.................... moves to amend H.F. No. 1114 as follows:
Delete everything after the enacting clause and insert:
"Section 1. Minnesota Statutes 2008, section 245A.11, subdivision 2a, is amended to
Subd. 2a. Adult foster care license capacity. The commissioner shall issue adult
1.6foster care licenses with a maximum licensed capacity of four beds, including nonstaff
1.7roomers and boarders, but may issue a license with a capacity of five beds, including
1.8roomers and boarders, only according to paragraph (a) through (e).
(a) An adult foster care license holder may have a maximum license capacity of five
if all persons in care are age 55 or over and do not have a serious and persistent mental
illness or a developmental disability.
(b) The commissioner may grant variances to paragraph (a) to allow a foster care
provider with a licensed capacity of five persons to admit an individual under the age of 55
if the variance complies with section
245A.04, subdivision 9
, and approval of the variance
is recommended by the county in which the licensed foster care provider is located.
(c) The commissioner may grant variances to paragraph (a) to allow the use of a fifth
bed for emergency crisis services for a person with serious and persistent mental illness
or a developmental disability, regardless of age, if the variance complies with section
1.19245A.04, subdivision 9
, and approval of the variance is recommended by the county in
which the licensed foster care provider is located.
Notwithstanding paragraph (a),
the commissioner may issue an adult foster
care license with a capacity of five adults if the fifth bed does not increase the overall
1.23statewide capacity of licensed adult foster care beds in homes which are not the primary
1.24residence of the license holder, over the licensed capacity in such homes on July 1, 2009,
1.25as identified in a plan submitted to the commissioner by the county,
when the capacity is
recommended by the county licensing agency of the county in which the facility is located
and if the recommendation verifies that:
(1) the facility meets the physical environment requirements in the adult foster
care licensing rule;
(2) the five-bed living arrangement is specified for each resident in the resident's:
(i) individualized plan of care;
(ii) individual service plan under section
256B.092, subdivision 1b
, if required; or
(iii) individual resident placement agreement under Minnesota Rules, part
9555.5105, subpart 19, if required;
(3) the license holder obtains written and signed informed consent from each
resident or resident's legal representative documenting the resident's informed choice to
living in the home and that the resident's refusal to consent would not have resulted in
service termination; and
(4) the facility was licensed for adult foster care before March 1,
(e) The commissioner shall not issue a new adult foster care license under paragraph
(d) after June 30,
. The commissioner shall allow a facility with an adult foster
care license issued under paragraph (d) before June 30,
, to continue with a
capacity of five adults if the license holder continues to comply with the requirements in
Sec. 2. Minnesota Statutes 2008, section 256B.092, subdivision 5a, is amended to read:
Subd. 5a. Increasing adult foster care capacity to serve five persons.
an a licensed
adult foster care provider increases the capacity of an existing four-bed
licensed to serve four persons and obtains a license
to serve a fifth person under this
section, the county agency shall
reduce the contracted negotiate
per diem cost for room
and board and the
of the existing foster care
2.24 home by an average of 14 percent for all individuals living in that home. A county agency
2.25 may average the required per diem rate reductions across several adult foster care homes
2.26 that expand capacity under this section to achieve the necessary overall per diem reduction
2.27with the provider to manage a legislated rate reduction. The revised per diem costs must
2.28demonstrate an overall reduction in the payment to the provider for the persons receiving
2.29services affected by the occupancy change
(b) Following the contract changes in paragraph (a), the commissioner shall adjust:
2.31 (1) individual county allocations for developmental disability waivered services by
2.32 the amount of savings that results from the changes made for developmental disability
2.33 waiver recipients for whom the county is financially responsible; and
2.34 (2) group residential housing rate payments to the adult foster care home by the
2.35 amount of savings that results from the changes made.
3.1 (c) Effective July 1, 2003, when a new five-person adult foster care home is licensed
3.2 under this section, county agencies shall not establish group residential housing room
3.3 and board rates and developmental disability waiver service rates for the new home that
3.4 exceed 86 percent of the average per diem room and board and developmental disability
3.5 waiver services costs of four-person homes serving persons with comparable needs and in
3.6 the same geographic area. A county agency developing more than one new five-person
3.7 adult foster care home may average the required per diem rates across the homes to
3.8 achieve the necessary overall per diem reductions.
3.9 (d) The commissioner shall reduce the individual county allocations for
3.10 developmental disability waivered services by the savings resulting from the per diem
3.11 limits on adult foster care recipients for whom the county is financially responsible, and
3.12 shall limit the group residential housing rate for a new five-person adult foster care home.
Sec. 3. Minnesota Statutes 2008, section 256B.49, subdivision 17, is amended to read:
Subd. 17. Cost of services and supports.
(a) The commissioner shall ensure
that the average per capita expenditures estimated in any fiscal year for home and
community-based waiver recipients does not exceed the average per capita expenditures
that would have been made to provide institutional services for recipients in the absence
of the waiver.
(b) The commissioner shall implement on January 1, 2002, one or more aggregate,
need-based methods for allocating to local agencies the home and community-based
waivered service resources available to support recipients with disabilities in need of
the level of care provided in a nursing facility or a hospital. The commissioner shall
allocate resources to single counties and county partnerships in a manner that reflects
(1) an incentive-based payment process for achieving outcomes;
(2) the need for a state-level risk pool;
(3) the need for retention of management responsibility at the state agency level; and
(4) a phase-in strategy as appropriate.
(c) Until the allocation methods described in paragraph (b) are implemented, the
annual allowable reimbursement level of home and community-based waiver services
shall be the greater of:
(1) the statewide average payment amount which the recipient is assigned under the
waiver reimbursement system in place on June 30, 2001, modified by the percentage of
any provider rate increase appropriated for home and community-based services; or
(2) an amount approved by the commissioner based on the recipient's extraordinary
needs that cannot be met within the current allowable reimbursement level. The
increased reimbursement level must be necessary to allow the recipient to be discharged
from an institution or to prevent imminent placement in an institution. The additional
reimbursement may be used to secure environmental modifications; assistive technology
and equipment; and increased costs for supervision, training, and support services
necessary to address the recipient's extraordinary needs. The commissioner may approve
an increased reimbursement level for up to one year of the recipient's relocation from an
institution or up to six months of a determination that a current waiver recipient is at
imminent risk of being placed in an institution.
(d) Beginning July 1, 2001, medically necessary private duty nursing services will be
authorized under this section as complex and regular care according to sections
. The rate established by the commissioner for registered
nurse or licensed practical nurse services under any home and community-based waiver as
of January 1, 2001, shall not be reduced.
4.16(e) When a licensed adult foster care provider seeks to increase the capacity of an
4.17existing four-bed home to be licensed to serve a fifth person under section 245A.11,
4.18subdivision 2a, the county agency shall negotiate the per diem cost for room and board and
4.19the waiver services with the provider to manage a legislatively required rate reduction.
4.20The revised per diem costs must demonstrate an overall reduction in the payment to the
4.21provider for the persons receiving services affected by the occupancy change.
Sec. 4. RESIDENTIAL HOME AND COMMUNITY-BASED WAIVERED
4.24Minnesota Statutes, section 252.28, subdivision 3, paragraph (d), shall not be in
4.25effect from July 1, 2009, to June 30, 2011, to allow the commissioner to issue licenses
4.26for residential programs with a capacity of five adults under the conditions specified in
4.27section 245A.11, subdivision 2a.
Sec. 5. WAIVER.
4.29By December 1, 2009, the commissioner shall request all federal approvals and
4.30waiver amendments to the disability home and community-based waivers to allow properly
4.31licensed adult foster care homes to provide residential services for up to five individuals.
Sec. 6. EFFECTIVE DATE.
4.33Sections 1 to 5 are effective July 1, 2009.
Amend the title accordingly