1.1                          A bill for an act
  1.2             relating to human services; eliminating the Medicare 
  1.3             certification requirement for home care providers; 
  1.4             amending Minnesota Statutes 1996, sections 144A.46, 
  1.5             subdivision 2; 256B.055, subdivision 12; and 256B.071, 
  1.6             subdivisions 1, 3, and 4. 
  1.7   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.8      Section 1.  Minnesota Statutes 1996, section 144A.46, 
  1.9   subdivision 2, is amended to read: 
  1.10     Subd. 2.  [EXEMPTIONS.] The following individuals or 
  1.11  organizations are exempt from the requirement to obtain a home 
  1.12  care provider license: 
  1.13     (1) a person who is licensed as a registered nurse under 
  1.14  sections 148.171 to 148.285 and who independently provides 
  1.15  nursing services in the home without any contractual or 
  1.16  employment relationship to a home care provider or other 
  1.17  organization; 
  1.18     (2) a personal care assistant who provides services to only 
  1.19  one individual under the medical assistance program as 
  1.20  authorized under sections 256B.0625, subdivision 19, and 
  1.21  256B.04, subdivision 16; 
  1.22     (3) a person or organization that exclusively offers, 
  1.23  provides, or arranges for personal care assistant services to 
  1.24  only one individual under the medical assistance program as 
  1.25  authorized under sections 256B.0625, subdivision 19, and 
  1.26  256B.04, subdivision 16; 
  2.1      (4) a person who is registered under sections 148.65 to 
  2.2   148.78 and who independently provides physical therapy services 
  2.3   in the home without any contractual or employment relationship 
  2.4   to a home care provider or other organization; 
  2.5      (5) a provider that is licensed by the commissioner of 
  2.6   human services to provide semi-independent living services under 
  2.7   Minnesota Rules, parts 9525.0500 to 9525.0660 when providing 
  2.8   home care services to a person with a developmental disability; 
  2.9      (6) a provider that is licensed by the commissioner of 
  2.10  human services to provide home and community-based services 
  2.11  under Minnesota Rules, parts 9525.2000 to 9525.2140 when 
  2.12  providing home care services to a person with a developmental 
  2.13  disability; 
  2.14     (7) a person or organization that provides only home 
  2.15  management services, if the person or organization is registered 
  2.16  under section ~~144A.43, subdivision 3~~ 144A.461; or 
  2.17     (8) a person who is licensed as a social worker under 
  2.18  sections 148B.18 to 148B.28 and who provides social work 
  2.19  services in the home independently and not through any 
  2.20  contractual or employment relationship with a home care provider 
  2.21  or other organization. 
  2.22     An exemption under this subdivision does not excuse the 
  2.23  individual from complying with applicable provisions of the home 
  2.24  care bill of rights. 
  2.25     Sec. 2.  Minnesota Statutes 1996, section 256B.055, 
  2.26  subdivision 12, is amended to read: 
  2.27     Subd. 12.  [DISABLED CHILDREN.] (a) A person is eligible 
  2.28  for medical assistance if the person is under age 19 and 
  2.29  qualifies as a disabled individual under United States Code, 
  2.30  title 42, section 1382c(a), and would be eligible for medical 
  2.31  assistance under the state plan if residing in a medical 
  2.32  institution, and the child requires a level of care provided in 
  2.33  a hospital, nursing facility, or intermediate care facility for 
  2.34  persons with mental retardation or related conditions, for whom 
  2.35  home care is appropriate, provided that the cost to medical 
  2.36  assistance under this section is not more than the amount that 
  3.1   medical assistance would pay for if the child resides in an 
  3.2   institution.  After the child is determined to be eligible under 
  3.3   this section, the commissioner shall review the child's 
  3.4   disability under United States Code, title 42, section 1382c(a) 
  3.5   and level of care defined under this section no more often than 
  3.6   annually and may elect, based on the recommendation of health 
  3.7   care professionals under contract with the state medical review 
  3.8   team, to extend the review of disability and level of care up to 
  3.9   a maximum of four years.  The commissioner's decision on the 
  3.10  frequency of continuing review of disability and level of care 
  3.11  is not subject to administrative appeal under section 256.045.  
  3.12  Nothing in this subdivision shall be construed as affecting 
  3.13  other redeterminations of medical assistance eligibility under 
  3.14  this chapter and annual cost-effective reviews under this 
  3.15  section.  
  3.16     (b) For purposes of this subdivision, "hospital" means an 
  3.17  institution as defined in section 144.696, subdivision 3, 
  3.18  144.55, subdivision 3, or Minnesota Rules, part 4640.3600, and 
  3.19  licensed pursuant to sections 144.50 to 144.58.  For purposes of 
  3.20  this subdivision, a child requires a level of care provided in a 
  3.21  hospital if the child is determined by the commissioner to need 
  3.22  an extensive array of health services, including mental health 
  3.23  services, for an undetermined period of time, whose health 
  3.24  condition requires frequent monitoring and treatment by a health 
  3.25  care professional or by a person supervised by a health care 
  3.26  professional, who would reside in a hospital or require frequent 
  3.27  hospitalization if these services were not provided, and the 
  3.28  daily care needs are more complex than a nursing facility level 
  3.29  of care.  
  3.30     A child with serious emotional disturbance requires a level 
  3.31  of care provided in a hospital if the commissioner determines 
  3.32  that the individual requires 24-hour supervision because the 
  3.33  person exhibits recurrent or frequent suicidal or homicidal 
  3.34  ideation or behavior, recurrent or frequent psychosomatic 
  3.35  disorders or somatopsychic disorders that may become life 
  3.36  threatening, recurrent or frequent severe socially unacceptable 
  4.1   behavior associated with psychiatric disorder, ongoing and 
  4.2   chronic psychosis or severe, ongoing and chronic developmental 
  4.3   problems requiring continuous skilled observation, or severe 
  4.4   disabling symptoms for which office-centered outpatient 
  4.5   treatment is not adequate, and which overall severely impact the 
  4.6   individual's ability to function. 
  4.7      (c) For purposes of this subdivision, "nursing facility" 
  4.8   means a facility which provides nursing care as defined in 
  4.9   section 144A.01, subdivision 5, licensed pursuant to sections 
  4.10  144A.02 to 144A.10, which is appropriate if a person is in 
  4.11  active restorative treatment; is in need of special treatments 
  4.12  provided or supervised by a licensed nurse; or has unpredictable 
  4.13  episodes of active disease processes requiring immediate 
  4.14  judgment by a licensed nurse.  For purposes of this subdivision, 
  4.15  a child requires the level of care provided in a nursing 
  4.16  facility if the child is determined by the commissioner to meet 
  4.17  the requirements of the preadmission screening assessment 
  4.18  document under section 256B.0911 and the home care independent 
  4.19  rating document under section 256B.0627, subdivision 5, 
  4.20  paragraph (f), item (iii), adjusted to address age-appropriate 
  4.21  standards for children age 18 and under, pursuant to section 
  4.22  256B.0627, subdivision 5, paragraph (d), clause (2). 
  4.23     (d) For purposes of this subdivision, "intermediate care 
  4.24  facility for persons with mental retardation or related 
  4.25  conditions" or "ICF/MR" means a program licensed to provide 
  4.26  services to persons with mental retardation under section 
  4.27  252.28, and chapter 245A, and a physical plant licensed as a 
  4.28  supervised living facility under chapter 144, which together are 
  4.29  certified by the Minnesota department of health as meeting the 
  4.30  standards in Code of Federal Regulations, title 42, part 483, 
  4.31  for an intermediate care facility which provides services for 
  4.32  persons with mental retardation or persons with related 
  4.33  conditions who require 24-hour supervision and active treatment 
  4.34  for medical, behavioral, or habilitation needs.  For purposes of 
  4.35  this subdivision, a child requires a level of care provided in 
  4.36  an ICF/MR if the commissioner finds that the child has mental 
  5.1   retardation or a related condition in accordance with section 
  5.2   256B.092, is in need of a 24-hour plan of care and active 
  5.3   treatment similar to persons with mental retardation, and there 
  5.4   is a reasonable indication that the child will need ICF/MR 
  5.5   services. 
  5.6      (e) For purposes of this subdivision, a person requires the 
  5.7   level of care provided in a nursing facility if the person 
  5.8   requires 24-hour monitoring or supervision and a plan of mental 
  5.9   health treatment because of specific symptoms or functional 
  5.10  impairments associated with a serious mental illness or disorder 
  5.11  diagnosis, which meet severity criteria for mental health 
  5.12  established by the commissioner ~~based on standards developed for~~ 
  5.13  ~~the Wisconsin Katie Beckett program~~ and published in ~~July~~ 
  5.14  ~~1994~~ March 1997 as the Minnesota mental health level of care for 
  5.15  children and adolescents with severe emotional disorders. 
  5.16     (f) The determination of the level of care needed by the 
  5.17  child shall be made by the commissioner based on information 
  5.18  supplied to the commissioner by the parent or guardian, the 
  5.19  child's physician or physicians, and other professionals as 
  5.20  requested by the commissioner.  The commissioner shall establish 
  5.21  a screening team to conduct the level of care determinations 
  5.22  according to this subdivision. 
  5.23     (g) If a child meets the conditions in paragraph (b), (c), 
  5.24  (d), or (e), the commissioner must assess the case to determine 
  5.25  whether: 
  5.26     (1) the child qualifies as a disabled individual under 
  5.27  United States Code, title 42, section 1382c(a), and would be 
  5.28  eligible for medical assistance if residing in a medical 
  5.29  institution; and 
  5.30     (2) the cost of medical assistance services for the child, 
  5.31  if eligible under this subdivision, would not be more than the 
  5.32  cost to medical assistance if the child resides in a medical 
  5.33  institution to be determined as follows: 
  5.34     (i) for a child who requires a level of care provided in an 
  5.35  ICF/MR, the cost of care for the child in an institution shall 
  5.36  be determined using the average payment rate established for the 
  6.1   regional treatment centers that are certified as ICFs/MR; 
  6.2      (ii) for a child who requires a level of care provided in 
  6.3   an inpatient hospital setting according to paragraph (b), 
  6.4   cost-effectiveness shall be determined according to Minnesota 
  6.5   Rules, part 9505.3520, items F and G; and 
  6.6      (iii) for a child who requires a level of care provided in 
  6.7   a nursing facility according to paragraph (c) or (e), 
  6.8   cost-effectiveness shall be determined according to Minnesota 
  6.9   Rules, part 9505.3040, except that the nursing facility average 
  6.10  rate shall be adjusted to reflect rates which would be paid for 
  6.11  children under age 16.  The commissioner may authorize an amount 
  6.12  up to the amount medical assistance would pay for a child 
  6.13  referred to the commissioner by the preadmission screening team 
  6.14  under section 256B.0911. 
  6.15     (h) Children eligible for medical assistance services under 
  6.16  section 256B.055, subdivision 12, as of June 30, 1995, must be 
  6.17  screened according to the criteria in this subdivision prior to 
  6.18  January 1, 1996.  Children found to be ineligible may not be 
  6.19  removed from the program until January 1, 1996. 
  6.20     Sec. 3.  Minnesota Statutes 1996, section 256B.071, 
  6.21  subdivision 1, is amended to read: 
  6.22     Subdivision 1.  [DEFINITION.] (a) "Dual entitlees" means 
  6.23  recipients eligible for either the medical assistance program or 
  6.24  the alternative care program who are also eligible for the 
  6.25  federal Medicare program.  
  6.26     (b) For purposes of this section, "home care services" 
  6.27  means home health agency services, private duty nursing 
  6.28  services, personal care assistant services, waivered services, 
  6.29  alternative care program services, hospice services, 
  6.30  rehabilitation therapy services, and suppliers of medical 
  6.31  supplies and equipment. 
  6.32     Sec. 4.  Minnesota Statutes 1996, section 256B.071, 
  6.33  subdivision 3, is amended to read: 
  6.34     Subd. 3.  [REFERRALS TO MEDICARE ~~CERTIFIED~~ PROVIDERS 
  6.35  REQUIRED.] Non-Medicare certified home care providers and 
  6.36  ~~nonparticipating Medicare certified home care service~~ 
  7.1   ~~providers~~ medical suppliers that do not participate or accept 
  7.2   Medicare assignment must refer and document the referral of dual 
  7.3   eligible recipients to Medicare ~~certified~~ providers when 
  7.4   Medicare is determined to be the appropriate payer for services 
  7.5   and supplies and equipment ~~or services~~.  ~~Non-Medicare certified~~ 
  7.6   ~~and nonparticipating Medicare certified home care service~~ 
  7.7   Providers will be terminated from participation in the medical 
  7.8   assistance program for failure to make such referrals. 
  7.9      Sec. 5.  Minnesota Statutes 1996, section 256B.071, 
  7.10  subdivision 4, is amended to read: 
  7.11     Subd. 4.  [MEDICARE CERTIFICATION REQUIREMENT.] Medicare 
  7.12  certification is required of all medical assistance enrolled 
  7.13  home care service providers as ~~defined in subdivision 1 within~~ 
  7.14  ~~one year of the date the Minnesota department of health gives~~ 
  7.15  ~~notice to the department that initial Medicare surveys will~~ 
  7.16  ~~resume~~ required under Title XIX of the Social Security Act.  
  7.17     Sec. 6.  [PERSONAL CARE ASSISTANT PROVIDERS.] 
  7.18     The commissioner of health shall create a unique category 
  7.19  of licensure as appropriate for providers offering, providing, 
  7.20  or arranging personal care assistant services to more than one 
  7.21  individual.  The commissioner shall work with the department of 
  7.22  human services, providers, consumers, and advocates in 
  7.23  developing the licensure standards.  Prior to promulgating the 
  7.24  rule, the commissioner shall submit the proposed rule to the 
  7.25  legislature by January 15, 1999. 
  7.26     Sec. 7.  [WAIVER AMENDMENT.] 
  7.27     By July 15, 1997, the commissioner shall submit proposed 
  7.28  amendments to the health care financing administration for 
  7.29  changes in the home- and community-based waiver for persons with 
  7.30  mental retardation or a related condition, which maximize the 
  7.31  number of persons served within the limits of appropriations and 
  7.32  diverts persons from institutional placement.  The commissioner 
  7.33  shall monitor county utilization of allocated resources and 
  7.34  reassign those not utilized as appropriate.  Priority 
  7.35  consideration for the reassignment of resources shall be given 
  7.36  to counties who enter into written agreements with other 
  8.1   counties to jointly plan, request resources, and develop 
  8.2   services for persons with mental retardation or a related 
  8.3   condition who are screened and waiting for waivered services.  
  8.4   In addition to the priorities listed in Minnesota Rules, part 
  8.5   9525.1880, the commissioner shall also give priority 
  8.6   consideration to persons whose living situations are unstable 
  8.7   due to the age or incapacity of the primary caregiver.  The 
  8.8   commissioner shall report to the chairs of the senate health and 
  8.9   family security budget division and the house health and human 
  8.10  services finance division by March 1, 1998, on the results of 
  8.11  the waiver amendment, the authorization and utilization of 
  8.12  waivered services for persons with mental retardation or a 
  8.13  related condition, including crisis respite services, plans to 
  8.14  increase the number of counties working together, additional 
  8.15  persons served by the reassignment of resources, and options 
  8.16  which would allow an increased number of persons served within 
  8.17  the existing appropriation. 
  8.18     Sec. 8.  [EFFECTIVE DATE.] 
  8.19     Sections 1 to 5 are effective the day following final 
  8.20  enactment.