1.1                          A bill for an act 
  1.2             relating to human services; modifying provisions in 
  1.3             continuing care services for persons with 
  1.4             disabilities; expanding the rights of parents to serve 
  1.5             as both legal guardian and personal care assistant for 
  1.6             their children; clarifying mental health case manager 
  1.7             training and skill requirements; amending Minnesota 
  1.8             Statutes 1998, sections 62D.09, subdivision 8; and 
  1.9             256B.0625, subdivision 19a; Minnesota Statutes 1999 
  1.10            Supplement, sections 62Q.73, subdivision 2; 245.462, 
  1.11            subdivision 4; 245.4871, subdivision 4; 256B.0625, 
  1.12            subdivision 19c; 256B.0627, subdivisions 5, 8, and 11; 
  1.13            256B.501, subdivision 8a; 256B.5011, subdivision 2; 
  1.14            256B.5013, subdivision 1, and by adding subdivisions; 
  1.15            and 256B.77, subdivision 8. 
  1.16  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.17     Section 1.  Minnesota Statutes 1998, section 62D.09, 
  1.18  subdivision 8, is amended to read: 
  1.19     Subd. 8.  Each health maintenance organization shall issue 
  1.20  a membership card to its enrollees.  The membership card must: 
  1.21     (1) identify the health maintenance organization; 
  1.22     (2) include the name, address, and telephone number to call 
  1.23  if the enrollee has a complaint; 
  1.24     (3) include the telephone number to call or the instruction 
  1.25  on how to receive authorization for emergency care; and 
  1.26     (4) include one of the following: 
  1.27     (i) the telephone number to call to appeal to or file a 
  1.28  complaint with the commissioner of health; or 
  1.29     (ii) for persons enrolled under section 256B.69, 256B.77, 
  1.30  256D.03, or 256L.12, the telephone number to call to file a 
  2.1   complaint with the ombudsperson designated by the commissioner 
  2.2   of human services under section 256B.69 or the office of the 
  2.3   ombudsman for mental health and mental retardation under section 
  2.4   256B.77 and the address to appeal to the commissioner of human 
  2.5   services.  The ombudsperson shall annually provide the 
  2.6   commissioner of health with a summary of complaints and actions 
  2.7   taken. 
  2.8      Sec. 2.  Minnesota Statutes 1999 Supplement, section 
  2.9   62Q.73, subdivision 2, is amended to read: 
  2.10     Subd. 2.  [EXCEPTION.] (a) This section does not apply to 
  2.11  governmental programs except as permitted under paragraph (b). 
  2.12  For purposes of this subdivision, "governmental programs" means 
  2.13  the prepaid medical assistance program, the MinnesotaCare 
  2.14  program, the prepaid general assistance medical care 
  2.15  program, the demonstration project for people with disabilities, 
  2.16  and the federal Medicare program. 
  2.17     (b) In the course of a recipient's appeal of a medical 
  2.18  determination to the commissioner of human services under 
  2.19  section 256.045, the recipient may request an expert medical 
  2.20  opinion be arranged by the external review entity under contract 
  2.21  to provide independent external reviews under this section.  If 
  2.22  such a request is made, the cost of the review shall be paid by 
  2.23  the commissioner of human services.  Any medical opinion 
  2.24  obtained under this paragraph shall only be used by a state 
  2.25  human services referee as evidence in the recipient's appeal to 
  2.26  the commissioner of human services under section 256.045.  
  2.27     (c) Nothing in this subdivision shall be construed to limit 
  2.28  or restrict the appeal rights provided in section 256.045 for 
  2.29  governmental program recipients. 
  2.30     Sec. 3.  Minnesota Statutes 1999 Supplement, section 
  2.31  245.462, subdivision 4, is amended to read: 
  2.32     Subd. 4.  [CASE MANAGEMENT SERVICE PROVIDER.] (a) "Case 
  2.33  management service provider" means a case manager or case 
  2.34  manager associate employed by the county or other entity 
  2.35  authorized by the county board to provide case management 
  2.36  services specified in section 245.4711.  
  3.1      (b) A case manager must: 
  3.2      (1) be skilled in the process of identifying and assessing 
  3.3   a wide range of client needs; 
  3.4      (2) be knowledgeable about local community resources and 
  3.5   how to use those resources for the benefit of the client; 
  3.6      (3) have a bachelor's degree in one of the behavioral 
  3.7   sciences or related fields including, but not limited to, social 
  3.8   work, psychology, or nursing from an accredited college or 
  3.9   university~~.  A case manager must have at least 2,000 hours of~~ 
  3.10  ~~supervised experience in the delivery of services to adults with~~ 
  3.11  ~~mental illness, must be skilled in the process of identifying~~ 
  3.12  ~~and assessing a wide range of client needs, and must be~~ 
  3.13  ~~knowledgeable about local community resources and how to use~~ 
  3.14  ~~those resources for the benefit of the client~~ or meet the 
  3.15  requirements of paragraph (c); and 
  3.16     (4) meet the supervision and continuing education 
  3.17  requirements described in paragraphs (d), (e), and (f), as 
  3.18  applicable.  
  3.19     ~~(b) Supervision for a case manager during the first year of~~ 
  3.20  ~~service providing case management services shall be one hour per~~ 
  3.21  ~~week of clinical supervision from a case management supervisor.~~  
  3.22  ~~After the first year, the case manager shall receive regular~~ 
  3.23  ~~ongoing supervision totaling 38 hours per year, of which at~~ 
  3.24  ~~least one hour per month must be clinical supervision regarding~~ 
  3.25  ~~individual service delivery with a case management supervisor.~~  
  3.26  ~~The remainder may be provided by a case manager with two years~~ 
  3.27  ~~of experience.  Group supervision may not constitute more than~~ 
  3.28  ~~one-half of the required supervision hours.  Clinical~~ 
  3.29  ~~supervision must be documented in the client record.~~ 
  3.30     ~~(c) A case manager with a bachelor's degree who is not~~ 
  3.31  ~~licensed, registered, or certified by a health-related licensing~~ 
  3.32  ~~board must receive 30 hours of continuing education and training~~ 
  3.33  ~~in mental illness and mental health services annually.~~  
  3.34     ~~(d) A case manager with a bachelor's degree but without~~ 
  3.35  ~~2,000 hours of supervised experience described in paragraph (a),~~ 
  3.36  ~~must complete 40 hours of training approved by the commissioner~~ 
  4.1   ~~covering case management skills and the characteristics and~~ 
  4.2   ~~needs of adults with serious and persistent mental illness.~~  
  4.3      ~~(e)~~ (c) A case ~~managers~~ manager without a bachelor's degree 
  4.4   must meet one of the requirements in clauses (1) to (3):  
  4.5      (1) have three or four years of experience as a case 
  4.6   manager associate as defined in this section; 
  4.7      (2) be a registered nurse without a bachelor's degree and 
  4.8   have a combination of specialized training in psychiatry and 
  4.9   work experience consisting of community interaction and 
  4.10  involvement or community discharge planning in a mental health 
  4.11  setting totaling three years; or 
  4.12     (3) be a person who qualified as a case manager under the 
  4.13  1998 department of human service ~~federal~~ waiver provision and 
  4.14  meet the continuing education and mentoring requirements in this 
  4.15  section.  
  4.16     (d) A case manager with at least 2,000 hours of supervised 
  4.17  experience in the delivery of services to adults with mental 
  4.18  illness must receive regular ongoing supervision and clinical 
  4.19  supervision totaling 38 hours per year of which at least one 
  4.20  hour per month must be clinical supervision regarding individual 
  4.21  service delivery with a case management supervisor.  The 
  4.22  remaining 26 hours of supervision may be provided by a case 
  4.23  manager with two years of experience.  Group supervision may not 
  4.24  constitute more than one-half of the required supervision 
  4.25  hours.  Clinical supervision must be documented in the client 
  4.26  record. 
  4.27     (e) A case manager without 2,000 hours of supervised 
  4.28  experience in the delivery of services to adults with mental 
  4.29  illness must: 
  4.30     (1) receive clinical supervision regarding individual 
  4.31  service delivery from a mental health professional at least one 
  4.32  hour per week until the requirement of 2,000 hours of experience 
  4.33  is met; and 
  4.34     (2) complete 40 hours of training approved by the 
  4.35  commissioner in case management skills and the characteristics 
  4.36  and needs of adults with serious and persistent mental illness.  
  5.1      (f) A case manager who is not licensed, registered, or 
  5.2   certified by a health-related licensing board must receive 30 
  5.3   hours of continuing education and training in mental illness and 
  5.4   mental health services annually. 
  5.5      (g) A case manager associate (CMA) must: 
  5.6      (1) work under the direction of a case manager or case 
  5.7   management supervisor ~~and must~~; 
  5.8      (2) be at least 21 years of age~~.  A case manager associate~~ 
  5.9   ~~must also~~; 
  5.10     (3) have at least a high school diploma or its equivalent; 
  5.11  and 
  5.12     (4) meet one of the following criteria: 
  5.13     ~~(1)~~ (i) have an associate of arts degree in one of the 
  5.14  behavioral sciences or human services; 
  5.15     ~~(2)~~ (ii) be a registered nurse without a bachelor's degree; 
  5.16     ~~(3)~~ (iii) within the previous ten years, have three years 
  5.17  of life experience with serious and persistent mental illness as 
  5.18  defined in section 245.462, subdivision 20; or as a child had 
  5.19  severe emotional disturbance as defined in section 245.4871, 
  5.20  subdivision 6; or have three years life experience as a primary 
  5.21  caregiver to an adult with serious and persistent mental illness 
  5.22  within the previous ten years; 
  5.23     ~~(4)~~ (iv) have 6,000 hours work experience as a nondegreed 
  5.24  state hospital technician; or 
  5.25     ~~(5)~~ (v) be a mental health practitioner as defined in 
  5.26  section 245.462, subdivision 17, clause (2). 
  5.27     Individuals meeting one of the criteria in ~~clauses (1) to~~ 
  5.28  ~~(4)~~ items (i) to (iv) may qualify as a case manager after four 
  5.29  years of supervised work experience as a case manager 
  5.30  associate.  Individuals meeting the criteria in ~~clause (5)~~ item 
  5.31  (v) may qualify as a case manager after three years of 
  5.32  supervised experience as a case manager associate. 
  5.33     (h) A case management ~~associates~~ associate must meet the 
  5.34  following supervision, mentoring, and continuing education 
  5.35  requirements:  
  5.36     (1) have 40 hours of preservice training described under 
  6.1   paragraph ~~(d) and~~ (e), clause (2); 
  6.2      (2) receive at least 40 hours of continuing education in 
  6.3   mental illness and mental health services annually~~.  Case~~ 
  6.4   ~~manager associates shall~~; and 
  6.5      (3) receive at least five hours of mentoring per week from 
  6.6   a case management mentor.  
  6.7   A "case management mentor" means a qualified, practicing case 
  6.8   manager or case management supervisor who teaches or advises and 
  6.9   provides intensive training and clinical supervision to one or 
  6.10  more case manager associates.  Mentoring may occur while 
  6.11  providing direct services to consumers in the office or in the 
  6.12  field and may be provided to individuals or groups of case 
  6.13  manager associates.  At least two mentoring hours per week must 
  6.14  be individual and face-to-face. 
  6.15     ~~(g)~~ (i) A case management supervisor must meet the criteria 
  6.16  for mental health professionals, as specified in section 
  6.17  245.462, subdivision 18. 
  6.18     ~~(h)~~ (j) An immigrant who does not have the qualifications 
  6.19  specified in this subdivision may provide case management 
  6.20  services to adult immigrants with serious and persistent mental 
  6.21  illness who are members of the same ethnic group as the case 
  6.22  manager if the person:  
  6.23     (1) is currently enrolled in and is actively pursuing 
  6.24  credits toward the completion of a bachelor's degree in one of 
  6.25  the behavioral sciences or a related field including, but not 
  6.26  limited to, social work, psychology, or nursing from an 
  6.27  accredited college or university; 
  6.28     (2) completes 40 hours of training as specified in this 
  6.29  subdivision; and 
  6.30     (3) receives clinical supervision at least once a week 
  6.31  until the requirements of this subdivision are met. 
  6.32     Sec. 4.  Minnesota Statutes 1999 Supplement, section 
  6.33  245.4871, subdivision 4, is amended to read: 
  6.34     Subd. 4.  [CASE MANAGEMENT SERVICE PROVIDER.] (a) "Case 
  6.35  management service provider" means a case manager or case 
  6.36  manager associate employed by the county or other entity 
  7.1   authorized by the county board to provide case management 
  7.2   services specified in subdivision 3 for the child with severe 
  7.3   emotional disturbance and the child's family.  ~~A case manager~~ 
  7.4   ~~must have experience and training in working with children.~~ 
  7.5      (b) A case manager must: 
  7.6      (1) have experience and training in working with children; 
  7.7      (2) have at least a bachelor's degree in one of the 
  7.8   behavioral sciences or a related field including, but not 
  7.9   limited to, social work, psychology, or nursing from an 
  7.10  accredited college or university or meet the requirements of 
  7.11  paragraph (d); 
  7.12     ~~(2) have at least 2,000 hours of supervised experience in~~ 
  7.13  ~~the delivery of mental health services to children;~~ 
  7.14     (3) have experience and training in identifying and 
  7.15  assessing a wide range of children's needs; ~~and~~ 
  7.16     (4) be knowledgeable about local community resources and 
  7.17  how to use those resources for the benefit of children and their 
  7.18  families; and 
  7.19     (5) meets the supervision and continuing education 
  7.20  requirements of paragraphs (e), (f), and (g), as applicable. 
  7.21     (c) ~~The~~ A case manager may be a member of any professional 
  7.22  discipline that is part of the local system of care for children 
  7.23  established by the county board. 
  7.24     (d) A case manager without a bachelor's degree must meet 
  7.25  one of the requirements in clauses (1) to (3):  
  7.26     (1) have three or four years of experience as a case 
  7.27  manager associate; 
  7.28     (2) be a registered nurse without a bachelor's degree who 
  7.29  has a combination of specialized training in psychiatry and work 
  7.30  experience consisting of community interaction and involvement 
  7.31  or community discharge planning in a mental health setting 
  7.32  totaling three years; or 
  7.33     (3) be a person who qualified as a case manager under the 
  7.34  1998 department of human services waiver provision and meets the 
  7.35  continuing education, supervision, and mentoring requirements in 
  7.36  this section. 
  8.1      (e) ~~The~~ A case manager ~~shall~~ with at least 2,000 hours of 
  8.2   supervised experience in the delivery of mental health services 
  8.3   to children must receive regular ongoing supervision and 
  8.4   clinical supervision totaling 38 hours per year, of which at 
  8.5   least one hour per month must be clinical supervision regarding 
  8.6   individual service delivery with a case management supervisor.  
  8.7   The ~~remainder~~ other 26 hours of supervision may be provided by a 
  8.8   case manager with two years of experience.  Group supervision 
  8.9   may not constitute more than one-half of the required 
  8.10  supervision hours. 
  8.11     ~~(e)~~ (f) A case ~~managers with a bachelor's degree~~ 
  8.12  ~~but~~ manager without 2,000 hours of supervised experience in the 
  8.13  delivery of mental health services to children with emotional 
  8.14  disturbance must: 
  8.15     (1) begin 40 hours of training approved by the commissioner 
  8.16  of human services in case management skills and in the 
  8.17  characteristics and needs of children with severe emotional 
  8.18  disturbance before beginning to provide case management 
  8.19  services; and 
  8.20     (2) receive clinical supervision regarding individual 
  8.21  service delivery from a mental health professional at least one 
  8.22  hour each week until the requirement of 2,000 hours of 
  8.23  experience is met. 
  8.24     (g) A case manager who is not licensed, registered, or 
  8.25  certified by a health-related licensing board must receive 30 
  8.26  hours of continuing education and training in severe emotional 
  8.27  disturbance and mental health services annually.  
  8.28     ~~(f)~~ (h) Clinical supervision must be documented in the 
  8.29  child's record.  When the case manager is not a mental health 
  8.30  professional, the county board must provide or contract for 
  8.31  needed clinical supervision. 
  8.32     ~~(g)~~ (i) The county board must ensure that the case manager 
  8.33  has the freedom to access and coordinate the services within the 
  8.34  local system of care that are needed by the child. 
  8.35     ~~(h) Case managers who have a bachelor's degree but are not~~ 
  8.36  ~~licensed, registered, or certified by a health-related licensing~~ 
  9.1   ~~board must receive 30 hours of continuing education and training~~ 
  9.2   ~~in severe emotional disturbance and mental health services~~ 
  9.3   ~~annually.~~ 
  9.4      ~~(i) Case managers without a bachelor's degree must meet one~~ 
  9.5   ~~of the requirements in clauses (1) to (3):~~ 
  9.6      ~~(1) have three or four years of experience as a case~~ 
  9.7   ~~manager associate;~~ 
  9.8      ~~(2) be a registered nurse without a bachelor's degree who~~ 
  9.9   ~~has a combination of specialized training in psychiatry and work~~ 
  9.10  ~~experience consisting of community interaction and involvement~~ 
  9.11  ~~or community discharge planning in a mental health setting~~ 
  9.12  ~~totaling three years; or~~ 
  9.13     ~~(3) be a person who qualified as a case manager under the~~ 
  9.14  ~~1998 department of human service federal waiver provision and~~ 
  9.15  ~~meets the continuing education and mentoring requirements in~~ 
  9.16  ~~this section.~~ 
  9.17     (j) A case manager associate (CMA) must: 
  9.18     (1) work under the direction of a case manager or case 
  9.19  management supervisor ~~and must~~; 
  9.20     (2) be at least 21 years of age~~.  A case manager associate~~ 
  9.21  ~~must also~~; 
  9.22     (3) have at least a high school diploma or its equivalent; 
  9.23  and 
  9.24     (4) meet one of the following criteria: 
  9.25     ~~(1)~~ (i) have an associate of arts degree in one of the 
  9.26  behavioral sciences or human services; 
  9.27     ~~(2)~~ (ii) be a registered nurse without a bachelor's degree; 
  9.28     ~~(3)~~ (iii) have three years of life experience as a primary 
  9.29  caregiver to a child with serious emotional disturbance as 
  9.30  defined in section 245.4871, subdivision 6, within the previous 
  9.31  ten years; 
  9.32     ~~(4)~~ (iv) have 6,000 hours work experience as a nondegreed 
  9.33  state hospital technician; or 
  9.34     ~~(5)~~ (v) be a mental health practitioner as defined in 
  9.35  ~~section 245.462,~~ subdivision ~~17~~ 26, clause (2). 
  9.36     Individuals meeting one of the criteria in ~~clauses~~ 
 10.1   ~~(1)~~ items (i) to ~~(4)~~ (iv) may qualify as a case manager after 
 10.2   four years of supervised work experience as a case manager 
 10.3   associate.  Individuals meeting the criteria in ~~clause (5)~~ item 
 10.4   (v) may qualify as a case manager after three years of 
 10.5   supervised experience as a case manager associate. 
 10.6      (k) A case manager ~~associates~~ associate must meet the 
 10.7   following supervision, mentoring, and continuing education 
 10.8   requirements: 
 10.9      (1) have 40 hours of preservice training described under 
 10.10  paragraph ~~(e)~~ (f), clause (1)~~, and~~; 
 10.11     (2) receive at least 40 hours of continuing education in 
 10.12  severe emotional disturbance and mental health service 
 10.13  annually~~.  Case manager associates shall~~; and 
 10.14     (3) receive at least five hours of mentoring per week from 
 10.15  a case management mentor.  A "case management mentor" means a 
 10.16  qualified, practicing case manager or case management supervisor 
 10.17  who teaches or advises and provides intensive training and 
 10.18  clinical supervision to one or more case manager associates.  
 10.19  Mentoring may occur while providing direct services to consumers 
 10.20  in the office or in the field and may be provided to individuals 
 10.21  or groups of case manager associates.  At least two mentoring 
 10.22  hours per week must be individual and face-to-face. 
 10.23     ~~(k)~~ (l) A case management supervisor must meet the criteria 
 10.24  for a mental health professional as specified in section 
 10.25  245.4871, subdivision 27. 
 10.26     ~~(l)~~ (m) An immigrant who does not have the qualifications 
 10.27  specified in this subdivision may provide case management 
 10.28  services to child immigrants with severe emotional disturbance 
 10.29  of the same ethnic group as the immigrant if the person:  
 10.30     (1) is currently enrolled in and is actively pursuing 
 10.31  credits toward the completion of a bachelor's degree in one of 
 10.32  the behavioral sciences or related fields at an accredited 
 10.33  college or university; 
 10.34     (2) completes 40 hours of training as specified in this 
 10.35  subdivision; and 
 10.36     (3) receives clinical supervision at least once a week 
 11.1   until the requirements of obtaining a bachelor's degree and 
 11.2   2,000 hours of supervised experience are met. 
 11.3      Sec. 5.  Minnesota Statutes 1998, section 256B.0625, 
 11.4   subdivision 19a, is amended to read: 
 11.5      Subd. 19a.  [PERSONAL CARE SERVICES.] Medical assistance 
 11.6   covers personal care services in a recipient's home.  To qualify 
 11.7   for personal care services, recipients or responsible parties 
 11.8   must be able to identify the recipient's needs, direct and 
 11.9   evaluate task accomplishment, and provide for health and 
 11.10  safety.  Approved hours may be used outside the home when normal 
 11.11  life activities take them outside the home and when, without the 
 11.12  provision of personal care, their health and safety would be 
 11.13  jeopardized.  To use personal care services at school, the 
 11.14  recipient or responsible party must provide written 
 11.15  authorization in the care plan identifying the chosen provider 
 11.16  and the daily amount of services to be used at school.  Total 
 11.17  hours for services, whether actually performed inside or outside 
 11.18  the recipient's home, cannot exceed that which is otherwise 
 11.19  allowed for personal care services in an in-home setting 
 11.20  according to section 256B.0627.  Medical assistance does not 
 11.21  cover personal care services for residents of a hospital, 
 11.22  nursing facility, intermediate care facility, health care 
 11.23  facility licensed by the commissioner of health, or unless a 
 11.24  resident who is otherwise eligible is on leave from the facility 
 11.25  and the facility either pays for the personal care services or 
 11.26  forgoes the facility per diem for the leave days that personal 
 11.27  care services are used.  All personal care services must be 
 11.28  provided according to section 256B.0627.  Personal care services 
 11.29  may not be reimbursed if the personal care assistant is the 
 11.30  spouse or legal guardian of the recipient or the parent of a 
 11.31  recipient under age 18, or the responsible party or the foster 
 11.32  care provider of a recipient who cannot direct the recipient's 
 11.33  own care unless, in the case of a foster care provider, a county 
 11.34  or state case manager visits the recipient as needed, but not 
 11.35  less than every six months, to monitor the health and safety of 
 11.36  the recipient and to ensure the goals of the care plan are met.  
 12.1   Parents of adult recipients, adult children of the recipient or 
 12.2   adult siblings of the recipient may be reimbursed for personal 
 12.3   care services if they are not the recipient's legal guardian and 
 12.4   are granted a waiver under section 256B.0627.  Until July 1, 
 12.5   2001, and notwithstanding the provisions of section 256B.0627, 
 12.6   subdivision 4, paragraph (b), clause (4), the noncorporate legal 
 12.7   guardian or conservator of an adult, who is not the responsible 
 12.8   party and not the personal care provider organization, may be 
 12.9   granted a hardship waiver under section 256B.0627, to be 
 12.10  reimbursed to provide personal care assistant services to the 
 12.11  recipient, and shall not be considered to have a service 
 12.12  provider interest for purposes of participation on the screening 
 12.13  team under section 256B.092, subdivision 7. 
 12.14     Sec. 6.  Minnesota Statutes 1999 Supplement, section 
 12.15  256B.0625, subdivision 19c, is amended to read: 
 12.16     Subd. 19c.  [PERSONAL CARE.] Medical assistance covers 
 12.17  personal care services provided by an individual who is 
 12.18  qualified to provide the services according to subdivision 19a 
 12.19  and section 256B.0627, where the services are prescribed by a 
 12.20  physician in accordance with a plan of treatment and are 
 12.21  supervised by the recipient under the fiscal agent option 
 12.22  according to section 256B.0627, subdivision 10, or a qualified 
 12.23  professional.  "Qualified professional" means a mental health 
 12.24  professional as defined in section 245.462, subdivision 18, or 
 12.25  245.4871, subdivision ~~26~~ 27; or a registered nurse as defined in 
 12.26  sections 148.171 to 148.285.  As part of the assessment, the 
 12.27  county public health nurse will consult with the recipient or 
 12.28  responsible party and identify the most appropriate person to 
 12.29  provide supervision of the personal care assistant.  The 
 12.30  qualified professional shall perform the duties described in 
 12.31  Minnesota Rules, part 9505.0335, subpart 4.  
 12.32     Sec. 7.  Minnesota Statutes 1999 Supplement, section 
 12.33  256B.0627, subdivision 5, is amended to read: 
 12.34     Subd. 5.  [LIMITATION ON PAYMENTS.] Medical assistance 
 12.35  payments for home care services shall be limited according to 
 12.36  this subdivision.  
 13.1      (a)  [LIMITS ON SERVICES WITHOUT PRIOR AUTHORIZATION.] A 
 13.2   recipient may receive the following home care services during a 
 13.3   calendar year: 
 13.4      (1) up to two face-to-face assessments to determine a 
 13.5   recipient's need for personal care assistant services; 
 13.6      (2) one service update done to determine a recipient's need 
 13.7   for personal care services; and 
 13.8      (3) up to five skilled nurse visits.  
 13.9      (b)  [PRIOR AUTHORIZATION; EXCEPTIONS.] All home care 
 13.10  services above the limits in paragraph (a) must receive the 
 13.11  commissioner's prior authorization, except when: 
 13.12     (1) the home care services were required to treat an 
 13.13  emergency medical condition that if not immediately treated 
 13.14  could cause a recipient serious physical or mental disability, 
 13.15  continuation of severe pain, or death.  The provider must 
 13.16  request retroactive authorization no later than five working 
 13.17  days after giving the initial service.  The provider must be 
 13.18  able to substantiate the emergency by documentation such as 
 13.19  reports, notes, and admission or discharge histories; 
 13.20     (2) the home care services were provided on or after the 
 13.21  date on which the recipient's eligibility began, but before the 
 13.22  date on which the recipient was notified that the case was 
 13.23  opened.  Authorization will be considered if the request is 
 13.24  submitted by the provider within 20 working days of the date the 
 13.25  recipient was notified that the case was opened; 
 13.26     (3) a third-party payor for home care services has denied 
 13.27  or adjusted a payment.  Authorization requests must be submitted 
 13.28  by the provider within 20 working days of the notice of denial 
 13.29  or adjustment.  A copy of the notice must be included with the 
 13.30  request; 
 13.31     (4) the commissioner has determined that a county or state 
 13.32  human services agency has made an error; or 
 13.33     (5) the professional nurse determines an immediate need for 
 13.34  up to 40 skilled nursing or home health aide visits per calendar 
 13.35  year and submits a request for authorization within 20 working 
 13.36  days of the initial service date, and medical assistance is 
 14.1   determined to be the appropriate payer. 
 14.2      (c)  [RETROACTIVE AUTHORIZATION.] A request for retroactive 
 14.3   authorization will be evaluated according to the same criteria 
 14.4   applied to prior authorization requests.  
 14.5      (d)  [ASSESSMENT AND SERVICE PLAN.] Assessments under 
 14.6   section 256B.0627, subdivision 1, paragraph (a), shall be 
 14.7   conducted initially, and at least annually thereafter, in person 
 14.8   with the recipient and result in a completed service plan using 
 14.9   forms specified by the commissioner.  Within 30 days of 
 14.10  recipient or responsible party request for home care services, 
 14.11  the assessment, the service plan, and other information 
 14.12  necessary to determine medical necessity such as diagnostic or 
 14.13  testing information, social or medical histories, and hospital 
 14.14  or facility discharge summaries shall be submitted to the 
 14.15  commissioner.  For personal care services: 
 14.16     (1) The amount and type of service authorized based upon 
 14.17  the assessment and service plan will follow the recipient if the 
 14.18  recipient chooses to change providers.  
 14.19     (2) If the recipient's medical need changes, the 
 14.20  recipient's provider may assess the need for a change in service 
 14.21  authorization and request the change from the county public 
 14.22  health nurse.  Within 30 days of the request, the public health 
 14.23  nurse will determine whether to request the change in services 
 14.24  based upon the provider assessment, or conduct a home visit to 
 14.25  assess the need and determine whether the change is appropriate. 
 14.26     (3) To continue to receive personal care services after the 
 14.27  first year, the recipient or the responsible party, in 
 14.28  conjunction with the public health nurse, may complete a service 
 14.29  update on forms developed by the commissioner according to 
 14.30  criteria and procedures in subdivision 1.  
 14.31     (e)  [PRIOR AUTHORIZATION.] The commissioner, or the 
 14.32  commissioner's designee, shall review the assessment, service 
 14.33  update, request for temporary services, service plan, and any 
 14.34  additional information that is submitted.  The commissioner 
 14.35  shall, within 30 days after receiving a complete request, 
 14.36  assessment, and service plan, authorize home care services as 
 15.1   follows:  
 15.2      (1)  [HOME HEALTH SERVICES.] All home health services 
 15.3   provided by a licensed nurse or a home health aide must be prior 
 15.4   authorized by the commissioner or the commissioner's designee.  
 15.5   Prior authorization must be based on medical necessity and 
 15.6   cost-effectiveness when compared with other care options.  When 
 15.7   home health services are used in combination with personal care 
 15.8   and private duty nursing, the cost of all home care services 
 15.9   shall be considered for cost-effectiveness.  The commissioner 
 15.10  shall limit nurse and home health aide visits to no more than 
 15.11  one visit each per day. 
 15.12     (2)  [PERSONAL CARE SERVICES.] (i) All personal care 
 15.13  services and supervision by a qualified professional must be 
 15.14  prior authorized by the commissioner or the commissioner's 
 15.15  designee except for the assessments established in paragraph 
 15.16  (a).  The amount of personal care services authorized must be 
 15.17  based on the recipient's home care rating.  A child may not be 
 15.18  found to be dependent in an activity of daily living if because 
 15.19  of the child's age an adult would either perform the activity 
 15.20  for the child or assist the child with the activity and the 
 15.21  amount of assistance needed is similar to the assistance 
 15.22  appropriate for a typical child of the same age.  Based on 
 15.23  medical necessity, the commissioner may authorize: 
 15.24     (A) up to two times the average number of direct care hours 
 15.25  provided in nursing facilities for the recipient's comparable 
 15.26  case mix level; or 
 15.27     (B) up to three times the average number of direct care 
 15.28  hours provided in nursing facilities for recipients who have 
 15.29  complex medical needs or are dependent in at least seven 
 15.30  activities of daily living and need physical assistance with 
 15.31  eating or have a neurological diagnosis; or 
 15.32     (C) up to 60 percent of the average reimbursement rate, as 
 15.33  of July 1, 1991, for care provided in a regional treatment 
 15.34  center for recipients who have Level I behavior, plus any 
 15.35  inflation adjustment as provided by the legislature for personal 
 15.36  care service; or 
 16.1      (D) up to the amount the commissioner would pay, as of July 
 16.2   1, 1991, plus any inflation adjustment provided for home care 
 16.3   services, for care provided in a regional treatment center for 
 16.4   recipients referred to the commissioner by a regional treatment 
 16.5   center preadmission evaluation team.  For purposes of this 
 16.6   clause, home care services means all services provided in the 
 16.7   home or community that would be included in the payment to a 
 16.8   regional treatment center; or 
 16.9      (E) up to the amount medical assistance would reimburse for 
 16.10  facility care for recipients referred to the commissioner by a 
 16.11  preadmission screening team established under section 256B.0911 
 16.12  or 256B.092; and 
 16.13     (F) a reasonable amount of time for the provision of 
 16.14  supervision by a qualified professional of personal care 
 16.15  services.  
 16.16     (ii) The number of direct care hours shall be determined 
 16.17  according to the annual cost report submitted to the department 
 16.18  by nursing facilities.  The average number of direct care hours, 
 16.19  as established by May 1, 1992, shall be calculated and 
 16.20  incorporated into the home care limits on July 1, 1992.  These 
 16.21  limits shall be calculated to the nearest quarter hour. 
 16.22     (iii) The home care rating shall be determined by the 
 16.23  commissioner or the commissioner's designee based on information 
 16.24  submitted to the commissioner by the county public health nurse 
 16.25  on forms specified by the commissioner.  The home care rating 
 16.26  shall be a combination of current assessment tools developed 
 16.27  under sections 256B.0911 and 256B.501 with an addition for 
 16.28  seizure activity that will assess the frequency and severity of 
 16.29  seizure activity and with adjustments, additions, and 
 16.30  clarifications that are necessary to reflect the needs and 
 16.31  conditions of recipients who need home care including children 
 16.32  and adults under 65 years of age.  The commissioner shall 
 16.33  establish these forms and protocols under this section and shall 
 16.34  use an advisory group, including representatives of recipients, 
 16.35  providers, and counties, for consultation in establishing and 
 16.36  revising the forms and protocols. 
 17.1      (iv) A recipient shall qualify as having complex medical 
 17.2   needs if the care required is difficult to perform and because 
 17.3   of recipient's medical condition requires more time than 
 17.4   community-based standards allow or requires more skill than 
 17.5   would ordinarily be required and the recipient needs or has one 
 17.6   or more of the following: 
 17.7      (A) daily tube feedings; 
 17.8      (B) daily parenteral therapy; 
 17.9      (C) wound or decubiti care; 
 17.10     (D) postural drainage, percussion, nebulizer treatments, 
 17.11  suctioning, tracheotomy care, oxygen, mechanical ventilation; 
 17.12     (E) catheterization; 
 17.13     (F) ostomy care; 
 17.14     (G) quadriplegia; or 
 17.15     (H) other comparable medical conditions or treatments the 
 17.16  commissioner determines would otherwise require institutional 
 17.17  care.  
 17.18     (v) A recipient shall qualify as having Level I behavior if 
 17.19  there is reasonable supporting evidence that the recipient 
 17.20  exhibits, or that without supervision, observation, or 
 17.21  redirection would exhibit, one or more of the following 
 17.22  behaviors that cause, or have the potential to cause: 
 17.23     (A) injury to the recipient's own body; 
 17.24     (B) physical injury to other people; or 
 17.25     (C) destruction of property. 
 17.26     (vi) Time authorized for personal care relating to Level I 
 17.27  behavior in subclause (v), items (A) to (C), shall be based on 
 17.28  the predictability, frequency, and amount of intervention 
 17.29  required. 
 17.30     (vii) A recipient shall qualify as having Level II behavior 
 17.31  if the recipient exhibits on a daily basis one or more of the 
 17.32  following behaviors that interfere with the completion of 
 17.33  personal care services under subdivision 4, paragraph (a): 
 17.34     (A) unusual or repetitive habits; 
 17.35     (B) withdrawn behavior; or 
 17.36     (C) offensive behavior. 
 18.1      (viii) A recipient with a home care rating of Level II 
 18.2   behavior in subclause (vii), items (A) to (C), shall be rated as 
 18.3   comparable to a recipient with complex medical needs under 
 18.4   subclause (iv).  If a recipient has both complex medical needs 
 18.5   and Level II behavior, the home care rating shall be the next 
 18.6   complex category up to the maximum rating under subclause (i), 
 18.7   item (B). 
 18.8      (3)  [PRIVATE DUTY NURSING SERVICES.] All private duty 
 18.9   nursing services shall be prior authorized by the commissioner 
 18.10  or the commissioner's designee.  Prior authorization for private 
 18.11  duty nursing services shall be based on medical necessity and 
 18.12  cost-effectiveness when compared with alternative care options.  
 18.13  The commissioner may authorize medically necessary private duty 
 18.14  nursing services in quarter-hour units when: 
 18.15     (i) the recipient requires more individual and continuous 
 18.16  care than can be provided during a nurse visit; or 
 18.17     (ii) the cares are outside of the scope of services that 
 18.18  can be provided by a home health aide or personal care assistant.
 18.19     The commissioner may authorize: 
 18.20     (A) up to two times the average amount of direct care hours 
 18.21  provided in nursing facilities statewide for case mix 
 18.22  classification "K" as established by the annual cost report 
 18.23  submitted to the department by nursing facilities in May 1992; 
 18.24     (B) private duty nursing in combination with other home 
 18.25  care services up to the total cost allowed under clause (2); 
 18.26     (C) up to 16 hours per day if the recipient requires more 
 18.27  nursing than the maximum number of direct care hours as 
 18.28  established in item (A) and the recipient meets the hospital 
 18.29  admission criteria established under Minnesota Rules, parts 
 18.30  9505.0500 to 9505.0540.  
 18.31     The commissioner may authorize up to 16 hours per day of 
 18.32  medically necessary private duty nursing services or up to 24 
 18.33  hours per day of medically necessary private duty nursing 
 18.34  services until such time as the commissioner is able to make a 
 18.35  determination of eligibility for recipients who are 
 18.36  cooperatively applying for home care services under the 
 19.1   community alternative care program developed under section 
 19.2   256B.49, or until it is determined by the appropriate regulatory 
 19.3   agency that a health benefit plan is or is not required to pay 
 19.4   for appropriate medically necessary health care services.  
 19.5   Recipients or their representatives must cooperatively assist 
 19.6   the commissioner in obtaining this determination.  Recipients 
 19.7   who are eligible for the community alternative care program may 
 19.8   not receive more hours of nursing under this section than would 
 19.9   otherwise be authorized under section 256B.49. 
 19.10     (4)  [VENTILATOR-DEPENDENT RECIPIENTS.] If the recipient is 
 19.11  ventilator-dependent, the monthly medical assistance 
 19.12  authorization for home care services shall not exceed what the 
 19.13  commissioner would pay for care at the highest cost hospital 
 19.14  designated as a long-term hospital under the Medicare program.  
 19.15  For purposes of this clause, home care services means all 
 19.16  services provided in the home that would be included in the 
 19.17  payment for care at the long-term hospital.  
 19.18  "Ventilator-dependent" means an individual who receives 
 19.19  mechanical ventilation for life support at least six hours per 
 19.20  day and is expected to be or has been dependent for at least 30 
 19.21  consecutive days.  
 19.22     (f)  [PRIOR AUTHORIZATION; TIME LIMITS.] The commissioner 
 19.23  or the commissioner's designee shall determine the time period 
 19.24  for which a prior authorization shall be effective.  If the 
 19.25  recipient continues to require home care services beyond the 
 19.26  duration of the prior authorization, the home care provider must 
 19.27  request a new prior authorization.  Under no circumstances, 
 19.28  other than the exceptions in paragraph (b), shall a prior 
 19.29  authorization be valid prior to the date the commissioner 
 19.30  receives the request or for more than 12 months.  A recipient 
 19.31  who appeals a reduction in previously authorized home care 
 19.32  services may continue previously authorized services, other than 
 19.33  temporary services under paragraph (h), pending an appeal under 
 19.34  section 256.045.  The commissioner must provide a detailed 
 19.35  explanation of why the authorized services are reduced in amount 
 19.36  from those requested by the home care provider.  
 20.1      (g)  [APPROVAL OF HOME CARE SERVICES.] The commissioner or 
 20.2   the commissioner's designee shall determine the medical 
 20.3   necessity of home care services, the level of caregiver 
 20.4   according to subdivision 2, and the institutional comparison 
 20.5   according to this subdivision, the cost-effectiveness of 
 20.6   services, and the amount, scope, and duration of home care 
 20.7   services reimbursable by medical assistance, based on the 
 20.8   assessment, primary payer coverage determination information as 
 20.9   required, the service plan, the recipient's age, the cost of 
 20.10  services, the recipient's medical condition, and diagnosis or 
 20.11  disability.  The commissioner may publish additional criteria 
 20.12  for determining medical necessity according to section 256B.04. 
 20.13     (h)  [PRIOR AUTHORIZATION REQUESTS; TEMPORARY SERVICES.] 
 20.14  The agency nurse, the independently enrolled private duty nurse, 
 20.15  or county public health nurse may request a temporary 
 20.16  authorization for home care services by telephone.  The 
 20.17  commissioner may approve a temporary level of home care services 
 20.18  based on the assessment, and service or care plan information, 
 20.19  and primary payer coverage determination information as required.
 20.20  Authorization for a temporary level of home care services 
 20.21  including nurse supervision is limited to the time specified by 
 20.22  the commissioner, but shall not exceed 45 days, unless extended 
 20.23  because the county public health nurse has not completed the 
 20.24  required assessment and service plan, or the commissioner's 
 20.25  determination has not been made.  The level of services 
 20.26  authorized under this provision shall have no bearing on a 
 20.27  future prior authorization. 
 20.28     (i)  [PRIOR AUTHORIZATION REQUIRED IN FOSTER CARE SETTING.] 
 20.29  Home care services provided in an adult or child foster care 
 20.30  setting must receive prior authorization by the department 
 20.31  according to the limits established in paragraph (a). 
 20.32     The commissioner may not authorize: 
 20.33     (1) home care services that are the responsibility of the 
 20.34  foster care provider under the terms of the foster care 
 20.35  placement agreement and administrative rules~~.  Requests for home~~ 
 20.36  ~~care services for recipients residing in a foster care setting~~ 
 21.1   ~~must include the foster care placement agreement and~~ 
 21.2   ~~determination of difficulty of care~~; 
 21.3      (2) personal care services when the foster care license 
 21.4   holder is also the personal care provider or personal care 
 21.5   assistant unless the recipient can direct the recipient's own 
 21.6   care, or case management is provided as required in section 
 21.7   256B.0625, subdivision 19a; 
 21.8      (3) personal care services when the responsible party is an 
 21.9   employee of, or under contract with, or has any direct or 
 21.10  indirect financial relationship with the personal care provider 
 21.11  or personal care assistant, unless case management is provided 
 21.12  as required in section 256B.0625, subdivision 19a; or 
 21.13     (4) ~~home~~ personal care assistant and private duty nursing 
 21.14  services when the number of foster care residents is greater 
 21.15  than four unless the county responsible for the recipient's 
 21.16  foster placement made the placement prior to April 1, 1992, 
 21.17  requests that ~~home~~ personal care assistant and private duty 
 21.18  nursing services be provided, and case management is provided as 
 21.19  required in section 256B.0625, subdivision 19a~~; or~~. 
 21.20     ~~(5) home care services when combined with foster care~~ 
 21.21  ~~payments, other than room and board payments that exceed the~~ 
 21.22  ~~total amount that public funds would pay for the recipient's~~ 
 21.23  ~~care in a medical institution.~~ 
 21.24     Sec. 8.  Minnesota Statutes 1999 Supplement, section 
 21.25  256B.0627, subdivision 8, is amended to read: 
 21.26     Subd. 8.  [SHARED PERSONAL CARE ASSISTANT SERVICES.] (a) 
 21.27  Medical assistance payments for shared personal care assistance 
 21.28  services shall be limited according to this subdivision. 
 21.29     (b) Recipients of personal care assistant services may 
 21.30  share staff and the commissioner shall provide a rate system for 
 21.31  shared personal care assistant services.  For two persons 
 21.32  sharing services, the rate paid to a provider shall not exceed 
 21.33  1-1/2 times the rate paid for serving a single individual, and 
 21.34  for three persons sharing services, the rate paid to a provider 
 21.35  shall not exceed twice the rate paid for serving a single 
 21.36  individual.  These rates apply only to situations in which all 
 22.1   recipients were present and received shared services on the date 
 22.2   for which the service is billed.  No more than three persons may 
 22.3   receive shared services from a personal care assistant in a 
 22.4   single setting. 
 22.5      (c) Shared service is the provision of personal care 
 22.6   services by a personal care assistant to two or three recipients 
 22.7   at the same time and in the same setting.  For the purposes of 
 22.8   this subdivision, "setting" means: 
 22.9      (1) the home or foster care home of one of the individual 
 22.10  recipients; or 
 22.11     (2) a child care program in which all recipients served by 
 22.12  one personal care assistant are participating, which is licensed 
 22.13  under chapter 245A or operated by a local school district or 
 22.14  private school~~.~~; or 
 22.15     (3) outside the home or foster care home of one of the 
 22.16  recipients when normal life activities take the recipients 
 22.17  outside the home.  
 22.18     The provisions of this subdivision do not apply when a 
 22.19  personal care assistant is caring for multiple recipients in 
 22.20  more than one setting. 
 22.21     (d) The recipient or the recipient's responsible party, in 
 22.22  conjunction with the county public health nurse, shall determine:
 22.23     (1) whether shared personal care assistant services is an 
 22.24  appropriate option based on the individual needs and preferences 
 22.25  of the recipient; and 
 22.26     (2) the amount of shared services allocated as part of the 
 22.27  overall authorization of personal care services. 
 22.28     The recipient or the responsible party, in conjunction with 
 22.29  the supervising qualified professional, shall arrange the 
 22.30  setting and grouping of shared services based on the individual 
 22.31  needs and preferences of the recipients.  Decisions on the 
 22.32  selection of recipients to share services must be based on the 
 22.33  ages of the recipients, compatibility, and coordination of their 
 22.34  care needs. 
 22.35     (e) The following items must be considered by the recipient 
 22.36  or the responsible party and the supervising qualified 
 23.1   professional, and documented in the recipient's health service 
 23.2   record: 
 23.3      (1) the additional qualifications needed by the personal 
 23.4   care assistant to provide care to several recipients in the same 
 23.5   setting; 
 23.6      (2) the additional training and supervision needed by the 
 23.7   personal care assistant to ensure that the needs of the 
 23.8   recipient are met appropriately and safely.  The provider must 
 23.9   provide on-site supervision by a qualified professional within 
 23.10  the first 14 days of shared services, and monthly thereafter; 
 23.11     (3) the setting in which the shared services will be 
 23.12  provided; 
 23.13     (4) the ongoing monitoring and evaluation of the 
 23.14  effectiveness and appropriateness of the service and process 
 23.15  used to make changes in service or setting; and 
 23.16     (5) a contingency plan which accounts for absence of the 
 23.17  recipient in a shared services setting due to illness or other 
 23.18  circumstances and staffing contingencies. 
 23.19     (f) The provider must offer the recipient or the 
 23.20  responsible party the option of shared or one-on-one personal 
 23.21  care assistant services.  The recipient or the responsible party 
 23.22  can withdraw from participating in a shared services arrangement 
 23.23  at any time. 
 23.24     (g) In addition to documentation requirements under 
 23.25  Minnesota Rules, part 9505.2175, a personal care provider must 
 23.26  meet documentation requirements for shared personal care 
 23.27  assistant services and must document the following in the health 
 23.28  service record for each individual recipient sharing services: 
 23.29     (1) permission by the recipient or the recipient's 
 23.30  responsible party, if any, for the maximum number of shared 
 23.31  services hours per week chosen by the recipient; 
 23.32     (2) permission by the recipient or the recipient's 
 23.33  responsible party, if any, for personal care assistant services 
 23.34  provided outside the recipient's residence; 
 23.35     (3) permission by the recipient or the recipient's 
 23.36  responsible party, if any, for others to receive shared services 
 24.1   in the recipient's residence; 
 24.2      (4) revocation by the recipient or the recipient's 
 24.3   responsible party, if any, of the shared service authorization, 
 24.4   or the shared service to be provided to others in the 
 24.5   recipient's residence, or the shared service to be provided 
 24.6   outside the recipient's residence; 
 24.7      (5) supervision of the shared personal care assistant 
 24.8   services by the qualified professional, including the date, time 
 24.9   of day, number of hours spent supervising the provision of 
 24.10  shared services, whether the supervision was face-to-face or 
 24.11  another method of supervision, changes in the recipient's 
 24.12  condition, shared services scheduling issues and 
 24.13  recommendations; 
 24.14     (6) documentation by the qualified professional of 
 24.15  telephone calls or other discussions with the personal care 
 24.16  assistant regarding services being provided to the recipient; 
 24.17  and 
 24.18     (7) daily documentation of the shared services provided by 
 24.19  each identified personal care assistant including: 
 24.20     (i) the names of each recipient receiving shared services 
 24.21  together; 
 24.22     (ii) the setting for the shared services, including the 
 24.23  starting and ending times that the recipient received shared 
 24.24  services; and 
 24.25     (iii) notes by the personal care assistant regarding 
 24.26  changes in the recipient's condition, problems that may arise 
 24.27  from the sharing of services, scheduling issues, care issues, 
 24.28  and other notes as required by the qualified professional. 
 24.29     (h) Unless otherwise provided in this subdivision, all 
 24.30  other statutory and regulatory provisions relating to personal 
 24.31  care services apply to shared services. 
 24.32     Nothing in this subdivision shall be construed to reduce 
 24.33  the total number of hours authorized for an individual recipient.
 24.34     Sec. 9.  Minnesota Statutes 1999 Supplement, section 
 24.35  256B.0627, subdivision 11, is amended to read: 
 24.36     Subd. 11.  [SHARED PRIVATE DUTY NURSING CARE OPTION.] (a) 
 25.1   Medical assistance payments for shared private duty nursing 
 25.2   services by a private duty nurse shall be limited according to 
 25.3   this subdivision.  For the purposes of this section, "private 
 25.4   duty nursing agency" means an agency licensed under chapter 144A 
 25.5   to provide private duty nursing services. 
 25.6      (b) Recipients of private duty nursing services may share 
 25.7   nursing staff and the commissioner shall provide a rate 
 25.8   methodology for shared private duty nursing.  For two persons 
 25.9   sharing nursing care, the rate paid to a provider shall not 
 25.10  exceed 1.5 times the nonwaivered private duty nursing rates paid 
 25.11  for serving a single individual who is not ventilator dependent, 
 25.12  by a registered nurse or licensed practical nurse.  These rates 
 25.13  apply only to situations in which both recipients are present 
 25.14  and receive shared private duty nursing care on the date for 
 25.15  which the service is billed.  No more than two persons may 
 25.16  receive shared private duty nursing services from a private duty 
 25.17  nurse in a single setting. 
 25.18     (c) Shared private duty nursing care is the provision of 
 25.19  nursing services by a private duty nurse to two recipients at 
 25.20  the same time and in the same setting.  For the purposes of this 
 25.21  subdivision, "setting" means: 
 25.22     (1) the home or foster care home of one of the individual 
 25.23  recipients; or 
 25.24     (2) a child care program licensed under chapter 245A or 
 25.25  operated by a local school district or private school; or 
 25.26     (3) an adult day care service licensed under chapter 245A~~.~~; 
 25.27  or 
 25.28     (4) outside the home or foster care home of one of the 
 25.29  recipients when normal life activities take the recipients 
 25.30  outside the home.  
 25.31     This subdivision does not apply when a private duty nurse 
 25.32  is caring for multiple recipients in more than one setting. 
 25.33     (d) The recipient or the recipient's legal representative, 
 25.34  and the recipient's physician, in conjunction with the home 
 25.35  health care agency, shall determine: 
 25.36     (1) whether shared private duty nursing care is an 
 26.1   appropriate option based on the individual needs and preferences 
 26.2   of the recipient; and 
 26.3      (2) the amount of shared private duty nursing services 
 26.4   authorized as part of the overall authorization of nursing 
 26.5   services. 
 26.6      (e) The recipient or the recipient's legal representative, 
 26.7   in conjunction with the private duty nursing agency, shall 
 26.8   approve the setting, grouping, and arrangement of shared private 
 26.9   duty nursing care based on the individual needs and preferences 
 26.10  of the recipients.  Decisions on the selection of recipients to 
 26.11  share services must be based on the ages of the recipients, 
 26.12  compatibility, and coordination of their care needs. 
 26.13     (f) The following items must be considered by the recipient 
 26.14  or the recipient's legal representative and the private duty 
 26.15  nursing agency, and documented in the recipient's health service 
 26.16  record: 
 26.17     (1) the additional training needed by the private duty 
 26.18  nurse to provide care to ~~several~~ two recipients in the same 
 26.19  setting and to ensure that the needs of the recipients are met 
 26.20  appropriately and safely; 
 26.21     (2) the setting in which the shared private duty nursing 
 26.22  care will be provided; 
 26.23     (3) the ongoing monitoring and evaluation of the 
 26.24  effectiveness and appropriateness of the service and process 
 26.25  used to make changes in service or setting; 
 26.26     (4) a contingency plan which accounts for absence of the 
 26.27  recipient in a shared private duty nursing setting due to 
 26.28  illness or other circumstances; 
 26.29     (5) staffing backup contingencies in the event of employee 
 26.30  illness or absence; and 
 26.31     (6) arrangements for additional assistance to respond to 
 26.32  urgent or emergency care needs of the recipients. 
 26.33     (g) The provider must offer the recipient or responsible 
 26.34  party the option of shared or one-on-one private duty nursing 
 26.35  services.  The recipient or responsible party can withdraw from 
 26.36  participating in a shared service arrangement at any time. 
 27.1      (h) The private duty nursing agency must document the 
 27.2   following in the health service record for each individual 
 27.3   recipient sharing private duty nursing care: 
 27.4      (1) permission by the recipient or the recipient's legal 
 27.5   representative for the maximum number of shared nursing care 
 27.6   hours per week chosen by the recipient; 
 27.7      (2) permission by the recipient or the recipient's legal 
 27.8   representative for shared private duty nursing services provided 
 27.9   outside the recipient's residence; 
 27.10     (3) permission by the recipient or the recipient's legal 
 27.11  representative for others to receive shared private duty nursing 
 27.12  services in the recipient's residence; 
 27.13     (4) revocation by the recipient or the recipient's legal 
 27.14  representative of the shared private duty nursing care 
 27.15  authorization, or the shared care to be provided to others in 
 27.16  the recipient's residence, or the shared private duty nursing 
 27.17  services to be provided outside the recipient's residence; and 
 27.18     (5) daily documentation of the shared private duty nursing 
 27.19  services provided by each identified private duty nurse, 
 27.20  including: 
 27.21     (i) the names of each recipient receiving shared private 
 27.22  duty nursing services together; 
 27.23     (ii) the setting for the shared services, including the 
 27.24  starting and ending times that the recipient received shared 
 27.25  private duty nursing care; and 
 27.26     (iii) notes by the private duty nurse regarding changes in 
 27.27  the recipient's condition, problems that may arise from the 
 27.28  sharing of private duty nursing services, and scheduling and 
 27.29  care issues. 
 27.30     (i) Unless otherwise provided in this subdivision, all 
 27.31  other statutory and regulatory provisions relating to private 
 27.32  duty nursing services apply to shared private duty nursing 
 27.33  services. 
 27.34     Nothing in this subdivision shall be construed to reduce 
 27.35  the total number of private duty nursing hours authorized for an 
 27.36  individual recipient under subdivision 5. 
 28.1      Sec. 10.  Minnesota Statutes 1999 Supplement, section 
 28.2   256B.501, subdivision 8a, is amended to read: 
 28.3      Subd. 8a.  [PAYMENT FOR PERSONS WITH SPECIAL NEEDS FOR 
 28.4   CRISIS INTERVENTION SERVICES.] Community-based crisis services 
 28.5   authorized by the commissioner or the commissioner's designee 
 28.6   for a resident of an intermediate care facility for persons with 
 28.7   mental retardation (ICF/MR) reimbursed under this section shall 
 28.8   be paid by medical assistance in accordance with the paragraphs 
 28.9   (a) to (g). 
 28.10     (a) "Crisis services" means the specialized services listed 
 28.11  in clauses (1) to (3) provided to prevent the recipient from 
 28.12  requiring placement in a more restrictive institutional setting 
 28.13  such as an inpatient hospital or regional treatment center and 
 28.14  to maintain the recipient in the present community setting. 
 28.15     (1) The crisis services provider shall assess the 
 28.16  recipient's behavior and environment to identify factors 
 28.17  contributing to the crisis. 
 28.18     (2) The crisis services provider shall develop a 
 28.19  recipient-specific intervention plan in coordination with the 
 28.20  service planning team and provide recommendations for revisions 
 28.21  to the individual service plan if necessary to prevent or 
 28.22  minimize the likelihood of future crisis situations.  The 
 28.23  intervention plan shall include a transition plan to aid the 
 28.24  recipient in returning to the community-based ICF/MR if the 
 28.25  recipient is receiving residential crisis services.  
 28.26     (3) The crisis services provider shall consult with and 
 28.27  provide training and ongoing technical assistance to the 
 28.28  recipient's service providers to aid in the implementation of 
 28.29  the intervention plan and revisions to the individual service 
 28.30  plan. 
 28.31     (b) "Residential crisis services" means crisis services 
 28.32  that are provided to a recipient admitted to an alternative, 
 28.33  state-licensed site approved by the commissioner, because the 
 28.34  ICF/MR receiving reimbursement under this section is not able, 
 28.35  as determined by the commissioner, to provide the intervention 
 28.36  and protection of the recipient and others living with the 
 29.1   recipient that is necessary to prevent the recipient from 
 29.2   requiring placement in a more restrictive institutional setting. 
 29.3      (c) Residential crisis services providers must maintain a 
 29.4   license from the commissioner for the residence when providing 
 29.5   crisis services for short-term crisis intervention, and must not 
 29.6   be located in a private residence. 
 29.7      (d) Payment rates shall be established consistent with 
 29.8   county negotiated crisis intervention services.  
 29.9      (e) Payment for residential crisis services is limited to 
 29.10  21 days, unless an additional period is authorized by the 
 29.11  commissioner or part of an approved regional plan.  
 29.12     (f) Payment for crisis services shall be made only for 
 29.13  services provided while the ICF/MR receiving reimbursement under 
 29.14  this section~~:~~ 
 29.15     ~~(1) has a shared services agreement with the crisis~~ 
 29.16  ~~services provider in effect under section 246.57; and~~ 
 29.17     ~~(2)~~ has executed a cooperative agreement with the crisis 
 29.18  services provider to implement the intervention plan and 
 29.19  revisions to the individual service plan as necessary to prevent 
 29.20  or minimize the likelihood of future crisis situations, to 
 29.21  maintain the recipient in the present community setting, and to 
 29.22  prevent the recipient from requiring a more restrictive 
 29.23  institutional setting. 
 29.24     (g) Payment to the ICF/MR receiving reimbursement under 
 29.25  this section shall be made for up to 18 therapeutic leave days 
 29.26  during which the recipient is receiving residential crisis 
 29.27  services, if the ICF/MR is otherwise eligible to receive payment 
 29.28  for a therapeutic leave day under Minnesota Rules, part 
 29.29  9505.0415.  Payment under this paragraph shall be terminated if 
 29.30  the commissioner determines that the ICF/MR is not meeting the 
 29.31  terms of the ~~shared~~ cooperative service agreement under 
 29.32  paragraph (f) or that the recipient will not return to the 
 29.33  ICF/MR. 
 29.34     Sec. 11.  Minnesota Statutes 1999 Supplement, section 
 29.35  256B.5011, subdivision 2, is amended to read: 
 29.36     Subd. 2.  [CONTRACT PROVISIONS.] (a) The service contract 
 30.1   with each intermediate care facility must include provisions for:
 30.2      (1) modifying payments when significant changes occur in 
 30.3   the needs of the consumers; 
 30.4      (2) the establishment and use of ~~continuous~~ a quality 
 30.5   improvement ~~processes using the results attained through service~~ 
 30.6   ~~quality monitoring~~ plan.  Using criteria and options for 
 30.7   performance measures developed by the commissioner, each 
 30.8   intermediate care facility must identify a minimum of one 
 30.9   performance measure on which to focus its efforts for quality 
 30.10  improvement during the contract period; 
 30.11     (3) appropriate and necessary statistical information 
 30.12  required by the commissioner; 
 30.13     (4) annual aggregate facility financial information; and 
 30.14     (5) additional requirements for intermediate care 
 30.15  facilities not meeting the standards set forth in the service 
 30.16  contract. 
 30.17     ~~(b) The commissioner shall recommend to the legislature by~~ 
 30.18  ~~January 15, 2000, whether the contract should include service~~ 
 30.19  ~~quality monitoring that may utilize performance indicators that~~ 
 30.20  ~~measure consumer and program outcomes.  Performance measurement~~ 
 30.21  ~~shall not increase or duplicate regulatory requirements.~~ 
 30.22     (b) The commissioner of human services and the commissioner 
 30.23  of health, in consultation with representatives from counties, 
 30.24  advocacy organizations, and the provider community, shall review 
 30.25  the consolidated standards under chapter 245B and the supervised 
 30.26  living facility rule under Minnesota Rules, chapter 4665, to 
 30.27  determine what provisions in Minnesota Rules, chapter 4665, may 
 30.28  be waived by the commissioner of health for intermediate care 
 30.29  facilities in order to enable facilities to implement the 
 30.30  performance measures in their contracts and provide quality 
 30.31  services to residents without a duplication of or increase in 
 30.32  regulatory requirements. 
 30.33     Sec. 12.  Minnesota Statutes 1999 Supplement, section 
 30.34  256B.5013, subdivision 1, is amended to read: 
 30.35     Subdivision 1.  [VARIABLE RATE ADJUSTMENTS.] For rate years 
 30.36  beginning on or after October 1, 2000, when there is a 
 31.1   documented increase in the resource needs of a current ICF/MR 
 31.2   recipient or recipients, or a person is admitted to a facility 
 31.3   who requires additional resources, the county of financial 
 31.4   responsibility may ~~approve an enhanced~~ recommend approval of a 
 31.5   variable rate ~~for one or more persons in the~~ to enable the 
 31.6   facility to meet the needs based on the recipient's screening.  
 31.7   Resource needs directly attributable to an individual that may 
 31.8   be considered under the variable rate adjustment include 
 31.9   increased direct staff hours and other specialized services, 
 31.10  equipment, and human resources.  The guidelines in paragraphs 
 31.11  (a) to (d) apply for the payment rate adjustments under this 
 31.12  section. 
 31.13     (a) All persons must be screened according to section 
 31.14  256B.092, subdivisions 7 and 8, prior to implementation of the 
 31.15  new payment system, and annually thereafter, and when a variable 
 31.16  rate is being requested due to changes in the needs of the 
 31.17  recipient.  Screening data shall be analyzed to develop broad 
 31.18  profiles of the functional characteristics of recipients.  ~~Three~~ 
 31.19  ~~components shall~~ Criteria to be used to ~~distinguish recipients~~ 
 31.20  ~~based on the following broad~~ develop these profiles shall 
 31.21  include, but not be limited to: 
 31.22     (1) the functional ability of a recipient to care for and 
 31.23  maintain ~~one's~~ the recipient's own basic needs; 
 31.24     (2) the intensity of any aggressive or destructive 
 31.25  behavior; ~~and~~ 
 31.26     (3) any history of obstructive behavior in combination with 
 31.27  a diagnosis of psychosis or neurosis~~.~~; 
 31.28     (4) a need for resources due to a change in resident day 
 31.29  program participation because the resident:  (i) has reached the 
 31.30  age of 65 or has a deteriorating health condition that makes it 
 31.31  difficult to participate in day training and habilitation 
 31.32  services over an extended period of time as provided in section 
 31.33  252.41, subdivision 3, clause (3); and (ii) has expressed a 
 31.34  desire for change through the developmental disabilities 
 31.35  screening process; and 
 31.36     (5) a need for additional resources for intensive 
 32.1   short-term training which is necessary prior to a recipient's 
 32.2   discharge to a less restrictive, more integrated setting. 
 32.3      The ~~profile groups~~ recipients' screenings shall be used to 
 32.4   link resource needs to funding.  The resource profile shall 
 32.5   determine the level of funding ~~that may be authorized by the~~ 
 32.6   ~~county.  The county of financial responsibility may approve a~~ 
 32.7   ~~rate adjustment for an individual.  The commissioner shall~~ 
 32.8   ~~recommend to the legislature by January 15, 2000, a methodology~~ 
 32.9   ~~using the profile groups to determine variable rates~~.  The 
 32.10  variable rate must be applied to expenses related to increased 
 32.11  direct staff hours and other specialized services, equipment, 
 32.12  and human resources.  ~~This variable rate component plus the~~ 
 32.13  ~~facility's current operating payment rate equals the~~ 
 32.14  ~~individual's total operating payment rate.~~ 
 32.15     (b) A recipient must be screened by the county of financial 
 32.16  responsibility using the developmental disabilities screening 
 32.17  document completed immediately prior to approval of a variable 
 32.18  rate by the county.  A comparison of the updated screening and 
 32.19  the previous screening must demonstrate an increase in resource 
 32.20  needs. 
 32.21     (c) Rate adjustments projected to exceed the authorized 
 32.22  funding level associated with the person's profile must be 
 32.23  submitted to the commissioner. 
 32.24     (d) ~~The new rate approved through this process shall not be~~ 
 32.25  ~~averaged across all persons living at a facility but shall be an~~ 
 32.26  ~~individual rate.~~  The county of financial responsibility must 
 32.27  indicate the projected length of time that the additional 
 32.28  funding may be needed ~~by~~ for the individual.  The need to 
 32.29  continue an individual variable rate must be reviewed at the end 
 32.30  of the anticipated duration of need but at least annually 
 32.31  through the completion of the developmental disabilities 
 32.32  screening document. 
 32.33     Sec. 13.  Minnesota Statutes 1999 Supplement, section 
 32.34  256B.5013, is amended by adding a subdivision to read: 
 32.35     Subd. 5.  [REQUIRED DATA; PAYMENT ADJUSTMENTS.] Facilities 
 32.36  shall maintain and submit monthly bed use data in the form of 
 33.1   resident days and variable rate information.  When a variable 
 33.2   rate is reported by a facility, monthly bed use data shall be 
 33.3   used to track the amount and time span of the rate adjustment.  
 33.4   The total payments made to a facility may be adjusted based on 
 33.5   concurrent changes in the needs of recipients that are covered 
 33.6   by a variable rate adjustment.  Any adjustment for multiple 
 33.7   resident changes shall not result in a decrease to the facility 
 33.8   base rate. 
 33.9      Sec. 14.  Minnesota Statutes 1999 Supplement, section 
 33.10  256B.5013, is amended by adding a subdivision to read: 
 33.11     Subd. 6.  [COMMISSIONER REVIEW.] During the initial 
 33.12  contracting period, the commissioner shall review the process of 
 33.13  variable rate adjustments to determine if the variable rate 
 33.14  process is being effectively implemented and whether the 
 33.15  variable rate process minimizes unnecessary detailed 
 33.16  recordkeeping and meets recipient needs. 
 33.17     Sec. 15.  Minnesota Statutes 1999 Supplement, section 
 33.18  256B.77, subdivision 8, is amended to read: 
 33.19     Subd. 8.  [RESPONSIBILITIES OF THE COUNTY ADMINISTRATIVE 
 33.20  ENTITY.] (a) The county administrative entity shall meet the 
 33.21  requirements of this subdivision, unless the county authority or 
 33.22  the commissioner, with written approval of the county authority, 
 33.23  enters into a service delivery contract with a service delivery 
 33.24  organization for any or all of the requirements contained in 
 33.25  this subdivision. 
 33.26     (b) The county administrative entity shall enroll eligible 
 33.27  individuals regardless of health or disability status. 
 33.28     (c) The county administrative entity shall provide all 
 33.29  enrollees timely access to the medical assistance benefit set.  
 33.30  Alternative services and additional services are available to 
 33.31  enrollees at the option of the county administrative entity and 
 33.32  may be provided if specified in the personal support plan.  
 33.33  County authorities are not required to seek prior authorization 
 33.34  from the department as required by the laws and rules governing 
 33.35  medical assistance. 
 33.36     (d) The county administrative entity shall cover necessary 
 34.1   services as a result of an emergency without prior 
 34.2   authorization, even if the services were rendered outside of the 
 34.3   provider network. 
 34.4      (e) The county administrative entity shall authorize 
 34.5   necessary and appropriate services when needed and requested by 
 34.6   the enrollee or the enrollee's legal representative in response 
 34.7   to an urgent situation.  Enrollees shall have 24-hour access to 
 34.8   urgent care services coordinated by experienced disability 
 34.9   providers who have information about enrollees' needs and 
 34.10  conditions. 
 34.11     (f) The county administrative entity shall accept the 
 34.12  capitation payment from the commissioner in return for the 
 34.13  provision of services for enrollees. 
 34.14     (g) The county administrative entity shall maintain 
 34.15  internal grievance and complaint procedures, including an 
 34.16  expedited informal complaint process in which the county 
 34.17  administrative entity must respond to verbal complaints within 
 34.18  ten calendar days, and a formal grievance process, in which the 
 34.19  county administrative entity must respond to written complaints 
 34.20  within 30 calendar days. 
 34.21     (h) The county administrative entity shall provide a 
 34.22  certificate of coverage, upon enrollment, to each enrollee and 
 34.23  the enrollee's legal representative, if any, which describes the 
 34.24  benefits covered by the county administrative entity, any 
 34.25  limitations on those benefits, and information about providers 
 34.26  and the service delivery network.  This information must also be 
 34.27  made available to prospective enrollees.  This certificate must 
 34.28  be approved by the commissioner. 
 34.29     (i) The county administrative entity shall present evidence 
 34.30  of an expedited process to approve exceptions to benefits, 
 34.31  provider network restrictions, and other plan limitations under 
 34.32  appropriate circumstances. 
 34.33     (j) The county administrative entity shall provide 
 34.34  enrollees or their legal representatives with written notice of 
 34.35  their appeal rights under subdivision 16, and of ombudsman and 
 34.36  advocacy programs under subdivisions 13 and 14, at the following 
 35.1   times:  upon enrollment, upon submission of a written complaint, 
 35.2   when a service is reduced, denied, or terminated, or when 
 35.3   renewal of authorization for ongoing service is refused. 
 35.4      (k) The county administrative entity shall determine 
 35.5   immediate needs, including services, support, and assessments, 
 35.6   within 30 calendar days after enrollment, or within a shorter 
 35.7   time frame if specified in the intergovernmental contract. 
 35.8      (l) The county administrative entity shall assess the need 
 35.9   for services of new enrollees within 60 calendar days after 
 35.10  enrollment, or within a shorter time frame if specified in the 
 35.11  intergovernmental contract, and periodically reassess the need 
 35.12  for services for all enrollees. 
 35.13     (m) The county administrative entity shall ensure the 
 35.14  development of a personal support plan for each person within 60 
 35.15  calendar days of enrollment, or within a shorter time frame if 
 35.16  specified in the intergovernmental contract, unless otherwise 
 35.17  agreed to by the enrollee and the enrollee's legal 
 35.18  representative, if any.  Until a personal support plan is 
 35.19  developed and agreed to by the enrollee, enrollees must have 
 35.20  access to the same amount, type, setting, duration, and 
 35.21  frequency of covered services that they had at the time of 
 35.22  enrollment unless other covered services are needed.  For an 
 35.23  enrollee who is not receiving covered services at the time of 
 35.24  enrollment and for enrollees whose personal support plan is 
 35.25  being revised, access to the medical assistance benefit set must 
 35.26  be assured until a personal support plan is developed or 
 35.27  revised.  If an enrollee chooses not to develop a personal 
 35.28  support plan, the enrollee will be subject to the network and 
 35.29  prior authorization requirements of the county administrative 
 35.30  entity or service delivery organization 60 days after 
 35.31  enrollment.  An enrollee can choose to have a personal support 
 35.32  plan developed at any time.  The personal support plan must be 
 35.33  based on choices, preferences, and assessed needs and strengths 
 35.34  of the enrollee.  The service coordinator shall develop the 
 35.35  personal support plan, in consultation with the enrollee or the 
 35.36  enrollee's legal representative and other individuals requested 
 36.1   by the enrollee.  The personal support plan must be updated as 
 36.2   needed or as requested by the enrollee.  Enrollees may choose 
 36.3   not to have a personal support plan. 
 36.4      (n) The county administrative entity shall ensure timely 
 36.5   authorization, arrangement, and continuity of needed and covered 
 36.6   supports and services. 
 36.7      (o) The county administrative entity shall offer service 
 36.8   coordination that fulfills the responsibilities under 
 36.9   subdivision 12 and is appropriate to the enrollee's needs, 
 36.10  choices, and preferences, including a choice of service 
 36.11  coordinator. 
 36.12     (p) The county administrative entity shall contract with 
 36.13  schools and other agencies as appropriate to provide otherwise 
 36.14  covered medically necessary medical assistance services as 
 36.15  described in an enrollee's individual family support plan, as 
 36.16  described in sections 125A.26 to 125A.48, or individual 
 36.17  education plan, as described in chapter 125A. 
 36.18     (q) The county administrative entity shall develop and 
 36.19  implement strategies, based on consultation with affected 
 36.20  groups, to respect diversity and ensure culturally competent 
 36.21  service delivery in a manner that promotes the physical, social, 
 36.22  psychological, and spiritual well-being of enrollees and 
 36.23  preserves the dignity of individuals, families, and their 
 36.24  communities. 
 36.25     (r) When an enrollee changes county authorities, county 
 36.26  administrative entities shall ensure coordination with the 
 36.27  entity that is assuming responsibility for administering the 
 36.28  medical assistance benefit set to ensure continuity of supports 
 36.29  and services for the enrollee. 
 36.30     (s) The county administrative entity shall comply with 
 36.31  additional requirements as specified in the intergovernmental 
 36.32  contract.  
 36.33     (t) To the extent that alternatives are approved under 
 36.34  subdivision 17, county administrative entities must provide for 
 36.35  the health and safety of enrollees and protect the rights to 
 36.36  privacy and to provide informed consent. 
 37.1      (u) Prepaid health plans serving counties with a nonprofit 
 37.2   community clinic or community health services agency must 
 37.3   contract with the clinic or agency to provide services to 
 37.4   clients who choose to receive services from the clinic or 
 37.5   agency, if the clinic or agency agrees to payment rates that are 
 37.6   competitive with rates paid to other health plan providers for 
 37.7   the same or similar services. 
 37.8      For purposes of this paragraph, "nonprofit community 
 37.9   clinic" includes, but is not limited to, a community mental 
 37.10  health center as defined in sections 245.62 and 256B.0625, 
 37.11  subdivision 5.