.30  ~~providing companion services will be monitored by the case~~ 
 37.31  ~~manager.~~ 
 37.32     ~~(l) For purposes of this section, training for direct~~ 
 37.33  ~~informal caregivers is defined as a classroom or home course of~~ 
 37.34  ~~instruction which may include:  transfer and lifting skills,~~ 
 37.35  ~~nutrition, personal and physical cares, home safety in a home~~ 
 37.36  ~~environment, stress reduction and management, behavioral~~ 
 38.1   ~~management, long-term care decision making, care coordination~~ 
 38.2   ~~and family dynamics.  The training is provided to an informal~~ 
 38.3   ~~unpaid caregiver of a 180-day eligible client which enables the~~ 
 38.4   ~~caregiver to deliver care in a home setting with high levels of~~ 
 38.5   ~~quality.  The training must be approved by the case manager as~~ 
 38.6   ~~part of the individual care plan.  Individuals, agencies, and~~ 
 38.7   ~~educational facilities which provide caregiver training and~~ 
 38.8   ~~education will be monitored by the case manager.~~ 
 38.9      ~~(m)~~ (j) A county agency may make payment from their 
 38.10  alternative care program allocation for "other services" 
 38.11  ~~provided to an alternative care program recipient if those~~ 
 38.12  ~~services prevent, shorten, or delay institutionalization.  These~~ 
 38.13  ~~services may~~ which include use of "discretionary funds" for 
 38.14  services that are not otherwise defined in this section and 
 38.15  direct cash payments to the ~~recipient~~ client for the purpose of 
 38.16  purchasing the ~~recipient's~~ services.  The following provisions 
 38.17  apply to payments under this paragraph: 
 38.18     (1) a cash payment to a client under this provision cannot 
 38.19  exceed 80 percent of the monthly payment limit for that client 
 38.20  as specified in subdivision 4, paragraph (a), clause ~~(7)~~ (6); 
 38.21     (2) a county may not approve any cash payment for a client 
 38.22  who meets either of the following: 
 38.23     (i) has been assessed as having a dependency in 
 38.24  orientation, unless the client has an authorized 
 38.25  representative ~~under section 256.476, subdivision 2, paragraph~~ 
 38.26  ~~(g), or for a client who~~.  An "authorized representative" means 
 38.27  an individual who is at least 18 years of age and is designated 
 38.28  by the person or the person's legal representative to act on the 
 38.29  person's behalf.  This individual may be a family member, 
 38.30  guardian, representative payee, or other individual designated 
 38.31  by the person or the person's legal representative, if any, to 
 38.32  assist in purchasing and arranging for supports; or 
 38.33     (ii) is concurrently receiving adult foster care, 
 38.34  residential care, or assisted living services; 
 38.35     (3) ~~any service approved under this section must be a~~ 
 38.36  ~~service which meets the purpose and goals of the program as~~ 
 39.1   ~~listed in subdivision 1;~~ 
 39.2      ~~(4) cash payments must also meet the criteria of and are~~ 
 39.3   ~~governed by the procedures and liability protection established~~ 
 39.4   ~~in section 256.476, subdivision 4, paragraphs (b) through (h),~~ 
 39.5   ~~and recipients of cash grants must meet the requirements in~~ 
 39.6   ~~section 256.476, subdivision 10; and~~ cash payments to a person 
 39.7   or a person's family will be provided through a monthly payment 
 39.8   and be in the form of cash, voucher, or direct county payment to 
 39.9   vendor.  Fees or premiums assessed to the person for eligibility 
 39.10  or health and human services are not reimbursable through this 
 39.11  service option.  Services and goods purchased through cash 
 39.12  payments must be identified in the person's individualized care 
 39.13  plan and must meet all of the following criteria: 
 39.14     (i) it must be over and above the normal cost of caring for 
 39.15  the person if the person did not have functional limitations; 
 39.16     (ii) it must be directly attributable to the person's 
 39.17  functional limitations; 
 39.18     (iii) it must have the potential to be effective at meeting 
 39.19  the goals of the program; 
 39.20     (iv) it must be consistent with the needs identified in the 
 39.21  individualized service plan.  The service plan shall specify the 
 39.22  needs of the person and family, the form and amount of payment, 
 39.23  the items and services to be reimbursed, and the arrangements 
 39.24  for management of the individual grant; and 
 39.25     (v) the person, the person's family, or the legal 
 39.26  representative shall be provided sufficient information to 
 39.27  ensure an informed choice of alternatives.  The local agency 
 39.28  shall document this information in the person's care plan, 
 39.29  including the type and level of expenditures to be reimbursed; 
 39.30     (4) the county, lead agency under contract, or tribal 
 39.31  government under contract to administer the alternative care 
 39.32  program shall not be liable for damages, injuries, or 
 39.33  liabilities sustained through the purchase of direct supports or 
 39.34  goods by the person, the person's family, or the authorized 
 39.35  representative with funds received through the cash payments 
 39.36  under this section.  Liabilities include, but are not limited 
 40.1   to, workers' compensation, the Federal Insurance Contributions 
 40.2   Act (FICA), or the Federal Unemployment Tax Act (FUTA); 
 40.3      (5) persons receiving grants under this section shall have 
 40.4   the following responsibilities: 
 40.5      (i) spend the grant money in a manner consistent with their 
 40.6   individualized service plan with the local agency; 
 40.7      (ii) notify the local agency of any necessary changes in 
 40.8   the grant-expenditures; 
 40.9      (iii) arrange and pay for supports; and 
 40.10     (iv) inform the local agency of areas where they have 
 40.11  experienced difficulty securing or maintaining supports; and 
 40.12     ~~(5)~~ (6) the county shall report client outcomes, services, 
 40.13  and costs under this paragraph in a manner prescribed by the 
 40.14  commissioner. 
 40.15     (k) Upon implementation of direct cash payments to clients 
 40.16  under this section, any person determined eligible for the 
 40.17  alternative care program who chooses a cash payment approved by 
 40.18  the county agency shall receive the cash payment under this 
 40.19  section and not under section 256.476 unless the person was 
 40.20  receiving a consumer support grant under section 256.476 before 
 40.21  implementation of direct cash payments under this section. 
 40.22     Sec. 22.  Minnesota Statutes 2000, section 256B.0913, 
 40.23  subdivision 6, is amended to read: 
 40.24     Subd. 6.  [ALTERNATIVE CARE PROGRAM ADMINISTRATION.] The 
 40.25  alternative care program is administered by the county agency.  
 40.26  This agency is the lead agency responsible for the local 
 40.27  administration of the alternative care program as described in 
 40.28  this section.  However, it may contract with the public health 
 40.29  nursing service to be the lead agency.  The commissioner may 
 40.30  contract with federally recognized Indian tribes with a 
 40.31  reservation in Minnesota to serve as the lead agency responsible 
 40.32  for the local administration of the alternative care program as 
 40.33  described in the contract. 
 40.34     Sec. 23.  Minnesota Statutes 2000, section 256B.0913, 
 40.35  subdivision 7, is amended to read: 
 40.36     Subd. 7.  [CASE MANAGEMENT.] Providers of case management 
 41.1   services for persons receiving services funded by the 
 41.2   alternative care program must meet the qualification 
 41.3   requirements and standards specified in section 256B.0915, 
 41.4   subdivision 1b.  The case manager must ensure the health and 
 41.5   safety of the individual client and must not approve alternative 
 41.6   care funding for a client in any setting in which the case 
 41.7   manager cannot reasonably ensure the client's health and 
 41.8   safety.  The case manager is responsible for the 
 41.9   cost-effectiveness of the alternative care individual care 
 41.10  plan and must not approve any care plan in which the cost of 
 41.11  services funded by alternative care and client contributions 
 41.12  exceeds the limit specified in section 256B.0915, subdivision 4, 
 41.13  paragraph (a), clause (6).  The county may allow a case manager 
 41.14  employed by the county to delegate certain aspects of the case 
 41.15  management activity to another individual employed by the county 
 41.16  provided there is oversight of the individual by the case 
 41.17  manager.  The case manager may not delegate those aspects which 
 41.18  require professional judgment including assessments, 
 41.19  reassessments, and care plan development. 
 41.20     Sec. 24.  Minnesota Statutes 2000, section 256B.0913, 
 41.21  subdivision 8, is amended to read: 
 41.22     Subd. 8.  [REQUIREMENTS FOR INDIVIDUAL CARE PLAN.] (a) The 
 41.23  case manager shall implement the plan of care for each ~~180-day~~ 
 41.24  ~~eligible~~ alternative care client and ensure that a client's 
 41.25  service needs and eligibility are reassessed at least every 12 
 41.26  months.  The plan shall include any services prescribed by the 
 41.27  individual's attending physician as necessary to allow the 
 41.28  individual to remain in a community setting.  In developing the 
 41.29  individual's care plan, the case manager should include the use 
 41.30  of volunteers from families and neighbors, religious 
 41.31  organizations, social clubs, and civic and service organizations 
 41.32  to support the formal home care services.  The county shall be 
 41.33  held harmless for damages or injuries sustained through the use 
 41.34  of volunteers under this subdivision including workers' 
 41.35  compensation liability.  ~~The lead agency shall provide~~ 
 41.36  ~~documentation to the commissioner verifying that the~~ 
 42.1   ~~individual's alternative care is not available at that time~~ 
 42.2   ~~through any other public assistance or service program.~~  The 
 42.3   lead agency shall provide documentation in each individual's 
 42.4   plan of care and, if requested, to the commissioner that the 
 42.5   most cost-effective alternatives available have been offered to 
 42.6   the individual and that the individual was free to choose among 
 42.7   available qualified providers, both public and private.  The 
 42.8   case manager must give the individual a ten-day written notice 
 42.9   of any decrease in or termination of alternative care services. 
 42.10     (b) If the county administering alternative care services 
 42.11  is different than the county of financial responsibility, the 
 42.12  care plan may be implemented without the approval of the county 
 42.13  of financial responsibility. 
 42.14     Sec. 25.  Minnesota Statutes 2000, section 256B.0913, 
 42.15  subdivision 9, is amended to read: 
 42.16     Subd. 9.  [CONTRACTING PROVISIONS FOR PROVIDERS.] ~~The lead~~ 
 42.17  ~~agency shall document to the commissioner that the agency made~~ 
 42.18  ~~reasonable efforts to inform potential providers of the~~ 
 42.19  ~~anticipated need for services under the alternative care program~~ 
 42.20  ~~or waiver programs under sections 256B.0915 and 256B.49,~~ 
 42.21  ~~including a minimum of 14 days' written advance notice of the~~ 
 42.22  ~~opportunity to be selected as a service provider and an annual~~ 
 42.23  ~~public meeting with providers to explain and review the criteria~~ 
 42.24  ~~for selection.  The lead agency shall also document to the~~ 
 42.25  ~~commissioner that the agency allowed potential providers an~~ 
 42.26  ~~opportunity to be selected to contract with the county agency.~~  
 42.27  ~~Funds reimbursed to counties under this subdivision~~ Alternative 
 42.28  care funds paid to service providers are subject to audit by the 
 42.29  commissioner for fiscal and utilization control.  
 42.30     The lead agency must select providers for contracts or 
 42.31  agreements using the following criteria and other criteria 
 42.32  established by the county: 
 42.33     (1) the need for the particular services offered by the 
 42.34  provider; 
 42.35     (2) the population to be served, including the number of 
 42.36  clients, the length of time services will be provided, and the 
 43.1   medical condition of clients; 
 43.2      (3) the geographic area to be served; 
 43.3      (4) quality assurance methods, including appropriate 
 43.4   licensure, certification, or standards, and supervision of 
 43.5   employees when needed; 
 43.6      (5) rates for each service and unit of service exclusive of 
 43.7   county administrative costs; 
 43.8      (6) evaluation of services previously delivered by the 
 43.9   provider; and 
 43.10     (7) contract or agreement conditions, including billing 
 43.11  requirements, cancellation, and indemnification. 
 43.12     The county must evaluate its own agency services under the 
 43.13  criteria established for other providers.  ~~The county shall~~ 
 43.14  ~~provide a written statement of the reasons for not selecting~~ 
 43.15  ~~providers.~~ 
 43.16     Sec. 26.  Minnesota Statutes 2000, section 256B.0913, 
 43.17  subdivision 10, is amended to read: 
 43.18     Subd. 10.  [ALLOCATION FORMULA.] (a) The alternative care 
 43.19  appropriation for fiscal years 1992 and beyond shall cover 
 43.20  only ~~180-day~~ alternative care eligible clients.  Prior to July 1 
 43.21  of each year, the commissioner shall allocate to county agencies 
 43.22  the state funds available for alternative care for persons 
 43.23  eligible under subdivision 2. 
 43.24     (b) ~~Prior to July 1 of each year, the commissioner shall~~ 
 43.25  ~~allocate to county agencies the state funds available for~~ 
 43.26  ~~alternative care for persons eligible under subdivision 2.  The~~ 
 43.27  ~~allocation for fiscal year 1992 shall be calculated using a base~~ 
 43.28  ~~that is adjusted to exclude the medical assistance share of~~ 
 43.29  ~~alternative care expenditures.  The adjusted base is calculated~~ 
 43.30  ~~by multiplying each county's allocation for fiscal year 1991 by~~ 
 43.31  ~~the percentage of county alternative care expenditures for~~ 
 43.32  ~~180-day eligible clients.  The percentage is determined based on~~ 
 43.33  ~~expenditures for services rendered in fiscal year 1989 or~~ 
 43.34  ~~calendar year 1989, whichever is greater.~~  The adjusted base for 
 43.35  each county is the county's current fiscal year base allocation 
 43.36  plus any targeted funds approved during the current fiscal 
 44.1   year.  Calculations for paragraphs (c) and (d) are to be made as 
 44.2   follows:  for each county, the determination of alternative care 
 44.3   program expenditures shall be based on payments for services 
 44.4   rendered from April 1 through March 31 in the base year, to the 
 44.5   extent that claims have been submitted and paid by June 1 of 
 44.6   that year.  
 44.7      (c) If the ~~county~~ alternative care program expenditures ~~for~~ 
 44.8   ~~180-day eligible clients~~ as defined in paragraph (b) are 95 
 44.9   percent or more of ~~its~~ the county's adjusted base allocation, 
 44.10  the allocation for the next fiscal year is 100 percent of the 
 44.11  adjusted base, plus inflation to the extent that inflation is 
 44.12  included in the state budget. 
 44.13     (d) If the ~~county~~ alternative care program expenditures ~~for~~ 
 44.14  ~~180-day eligible clients~~ as defined in paragraph (b) are less 
 44.15  than 95 percent of ~~its~~ the county's adjusted base allocation, 
 44.16  the allocation for the next fiscal year is the adjusted base 
 44.17  allocation less the amount of unspent funds below the 95 percent 
 44.18  level. 
 44.19     (e) ~~For fiscal year 1992 only, a county may receive an~~ 
 44.20  ~~increased allocation if annualized service costs for the month~~ 
 44.21  ~~of May 1991 for 180-day eligible clients are greater than the~~ 
 44.22  ~~allocation otherwise determined.  A county may apply for this~~ 
 44.23  ~~increase by reporting projected expenditures for May to the~~ 
 44.24  ~~commissioner by June 1, 1991.  The amount of the allocation may~~ 
 44.25  ~~exceed the amount calculated in paragraph (b).  The projected~~ 
 44.26  ~~expenditures for May must be based on actual 180-day eligible~~ 
 44.27  ~~client caseload and the individual cost of clients' care plans.~~  
 44.28  ~~If a county does not report its expenditures for May, the amount~~ 
 44.29  ~~in paragraph (c) or (d) shall be used.~~ 
 44.30     ~~(f) Calculations for paragraphs (c) and (d) are to be made~~ 
 44.31  ~~as follows:  for each county, the determination of expenditures~~ 
 44.32  ~~shall be based on payments for services rendered from April 1~~ 
 44.33  ~~through March 31 in the base year, to the extent that claims~~ 
 44.34  ~~have been submitted by June 1 of that year.  Calculations for~~ 
 44.35  ~~paragraphs (c) and (d) must also include the funds transferred~~ 
 44.36  ~~to the consumer support grant program for clients who have~~ 
 45.1   ~~transferred to that program from April 1 through March 31 in the~~ 
 45.2   ~~base year.~~  
 45.3      ~~(g) For the biennium ending June 30, 2001, the allocation~~ 
 45.4   ~~of state funds to county agencies shall be calculated as~~ 
 45.5   ~~described in paragraphs (c) and (d).~~  If the annual legislative 
 45.6   appropriation for the alternative care program is inadequate to 
 45.7   fund the combined county allocations for ~~fiscal year 2000 or~~ 
 45.8   ~~2001~~ a biennium, the commissioner shall distribute to each 
 45.9   county the entire annual appropriation as that county's 
 45.10  percentage of the computed base as calculated in ~~paragraph~~ 
 45.11  ~~(f)~~ paragraphs (c) and (d). 
 45.12     Sec. 27.  Minnesota Statutes 2000, section 256B.0913, 
 45.13  subdivision 11, is amended to read: 
 45.14     Subd. 11.  [TARGETED FUNDING.] (a) The purpose of targeted 
 45.15  funding is to make additional money available to counties with 
 45.16  the greatest need.  Targeted funds are not intended to be 
 45.17  distributed equitably among all counties, but rather, allocated 
 45.18  to those with long-term care strategies that meet state goals. 
 45.19     (b) The funds available for targeted funding shall be the 
 45.20  total appropriation for each fiscal year minus county 
 45.21  allocations determined under subdivision 10 as adjusted for any 
 45.22  inflation increases provided in appropriations for the biennium. 
 45.23     (c) The commissioner shall allocate targeted funds to 
 45.24  counties that demonstrate to the satisfaction of the 
 45.25  commissioner that they have developed feasible plans to increase 
 45.26  alternative care spending.  In making targeted funding 
 45.27  allocations, the commissioner shall use the following priorities:
 45.28     (1) counties that received a lower allocation in fiscal 
 45.29  year 1991 than in fiscal year 1990.  Counties remain in this 
 45.30  priority until they have been restored to their fiscal year 1990 
 45.31  level plus inflation; 
 45.32     (2) counties that sustain a base allocation reduction for 
 45.33  failure to spend 95 percent of the allocation if they 
 45.34  demonstrate that the base reduction should be restored; 
 45.35     (3) counties that propose projects to divert community 
 45.36  residents from nursing home placement or convert nursing home 
 46.1   residents to community living; and 
 46.2      (4) counties that can otherwise justify program growth by 
 46.3   demonstrating the existence of waiting lists, demographically 
 46.4   justified needs, or other unmet needs. 
 46.5      (d) Counties that would receive targeted funds according to 
 46.6   paragraph (c) must demonstrate to the commissioner's 
 46.7   satisfaction that the funds would be appropriately spent by 
 46.8   showing how the funds would be used to further the state's 
 46.9   alternative care goals as described in subdivision 1, and that 
 46.10  the county has the administrative and service delivery 
 46.11  capability to use them.  
 46.12     (e) The commissioner shall request applications ~~by June 1~~ 
 46.13  ~~each year, for county agencies to apply~~ for targeted funds by 
 46.14  November 1 of each year.  The counties selected for targeted 
 46.15  funds shall be notified of the amount of their additional 
 46.16  funding ~~by August 1 of each year~~.  Targeted funds allocated to a 
 46.17  county agency in one year shall be treated as part of the 
 46.18  county's base allocation for that year in determining 
 46.19  allocations for subsequent years.  No reallocations between 
 46.20  counties shall be made. 
 46.21     ~~(f) The allocation for each year after fiscal year 1992~~ 
 46.22  ~~shall be determined using the previous fiscal year's allocation,~~ 
 46.23  ~~including any targeted funds, as the base and then applying the~~ 
 46.24  ~~criteria under subdivision 10, paragraphs (c), (d), and (f), to~~ 
 46.25  ~~the current year's expenditures.~~ 
 46.26     Sec. 28.  Minnesota Statutes 2000, section 256B.0913, 
 46.27  subdivision 12, is amended to read: 
 46.28     Subd. 12.  [CLIENT PREMIUMS.] (a) A premium is required for 
 46.29  all ~~180-day~~ alternative care eligible clients to help pay for 
 46.30  the cost of participating in the program.  The amount of the 
 46.31  premium for the alternative care client shall be determined as 
 46.32  follows: 
 46.33     (1) when the alternative care client's income less 
 46.34  recurring and predictable medical expenses is greater than the 
 46.35  ~~medical assistance income standard~~ recipient's maintenance needs 
 46.36  allowance as defined in section 256B.0915, subdivision 1d, 
 47.1   paragraph (a), but less than 150 percent of the federal poverty 
 47.2   guideline effective on July 1 of the state fiscal year in which 
 47.3   the premium is being computed, and total assets are less than 
 47.4   $10,000, the fee is zero; 
 47.5      (2) when the alternative care client's income less 
 47.6   recurring and predictable medical expenses is greater than 150 
 47.7   percent of the federal poverty guideline effective on July 1 of 
 47.8   the state fiscal year in which the premium is being computed, 
 47.9   and total assets are less than $10,000, the fee is 25 percent of 
 47.10  the cost of alternative care services or the difference between 
 47.11  150 percent of the federal poverty guideline effective on July 1 
 47.12  of the state fiscal year in which the premium is being computed 
 47.13  and the client's income less recurring and predictable medical 
 47.14  expenses, whichever is less; and 
 47.15     (3) when the alternative care client's total assets are 
 47.16  greater than $10,000, the fee is 25 percent of the cost of 
 47.17  alternative care services.  
 47.18     For married persons, total assets are defined as the total 
 47.19  marital assets less the estimated community spouse asset 
 47.20  allowance, under section 256B.059, if applicable.  For married 
 47.21  persons, total income is defined as the client's income less the 
 47.22  monthly spousal allotment, under section 256B.058. 
 47.23     All alternative care services except case management shall 
 47.24  be included in the estimated costs for the purpose of 
 47.25  determining 25 percent of the costs. 
 47.26     The monthly premium shall be calculated based on the cost 
 47.27  of the first full month of alternative care services and shall 
 47.28  continue unaltered until the next reassessment is completed or 
 47.29  at the end of 12 months, whichever comes first.  Premiums are 
 47.30  due and payable each month alternative care services are 
 47.31  received unless the actual cost of the services is less than the 
 47.32  premium. 
 47.33     (b) The fee shall be waived by the commissioner when: 
 47.34     (1) a person who is residing in a nursing facility is 
 47.35  receiving case management only; 
 47.36     (2) a person is applying for medical assistance; 
 48.1      (3) a married couple is requesting an asset assessment 
 48.2   under the spousal impoverishment provisions; 
 48.3      (4) ~~a person is a medical assistance recipient, but has~~ 
 48.4   ~~been approved for alternative care-funded assisted living~~ 
 48.5   ~~services;~~ 
 48.6      ~~(5)~~ a person is found eligible for alternative care, but is 
 48.7   not yet receiving alternative care services; or 
 48.8      ~~(6)~~ (5) a person's fee under paragraph (a) is less than $25.
 48.9      (c) The county agency must collect the premium from the 
 48.10  client and forward the amounts collected to the commissioner in 
 48.11  the manner and at the times prescribed by the commissioner.  
 48.12  Money collected must be deposited in the general fund and is 
 48.13  appropriated to the commissioner for the alternative care 
 48.14  program.  The client must supply the county with the client's 
 48.15  social security number at the time of application.  If a client 
 48.16  fails or refuses to pay the premium due, the county shall supply 
 48.17  the commissioner with the client's social security number and 
 48.18  other information the commissioner requires to collect the 
 48.19  premium from the client.  The commissioner shall collect unpaid 
 48.20  premiums using the Revenue Recapture Act in chapter 270A and 
 48.21  other methods available to the commissioner.  The commissioner 
 48.22  may require counties to inform clients of the collection 
 48.23  procedures that may be used by the state if a premium is not 
 48.24  paid.  
 48.25     (d) The commissioner shall begin to adopt emergency or 
 48.26  permanent rules governing client premiums within 30 days after 
 48.27  July 1, 1991, including criteria for determining when services 
 48.28  to a client must be terminated due to failure to pay a premium.  
 48.29     Sec. 29.  Minnesota Statutes 2000, section 256B.0913, 
 48.30  subdivision 13, is amended to read: 
 48.31     Subd. 13.  [COUNTY BIENNIAL PLAN.] The county biennial plan 
 48.32  for the ~~preadmission screening~~ community assessment program 
 48.33  under section 256B.0911, the alternative care program under this 
 48.34  section, and waivers for the elderly under section 256B.0915, 
 48.35  ~~and waivers for the disabled under section 256B.49,~~ shall be 
 48.36  incorporated into the biennial Community Social Services Act 
 49.1   plan and shall meet the regulations and timelines of that plan.  
 49.2   ~~This county biennial plan shall include:~~ 
 49.3      ~~(1) information on the administration of the preadmission~~ 
 49.4   ~~screening program;~~ 
 49.5      ~~(2) information on the administration of the home and~~ 
 49.6   ~~community-based services waivers for the elderly under section~~ 
 49.7   ~~256B.0915, and for the disabled under section 256B.49; and~~ 
 49.8      ~~(3) information on the administration of the alternative~~ 
 49.9   ~~care program.~~ 
 49.10     Sec. 30.  Minnesota Statutes 2000, section 256B.0913, 
 49.11  subdivision 14, is amended to read: 
 49.12     Subd. 14.  [~~REIMBURSEMENT~~ PAYMENT AND RATE ADJUSTMENTS.] (a)
 49.13  ~~Reimbursement~~ Payment for ~~expenditures for the~~ provided 
 49.14  alternative care services as approved by the client's case 
 49.15  manager shall be through the invoice processing procedures of 
 49.16  the department's Medicaid Management Information System (MMIS).  
 49.17  To receive ~~reimbursement~~ payment, the county or vendor must 
 49.18  submit invoices within 12 months following the date of service.  
 49.19  The county agency and its vendors under contract shall not be 
 49.20  reimbursed for services which exceed the county allocation. 
 49.21     (b) ~~If a county collects less than 50 percent of the client~~ 
 49.22  ~~premiums due under subdivision 12, the commissioner may withhold~~ 
 49.23  ~~up to three percent of the county's final alternative care~~ 
 49.24  ~~program allocation determined under subdivisions 10 and 11.~~ 
 49.25     ~~(c)~~ The county shall negotiate individual rates with 
 49.26  vendors and may ~~be reimbursed~~ authorize service payment for 
 49.27  actual costs up to ~~the greater of~~ the county's current approved 
 49.28  rate ~~or 60 percent of the maximum rate in fiscal year 1994 and~~ 
 49.29  ~~65 percent of the maximum rate in fiscal year 1995 for each~~ 
 49.30  ~~alternative care service~~.  Notwithstanding any other rule or 
 49.31  statutory provision to the contrary, the commissioner shall not 
 49.32  be authorized to increase rates by an annual inflation factor, 
 49.33  unless so authorized by the legislature. 
 49.34     (c) To improve access to community services and eliminate 
 49.35  payment disparities between the alternative care program and the 
 49.36  elderly waiver program, the commissioner shall establish 
 50.1   statewide maximum service rate limits and eliminate 
 50.2   county-specific service rate limits. 
 50.3      (1) Effective July 1, 2001, for service rate limits, except 
 50.4   those in subdivision 5, paragraphs (d) and (j), the rate limit 
 50.5   for each service shall be the greater of the alternative care 
 50.6   statewide maximum rate or the elderly waiver statewide maximum 
 50.7   rate. 
 50.8      (2) Counties may negotiate individual service rates with 
 50.9   vendors for actual costs up to the statewide maximum service 
 50.10  rate limit. 
 50.11     ~~(d) On July 1, 1993, the commissioner shall increase the~~ 
 50.12  ~~maximum rate for home delivered meals to $4.50 per meal.~~ 
 50.13     Sec. 31.  Minnesota Statutes 2000, section 256B.0915, 
 50.14  subdivision 1d, is amended to read: 
 50.15     Subd. 1d.  [POSTELIGIBILITY TREATMENT OF INCOME AND 
 50.16  RESOURCES FOR ELDERLY WAIVER.] ~~(a)~~ Notwithstanding the 
 50.17  provisions of section 256B.056, the commissioner shall make the 
 50.18  following amendment to the medical assistance elderly waiver 
 50.19  program effective July 1, 1999, or upon federal approval, 
 50.20  whichever is later. 
 50.21     A recipient's maintenance needs will be an amount equal to 
 50.22  the Minnesota supplemental aid equivalent rate as defined in 
 50.23  section 256I.03, subdivision 5, plus the medical assistance 
 50.24  personal needs allowance as defined in section 256B.35, 
 50.25  subdivision 1, paragraph (a), when applying posteligibility 
 50.26  treatment of income rules to the gross income of elderly waiver 
 50.27  recipients, except for individuals whose income is in excess of 
 50.28  the special income standard according to Code of Federal 
 50.29  Regulations, title 42, section 435.236.  Recipient maintenance 
 50.30  needs shall be adjusted under this provision each July 1. 
 50.31     ~~(b) The commissioner of human services shall secure~~ 
 50.32  ~~approval of additional elderly waiver slots sufficient to serve~~ 
 50.33  ~~persons who will qualify under the revised income standard~~ 
 50.34  ~~described in paragraph (a) before implementing section~~ 
 50.35  ~~256B.0913, subdivision 16.~~ 
 50.36     ~~(c) In implementing this subdivision, the commissioner~~ 
 51.1   ~~shall consider allowing persons who would otherwise be eligible~~ 
 51.2   ~~for the alternative care program but would qualify for the~~ 
 51.3   ~~elderly waiver with a spenddown to remain on the alternative~~ 
 51.4   ~~care program.~~ 
 51.5      Sec. 32.  Minnesota Statutes 2000, section 256B.0915, 
 51.6   subdivision 3, is amended to read: 
 51.7      Subd. 3.  [LIMITS OF CASES, RATES, ~~REIMBURSEMENT~~ PAYMENTS, 
 51.8   AND FORECASTING.] (a) The number of medical assistance waiver 
 51.9   recipients that a county may serve must be allocated according 
 51.10  to the number of medical assistance waiver cases open on July 1 
 51.11  of each fiscal year.  Additional recipients may be served with 
 51.12  the approval of the commissioner. 
 51.13     (b) The monthly limit for the cost of waivered services to 
 51.14  an individual elderly waiver client shall be the ~~statewide~~ 
 51.15  ~~average payment~~ weighted average monthly nursing facility rate 
 51.16  of the case mix resident class to which the elderly waiver 
 51.17  client would be assigned under ~~the medical assistance case mix~~ 
 51.18  ~~reimbursement system.~~  Minnesota Rules, parts 9549.0050 to 
 51.19  9549.0059, less the recipient's maintenance needs allowance as 
 51.20  described in subdivision 1d, paragraph (a), until the first day 
 51.21  of the state fiscal year in which the resident assessment system 
 51.22  as described in section 256B.437 for nursing home rate 
 51.23  determination is implemented.  Effective on the first day of the 
 51.24  state fiscal year in which the resident assessment system as 
 51.25  described in section 256B.437 for nursing home rate 
 51.26  determination is implemented and the first day of each 
 51.27  subsequent state fiscal year, the monthly limit for the cost of 
 51.28  waivered services to an individual elderly waiver client shall 
 51.29  be the rate of the case mix resident class to which the waiver 
 51.30  client would be assigned under Minnesota Rules, parts 9549.0050 
 51.31  to 9549.0059, in effect on the last day of the previous state 
 51.32  fiscal year, adjusted by the greater of any legislatively 
 51.33  adopted home and community-based services cost-of-living 
 51.34  percentage increase or any legislatively adopted statewide 
 51.35  percent rate increase for nursing facilities. 
 51.36     (c) If extended medical supplies and equipment or 
 52.1   ~~adaptations~~ environmental modifications are or will be purchased 
 52.2   for an elderly waiver ~~services recipient, these~~ client, the 
 52.3   costs may be prorated ~~on a monthly basis throughout the year in~~ 
 52.4   ~~which they are purchased~~ for up to 12 consecutive months 
 52.5   beginning with the month of purchase.  If the monthly cost of a 
 52.6   recipient's ~~other~~ waivered services exceeds the monthly limit 
 52.7   established in ~~this~~ paragraph (b), the annual cost of ~~the~~ all 
 52.8   waivered services shall be determined.  In this event, the 
 52.9   annual cost of all waivered services shall not exceed 12 times 
 52.10  the monthly limit ~~calculated in this paragraph.  The statewide~~ 
 52.11  ~~average payment rate is calculated by determining the statewide~~ 
 52.12  ~~average monthly nursing home rate, effective July 1 of the~~ 
 52.13  ~~fiscal year in which the cost is incurred, less the statewide~~ 
 52.14  ~~average monthly income of nursing home residents who are age 65~~ 
 52.15  ~~or older, and who are medical assistance recipients in the month~~ 
 52.16  ~~of March of the previous state fiscal year.  The annual cost~~ 
 52.17  ~~divided by 12 of elderly or disabled waivered services~~ of 
 52.18  waivered services as described in paragraph (b).  
 52.19     (d) For a person who is a nursing facility resident at the 
 52.20  time of requesting a determination of eligibility for elderly ~~or~~ 
 52.21  ~~disabled~~ waivered services ~~shall be the greater of the monthly~~ 
 52.22  ~~payment for:  (i)~~, a monthly conversion limit for the cost of 
 52.23  elderly waivered services may be requested.  The monthly 
 52.24  conversion limit for the cost of elderly waiver services shall 
 52.25  be the resident class assigned under Minnesota Rules, parts 
 52.26  9549.0050 to 9549.0059, for that resident in the nursing 
 52.27  facility where the resident currently resides~~; or (ii) the~~ 
 52.28  ~~statewide average payment of the case mix resident class to~~ 
 52.29  ~~which the resident would be assigned under the medical~~ 
 52.30  ~~assistance case mix reimbursement system, provided that~~ until 
 52.31  July 1 of the state fiscal year in which the resident assessment 
 52.32  system as described in section 256B.437 for nursing home rate 
 52.33  determination is implemented.  Effective on July 1 of the state 
 52.34  fiscal year in which the resident assessment system as described 
 52.35  in section 256B.437 for nursing home rate determination is 
 52.36  implemented, the monthly conversion limit for the cost of 
 53.1   elderly waiver services shall be the per diem nursing facility 
 53.2   rate as determined by the resident assessment system as 
 53.3   described in section 256B.437 for that resident in the nursing 
 53.4   facility where the resident currently resides multiplied by 365 
 53.5   and divided by 12, less the recipient's maintenance needs 
 53.6   allowance as described in subdivision 1d.  The limit under this 
 53.7   clause only applies to persons discharged from a nursing 
 53.8   facility after a minimum 30-day stay and found eligible for 
 53.9   waivered services on or after July 1, 1997.  The following costs 
 53.10  must be included in determining the total monthly costs for the 
 53.11  waiver client: 
 53.12     (1) cost of all waivered services, including extended 
 53.13  medical supplies and equipment and environmental modifications; 
 53.14  and 
 53.15     (2) cost of skilled nursing, home health aide, and personal 
 53.16  care services reimbursable by medical assistance.  
 53.17     ~~(c)~~ (e) Medical assistance funding for skilled nursing 
 53.18  services, private duty nursing, home health aide, and personal 
 53.19  care services for waiver recipients must be approved by the case 
 53.20  manager and included in the individual care plan. 
 53.21     ~~(d) For both the elderly waiver and the nursing facility~~ 
 53.22  ~~disabled waiver, a county may purchase extended supplies and~~ 
 53.23  ~~equipment without prior approval from the commissioner when~~ 
 53.24  ~~there is no other funding source and the supplies and equipment~~ 
 53.25  ~~are specified in the individual's care plan as medically~~ 
 53.26  ~~necessary to enable the individual to remain in the community~~ 
 53.27  ~~according to the criteria in Minnesota Rules, part 9505.0210,~~ 
 53.28  ~~items A and B.~~  (f) A county is not required to contract with a 
 53.29  provider of supplies and equipment if the monthly cost of the 
 53.30  supplies and equipment is less than $250.  
 53.31     ~~(e)~~ (g) The adult foster care ~~daily~~ rate ~~for the elderly~~ 
 53.32  ~~and disabled waivers~~ shall be considered a difficulty of care 
 53.33  payment and shall not include room and board.  The adult foster 
 53.34  care service rate shall be negotiated between the county agency 
 53.35  and the foster care provider.  ~~The rate established under this~~ 
 53.36  ~~section shall not exceed the state average monthly nursing home~~ 
 54.1   ~~payment for the case mix classification to which the individual~~ 
 54.2   ~~receiving foster care is assigned; the rate must allow for other~~ 
 54.3   ~~waiver and medical assistance home care services to be~~ 
 54.4   ~~authorized by the case manager.~~  The elderly waiver payment for 
 54.5   the foster care service in combination with the payment for all 
 54.6   other elderly waiver services, including case management, must 
 54.7   not exceed the limit specified in paragraph (b). 
 54.8      ~~(f) The assisted living and residential care service rates~~ 
 54.9   ~~for elderly and community alternatives for disabled individuals~~ 
 54.10  ~~(CADI) waivers shall be made to the vendor as a monthly rate~~ 
 54.11  ~~negotiated with the county agency based on an individualized~~ 
 54.12  ~~service plan for each resident.  The rate shall not exceed the~~ 
 54.13  ~~nonfederal share of the greater of either the statewide or any~~ 
 54.14  ~~of the geographic groups' weighted average monthly medical~~ 
 54.15  ~~assistance nursing facility payment rate of the case mix~~ 
 54.16  ~~resident class to which the elderly or disabled client would be~~ 
 54.17  ~~assigned under Minnesota Rules, parts 9549.0050 to 9549.0059,~~ 
 54.18  ~~unless the services are provided by a home care provider~~ 
 54.19  ~~licensed by the department of health and are provided in a~~ 
 54.20  ~~building that is registered as a housing with services~~ 
 54.21  ~~establishment under chapter 144D and that provides 24-hour~~ 
 54.22  ~~supervision.  For alternative care assisted living projects~~ 
 54.23  ~~established under Laws 1988, chapter 689, article 2, section~~ 
 54.24  ~~256, monthly rates may not exceed 65 percent of the greater of~~ 
 54.25  ~~either the statewide or any of the geographic groups' weighted~~ 
 54.26  ~~average monthly medical assistance nursing facility payment rate~~ 
 54.27  ~~for the case mix resident class to which the elderly or disabled~~ 
 54.28  ~~client would be assigned under Minnesota Rules, parts 9549.0050~~ 
 54.29  ~~to 9549.0059.  The rate may not cover direct rent or food costs.~~ 
 54.30     (h) Payment for assisted living service shall be a monthly 
 54.31  rate negotiated and authorized by the county agency based on an 
 54.32  individualized service plan for each resident and may not cover 
 54.33  direct rent or food costs. 
 54.34     (1) The individualized monthly negotiated payment for 
 54.35  assisted living services as described in section 256B.0913, 
 54.36  subdivision 5, paragraph (g) or (h), and residential care 
 55.1   services as described in section 256B.0913, subdivision 5, 
 55.2   paragraph (f), shall not exceed the nonfederal share, in effect 
 55.3   on July 1 of the state fiscal year for which the rate limit is 
 55.4   being calculated, of the greater of either the statewide or any 
 55.5   of the geographic groups' weighted average monthly nursing 
 55.6   facility rate of the case mix resident class to which the 
 55.7   elderly waiver eligible client would be assigned under Minnesota 
 55.8   Rules, parts 9549.0050 to 9549.0059, less the maintenance needs 
 55.9   allowance as described in subdivision 1d, paragraph (a), until 
 55.10  the July 1 of the state fiscal year in which the resident 
 55.11  assessment system as described in section 256B.437 for nursing 
 55.12  home rate determination is implemented.  Effective on July 1 of 
 55.13  the state fiscal year in which the resident assessment system as 
 55.14  described in section 256B.437 for nursing home rate 
 55.15  determination is implemented and July 1 of each subsequent state 
 55.16  fiscal year, the individualized monthly negotiated payment for 
 55.17  the services described in this clause shall not exceed the limit 
 55.18  described in this clause which was in effect on June 30 of the 
 55.19  previous state fiscal year and which has been adjusted by the 
 55.20  greater of any legislatively adopted home and community-based 
 55.21  services cost-of-living percentage increase or any legislatively 
 55.22  adopted statewide percent rate increase for nursing facilities. 
 55.23     (2) The individualized monthly negotiated payment for 
 55.24  assisted living delivered by a provider licensed by the 
 55.25  department of health as a Class A home care provider or an 
 55.26  assisted living home care provider and provided in a building 
 55.27  that is registered as a housing with services establishment 
 55.28  under chapter 144D and that provides 24-hour supervision in 
 55.29  combination with the payment for other elderly waiver services, 
 55.30  including case management, must not exceed the limit specified 
 55.31  in paragraph (b). 
 55.32     ~~(g)~~ (i) The county shall negotiate individual service rates 
 55.33  with vendors and may ~~be reimbursed~~ authorize payment for actual 
 55.34  costs up to the ~~greater of the~~ county's current approved rate ~~or~~ 
 55.35  ~~60 percent of the maximum rate in fiscal year 1994 and 65~~ 
 55.36  ~~percent of the maximum rate in fiscal year 1995 for each service~~ 
 56.1   ~~within each program.~~  Persons or agencies must be employed by or 
 56.2   under a contract with the county agency or the public health 
 56.3   nursing agency of the local board of health in order to receive 
 56.4   funding under the elderly waiver program, except as a provider 
 56.5   of supplies and equipment when the monthly cost of the supplies 
 56.6   and equipment is less than $250.  
 56.7      ~~(h) On July 1, 1993, the commissioner shall increase the~~ 
 56.8   ~~maximum rate for home-delivered meals to $4.50 per meal.~~ 
 56.9      ~~(i)~~ (j) Reimbursement for the medical assistance recipients 
 56.10  under the approved waiver shall be made from the medical 
 56.11  assistance account through the invoice processing procedures of 
 56.12  the department's Medicaid Management Information System (MMIS), 
 56.13  only with the approval of the client's case manager.  The budget 
 56.14  for the state share of the Medicaid expenditures shall be 
 56.15  forecasted with the medical assistance budget, and shall be 
 56.16  consistent with the approved waiver.  
 56.17     (k) To improve access to community services and eliminate 
 56.18  payment disparities between the alternative care program and the 
 56.19  elderly waiver, the commissioner shall establish statewide 
 56.20  maximum service rate limits and eliminate county-specific 
 56.21  service rate limits. 
 56.22     (1) Effective July 1, 2001, for service rate limits, except 
 56.23  those in paragraphs (g) and (h), the rate limit for each service 
 56.24  shall be the greater of the alternative care statewide maximum 
 56.25  rate or the elderly waiver statewide maximum rate. 
 56.26     (2) Counties may negotiate individual service rates with 
 56.27  vendors for actual costs up to the statewide maximum service 
 56.28  rate limit. 
 56.29     ~~(j)~~ (l) Beginning July 1, 1991, the state shall reimburse 
 56.30  counties according to the payment schedule in section 256.025 
 56.31  for the county share of costs incurred under this subdivision on 
 56.32  or after January 1, 1991, for individuals who are receiving 
 56.33  medical assistance. 
 56.34     ~~(k) For the community alternatives for disabled individuals~~ 
 56.35  ~~waiver, and nursing facility disabled waivers, county may use~~ 
 56.36  ~~waiver funds for the cost of minor adaptations to a client's~~ 
 57.1   ~~residence or vehicle without prior approval from the~~ 
 57.2   ~~commissioner if there is no other source of funding and the~~ 
 57.3   ~~adaptation:~~ 
 57.4      ~~(1) is necessary to avoid institutionalization;~~ 
 57.5      ~~(2) has no utility apart from the needs of the client; and~~ 
 57.6      ~~(3) meets the criteria in Minnesota Rules, part 9505.0210,~~ 
 57.7   ~~items A and B.~~  
 57.8   ~~For purposes of this subdivision, "residence" means the client's~~ 
 57.9   ~~own home, the client's family residence, or a family foster~~ 
 57.10  ~~home.  For purposes of this subdivision, "vehicle" means the~~ 
 57.11  ~~client's vehicle, the client's family vehicle, or the client's~~ 
 57.12  ~~family foster home vehicle.~~ 
 57.13     ~~(l) The commissioner shall establish a maximum rate unit~~ 
 57.14  ~~for baths provided by an adult day care provider that are not~~ 
 57.15  ~~included in the provider's contractual daily or hourly rate.~~ 
 57.16  ~~This maximum rate must equal the home health aide extended rate~~ 
 57.17  ~~and shall be paid for baths provided to clients served under the~~ 
 57.18  ~~elderly and disabled waivers.~~ 
 57.19     Sec. 33.  Minnesota Statutes 2000, section 256B.0915, 
 57.20  subdivision 5, is amended to read: 
 57.21     Subd. 5.  [REASSESSMENTS FOR WAIVER CLIENTS.] A 
 57.22  reassessment of a client served under the elderly ~~or disabled~~ 
 57.23  waiver must be conducted at least every 12 months and at other 
 57.24  times when the case manager determines that there has been 
 57.25  significant change in the client's functioning.  This may 
 57.26  include instances where the client is discharged from the 
 57.27  hospital.  
 57.28     Sec. 34.  Minnesota Statutes 2000, section 256B.0917, is 
 57.29  amended by adding a subdivision to read: 
 57.30     Subd. 13.  [COMMUNITY SERVICE GRANTS.] The commissioner 
 57.31  shall award contracts for grants to public and private nonprofit 
 57.32  agencies to establish services that strengthen a community's 
 57.33  ability to provide a system of home and community-based services 
 57.34  for elderly persons.  The commissioner shall use a request for 
 57.35  proposal process.  Communities that have a planned closure of a 
 57.36  nursing facility approved under section 256B.436 will be given 
 58.1   preference for grants.  The commissioner shall consider grants 
 58.2   for: 
 58.3      (1) caregiver support and respite care projects under 
 58.4   subdivision 6; 
 58.5      (2) on-site coordination under section 256.9751; 
 58.6      (3) the living-at-home/block nurse grant under subdivisions 
 58.7   7 to 10; and 
 58.8      (4) services identified as needed for community transition. 
 58.9      Sec. 35.  Minnesota Statutes 2000, section 256B.431, is 
 58.10  amended by adding a subdivision to read: 
 58.11     Subd. 28a.  [FACILITY RATE INCREASES EFFECTIVE JULY 1, 
 58.12  2002.] For rate years beginning July 1, 2002, for nursing 
 58.13  facilities reimbursed under this section and section 256B.434 or 
 58.14  256B.435, the commissioner shall increase each nursing 
 58.15  facility's June 30, 2002, operating payment rate by two 
 58.16  percent.  The operating payment rate for rate years beginning 
 58.17  July 1, 2001, shall include the adjustment in section 256B.431, 
 58.18  subdivision 2i, paragraph (c). 
 58.19     Sec. 36.  Minnesota Statutes 2000, section 256B.435, 
 58.20  subdivision 1, is amended to read: 
 58.21     Subdivision 1.  [IN GENERAL.] Effective July 1, 2001, the 
 58.22  commissioner shall implement a ~~performance-based contracting~~ 
 58.23  contractual payment system to replace the current method of 
 58.24  setting operating cost payment rates under sections 256B.431 and 
 58.25  256B.434 and Minnesota Rules, parts 9549.0010 to 9549.0080.  
 58.26  Operating cost payment rates for newly established facilities 
 58.27  under Minnesota Rules, part 9549.0057, shall be established 
 58.28  using section 256B.431 and Minnesota Rules, parts 9549.0010 to 
 58.29  ~~9549.0070~~ 9549.0080.  A nursing facility in operation on May 1, 
 58.30  1998, with payment rates not established under section 256B.431 
 58.31  or 256B.434 on that date, is ineligible for 
 58.32  this ~~performance-based contracting~~ contractual payment system.  
 58.33  In determining prospective payment rates of nursing facility 
 58.34  services, the commissioner shall distinguish between operating 
 58.35  costs and property-related costs.  The commissioner of finance 
 58.36  shall include an annual inflationary adjustment in operating 
 59.1   costs for nursing facilities using the inflation factor 
 59.2   specified in subdivision 3 ~~and funding for incentive-based~~ 
 59.3   ~~payments~~ as a budget change request in each biennial detailed 
 59.4   expenditure budget submitted to the legislature under section 
 59.5   16A.11.  Property related payment rates, including real estate 
 59.6   taxes and special assessments, shall be determined under section 
 59.7   256B.431 or 256B.434 or under a new property-related 
 59.8   reimbursement system, if one is implemented by the commissioner 
 59.9   under subdivision 3.  ~~The commissioner shall present additional~~ 
 59.10  ~~recommendations for performance-based contracting for nursing~~ 
 59.11  ~~facilities to the legislature by February 15, 2000, in the~~ 
 59.12  ~~following specific areas:~~ 
 59.13     ~~(1) development of an interim default payment mechanism for~~ 
 59.14  ~~nursing facilities that do not respond to the state's request~~ 
 59.15  ~~for proposal but wish to continue participation in the medical~~ 
 59.16  ~~assistance program, and nursing facilities the state does not~~ 
 59.17  ~~select in the request for proposal process, and nursing~~ 
 59.18  ~~facilities whose contract has been canceled;~~ 
 59.19     ~~(2) development of criteria for facilities to earn~~ 
 59.20  ~~performance-based incentive payments based on relevant outcomes~~ 
 59.21  ~~negotiated by nursing facilities and the commissioner and that~~ 
 59.22  ~~recognize both continuous quality efforts and quality~~ 
 59.23  ~~improvement;~~ 
 59.24     ~~(3) development of criteria and a process under which~~ 
 59.25  ~~nursing facilities can request rate adjustments for low base~~ 
 59.26  ~~rates, geographic disparities, or other reasons;~~ 
 59.27     ~~(4) development of a dispute resolution mechanism for~~ 
 59.28  ~~nursing facilities that are denied a contract, denied incentive~~ 
 59.29  ~~payments, or denied a rate adjustment;~~ 
 59.30     ~~(5) development of a property payment system to address the~~ 
 59.31  ~~capital needs of nursing facilities that will be funded with~~ 
 59.32  ~~additional appropriations;~~ 
 59.33     ~~(6) establishment of a transitional plan to move from dual~~ 
 59.34  ~~assessment instruments to the federally mandated resident~~ 
 59.35  ~~assessment system, whereby the financial impact for each~~ 
 59.36  ~~facility would be budget neutral;~~ 
 60.1      ~~(7) identification of net cost implications for facilities~~ 
 60.2   ~~and to the department of preparing for and implementing~~ 
 60.3   ~~performance-based contracting or any proposed alternative~~ 
 60.4   ~~system;~~ 
 60.5      ~~(8) identification of facility financial and statistical~~ 
 60.6   ~~reporting requirements; and~~ 
 60.7      ~~(9) identification of exemptions from current regulations~~ 
 60.8   ~~and statutes applicable under performance-based contracting.~~  
 60.9      Sec. 37.  Minnesota Statutes 2000, section 256B.435, 
 60.10  subdivision 1a, is amended to read: 
 60.11     Subd. 1a.  [REQUESTS FOR PROPOSALS.] (a) For nursing 
 60.12  facilities with rates established under section 256B.434 on 
 60.13  ~~January 1~~ June 30, 2001, the commissioner shall renegotiate 
 60.14  contracts without requiring a response to a request for 
 60.15  proposal, notwithstanding the solicitation process described in 
 60.16  chapter 16C. 
 60.17     (b) Prior to July 1, 2001, the commissioner shall publish 
 60.18  in the State Register a request for proposals to provide nursing 
 60.19  facility services according to this section.  The commissioner 
 60.20  will consider proposals from all nursing facilities that have 
 60.21  payment rates established under section 256B.431.  The 
 60.22  commissioner must respond to all proposals in a timely manner. 
 60.23     (c) If facilities do not have a contract executed by July 
 60.24  1, 2001, under this section, the provisions of section 256B.48, 
 60.25  subdivision 1a, shall apply.  The commissioner must refuse to 
 60.26  pay for any new admissions after July 1, 2001, if a facility 
 60.27  does not have a contract on this date. 
 60.28     (d) In issuing a request for proposals, the commissioner 
 60.29  may develop reasonable requirements which, in the judgment of 
 60.30  the commissioner, are necessary to protect residents or ensure 
 60.31  that the ~~performance-based contracting~~ contractual payment 
 60.32  system furthers the interests of the state of Minnesota.  The 
 60.33  request for proposals may include, but need not be limited to: 
 60.34     (1) a requirement that a nursing facility make reasonable 
 60.35  efforts to maximize Medicare payments on behalf of eligible 
 60.36  residents; 
 61.1      (2) requirements designed to prevent inappropriate or 
 61.2   illegal discrimination against residents enrolled in the medical 
 61.3   assistance program as compared to private paying residents; 
 61.4      (3) requirements designed to ensure that admissions to a 
 61.5   nursing facility are appropriate and that reasonable efforts are 
 61.6   made to place residents in home and community-based settings 
 61.7   when appropriate; 
 61.8      (4) a requirement to agree to participate in the 
 61.9   development of data collection systems and outcome-based 
 61.10  standards.  Among other requirements specified by the 
 61.11  commissioner, each facility entering into a contract may be 
 61.12  required to pay an annual fee not to exceed $1,000.  The 
 61.13  commissioner must use revenue generated from the fees to 
 61.14  contract with a qualified consultant or contractor to develop 
 61.15  data collection systems and outcome-based contracting standards; 
 61.16     (5) a requirement that Medicare-certified contractors agree 
 61.17  to maintain Medicare cost reports and to submit them to the 
 61.18  commissioner upon request, or at times specified by the 
 61.19  commissioner; and that contractors that are not 
 61.20  Medicare-certified agree to maintain a uniform cost report in a 
 61.21  format established by the commissioner and to submit the report 
 61.22  to the commissioner upon request, or at times specified by the 
 61.23  commissioner; 
 61.24     (6) a requirement ~~that demonstrates willingness and ability~~ 
 61.25  ~~to develop and maintain data collection and retrieval systems to~~ 
 61.26  ~~measure outcomes~~ to agree to provide statistical, financial, and 
 61.27  performance measurement information; and 
 61.28     (7) a requirement to provide all information and assurances 
 61.29  required by the terms and conditions of the federal waiver or 
 61.30  federal approval. 
 61.31     ~~(d)~~ (e) In addition to the information and assurances 
 61.32  contained in the submitted proposals, the commissioner may 
 61.33  consider the following criteria in developing the terms of the 
 61.34  contract: 
 61.35     (1) the facility's history of compliance with federal and 
 61.36  state laws and rules.  A facility deemed to be in substantial 
 62.1   compliance with federal and state laws and rules is eligible to 
 62.2   respond to a request for proposals.  A facility's compliance 
 62.3   history shall not be the sole determining factor in situations 
 62.4   where the facility has been sold and the new owners have 
 62.5   submitted a proposal; 
 62.6      (2) whether the facility has a record of excessive 
 62.7   licensure fines or sanctions or fraudulent cost reports; 
 62.8      (3) the facility's financial history and solvency; and 
 62.9      (4) other factors identified by the commissioner deemed 
 62.10  relevant to developing the terms of the contract, including a 
 62.11  determination that a contract with a particular facility is not 
 62.12  in the best interests of the residents of the facility or the 
 62.13  state of Minnesota. 
 62.14     ~~(e)~~ (f) Notwithstanding the requirements of the 
 62.15  solicitation process described in chapter 16C, the commissioner 
 62.16  may contract with nursing facilities established according to 
 62.17  section 144A.073 without issuing a request for proposals. 
 62.18     ~~(f)~~ (g) Notwithstanding subdivision 1, after July 1, 2001, 
 62.19  the commissioner may contract with additional nursing 
 62.20  facilities, according to requests for proposals. 
 62.21     Sec. 38.  Minnesota Statutes 2000, section 256B.435, 
 62.22  subdivision 2, is amended to read: 
 62.23     Subd. 2.  [CONTRACT PROVISIONS.] (a) The ~~performance-based~~ 
 62.24  contract with each nursing facility must include provisions that:
 62.25     (1) ~~apply the resident case mix assessment provisions of~~ 
 62.26  ~~Minnesota Rules, parts 9549.0051, 9549.0058, and 9549.0059, or~~ 
 62.27  ~~another assessment system, with the goal of moving to a single~~ 
 62.28  ~~assessment system;~~ 
 62.29     ~~(2)~~ monitor resident outcomes through various methods, such 
 62.30  as quality indicators based on the minimum data set and other 
 62.31  utilization and performance measures; 
 62.32     ~~(3)~~ (2) require the establishment and use of a continuous 
 62.33  quality improvement process that integrates information from 
 62.34  quality indicators and regular resident and family satisfaction 
 62.35  interviews; 
 62.36     ~~(4)~~ (3) require ~~annual~~ reporting of facility statistical 
 63.1   and financial information~~, including resident days by case mix~~ 
 63.2   ~~category, productive nursing hours, wages and benefits, and raw~~ 
 63.3   ~~food costs~~ for use by the commissioner in the development of 
 63.4   facility ~~profiles that include trends in payment and service~~ 
 63.5   ~~utilization~~ or industry analyses; 
 63.6      ~~(5)~~ (4) require from each nursing facility an annual 
 63.7   certified audited financial statement consisting of a balance 
 63.8   sheet, income and expense statements, and an opinion from either 
 63.9   a licensed or certified public accountant, if a certified audit 
 63.10  was prepared, or unaudited financial statements if no certified 
 63.11  audit was prepared; 
 63.12     ~~(6)~~ (5) specify the method for resolving disputes; and 
 63.13     ~~(7)~~ (6) establish additional requirements and penalties for 
 63.14  nursing facilities not meeting the standards set forth in the 
 63.15  ~~performance-based~~ payment system contract. 
 63.16     (b) ~~The commissioner may develop additional incentive-based~~ 
 63.17  ~~payments for achieving specified outcomes specified in each~~ 
 63.18  ~~contract.  The specified facility-specific outcomes must be~~ 
 63.19  ~~measurable and approved by the commissioner.~~  
 63.20     ~~(c)~~ The commissioner may also contract with nursing 
 63.21  facilities in other ways through requests for proposals, 
 63.22  including contracts on a risk or nonrisk basis, with nursing 
 63.23  facilities or consortia of nursing facilities, to provide 
 63.24  comprehensive long-term care coverage on a premium or capitated 
 63.25  basis. 
 63.26     ~~(d)~~ (c) The commissioner may negotiate different contract 
 63.27  terms for different nursing facilities. 
 63.28     Sec. 39.  Minnesota Statutes 2000, section 256B.435, 
 63.29  subdivision 3, is amended to read: 
 63.30     Subd. 3.  [PAYMENT RATE PROVISIONS.] (a) For rate years 
 63.31  beginning on or after July 1, 2001, within the limits of 
 63.32  appropriations specifically for this purpose, the commissioner 
 63.33  shall determine operating cost payment rates for each licensed 
 63.34  and certified nursing facility by indexing its operating cost 
 63.35  payment rates in effect on June 30, 2001, for inflation.  For 
 63.36  rate years beginning on or after July 1, 2001, the inflation 
 64.1   factor must be based on the change in the Employment Cost Index 
 64.2   for Private Industry Workers - Total Compensation as forecasted 
 64.3   by the commissioner of finance's national economic consultant, 
 64.4   in the fourth quarter preceding the rate year.  The forecasted 
 64.5   index for operating cost payment rates shall be based on the 
 64.6   12-month period from the midpoint of the nursing facility's 
 64.7   prior rate year to the midpoint of the rate year for which the 
 64.8   operating payment rate is being determined.  The operating cost 
 64.9   payment rate to be inflated shall be the total payment rate in 
 64.10  effect on June 30, 2001, minus the portion determined to be the 
 64.11  property-related payment rate, minus the per diem amount of the 
 64.12  preadmission screening cost included in the nursing facility's 
 64.13  last payment rate established under section 256B.431. 
 64.14     (b) A per diem amount for ~~preadmission screening~~ long-term 
 64.15  care consultation services will be added onto the contract 
 64.16  payment rates according to the method of distribution of county 
 64.17  allocation described in section 256B.0911, subdivision 6, 
 64.18  paragraph (a). 
 64.19     (c) Beginning July 1, 2001, nursing facilities shall elect 
 64.20  to have property rates established:  
 64.21     (1) according to section 256B.431 and Minnesota Rules, 
 64.22  parts 9459.0010 to 9549.0080; or 
 64.23     (2) by indexing their June 30, 2001, property-related 
 64.24  payment rate.  The index to be used must be based on the change 
 64.25  in the Consumer Price Index - All Items United States city 
 64.26  average (CPI-U) forecast by Data Resources, Inc., as forecast in 
 64.27  the fourth quarter of the calendar year preceding the rate 
 64.28  year.  The inflation adjustment must be based on the 12-month 
 64.29  period from the midpoint of the previous rate year to the 
 64.30  midpoint of the rate year for which the rate is being 
 64.31  determined.  Once the facility has made the election in this 
 64.32  paragraph, the election shall remain in effect for at least four 
 64.33  years or until an alternative property payment system is 
 64.34  developed. 
 64.35     (d) For rate years beginning on or after July 1, 2001, the 
 64.36  commissioner may implement a new method of payment for 
 65.1   property-related costs that addresses the capital needs of 
 65.2   facilities.  Notwithstanding paragraph (c), the new property 
 65.3   payment system or systems, if implemented, shall replace the 
 65.4   current methods of setting property payment rates under sections 
 65.5   256B.431 and 256B.434. 
 65.6      Sec. 40.  Minnesota Statutes 2000, section 256B.435, 
 65.7   subdivision 5, is amended to read: 
 65.8      Subd. 5.  [CONSUMER PROTECTION.] In addition to complying 
 65.9   with all applicable laws regarding consumer protection, as a 
 65.10  condition of entering into a contract under this section, a 
 65.11  nursing facility must agree to: 
 65.12     (1) establish resident grievance procedures; 
 65.13     (2) establish expedited grievance procedures to resolve 
 65.14  complaints made by short-stay residents; and 
 65.15     (3) make available to residents and families a copy of the 
 65.16  ~~performance-based~~ contract and outcomes to be achieved. 
 65.17     Sec. 41.  Minnesota Statutes 2000, section 256B.435, 
 65.18  subdivision 6, is amended to read: 
 65.19     Subd. 6.  [CONTRACTS ARE VOLUNTARY.] Participation of 
 65.20  nursing facilities in the medical assistance program is 
 65.21  voluntary.  The terms and procedures governing the 
 65.22  ~~performance-based~~ contract are determined under this section and 
 65.23  through negotiations between the commissioner and nursing 
 65.24  facilities.  
 65.25     Sec. 42.  Minnesota Statutes 2000, section 256B.435, 
 65.26  subdivision 7, is amended to read: 
 65.27     Subd. 7.  [FEDERAL REQUIREMENTS.] The commissioner shall 
 65.28  implement the ~~performance-based contracting~~ contractual payment 
 65.29  system subject to any required federal waivers or approval and 
 65.30  in a manner that is consistent with federal requirements.  If a 
 65.31  provision of this section is inconsistent with a federal 
 65.32  requirement, the federal requirement supersedes the inconsistent 
 65.33  provision.  The commissioner shall seek federal approval and 
 65.34  request waivers as necessary to implement this section. 
 65.35     Sec. 43.  Minnesota Statutes 2000, section 256B.435, 
 65.36  subdivision 8, is amended to read: 
 66.1      Subd. 8.  [CASE-MIX ADJUSTMENTS BASED UPON THE MINIMUM DATA 
 66.2   SET.] The ~~performance-based contracting~~ contractual payment 
 66.3   system must include case-mix adjustments that are based upon the 
 66.4   federally mandated minimum data set assessment instrument.  
 66.5   These case-mix adjustments must be incorporated into 
 66.6   the ~~performance-based contracting~~ contractual payment system 
 66.7   beginning on or after July 1, ~~2001~~ 2002, but no later than 
 66.8   January 1, ~~2002~~ 2003, and must have a budget neutral financial 
 66.9   impact on each facility at the time of implementation, relative 
 66.10  to case-mix adjustments based upon the current state case-mix. 
 66.11     Sec. 44.  Minnesota Statutes 2000, section 256B.435, is 
 66.12  amended by adding a subdivision to read: 
 66.13     Subd. 9.  [EXEMPTIONS.] (a) A facility that elected to have 
 66.14  its property-related payment rate established according to 
 66.15  subdivision 3, paragraph (c), clause (2), is not subject to the 
 66.16  moratorium on licensure or certification of new nursing home 
 66.17  beds in section 144A.071, unless the project results in a net 
 66.18  increase in bed capacity or involves relocation of beds from one 
 66.19  site to another.  Contract payment rates must not be adjusted to 
 66.20  reflect any additional costs that a nursing facility incurs as a 
 66.21  result of a construction project undertaken under this 
 66.22  subdivision.  In addition, as a condition of exercising this 
 66.23  exemption, a nursing facility must agree that any future medical 
 66.24  assistance payments for nursing facility services will not 
 66.25  reflect any additional costs attributable to the sale of a 
 66.26  nursing facility under this section and to construction 
 66.27  undertaken under this paragraph that otherwise would not be 
 66.28  authorized under the moratorium in sections 144A.071 and 
 66.29  144A.073.  Nothing in this section prevents a nursing facility 
 66.30  from seeking approval of an exception to the moratorium through 
 66.31  the process established in sections 144A.071 and 144A.073, and, 
 66.32  if approved, the facility's rates shall be adjusted to reflect 
 66.33  the cost of the project. 
 66.34     Sec. 45.  Minnesota Statutes 2000, section 256B.435, is 
 66.35  amended by adding a subdivision to read: 
 66.36     Subd. 10.  [DEVELOPMENT AND IMPLEMENTATION OF QUALITY 
 67.1   PROFILES.] (a) The commissioner shall develop and implement a 
 67.2   quality profile system for nursing facilities and, beginning no 
 67.3   later than July 1, 2003, other providers of long-term care 
 67.4   services.  The system shall be designed to provide information 
 67.5   on quality: 
 67.6      (1) to consumers and their families in order to facilitate 
 67.7   informed choices of service providers; 
 67.8      (2) to providers to enable them to measure the results of 
 67.9   their quality improvement efforts and compare quality 
 67.10  achievements with other service providers; and 
 67.11     (3) to public and private purchasers of long-term care 
 67.12  services to enable them to purchase high-quality care. 
 67.13     (b) The system shall be developed in consultation with the 
 67.14  long-term care task force and representatives of consumers, 
 67.15  providers, and labor unions.  Within the limits of available 
 67.16  appropriations, the commissioner may employ consultants to 
 67.17  assist with this project. 
 67.18     Subd. 2.  [QUALITY MEASUREMENT TOOLS.) The commissioner 
 67.19  shall identify and apply existing quality measurement tools in 
 67.20  order to: 
 67.21     (1) emphasize quality of care and the relationship to 
 67.22  quality of life; and 
 67.23     (2) address the needs of various users of long-term care 
 67.24  services, including, but not limited to, short-stay residents, 
 67.25  persons with behavioral problems, persons with Alzheimer's 
 67.26  disease, and persons who are members of minority groups.  
 67.27     The tools shall be identified and applied, to the extent 
 67.28  possible, without requiring providers to supply information 
 67.29  beyond current state and federal requirements. 
 67.30     Subd. 3.  [CONSUMER SURVEYS.] Following identification of 
 67.31  the quality measurement tools, the commissioner shall conduct 
 67.32  surveys of long-term care service consumers in order to develop 
 67.33  quality profiles of providers.  To the extent possible, surveys 
 67.34  shall be conducted face-to-face by state employees or 
 67.35  contractors.  At the discretion of the commissioner, surveys may 
 67.36  be conducted by telephone or in person by provider staff.  
 68.1   Surveys shall be conducted periodically in order to update 
 68.2   quality profiles of individual service providers. 
 68.3      Subd. 4.  [DISSEMINATION OF QUALITY PROFILES.] By July 1, 
 68.4   2002, the commissioner shall implement a system to disseminate 
 68.5   the quality profiles developed from consumer surveys using the 
 68.6   quality measurement tools.  Profiles shall be disseminated to 
 68.7   consumers, providers, and purchasers of long-term care services 
 68.8   through all feasible printed and electronic outlets.  The 
 68.9   commissioner shall conduct a public awareness campaign to inform 
 68.10  potential users regarding profile contents and potential uses.  
 68.11     Sec. 46.  Minnesota Statutes 2000, section 256B.436, 
 68.12  subdivision 1, is amended to read: 
 68.13     Subdivision 1.  [DEFINITIONS.] (a) The definitions in this 
 68.14  subdivision apply to subdivisions 2 to 8a.  
 68.15     ~~(a)~~ (b) "Closure" means the ~~voluntary~~ cessation of 
 68.16  operations of a nursing ~~facility~~ home and ~~voluntary~~ delicensure 
 68.17  and decertification of all ~~nursing facility~~ beds ~~of~~ within the 
 68.18  ~~nursing~~ facility. 
 68.19     ~~(b)~~ (c) "Commencement of closure" means the date on which 
 68.20  the commissioner of health is notified of a planned closure in 
 68.21  accordance with section 144A.16 as part of an approved closure 
 68.22  plan. 
 68.23     ~~(c)~~ (d) "Completion of closure" means the date on which the 
 68.24  final resident of the nursing facility or nursing facilities 
 68.25  designated for closure in an approved closure plan is discharged 
 68.26  from the facility or facilities. 
 68.27     ~~(d)~~ (e) "Closure plan" means a plan to close one or more 
 68.28  nursing facilities and reallocate the resulting savings to 
 68.29  provide special rate adjustments at other facilities. 
 68.30     ~~(e) "Interim closure payments" means the medical assistance~~ 
 68.31  ~~payments that may be made to a nursing facility designated for~~ 
 68.32  ~~closure in an approved plan under this section.~~ 
 68.33     (f) ~~"Phased plan" means a closure plan affecting more than~~ 
 68.34  ~~one nursing facility undergoing closure that is commenced and~~ 
 68.35  ~~completed in phases~~ "Partial closure" means the delicensure and 
 68.36  decertification of a portion of the beds within the facility. 
 69.1      (g) "~~Special~~ Planned closure rate adjustment" means an 
 69.2   increase in a nursing facility's operating rates under this 
 69.3   section. 
 69.4      ~~(h) "Standardized resident days" means the standardized~~ 
 69.5   ~~resident days as calculated under Minnesota Rules, part~~ 
 69.6   ~~9549.0054, subpart 2, based on the resident days in each~~ 
 69.7   ~~resident class for the most recent reporting period required to~~ 
 69.8   ~~be reported to the commissioner.~~ 
 69.9      Sec. 47.  Minnesota Statutes 2000, section 256B.436, is 
 69.10  amended by adding a subdivision to read: 
 69.11     Subd. 1a.  [REGIONAL LONG-TERM CARE PLANNING AND 
 69.12  DEVELOPMENT.] (a) The commissioner shall establish a process to 
 69.13  adjust the capacity and distribution of long-term care services 
 69.14  in order to equalize the supply and demand for different types 
 69.15  of services.  The process shall include community and regional 
 69.16  planning and voluntary nursing facility closures.  
 69.17     (b) The commissioner shall issue a request for proposals to 
 69.18  contract with regional long-term care planning groups.  Each 
 69.19  group shall: 
 69.20     (1) consist of county health and social services agencies, 
 69.21  consumers, housing agencies, a representative of nursing 
 69.22  facilities, a representative of home and community-based 
 69.23  services providers, and area agencies on aging in the geographic 
 69.24  area; and 
 69.25     (2) serve an area that has at least 2,000 people who are 85 
 69.26  years of age or older.  In awarding contracts, the commissioner 
 69.27  shall give preference to groups that represent an entire area 
 69.28  agency on aging region where there is not already a planning and 
 69.29  development group established under section 256B.0917.  
 69.30     (c) Each regional long-term care planning group shall: 
 69.31     (1) conduct a detailed assessment of the region's long-term 
 69.32  care services system.  This assessment must be completed within 
 69.33  120 days of the contract award and shall evaluate the adequacy 
 69.34  of nursing facility beds and the impact of potential nursing 
 69.35  facility closures.  The commissioner shall provide data to the 
 69.36  group on nursing facility bed distribution, housing-with-service 
 70.1   options, and other available data; 
 70.2      (2) plan options for increasing community capacity to 
 70.3   provide more home and community-based services to reduce 
 70.4   reliance on nursing facility services; 
 70.5      (3) respond to receipt of a notice from a nursing facility 
 70.6   of its intent to propose voluntary bed closures under this 
 70.7   section.  This response must consist of reviewing, assessing, 
 70.8   and providing recommendations to the commissioner, to the 
 70.9   interagency long-term care planning committee, and to the 
 70.10  nursing facility about the impact of a nursing facility closure; 
 70.11  and 
 70.12     (4) develop community services alternatives to ensure that 
 70.13  sufficient community-based services are available to meet demand.
 70.14     <b>[EFFECTIVE DATE.]</b> This subdivision is effective the day 
 70.15  following final enactment. 
 70.16     Sec. 48.  Minnesota Statutes 2000, section 256B.436, 
 70.17  subdivision 2, is amended to read: 
 70.18     Subd. 2.  [~~PROPOSAL FOR A CLOSURE PLAN~~ REQUEST FOR 
 70.19  APPLICATIONS FOR PLANNED CLOSURE OF NURSING FACILITIES.] (a) ~~One~~ 
 70.20  ~~or more nursing facilities that are owned or operated by a~~ 
 70.21  ~~nonprofit corporation owning or operating more than 22 nursing~~ 
 70.22  ~~facilities licensed in the state of Minnesota may submit to the~~ 
 70.23  ~~commissioner a proposal for a closure plan under this section~~ By 
 70.24  July 15, 2001, the commissioner shall publish a request for 
 70.25  applications for closure or partial closure of nursing 
 70.26  facilities.  The request for applications must specify: 
 70.27     (1) the criteria that will be used by the interagency 
 70.28  long-term care planning committee established under section 
 70.29  144A.31 and the commissioner to approve or reject applications; 
 70.30     (2) a requirement for the submission of a letter of intent 
 70.31  before the submission of an application; 
 70.32     (3) the information that must accompany an application; 
 70.33     (4) a schedule for letters of intent, applications, and 
 70.34  consideration of applications for a minimum of four review 
 70.35  processes to be conducted before June 30, 2003; and 
 70.36     (5) that applications may combine planned closure rate 
 71.1   adjustments with moratorium exception funding, in which case a 
 71.2   single application may service both purposes. 
 71.3   Between ~~February 25, 2000~~ October 1, 2001, and June 30, ~~2001~~ 
 71.4   2003, the commissioner may ~~negotiate phased plans for~~ 
 71.5   ~~closure~~ approve planned closures of up to ~~seven~~ 4,700 nursing 
 71.6   ~~facilities~~ facility beds, with no more than 2,200 approved for 
 71.7   closure prior to July 1, 2002. 
 71.8      (b) A facility or facilities reimbursed under section 
 71.9   256B.431 ~~or~~, 256B.434, or 256B.435 with a closure plan approved 
 71.10  by the commissioner under subdivision ~~4 are eligible for the~~ 
 71.11  ~~following payments:~~ 
 71.12     ~~(1) facilities designated for closure are eligible for~~ 
 71.13  ~~interim closure payments under subdivision 5; and~~ 
 71.14     ~~(2) facilities that remain open are eligible for a~~ 
 71.15  ~~special~~ 5a may assign a planned closure rate adjustment to 
 71.16  another facility that is not closing.  The planned closure rate 
 71.17  adjustment shall be calculated under subdivision 6a.  A planned 
 71.18  closure rate adjustment under this section shall be effective on 
 71.19  the first day of the month following completion of closure of 
 71.20  all facilities designated for closure in the application and 
 71.21  shall become part of the nursing facility's total operating 
 71.22  payment rate.  Applicants may use the planned closure rate 
 71.23  adjustment to allow for a property payment for a new nursing 
 71.24  facility or an addition to an existing nursing facility.  
 71.25  Applications approved under this clause are exempt from other 
 71.26  requirements for moratorium exceptions under sections 144A.071 
 71.27  to 144A.073. 
 71.28     (c) To be considered for approval, ~~a proposal~~ an 
 71.29  application must include ~~the following~~: 
 71.30     (1) a description of the proposed closure plan, which shall 
 71.31  include identification of the facility or facilities to receive 
 71.32  a ~~special~~ planned closure rate adjustment, and the amount and 
 71.33  timing of a ~~special~~ planned closure rate adjustment proposed for 
 71.34  each facility ~~for the case mix level "A" operating rate, the~~ 
 71.35  ~~standardized resident days for each facility for which a special~~ 
 71.36  ~~rate adjustment is proposed, and the effective date for each~~ 
 72.1   ~~special rate adjustment.  The actual special rate adjustment for~~ 
 72.2   ~~a facility shall be allocated proportionately to the various~~ 
 72.3   ~~rate per diems included in that facility's operating rate~~; 
 72.4      (2) ~~an analysis of the projected state medical assistance~~ 
 72.5   ~~costs of the closure plan as proposed, including the estimated~~ 
 72.6   ~~costs of the special rate adjustments and estimated resident~~ 
 72.7   ~~relocation costs, including county government costs;~~ 
 72.8      ~~(3) an analysis of the projected state medical assistance~~ 
 72.9   ~~savings of the closure plan as proposed, including any savings~~ 
 72.10  ~~projected to result from closure of one or more nursing~~ 
 72.11  ~~facilities;~~ 
 72.12     ~~(4)~~ the proposed timetable for any proposed closure, 
 72.13  including the proposed dates for announcement to residents, 
 72.14  commencement of closure, and completion of closure; 
 72.15     ~~(5)~~ (3) the proposed relocation plan for current residents 
 72.16  of any facility designated for closure.  The proposed relocation 
 72.17  plan must be designed to comply with all applicable state and 
 72.18  federal statutes and regulations, including, but not limited to, 
 72.19  ~~section~~ sections 144A.16 and 144A.161; ~~and Minnesota Rules,~~ 
 72.20  ~~parts 4655.6810 to 4655.6830; parts 4658.1600 to 4658.1690; and~~ 
 72.21  ~~parts 9546.0010 to 9546.0060; and~~ 
 72.22     (4) a description of the relationship between the nursing 
 72.23  facility that is proposed for closure and the nursing facility 
 72.24  or facilities proposed to receive the planned closure rate 
 72.25  adjustment.  If these facilities are not under common ownership, 
 72.26  copies of any contracts, purchase agreements, or other documents 
 72.27  establishing a relationship or proposed relationship must be 
 72.28  provided; 
 72.29     ~~(6)~~ (5) documentation, in a format approved by the 
 72.30  commissioner, that all the nursing facilities receiving a 
 72.31  ~~special~~ planned closure rate adjustment under the plan have 
 72.32  accepted joint and several liability for recovery of 
 72.33  overpayments under section 256B.0641, subdivision 2, for the 
 72.34  facilities designated for closure under the plan~~.~~; and 
 72.35     (6) a detailed plan developed by the facility submitting 
 72.36  the application and by: 
 73.1      (i) a regional long-term care planning group established 
 73.2   under subdivision 1a; 
 73.3      (ii) a seniors' agenda for independent living (SAIL) 
 73.4   project under section 256B.0917; or 
 73.5      (iii) if a grantee under item (i) or (ii) has not been 
 73.6   established, a group similar to the group described in 
 73.7   subdivision 1a that is coordinated by the local area agency on 
 73.8   aging and is engaged in regional planning.  The plan shall 
 73.9   address how services will be established or expanded in the 
 73.10  community to meet the needs of people who require long-term care 
 73.11  or demonstrate that adequate services are already available in 
 73.12  the community. 
 73.13     (d) The application must address the criteria listed in 
 73.14  subdivision 3a. 
 73.15     Sec. 49.  Minnesota Statutes 2000, section 256B.436, is 
 73.16  amended by adding a subdivision to read: 
 73.17     Subd. 3a.  [CRITERIA FOR REVIEW OF APPLICATION.] In 
 73.18  reviewing and approving closure proposals, the commissioner 
 73.19  shall consider, but not be limited to, the following criteria: 
 73.20     (1) improved quality of care and quality of life for 
 73.21  consumers; 
 73.22     (2) closure of a nursing facility that has a poor physical 
 73.23  plant; 
 73.24     (3) the existence of excess nursing facility beds in the 
 73.25  region; 
 73.26     (4) low occupancy rates; 
 73.27     (5) evidence of a community planning process to determine 
 73.28  what services will be needed and assurance that needed services 
 73.29  will be established; 
 73.30     (6) innovative use of reinvestment funds; 
 73.31     (7) innovative use planned for the closed facility's 
 73.32  physical plant; and 
 73.33     (8) the proposal serves the interests of the state. 
 73.34     Sec. 50.  Minnesota Statutes 2000, section 256B.436, 
 73.35  subdivision 4, is amended to read: 
 73.36     Subd. 4.  [~~REVIEW AND APPROVAL OF PROPOSALS~~ 
 74.1   CERTIFICATION.] ~~(a) The commissioner may grant interim closure~~ 
 74.2   ~~payments or special rate adjustments for a nursing facility or~~ 
 74.3   ~~facilities according to an approved plan that satisfies the~~ 
 74.4   ~~requirements of this section.  The commissioner shall not~~ 
 74.5   ~~approve a proposal unless the commissioner determines that~~ 
 74.6   ~~projected state savings of the plan equal or exceed projected~~ 
 74.7   ~~state and county government costs, including facility costs~~ 
 74.8   ~~during the closure period, the estimated costs of special rate~~ 
 74.9   ~~adjustments, estimated resident relocation costs, the cost of~~ 
 74.10  ~~services to relocated residents, and state agency administrative~~ 
 74.11  ~~costs directly related to the accomplishment of duties specified~~ 
 74.12  ~~in this subdivision relative to that proposal.  To achieve cost~~ 
 74.13  ~~neutrality costs may only be offset against savings that occur~~ 
 74.14  ~~within the same fiscal year.  For purposes of a phased plan, the~~ 
 74.15  ~~requirement that costs must not exceed savings applies to both~~ 
 74.16  ~~the aggregate costs and savings of the plan and to each phase of~~ 
 74.17  ~~the plan.  A special rate adjustment under this section shall be~~ 
 74.18  ~~effective no earlier than the first day of the month following~~ 
 74.19  ~~completion of closure of all facilities designated for closure~~ 
 74.20  ~~under the plan.  For purposes of a phased plan, the special rate~~ 
 74.21  ~~adjustment for each phase shall be effective no earlier than the~~ 
 74.22  ~~first day of the month following completion of closure of all~~ 
 74.23  ~~facilities designated for closure in that phase of the plan.  No~~ 
 74.24  ~~special rate adjustment under this section shall take effect~~ 
 74.25  ~~prior to July 1, 2000.~~ 
 74.26     ~~(b)~~ Upon receipt of ~~a proposal~~ an application for ~~a closure~~ 
 74.27  ~~plan~~ planned closure, the commissioner shall provide a copy of 
 74.28  the ~~proposal~~ application to the commissioner of health.  The 
 74.29  commissioner of health shall certify to the commissioner within 
 74.30  30 days whether the ~~proposal~~ application, if implemented, will 
 74.31  satisfy the requirements of ~~section~~ sections 144A.16~~; and~~ 
 74.32  ~~Minnesota Rules, parts 4655.6810 to 4655.6830, and parts~~ 
 74.33  ~~4658.1600 to 4658.1690~~ and 144A.161.  The commissioner shall ~~not~~ 
 74.34  ~~approve a plan under this section unless~~ reject all applications 
 74.35  for which the commissioner of health ~~has made~~ does not make the 
 74.36  certification required under this ~~paragraph~~ subdivision. 
 75.1      ~~(c) The commissioner shall review a proposal for a closure~~ 
 75.2   ~~plan to determine whether it satisfies the requirements of this~~ 
 75.3   ~~section.  A determination shall be made within 60 days of the~~ 
 75.4   ~~date the proposal is submitted.  If the commissioner determines~~ 
 75.5   ~~that the proposal does not satisfy the requirements of this~~ 
 75.6   ~~section, or if the commissioner of health does not certify the~~ 
 75.7   ~~proposal under paragraph (b), the applicant shall be provided~~ 
 75.8   ~~written notice as soon as practicable specifying the~~ 
 75.9   ~~deficiencies of the proposal.  The proposal may be modified and~~ 
 75.10  ~~resubmitted for further review by each commissioner.  The~~ 
 75.11  ~~commissioner of health shall review a modified proposal within~~ 
 75.12  ~~30 days from the date it is submitted, and the commissioner~~ 
 75.13  ~~shall make a final determination on whether the proposal~~ 
 75.14  ~~satisfies the requirements of this section within 60 days of the~~ 
 75.15  ~~date the modified proposal is submitted.~~ 
 75.16     ~~(d) Approval of a closure plan expires 18 months after~~ 
 75.17  ~~approval by the commissioner, unless commencement of closure has~~ 
 75.18  ~~occurred at all facilities designated for closure under the plan.~~
 75.19     Sec. 51.  Minnesota Statutes 2000, section 256B.436, is 
 75.20  amended by adding a subdivision to read: 
 75.21     Subd. 5a.  [REVIEW AND APPROVAL OF PROPOSALS.] (a) The 
 75.22  interagency long-term care planning committee may recommend that 
 75.23  the commissioner grant approval, within the limits established 
 75.24  in subdivision 2, paragraph (a), to applications that satisfy 
 75.25  the requirements of this section.  The interagency committee may 
 75.26  appoint an advisory review panel composed of representatives of 
 75.27  counties, SAIL projects, consumers, and providers to review 
 75.28  proposals and provide comments and recommendations to the 
 75.29  committee.  The commissioners of human services and health shall 
 75.30  provide staff and technical assistance to the committee for the 
 75.31  review and analysis of proposals.  The commissioners of human 
 75.32  services and health shall jointly approve or disapprove an 
 75.33  application within 30 days after receiving the committee's 
 75.34  recommendations. 
 75.35     (b) Approval of a planned closure expires 18 months after 
 75.36  approval by the commissioner, unless commencement of closure has 
 76.1   begun. 
 76.2      (c) The commissioner may change any provision of the 
 76.3   application to which all parties agree. 
 76.4      Sec. 52.  Minnesota Statutes 2000, section 256B.436, is 
 76.5   amended by adding a subdivision to read: 
 76.6      Subd. 6a.  [PLANNED CLOSURE RATE ADJUSTMENT.] The 
 76.7   commissioner shall calculate the amount of the planned closure 
 76.8   rate adjustment available under subdivision 2, paragraph (b), 
 76.9   clause (1), according to clauses (1) to (4): 
 76.10     (1) the amount available shall be the net reduction of 
 76.11  nursing facility beds multiplied by $2,080: 
 76.12     (2) the total number of beds in the nursing facility or 
 76.13  nursing facilities receiving the planned closure rate adjustment 
 76.14  shall be identified; 
 76.15     (3) capacity days shall be determined by multiplying the 
 76.16  number determined under clause (2) by 365; and 
 76.17     (4) the planned closure rate adjustment shall be the amount 
 76.18  available in clause (1), divided by capacity days determined 
 76.19  under clause (3). 
 76.20     Sec. 53.  Minnesota Statutes 2000, section 256B.436, 
 76.21  subdivision 7, is amended to read: 
 76.22     Subd. 7.  [OTHER RATE ADJUSTMENTS.] ~~Except as otherwise~~ 
 76.23  ~~provided in subdivision 5,~~ Facilities subject to this section 
 76.24  remain eligible for any applicable rate adjustments provided 
 76.25  under section 256B.431, 256B.434, or any other section. 
 76.26     Sec. 54.  Minnesota Statutes 2000, section 256B.436, is 
 76.27  amended by adding a subdivision to read: 
 76.28     Subd. 8a.  [COUNTY COSTS.] The commissioner may allocate up 
 76.29  to $400 per nursing facility bed that is closing, within the 
 76.30  limits of the appropriation specified for this purpose, to be 
 76.31  used for relocation costs incurred by counties for planned 
 76.32  closures under this section and resident relocation under 
 76.33  sections 144A.16 and 144A.161.  To be eligible for this 
 76.34  allocation, a county in which a nursing facility closes must 
 76.35  provide to the commissioner a detailed statement, in a form 
 76.36  provided by the commissioner, of additional costs, not to exceed 
 77.1   $400 per bed closed, directly incurred related to the county's 
 77.2   required role in the relocation process.  Funds appropriated for 
 77.3   county resident relocation costs may be carried forward into 
 77.4   future years until the entire appropriation has been expended. 
 77.5      Sec. 55.  [REPEALER.] 
 77.6      (a) Minnesota Statutes 2000, sections 144A.16; 256B.0911, 
 77.7   subdivisions 2, 2a, 4, 8, and 9; 256B.0913, subdivisions 3, 15a, 
 77.8   15b, and 16; 256B.0915, subdivisions 3a, 3b, and 3c; and 
 77.9   256B.436, subdivisions 3, 5, 6, and 8, are repealed. 
 77.10     (b) Minnesota Rules, parts 4655.6810; 4655.6820; 4655.6830; 
 77.11  4658.1600; 4658.1605; 4658.1610; 4658.1690; 9505.2390; 
 77.12  9505.2395; 9505.2396; 9505.2400; 9505.2405; 9505.2410; 
 77.13  9505.2413; 9505.2415; 9505.2420; 9505.2425; 9505.2426; 
 77.14  9505.2430; 9505.2435; 9505.2440; 9505.2445; 9505.2450; 
 77.15  9505.2455; 9505.2458; 9505.2460; 9505.2465; 9505.2470; 
 77.16  9505.2473; 9505.2475; 9505.2480; 9505.2485; 9505.2486; 
 77.17  9505.2490; 9505.2495; 9505.2496; 9505.2500; 9546.0010; 
 77.18  9546.0020; 9546.0030; 9546.0040; 9546.0050; and 9546.0060, are 
 77.19  repealed. 
 77.20     Sec. 56.  [REVISOR INSTRUCTION.] 
 77.21     The revisor of statutes shall delete any reference to 
 77.22  Minnesota Statutes, section 144A.16, in Minnesota Statutes and 
 77.23  Minnesota Rules.