1.1.................... moves to amend H.F. No. 666 as follows:
1.2Delete everything after the enacting clause and insert:

1.3    "Section 1. Minnesota Statutes 2008, section 144A.04, subdivision 11, is amended to
1.5    Subd. 11. Incontinent residents. Notwithstanding Minnesota Rules, part
1.64658.0520, an incontinent resident must be checked according to a specific time interval
1.7written in the resident's treated according to the comprehensive assessment and care plan.
1.8The resident's attending physician must authorize in writing any interval longer than
1.9two hours unless the resident, if competent, or a family member or legally appointed
1.10conservator, guardian, or health care agent of a resident who is not competent, agrees in
1.11writing to waive physician involvement in determining this interval, and this waiver
1.12is documented in the resident's care plan.

1.13    Sec. 2. Minnesota Statutes 2008, section 144A.04, is amended by adding a subdivision
1.14to read:
1.15    Subd. 12. Resident positioning. Notwithstanding Minnesota Rules, part 4658.0525,
1.16subpart 4, the position of residents unable to change their own position must be changed
1.17based on the comprehensive assessment and care plan.

1.18    Sec. 3. Minnesota Statutes 2008, section 256B.0915, subdivision 3h, is amended to
1.20    Subd. 3h. Service rate limits; 24-hour customized living services. (a) The
1.21payment rates for 24-hour customized living services is a monthly rate negotiated and
1.22authorized by the lead agency within the parameters established by the commissioner
1.23of human services. The payment agreement must delineate the services that have been
1.24customized for each recipient and specify the amount of each service to be provided. The
1.25lead agency shall ensure that there is a documented need for all services authorized.
2.1The lead agency shall not authorize 24-hour customized living services unless there is
2.2a documented need for 24-hour supervision. For purposes of this section, "24-hour
2.3supervision" means that the recipient requires assistance due to needs related to one or
2.4more of the following:
2.5    (1) intermittent assistance with toileting or transferring;
2.6    (2) cognitive or behavioral issues;
2.7    (3) a medical condition that requires clinical monitoring; or
2.8    (4) other conditions or needs as defined by the commissioner of human services.
2.9The lead agency shall ensure that the frequency and mode of supervision of the recipient
2.10and the qualifications of staff providing supervision are described and meet the needs
2.11of the recipient. Customized living services must not include rent or raw food costs.
2.12The negotiated payment rate for 24-hour customized living services must be based on
2.13services to be provided. Negotiated rates must not exceed payment rates for comparable
2.14elderly waiver or medical assistance services and must reflect economies of scale. The
2.15individually negotiated 24-hour customized living payments, in combination with the
2.16payment for other elderly waiver services, including case management, must not exceed
2.17the recipient's community budget cap specified in subdivision 3a.
2.18(b) Twenty-four-hour customized living services are delivered by a provider licensed
2.19by the commissioner of health as a class A or class F home care provider and provided in a
2.20building that is registered as a housing with services establishment under chapter 144D.
2.21Those home care providers with a capacity to serve 12 or fewer clients may provide
2.22nighttime supervision to clients using personnel who have other duties and are located in
2.23an adjoining building if:
2.24(1) the personnel providing supervision have been trained and determined to be
2.25competent in accordance with all applicable home care licensing requirements;
2.26(2) the provider has assessed the clients needing 24-hour supervision and determined
2.27that their needs can be safely met;
2.28(3) the provider has a communication system that permits staff providing supervision
2.29to be summoned by the clients; and
2.30(4) staff providing supervision to clients are able to respond within a time frame that
2.31meets the clients' needs and in no event exceeds ten minutes."
2.32Amend the title accordingly