.................... moves to amend H.F. No. 1780 as follows:
Page 52, delete section 6 and insert:
"Sec. ... [144A.472] HOME CARE PROVIDER LICENSE; APPLICATION
1.5 Subdivision 1. License applications. Each application for a home care provider
1.6license must include information sufficient to show that the applicant meets the
1.7requirements of licensure, including:
1.8 (1) the applicant's name, e-mail address, physical address, and mailing address,
1.9including the name of the county in which the applicant resides and has a principal
1.10place of business;
1.11 (2) the initial license fee in the amount specified in subdivision 7;
1.12 (3) e-mail address, physical address, mailing address, and telephone number of the
1.13principal administrative office;
1.14 (4) e-mail address, physical address, mailing address, and telephone number of
1.15each branch office, if any;
1.16 (5) names, e-mail and mailing addresses, and telephone numbers of all owners
1.17and managerial officials;
1.18 (6) documentation of compliance with the background study requirements of section
1.19144A.476 for all persons involved in the management, operation, or control of the home
1.21 (7) documentation of a background study as required by section 144.057 for any
1.22individual seeking employment, paid or volunteer, with the home care provider;
1.23 (8) evidence of workers' compensation coverage as required by sections 176.181
1.25 (9) documentation of liability coverage, if the provider has it;
1.26 (10) identification of the license level the provider is seeking;
2.1 (11) documentation that identifies the managerial official who is in charge of
2.2day-to-day operations and attestation that the person has reviewed and understands the
2.3home care provider regulations;
2.4 (12) documentation that the applicant has designated one or more owners,
2.5managerial officials, or employees as an agent or agents, which shall not affect the legal
2.6responsibility of any other owner or managerial official under this chapter;
2.7 (13) the signature of the officer or managing agent on behalf of an entity, corporation,
2.8association, or unit of government;
2.9 (14) verification that the applicant has the following policies and procedures in place
2.10so that if a license is issued, the applicant will implement the policies and procedures
2.11and keep them current:
2.12 (i) requirements in sections 626.556, reporting of maltreatment of minors, and
2.13626.557, reporting of maltreatment of vulnerable adults;
2.14 (ii) conducting and handling background studies on employees;
2.15 (iii) orientation, training, and competency evaluations of home care staff, and a
2.16process for evaluating staff performance;
2.17 (iv) handling complaints from clients, family members, or client representatives
2.18regarding staff or services provided by staff;
2.19 (v) conducting initial evaluation of clients' needs and the providers' ability to provide
2.21 (vi) conducting initial and ongoing client evaluations and assessments and how
2.22changes in a client's condition are identified, managed, and communicated to staff and
2.23other health care providers as appropriate;
2.24 (vii) orientation to and implementation of the home care client bill of rights;
2.25 (viii) infection control practices;
2.26 (ix) reminders for medications, treatments, or exercises, if provided; and
2.27 (x) conducting appropriate screenings, or documentation of prior screenings, to
2.28show that staff are free of tuberculosis, consistent with current United States Centers for
2.29Disease Control standards; and
2.30 (15) other information required by the department.
2.31 Subd. 2. Comprehensive home care license applications. In addition to the
2.32information and fee required in subdivision 1, applicants applying for a comprehensive
2.33home care license must also provide verification that the applicant has the following
2.34policies and procedures in place so that if a license is issued, the applicant will implement
2.35the policies and procedures in this subdivision and keep them current:
3.1 (1) conducting initial and ongoing assessments of the client's needs by a registered
3.2nurse or appropriate licensed health professional, including how changes in the client's
3.3conditions are identified, managed, and communicated to staff and other health care
3.4providers, as appropriate;
3.5 (2) ensuring that nurses and licensed health professionals have current and valid
3.6licenses to practice;
3.7 (3) medication and treatment management;
3.8 (4) delegation of home care tasks by registered nurses or licensed health professionals;
3.9 (5) supervision of registered nurses and licensed health professionals; and
3.10 (6) supervision of unlicensed personnel performing delegated home care tasks.
3.11 Subd. 3. License renewal. (a) Except as provided in section 144A.475, a license
3.12may be renewed for a period of one year if the licensee satisfies the following:
3.13 (1) submits an application for renewal in the format provided by the commissioner
3.14at least 30 days before expiration of the license;
3.15 (2) submits the renewal fee in the amount specified in subdivision 7;
3.16 (3) has provided home care services within the past 12 months;
3.17 (4) complies with sections 144A.43 to 144A.4799;
3.18 (5) provides information sufficient to show that the applicant meets the requirements
3.19of licensure, including items required under subdivision 1;
3.20 (6) provides verification that all policies under subdivision 1, are current; and
3.21 (7) provides any other information deemed necessary by the commissioner.
3.22 (b) A renewal applicant who holds a comprehensive home care license must also
3.23provide verification that policies listed under subdivision 2 are current.
3.24 Subd. 4. Multiple units. Multiple units or branches of a licensee must be separately
3.25licensed if the commissioner determines that the units cannot adequately share supervision
3.26and administration of services from the main office.
3.27 Subd. 5. Transfers prohibited; changes in ownership. Any home care license
3.28issued by the commissioner may not be transferred to another party. Before acquiring
3.29ownership of a home care provider business, a prospective applicant must apply for a
3.30new temporary license. A change of ownership is a transfer of operational control to
3.31a different business entity, and includes:
3.32 (1) transfer of the business to a different or new corporation;
3.33 (2) in the case of a partnership, the dissolution or termination of the partnership under
3.34chapter 323A, with the business continuing by a successor partnership or other entity;
3.35 (3) relinquishment of control of the provider to another party, including to a contract
3.36management firm that is not under the control of the owner of the business' assets;
4.1 (4) transfer of the business by a sole proprietor to another party or entity; or
4.2 (5) in the case of a privately held corporation, the change in ownership or control of
4.350 percent or more of the outstanding voting stock.
4.4 Subd. 6. Notification of changes of information. The temporary licensee or
4.5licensee shall notify the commissioner in writing within ten working days after any
4.6change in the information required in subdivision 1, except the information required in
4.7subdivision 1, clause (5), is required at the time of license renewal.
4.8 Subd. 7. Fees; application, change of ownership, and renewal. (a) An initial
4.9applicant seeking a temporary home care licensure must submit the following application
4.10fee to the commissioner along with a completed application:
4.11 (1) basic home care provider, $2,100; or
4.12 (2) comprehensive home care provider, $4,200.
4.13 (b) A home care provider who is filing a change of ownership as required under
4.14subdivision 5 must submit the following application fee to the commissioner, along with
4.15the documentation required for the change of ownership:
4.16 (1) basic home care provider, $2,100; or
4.17 (2) comprehensive home care provider, $4,200.
4.18 (c) A home care provider who is seeking to renew the provider's license shall pay a
4.19fee to the commissioner based on revenues derived from the provision of home care
4.20services during the calendar year prior to the year in which the application is submitted,
4.21according to the following schedule:
4.22 License Renewal Fee
5.10 (d) If requested, the home care provider shall provide the commissioner information
5.11to verify the provider's annual revenues or other information as needed, including copies
5.12of documents submitted to the Department of Revenue.
5.13 (e) At each annual renewal, a home care provider may elect to pay the highest
5.14renewal fee for its license category, and not provide annual revenue information to the
5.16 (f) A temporary license or license applicant, or temporary licensee or licensee that
5.17knowingly provides the commissioner incorrect revenue amounts for the purpose of
5.18paying a lower license fee, shall be subject to a civil penalty in the amount of double the
5.19fee the provider should have paid.
5.20 (g) Fees and penalties collected under this section shall be deposited in the state
5.21treasury and credited to the special state government revenue fund.
5.22 (h) The license renewal fee schedule in this subdivision is effective July 1, 2016.
|Provider Annual Revenue
|greater than $1,500,000
|greater than $1,275,000 and no more than
|greater than $1,100,000 and no more than
|greater than $950,000 and no more than
|greater than $850,000 and no more than
|greater than $750,000 and no more than
|greater than $650,000 and no more than
|greater than $550,000 and no more than
|greater than $450,000 and no more than
|greater than $350,000 and no more than
|greater than $250,000 and no more than
|greater than $100,000 and no more than
|greater than $50,000 and no more than $100,000
|greater than $25,000 and no more than $50,000
|no more than $25,000
Page 58, delete section 8 and insert:
"Sec. ... [144A.474] SURVEYS AND INVESTIGATIONS.
5.25 Subdivision 1. Surveys. The commissioner shall conduct surveys of each home
5.26care provider. By June 30, 2016, the commissioner shall conduct a survey of home care
5.27providers on a frequency of at least once every three years. Survey frequency may be
5.28based on the license level, the provider's compliance history, number of clients served,
5.29or other factors as determined by the department deemed necessary to ensure the health,
5.30safety, and welfare of clients and compliance with the law.
5.31 Subd. 2. Types of home care surveys. (a) "Initial full survey" is the survey
5.32conducted of a new temporary licensee after the department is notified or has evidence that
5.33the licensee is providing home care services to determine if the provider is in compliance
5.34with home care requirements. Initial surveys must be completed within 14 months after
5.35the department's issuance of a temporary basic or comprehensive license.
5.36 (b) "Core survey" means periodic inspection of home care providers to determine
5.37ongoing compliance with the home care requirements, focusing on the essential health and
6.1safety requirements. Core surveys are available to licensed home care providers who have
6.2been licensed for three years and surveyed at least once in the past three years with the
6.3latest survey having no widespread violations beyond Level 1 as provided in subdivision
6.411. Providers must also not have had any substantiated licensing complaints, substantiated
6.5complaints against the agency under the Vulnerable Adults Act or Maltreatment of Minors
6.6Act, or an enforcement action as authorized in section 144A.475 in the past three years.
6.7 (1) The core survey for basic license-level providers reviews compliance in the
6.9 (i) reporting of maltreatment;
6.10 (ii) orientation to and implementation of Home Care Client Bill of Rights;
6.11 (iii) statement of home care services;
6.12 (iv) initial evaluation of clients and initiation of services;
6.13 (v) basic-license level client review and monitoring;
6.14 (vi) service plan implementation and changes to the service plan;
6.15 (vii) client complaint and investigative process;
6.16 (viii) competency of unlicensed personnel; and
6.17 (ix) infection control.
6.18 (2) For comprehensive license-level providers, the core survey will include
6.19everything in the basic license-level core survey plus these areas:
6.20 (i) delegation to unlicensed personnel;
6.21 (ii) assessment, monitoring, and reassessment of clients; and
6.22 (iii) medication, treatment, and therapy management.
6.23 (c) "Full survey" means the periodic inspection of home care providers to determine
6.24ongoing compliance with the home care requirements that cover the core survey areas
6.25and all the legal requirements for home care providers. A full survey is conducted for all
6.26temporary licensees and for providers who do not meet the requirements needed for a core
6.27survey, and when a surveyor identifies unacceptable client health or safety risks during a
6.28core survey. A full survey will include all the tasks identified as part of the core survey
6.29and any additional review deemed necessary by the department, including additional
6.30observation, interviewing, or records review of additional clients and staff.
6.31 (d) "Follow-up surveys" are conducted to determine if a home care provider has
6.32corrected deficient issues and systems identified during a core survey, full survey, or
6.33complaint investigation. Follow-up surveys may be conducted via phone, e-mail, fax,
6.34mail, or on-site reviews. Follow-up surveys, other than complaint surveys, shall be
6.35concluded with an exit conference and written information provided on the process for
6.36requesting a reconsideration of the survey results.
7.1 (e) Upon receiving information that a home care provider has violated or is currently
7.2violating a requirement of sections 144A.43 to 144A.482, the commissioner shall
7.3investigate the complaint according to sections 144A.51 to 144A.54.
7.4 Subd. 3. Survey process. (a) The survey process for core surveys shall include the
7.5following as applicable to the particular licensee and setting surveyed:
7.6 (1) presurvey review of pertinent documents and notification to the ombudsman
7.7for long-term care;
7.8 (2) an entrance conference with available staff;
7.9 (3) communication with managerial officials or the registered nurse in charge, if
7.10available, and ongoing communication with key staff throughout the survey regarding
7.11information needed by the surveyor, clarifications regarding home care requirements, and
7.12applicable standards of practice;
7.13 (4) presentation of written contact information to the provider about the survey staff
7.14conducting the survey, the supervisor, and the process for requesting a reconsideration of
7.15the survey results;
7.16 (5) a brief tour of a sample of the housing with services establishments in which the
7.17provider is providing home care services;
7.18 (6) a sample selection of home care clients;
7.19 (7) information-gathering through client and staff observations, client and staff
7.20interviews, and reviews of records, policies, procedures, practices, and other agency
7.22 (8) interviews of clients' family members, if available, with clients' consent when the
7.23client can legally give consent;
7.24 (9) except for complaint surveys conducted by the Office of Health Facilities
7.25Complaints, exit conference, with preliminary findings shared and discussed with the
7.26provider and written information provided on the process for requesting a reconsideration
7.27of the survey results; and
7.28 (10) postsurvey analysis of findings and formulation of survey results, including
7.29correction orders when applicable.
7.30 Subd. 4. Scheduling surveys. Surveys and investigations shall be conducted
7.31without advance notice to home care providers. Surveyors may contact the home care
7.32provider on the day of a survey to arrange for someone to be available at the survey site.
7.33The contact does not constitute advance notice.
7.34 Subd. 5. Information provided by home care provider. The home care provider
7.35shall provide accurate and truthful information to the department during a survey,
7.36investigation, or other licensing activities.
8.1 Subd. 6. Providing client records. Upon request of a surveyor, home care providers
8.2shall provide a list of current and past clients or client representatives that includes
8.3addresses and telephone numbers and any other information requested about the services
8.4to clients within a reasonable period of time.
8.5 Subd. 7. Contacting and visiting clients. Surveyors may contact or visit a home
8.6care provider's clients to gather information without notice to the home care provider.
8.7Before visiting a client, a surveyor shall obtain the client's or client's representative's
8.8permission by telephone, mail, or in person. Surveyors shall inform all clients or client's
8.9representatives of their right to decline permission for a visit.
8.10 Subd. 8. Correction orders. (a) A correction order may be issued whenever the
8.11commissioner finds upon survey or during a complaint investigation that a home care
8.12provider, a managerial official, or an employee of the provider is not in compliance with
8.13sections 144A.43 to 144A.482. The correction order shall cite the specific statute and
8.14document areas of noncompliance and the time allowed for correction.
8.15 (b) The commissioner shall mail copies of any correction order within 30 calendar
8.16days after exit survey to the last known address of the home care provider. A copy of each
8.17correction order and copies of any documentation supplied to the commissioner shall be
8.18kept on file by the home care provider, and public documents shall be made available for
8.19viewing by any person upon request. Copies may be kept electronically.
8.20 (c) By the correction order date, the home care provider must document in the
8.21provider's records any action taken to comply with the correction order. The commissioner
8.22may request a copy of this documentation and the home care provider's action to respond
8.23to the correction order in future surveys, upon a complaint investigation, and as otherwise
8.25 Subd. 9. Follow-up surveys. For providers that have Level 3 or Level 4 violations
8.26or any violations determined to be widespread, the department shall conduct a follow-up
8.27survey within 90 calendar days of the survey. When conducting a follow-up survey, the
8.28surveyor will focus on whether the previous violations have been corrected and may also
8.29address any new violations that are observed while evaluating the corrections that have
8.30been made. If a new violation is identified on a follow-up survey, no fine will be imposed
8.31unless it is not corrected on the next follow-up survey.
8.32 Subd. 10. Performance incentive. A licensee is eligible for a performance
8.33incentive if there are no violations identified in a core or full survey. The performance
8.34incentive is a ten percent discount on the licensee's next home care renewal license fee.
8.35 Subd. 11. Fines. (a) Fines and enforcement actions under this subdivision may be
8.36assessed based on the level and scope of the violations described in paragraph (c) as follows:
9.1 (1) Level 1, no fines or enforcement;
9.2 (2) Level 2, fines ranging from $0 to $500, in addition to any of the enforcement
9.3mechanisms authorized in section 144A.475 for widespread violations;
9.4 (3) Level 3, fines ranging from $500 to $1,000, in addition to any of the enforcement
9.5mechanisms authorized in section 144A.475; and
9.6 (4) Level 4, fines ranging from $1,000 to $5,000, in addition to any of the
9.7enforcement mechanisms authorized in section 144A.475.
9.8 (b) Correction orders for violations are categorized by both level and scope as
9.9follows and fines will be assessed accordingly:
9.10 (1) Level of violation:
9.11 (i) Level 1. A violation that has no potential to cause more than a minimal impact on
9.12the client and does not affect health or safety.
9.13 (ii) Level 2. A violation that did not harm the client's health or safety, but had the
9.14potential to have harmed a client's health or safety, but was not likely to cause serious
9.15injury, impairment, or death.
9.16 (iii) Level 3. A violation that harmed a client's health or safety, not including serious
9.17injury, impairment, or death, or a violation that has the potential to lead to serious injury,
9.18impairment, or death.
9.19 (iv) Level 4. A violation that results in serious injury, impairment, or death.
9.20 (2) Scope of violation:
9.21 (i) Isolated. When one or a limited number of clients are affected, or one or a limited
9.22number of staff are involved, or the situation has occurred only occasionally.
9.23 (ii) Pattern. When more than a limited number of clients are affected, more than
9.24a limited number of staff are involved, or the situation has occurred repeatedly but is
9.25not found to be pervasive.
9.26 (iii) Widespread. When problems are pervasive or represent a systemic failure that
9.27has affected or has the potential to affect a large portion or all of the clients.
9.28 (c) If the commissioner finds that the applicant or a home care provider required
9.29to be licensed under sections 144A.43 to 144A.482 has not corrected violations by the
9.30date specified in the correction order or conditional license resulting from a survey or
9.31complaint investigation, the commissioner may impose a fine. A notice of noncompliance
9.32with a correction order must be mailed to the applicant's or provider's last known address.
9.33The noncompliance notice must list the violations not corrected.
9.34 (d) The license holder must pay the fines assessed on or before the payment date
9.35specified. If the license holder fails to fully comply with the order, the commissioner
9.36may issue a second fine or suspend the license until the license holder complies by
10.1paying the fine. A timely appeal shall stay payment of the fine until the commissioner
10.2issues a final order.
10.3 (e) A license holder shall promptly notify the commissioner in writing when a
10.4violation specified in the order is corrected. If upon reinspection the commissioner
10.5determines that a violation has not been corrected as indicated by the order, the
10.6commissioner may issue a second fine. The commissioner shall notify the license holder by
10.7mail to the last known address in the licensing record that a second fine has been assessed.
10.8The license holder may appeal the second fine as provided under this subdivision.
10.9 (f) A home care provider that has been assessed a fine under this subdivision has a
10.10right to a reconsideration or a hearing under this section and chapter 14.
10.11 (g) When a fine has been assessed, the license holder may not avoid payment by
10.12closing, selling, or otherwise transferring the licensed program to a third party. In such an
10.13event, the license holder shall be liable for payment of the fine.
10.14 (h) In addition to any fine imposed under this section, the commissioner may assess
10.15costs related to an investigation that results in a final order assessing a fine or other
10.16enforcement action authorized by this chapter.
10.17 (i) Fines collected under this subdivision shall be deposited in the state government
10.18special revenue fund and credited to an account separate from the revenue collected under
10.19section 144A.472. Subject to an appropriation by the legislature, the revenue from the
10.20fines collected may be used by the commissioner for special projects to improve home care
10.21in Minnesota as recommended by the advisory council established in section 144A.4799.
10.22 Subd. 12. Reconsideration. The commissioner shall make available to home
10.23care providers a correction order reconsideration process. This process may be used
10.24to challenge the correction order issued, including the level and scope described in
10.25subdivision 9, and any fine assessed. During the correction order reconsideration request,
10.26the issuance for the correction orders under reconsideration are not stayed, but the
10.27department will post in formation on the Web site with the correction order that the
10.28licensee has requested a reconsideration required and that the review is pending.
10.29 (a) A licensed home care provider may request from the commissioner, in writing,
10.30a correction order reconsideration regarding any correction order issued to the provider.
10.31The correction order reconsideration shall not be reviewed by any surveyor, investigator,
10.32or supervisor that participated in the writing or reviewing of the correction order being
10.33disputed. The correction order reconsiderations may be conducted in person by telephone,
10.34by another electronic form, or in writing, as determined by the commissioner. The
10.35commissioner shall respond in writing to the request from a home care provider for
10.36a correction order reconsideration within 60 days of the date the provider requests a
11.1reconsideration. The commissioner's response shall identify the commissioner's decision
11.2regarding each citation challenged by the home care provider.
11.3 The findings of a correction order reconsideration process shall be one or more of
11.5 (1) Supported in full. The correction order is supported in full, with no deletion of
11.6findings to the citation.
11.7 (2) Supported in substance. The correction order is supported, but one or more
11.8findings are deleted or modified without any change in the citation.
11.9 (3) Correction order cited an incorrect home care licensing requirement. The
11.10correction order is amended by changing the correction order to the appropriate statutory
11.12 (4) Correction order was issued under an incorrect citation. The correction order is
11.13amended to be issued under the more appropriate correction order citation.
11.14 (5) The correction order is rescinded.
11.15 (6) Fine is amended. It is determined the fine assigned to the correction order was
11.17 (7) The level or scope of the citation is modified based on the reconsideration.
11.18 (b) If the correction order findings are changed by the commissioner, the
11.19commissioner shall update the correction order Web site accordingly.
11.20 Subd. 13. Home care surveyor training. Before conducting a home care survey,
11.21each home care surveyor must receive training on the following topics:
11.22 (1) Minnesota home care licensure requirements;
11.23 (2) Minnesota Home Care Client Bill of Rights;
11.24 (3) Minnesota Vulnerable Adults Act and reporting of maltreatment of minors;
11.25 (4) principles of documentation;
11.26 (5) survey protocol and processes;
11.27 (6) Offices of the Ombudsman roles;
11.28 (7) Office of Health Facility Complaints;
11.29 (8) Minnesota landlord-tenant and housing with services laws;
11.30 (9) types of payors for home care services; and
11.31 (10) Minnesota Nurse Practice Act for nurse surveyors.
11.32 Materials used for this training will be posted on the department Web site. Requisite
11.33understanding of these topics will be reviewed as part of the quality improvement plan
11.34in section 28.
Page 76, delete section 15 and insert:
"Sec. ... [144A.4792] MEDICATION MANAGEMENT.
12.1 Subdivision 1. Medication management services; comprehensive home care
12.2license. (a) This subdivision applies only to home care providers with a comprehensive
12.3home care license that provides medication management services to clients. Medication
12.4management services may not be provided by a home care provider that has a basic
12.5home care license.
12.6 (b) A comprehensive home care provider who provides medication management
12.7services must develop, implement, and maintain current written medication management
12.8policies and procedures. The policies and procedures must be developed under the
12.9supervision and direction of a registered nurse, licensed health professional, or pharmacist
12.10consistent with current practice standards and guidelines.
12.11 (c) The written policies and procedures must address requesting and receiving
12.12prescriptions for medications; preparing and giving medications; verifying that
12.13prescription drugs are administered as prescribed; documenting medication management
12.14activities; controlling and storing medications; monitoring and evaluating medication use;
12.15resolving medication errors; communicating with the prescriber, pharmacist, and client
12.16and client representative, if any; disposing of unused medications; and educating clients
12.17and client representatives about medications. When controlled substances are being
12.18managed, the policies and procedures must also identify how the provider will ensure
12.19security and accountability for the overall management, control, and disposition of those
12.20substances in compliance with state and federal regulations and with subdivision 22.
12.21 Subd. 2. Provision of medication management services. (a) For each client who
12.22requests medication management services, the comprehensive home care provider shall,
12.23prior to providing medication management services, have a registered nurse, licensed
12.24health professional, or authorized prescriber under section 151.37 conduct an assessment
12.25to determine what mediation management services will be provided and how the services
12.26will be provided. This assessment must be conducted face-to-face with the client. The
12.27assessment must include an identification and review of all medications the client is known
12.28to be taking. The review and identification must include indications for medications, side
12.29effects, contraindications, allergic or adverse reactions, and actions to address these issues.
12.30 (b) The assessment must identify interventions needed in management of
12.31medications to prevent diversion of medication by the client or others who may have
12.32access to the medications. Diversion of medications means the misuse, theft, or illegal
12.33or improper disposition of medications.
12.34 Subd. 3. Individualized medication monitoring and reassessment. The
12.35comprehensive home care provider must monitor and reassess the client's medication
13.1management services as needed under subdivision 14 when the client presents with
13.2symptoms or other issues that may be medication-related and, at a minimum, annually.
13.3 Subd. 4. Client refusal. The home care provider must document in the client's
13.4record any refusal for an assessment for medication management by the client. The
13.5provider must discuss with the client the possible consequences of the client's refusal and
13.6document the discussion in the client's record.
13.7 Subd. 5. Individualized medication management plan. (a) For each client
13.8receiving medication management services, the comprehensive home care provider must
13.9prepare and include in the service plan a written statement of the medication management
13.10services that will be provided to the client. The provider must develop and maintain a
13.11current individualized medication management record for each client based on the client's
13.12assessment that must contain the following:
13.13 (1) a statement describing the medication management services that will be provided;
13.14 (2) a description of storage of medications based on the client's needs and
13.15preferences, risk of diversion, and consistent with the manufacturer's directions;
13.16 (3) documentation of specific client instructions relating to the administration
13.18 (4) identification of persons responsible for monitoring medication supplies and
13.19ensuring that medication refills are ordered on a timely basis;
13.20 (5) identification of medication management tasks that may be delegated to
13.22 (6) procedures for staff notifying a registered nurse or appropriate licensed health
13.23professional when a problem arises with medication management services; and
13.24 (7) any client-specific requirements relating to documenting medication
13.25administration, verifications that all medications are administered as prescribed, and
13.26monitoring of medication use to prevent possible complications or adverse reactions.
13.27 (b) The medication management record must be current and updated when there are
13.29 Subd. 6. Administration of medication. Medications may be administered by a
13.30nurse, physician, or other licensed health practitioner authorized to administer medications
13.31or by unlicensed personnel who have been delegated medication administration tasks by
13.32a registered nurse.
13.33 Subd. 7. Delegation of medication administration. When administration of
13.34medications is delegated to unlicensed personnel, the comprehensive home care provider
13.35must ensure that the registered nurse has:
14.1 (1) instructed the unlicensed personnel in the proper methods to administer the
14.2medications, and the unlicensed personnel has demonstrated ability to competently follow
14.4 (2) specified, in writing, specific instructions for each client and documented those
14.5instructions in the client's records; and
14.6 (3) communicated with the unlicensed personnel about the individual needs of
14.8 Subd. 8. Documentation of administration of medications. Each medication
14.9administered by comprehensive home care provider staff must be documented in the
14.10client's record. The documentation must include the signature and title of the person
14.11who administered the medication. The documentation must include the medication
14.12name, dosage, date and time administered, and method and route of administration. The
14.13staff must document the reason why medication administration was not completed as
14.14prescribed and document any follow-up procedures that were provided to meet the client's
14.15needs when medication was not administered as prescribed and in compliance with the
14.16client's medication management plan.
14.17 Subd. 9. Documentation of medication set up. Documentation of dates of
14.18medication set up, name of medication, quantity of dose, times to be administered, route
14.19of administration, and name of person completing medication set up must be done at
14.20time of set up.
14.21 Subd. 10. Medications management for clients who will be away from home. (a)
14.22A home care provider that is providing medication management services to the client and
14.23controls the client's access to the medications must develop and implement policies and
14.24procedures for giving accurate and current medications to clients for planned or unplanned
14.25times away from home according to the client's individualized medication management
14.26plan. The policy and procedures must state that:
14.27 (1) for planned time away, the medications must be obtained from the pharmacy or
14.28set up by the registered nurse according to appropriate state and federal laws and nursing
14.29standards of practice;
14.30 (2) for unplanned time away, when the pharmacy is not able to provide the
14.31medications, a licensed nurse or unlicensed personnel shall give the client or client's
14.32representative medications in amounts and dosages needed for the length of the anticipated
14.33absence, not to exceed 120 hours;
14.34 (3) the client, or the client's representative, must be provided written information
14.35on medications, including any special instructions for administering or handling the
14.36medications, including controlled substances;
15.1 (4) the medications must be placed in a medication container or containers
15.2appropriate to the provider's medication system and must be labeled with the client's name
15.3and the dates and times that the medications are scheduled; and
15.4 (5) the client or client's representative must be provided in writing the home care
15.5provider's name and information on how to contact the home care provider.
15.6 (b) For unplanned time away when the licensed nurse is not available, the registered
15.7nurse may delegate this task to unlicensed personnel if:
15.8 (1) the registered nurse has trained the unlicensed staff and determined the
15.9unlicensed staff is competent to follow the procedures for giving medications to clients;
15.10 (2) the registered nurse has developed written procedures for the unlicensed
15.11personnel, including any special instructions or procedures regarding controlled substances
15.12that are prescribed for the client. The procedures must address:
15.13 (i) the type of container or containers to be used for the medications appropriate to
15.14the provider's medication system;
15.15 (ii) how the container or containers must be labeled;
15.16 (iii) the written information about the medications to be given to the client or client's
15.18 (iv) how the unlicensed staff will document in the client's record that medications
15.19have been given to the client or the client's representative, including documenting the date
15.20the medications were given to the client or the client's representative and who received the
15.21medications, the person who gave the medications to the client, the number of medications
15.22that were given to the client, and other required information;
15.23 (v) how the registered nurse will be notified that medications have been given to
15.24the client or client's representative and whether the registered nurse needs to be contacted
15.25before the medications are given to the client or the client's representative; and
15.26 (vi) a review by the registered nurse of the completion of this task to verify that this
15.27task was completed accurately by the unlicensed personnel.
15.28 Subd. 11. Prescribed and nonprescribed medication. The comprehensive home
15.29care provider must determine whether it will require a prescription for all medications it
15.30manages. The comprehensive home care provider must inform the client or the client's
15.31representative whether the comprehensive home care provider requires a prescription
15.32for all over-the-counter and dietary supplements before the comprehensive home care
15.33provider will agree to manage those medications.
15.34 Subd. 12. Medications; over-the-counter; dietary supplements not prescribed.
15.35 A comprehensive home care provider providing medication management services for
15.36over-the-counter drugs or dietary supplements must retain those items in the original labeled
16.1container with directions for use prior to setting up for immediate or later administration.
16.2The provider must verify that the medications are up-to-date and stored as appropriate.
16.3 Subd. 13. Prescriptions. There must be a current written or electronically recorded
16.4prescription as defined in Minnesota Rules, part 6800.0100, subpart 11a, for all prescribed
16.5medications that the comprehensive home care provider is managing for the client.
16.6 Subd. 14. Renewal of prescriptions. Prescriptions must be renewed at least
16.7every 12 months or more frequently as indicated by the assessment in subdivision 2.
16.8Prescriptions for controlled substances must comply with chapter 152.
16.9 Subd. 15. Verbal prescription orders. Verbal prescription orders from an
16.10authorized prescriber must be received by a nurse or pharmacist. The order must be
16.11handled according to Minnesota Rules, part 6800.6200.
16.12 Subd. 16. Written or electronic prescription. When a written or electronic
16.13prescription is received, it must be communicated to the registered nurse in charge and
16.14recorded or placed in the client's record.
16.15 Subd. 17. Records confidential. A prescription or order received verbally, in
16.16writing, or electronically must be kept confidential according to sections 144.291 to
16.17144.298 and 144A.44.
16.18 Subd. 18. Medications provided by client or family members. When the
16.19comprehensive home care provider is aware of any medications or dietary supplements
16.20that are being used by the client and are not included in the assessment for medication
16.21management services, the staff must advise the registered nurse and document that in
16.22the client's record.
16.23 Subd. 19. Storage of drugs. A comprehensive home care provider providing
16.24storage of medications outside of the client's private living space must store all prescription
16.25drugs in securely locked and substantially constructed compartments according to the
16.26manufacturer's directions and permit only authorized personnel to have access.
16.27 Subd. 20. Prescription drugs. A prescription drug, prior to being set up for
16.28immediate or later administration, must be kept in the original container in which it was
16.29dispensed by the pharmacy bearing the original prescription label with legible information
16.30including the expiration or beyond-use date of a time-dated drug.
16.31 Subd. 21. Prohibitions. No prescription drug supply for one client may be used or
16.32saved for use by anyone other than the client.
16.33 Subd. 22. Disposition of drugs. (a) Any current medications being managed by the
16.34comprehensive home care provider must be given to the client or the client's representative
16.35when the client's service plan ends or medication management services are no longer part
16.36of the service plan. Medications that have been stored in the client's private living space
17.1for a client that is deceased or that have been discontinued or that have expired may be
17.2given to the client or the client's representative for disposal.
17.3 (b) The comprehensive home care provider will dispose of any medications
17.4remaining with the comprehensive home care provider that are discontinued or expired or
17.5upon the termination of the service contract or the client's death according to state and
17.6federal regulations for disposition of drugs and controlled substances.
17.7 (c) Upon disposition, the comprehensive home care provider must document in the
17.8client's record the disposition of the medications including the medication's name, strength,
17.9prescription number as applicable, quantity, to whom the medications were given, date of
17.10disposition, and names of staff and other individuals involved in the disposition.
17.11 Subd. 23. Loss or spillage. (a) Comprehensive home care providers providing
17.12medication management must develop and implement procedures for loss or spillage of all
17.13controlled substances defined in Minnesota Rules, part 6800.4220. These procedures must
17.14require that when a spillage of a controlled substance occurs, a notation must be made
17.15in the client's record explaining the spillage and the actions taken. The notation must
17.16be signed by the person responsible for the spillage and include verification that any
17.17contaminated substance was disposed of according to state or federal regulations.
17.18 (b) The procedures must require the comprehensive home care provider of
17.19medication management to investigate any known loss or unaccounted for prescription
17.20drugs and take appropriate action required under state or federal regulations and document
17.21the investigation in required records.
Page 81, delete section 16 and insert:
"Sec. ... [144A.4793] TREATMENT AND THERAPY MANAGEMENT
17.25 Subdivision 1. Providers with a comprehensive home care license. This section
17.26applies only to home care providers with a comprehensive home care license that provide
17.27treatment or therapy management services to clients. Treatment or therapy management
17.28services cannot be provided by a home care provider that has a basic home care license.
17.29 Subd. 2. Policies and procedures. (a) A comprehensive home care provider who
17.30provides treatment and therapy management services must develop, implement, and
17.31maintain up-to-date written treatment or therapy management policies and procedures.
17.32The policies and procedures must be developed under the supervision and direction of
17.33a registered nurse or appropriate licensed health professional consistent with current
17.34practice standards and guidelines.
17.35 (b) The written policies and procedures must address requesting and receiving
17.36orders or prescriptions for treatments or therapies, providing the treatment or therapy,
18.1documenting of treatment or therapy activities, educating and communicating with clients
18.2about treatments or therapy they are receiving, monitoring and evaluating the treatment
18.3and therapy, and communicating with the prescriber.
18.4 Subd. 3. Individualized treatment or therapy management plan. For each
18.5client receiving management of ordered or prescribed treatments or therapy services, the
18.6comprehensive home care provider must prepare and include in the service plan a written
18.7statement of the treatment or therapy services that will be provided to the client. The
18.8provider must also develop and maintain a current individualized treatment and therapy
18.9management record for each client which must contain at least the following:
18.10 (1) a statement of the type of services that will be provided;
18.11 (2) documentation of specific client instructions relating to the treatments or therapy
18.13 (3) identification of treatment or therapy tasks that will be delegated to unlicensed
18.15 (4) procedures for notifying a registered nurse or appropriate licensed health
18.16professional when a problem arises with treatments or therapy services; and
18.17 (5) any client-specific requirements relating to documentation of treatment
18.18and therapy received, verification that all treatment and therapy was administered as
18.19prescribed, and monitoring of treatment or therapy to prevent possible complications or
18.20adverse reactions. The treatment or therapy management record must be current and
18.21updated when there are any changes.
18.22 Subd. 4. Administration of treatments and therapy. Ordered or prescribed
18.23treatments or therapies must be administered by a nurse, physician, or other licensed health
18.24professional authorized to perform the treatment or therapy, or may be delegated or assigned
18.25to unlicensed personnel by the licensed health professional according to the appropriate
18.26practice standards for delegation or assignment. When administration of a treatment or
18.27therapy is delegated or assigned to unlicensed personnel, the home care provider must
18.28ensure that the registered nurse or authorized licensed health professional has:
18.29 (1) instructed the unlicensed personnel in the proper methods with respect to each
18.30client and has demonstrated their ability to competently follow the procedures;
18.31 (2) specified, in writing, specific instructions for each client and documented those
18.32instructions in the client's record; and
18.33 (3) communicated with the unlicensed personnel about the individual needs of
18.35 Subd. 5. Documentation of administration of treatments and therapies. Each
18.36treatment or therapy administered by a comprehensive home care provider must be
19.1documented in the client's record. The documentation must include the signature and title
19.2of the person who administered the treatment or therapy and must include the date and
19.3time of administration. When treatment or therapies are not administered as ordered or
19.4prescribed, the provider must document the reason why it was not administered and any
19.5follow-up procedures that were provided to meet the client's needs.
19.6 Subd. 6. Orders or prescriptions. There must be an up-to-date written or
19.7electronically recorded order or prescription for all treatments and therapies. The order
19.8must contain the name of the client, description of the treatment or therapy to be provided,
19.9and the frequency and other information needed to administer the treatment or therapy.
Page 87, delete section 19 and insert:
"Sec. ... [144A.4796] ORIENTATION AND ANNUAL TRAINING
19.13 Subdivision 1. Orientation of staff and supervisors to home care. All staff
19.14providing and supervising direct home care services must complete an orientation to home
19.15care licensing requirements and regulations before providing home care services to clients.
19.16The orientation may be incorporated into the training required under subdivision 6. The
19.17orientation need only be completed once for each staff person and is not transferable
19.18to another home care provider.
19.19 Subd. 2. Content. The orientation must contain the following topics:
19.20 (1) an overview of sections 144A.43 to 144A.4798;
19.21 (2) introduction and review of all the provider's policies and procedures related to
19.22the provision of home care services;
19.23 (3) handling of emergencies and use of emergency services;
19.24 (4) compliance with and reporting the maltreatment of minors or vulnerable adults
19.25under sections 626.556 and 626.557;
19.26 (5) home care bill of rights, under section 144A.44;
19.27 (6) handling of clients' complaints; reporting of complaints and where to report
19.28complaints including information on the Office of Health Facility Complaints and the
19.29Common Entry Point;
19.30 (7) consumer advocacy services of the Office of Ombudsman for Long-Term Care,
19.31Office of Ombudsman for Mental Health and Developmental Disabilities, Managed Care
19.32Ombudsman at the Department of Human Services, county managed care advocates,
19.33or other relevant advocacy services; and
19.34 (8) review of the types of home care services the employee will be providing and
19.35the provider's scope of licensure.
20.1 Subd. 3. Verification and documentation of orientation. Each home care provider
20.2shall retain evidence in the employee record of each staff person having completed the
20.3orientation required by this section.
20.4 Subd. 4. Orientation to client. Staff providing home care services must be oriented
20.5specifically to each individual client and the services to be provided. This orientation may
20.6be provided in person, orally, in writing, or electronically.
20.7 Subd. 5. Training required relating to Alzheimer's disease and related disorders.
20.8 For home care providers that provide services for persons with Alzheimer's or related
20.9disorders, all direct care staff and supervisors working with those clients must receive
20.10training that includes a current explanation of Alzheimer's disease and related disorders
20.11effective approaches to use to problem solve when working with a client's challenging
20.12behaviors, and how to communicate with clients who have Alzheimer's or related disorders.
20.13 Subd. 6. Required annual training. All staff that perform direct home care
20.14services must complete at least eight hours of annual training for each 12 months of
20.15employment. The training may be obtained from the home care provider or another source
20.16and must include topics relevant to the provision of home care services. The annual
20.17training must include:
20.18 (1) training on reporting of maltreatment of minors under section 626.556 and
20.19maltreatment of vulnerable adults under section 626.557, whichever is applicable to the
20.21 (2) review of the home care bill of rights in section 144A.44;
20.22 (3) review of infection control techniques used in the home and implementation of
20.23infection control standards including a review of hand washing techniques; the need for
20.24and use of protective gloves, gowns, and masks; appropriate disposal of contaminated
20.25materials and equipment, such as dressings, needles, syringes, and razor blades;
20.26disinfecting reusable equipment; disinfecting environmental surfaces; and reporting of
20.27communicable diseases; and
20.28 (4) review of the provider's policies and procedures relating to the provision of home
20.29care services and how to implement those policies and procedures.
20.30 Subd. 7. Documentation. A home care provider must retain documentation in the
20.31employee records of the staff that have satisfied the orientation and training requirements
20.32of this section.
Page 92, delete sections 23 and 24 and insert:
"Sec. ... [144A.481] HOME CARE LICENSING IMPLEMENTATION FOR
20.35NEW LICENSEES AND TRANSITION PERIOD FOR CURRENT LICENSEES.
21.1 Subdivision 1. Temporary home care licenses and changes of ownership. (a)
21.2Beginning January 1, 2014, all temporary license applicants must apply for either a
21.3temporary basic or comprehensive home care license.
21.4 (b) Temporary home care temporary licenses issued beginning January 1, 2014,
21.5will be issued according to the provisions in sections 144A.43 to 144A.4799 and fees in
21.6section 144A.472 and will be required to comply with this chapter.
21.7 (c) No temporary licenses or licenses will be accepted or issued between October 1,
21.82013, and December 31, 2013.
21.9 (d) Beginning October 1, 2013, changes in ownership applications will require
21.10payment of the new fees listed in section 144A.472.
21.11 Subd. 2. Current home care licensees with licenses prior to July 1, 2013. (a)
21.12Beginning July 1, 2014, department licensed home care providers must apply for either
21.13the basic or comprehensive home care license on their regularly scheduled renewal date.
21.14 (b) By June 30, 2015, all home care providers must either have a basic or
21.15comprehensive home care license or temporary license.
21.16 Subd. 3. Renewal application of home care licensure during transition period.
21.17 Renewal of home care licenses issued beginning July 1, 2014, will be issued according to
21.18sections 144A.43 to 144A.4799 and, upon license renewal, providers must comply with
21.19sections 144A.43 to 144A.4799. Prior to renewal, providers must comply with the home
21.20care licensure law in effect on June 30, 2013.
21.21 The fees charged for licenses renewed between July 1, 2014, and June 30, 2016,
21.22shall be the lesser of 200 percent or $1,000, except where the 200 percent or $1,000
21.23increase exceeds the actual renewal fee charged, with a maximum renewal fee of $6,625.
21.24 For fiscal year 2014 only, the fees for providers with revenues greater than $25,000
21.25and no more than $100,000 will be $313 and for providers with revenues no more than
21.26$25,000 the fee will be $125.
Sec. ... [144A.482] REGISTRATION OF HOME MANAGEMENT PROVIDERS.
21.28 (a) For purposes of this section, a home management provider is an individual or
21.29organization that provides at least two of the following services: housekeeping, meal
21.30preparation, and shopping, to a person who is unable to perform these activities due to
21.31illness, disability, or physical condition.
21.32 (b) A person or organization that provides only home management services may not
21.33operate in the state without a current certificate of registration issued by the commissioner
21.34of health. To obtain a certificate of registration, the person or organization must annually
21.35submit to the commissioner the name, mailing and physical address, e-mail address, and
22.1telephone number of the individual or organization and a signed statement declaring that
22.2the individual or organization is aware that the home care bill of rights applies to their
22.3clients and that the person or organization will comply with the home care bill of rights
22.4provisions contained in section 144A.44. An individual or organization applying for a
22.5certificate must also provide the name, business address, and telephone number of each of
22.6the individuals responsible for the management or direction of the organization.
22.7 (c) The commissioner shall charge an annual registration fee of $20 for individuals
22.8and $50 for organizations. The registration fee shall be deposited in the state treasury and
22.9credited to the state government special revenue fund.
22.10 (d) A home care provider that provides home management services and other home
22.11care services must be licensed, but licensure requirements other than the home care bill of
22.12rights do not apply to those employees or volunteers who provide only home management
22.13services to clients who do not receive any other home care services from the provider.
22.14A licensed home care provider need not be registered as a home management service
22.15provider, but must provide an orientation on the home care bill of rights to its employees
22.16or volunteers who provide home management services.
22.17 (e) An individual who provides home management services under this section must,
22.18within 120 days after beginning to provide services, attend an orientation session approved
22.19by the commissioner that provides training on the home care bill of rights and an orientation
22.20on the aging process and the needs and concerns of elderly and disabled persons.
22.21 (f) The commissioner may suspend or revoke a provider's certificate of registration
22.22or assess fines for violation of the home care bill of rights. Any fine assessed for a
22.23violation of the home care bill of rights by a provider registered under this section shall be
22.24in the amount established in the licensure rules for home care providers. As a condition
22.25of registration, a provider must cooperate fully with any investigation conducted by the
22.26commissioner, including providing specific information requested by the commissioner on
22.27clients served and the employees and volunteers who provide services. Fines collected
22.28under this paragraph shall be deposited in the state treasury and credited to the fund
22.29specified in the statute or rule in which the penalty was established.
22.30 (g) The commissioner may use any of the powers granted in sections 144A.43 to
22.31144A.4799 to administer the registration system and enforce the home care bill of rights
22.32under this section.
Page 94, delete section 1
Page 96, delete section 2
Page 97, delete section 3
Page 98, delete sections 4 to 6
Page 99 delete sections 7 to 9
Page 100, delete section 10
Page 104, delete section 11
Page 117, delete sections 15 and 16
Page 118, delete section 17
Page 120, after line 29, insert:
Section 1. Minnesota Statutes 2012, section 256.01, is amended by adding a
subdivision to read:
23.11 Subd. 35. Commissioner must annually report certain prepaid medical
23.12assistance plan data. (a) The commissioner of human services and the commissioner
23.13of education may share private or nonpublic data to allow the commissioners to analyze
23.14the screening, diagnosis, and treatment of children with autism spectrum disorder and
23.15other developmental conditions. The commissioners may share the individual-level data
23.17 (1) measure the prevalence of autism spectrum disorder and other developmental
23.19 (2) analyze the effectiveness of existing policies and procedures in the early
23.20identification of children with autism spectrum disorder and other developmental
23.22 (3) assess the effectiveness of screening, diagnosis, and treatment to allow children
23.23with autism spectrum disorder and other developmental conditions to meet developmental
23.24and social-emotional milestones;
23.25 (4) identify and address disparities in screening, diagnosis, and treatment related
23.26to the native language or race and ethnicity of the child;
23.27 (5) measure the effectiveness of public health care programs in addressing the medical
23.28needs of children with autism spectrum disorder and other developmental conditions; and
23.29 (6) determine the capacity of educational systems and health care systems to meet
23.30the needs of children with autism spectrum disorder and other developmental conditions.
23.31 (b) The commissioner of human services shall use the data shared with the
23.32commissioner of education under this subdivision to improve public health care program
23.33performance in early screening, diagnosis, and treatment for children once data are
23.34available and shall report on the results and any summary data, as defined in section 13.02,
23.35subdivision 19, on the department's public Web site by September 30 each year.
Sec. 2. [256B.0949] AUTISM EARLY INTENSIVE INTERVENTION BENEFIT.
24.2 Subdivision 1. Purpose. This section creates a new benefit available under the
24.3medical assistance state plan when federal approval consistent with the provisions in
24.4subdivision 11 is obtained for a 1915(i) waiver pursuant to the Affordable Care Act, section
24.52402(c), amending United States Code, title 42, section 1396n(i)(1), or other option to
24.6provide early intensive intervention to a child with an autism spectrum disorder diagnosis.
24.7This benefit must provide coverage for diagnosis, multidisciplinary assessment, ongoing
24.8progress evaluation, and medically necessary treatment of autism spectrum disorder.
24.9 Subd. 2. Definitions. (a) For the purposes of this section, the terms defined in
24.10this subdivision have the meanings given.
24.11 (b) "Autism spectrum disorder diagnosis" is defined by diagnostic code 299 in the
24.12current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM).
24.13 (c) "Child" means a person under the age of seven, or for two years at any age under
24.14age 18 if the person was not diagnosed with autism spectrum disorder before age five, or a
24.15person under age 18 pursuant to subdivision 12.
24.16 (d) "Commissioner" means the commissioner of human services, unless otherwise
24.18 (e) "Early intensive intervention benefit" means autism treatment options based in
24.19behavioral and developmental science, which may include modalities such as applied
24.20behavior analysis, developmental treatment approaches, and naturalistic and parent
24.22 (f) "Generalizable goals" means results or gains that are observed during a variety
24.23of activities with different people, such as providers, family members, other adults, and
24.24children, and in different environments including, but not limited to, clinics, homes,
24.25schools, and the community.
24.26 Subd. 3. Initial eligibility. This benefit is available to a child enrolled in medical
24.28 (1) has an autism spectrum disorder diagnosis;
24.29 (2) has had a diagnostic assessment described in subdivision 5, which recommends
24.30early intensive intervention services;
24.31 (3) meets the criteria for medically necessary autism early intensive intervention
24.33 (4) declines to enroll in the state services described in section 252.27.
24.34 Subd. 4. Diagnosis. (a) A diagnosis must:
24.35 (1) be based upon current DSM criteria including direct observations of the child
24.36and reports from parents or primary caregivers;
25.1 (2) be completed by a professional who has expertise and training in autism spectrum
25.2disorder and child development and who is a licensed physician, nurse practitioner, or
25.3a licensed mental health professional until the commissioner's assessment required in
25.4subdivision 8, clause (7), shows there are adequate professionals to avoid access problems
25.5or delays in diagnosis for young children if two professionals are required for a diagnosis
25.6pursuant to clause (3); and
25.7 (3) be completed by both a medical and mental health professional who have expertise
25.8and training in autism spectrum disorder and child development when the assessment in
25.9subdivision 8, clause (7), demonstrates that there are sufficient professionals available.
25.10 (b) Additional diagnostic assessment information including from special education
25.11evaluations and licensed school personnel, and from professionals licensed in the fields of
25.12medicine, speech and language, psychology, occupational therapy, and physical therapy
25.13may be considered.
25.14 Subd. 5. Diagnostic assessment. The following information and assessments must
25.15be performed, reviewed, and relied upon for the eligibility determination, treatment and
25.16services recommendations, and treatment plan development for the child:
25.17 (1) an assessment of the child's developmental skills, functional behavior, needs,
25.18and capacities based on direct observation of the child which must be administered by
25.19a licensed mental health professional and may also include observations from family
25.20members, licensed school personnel, child care providers, or other caregivers, as well as
25.21any medical or assessment information from other licensed professionals such as the
25.22child's physician, rehabilitation therapists, or mental health professionals; and
25.23 (2) an assessment of parental or caregiver capacity to participate in therapy including
25.24the type and level of parental or caregiver involvement and training recommended.
25.25 Subd. 6. Treatment plan. (a) Each child's treatment plan must be:
25.26 (1) based on the diagnostic assessment information specified in subdivisions 4 and 5;
25.27 (2) coordinated with medically necessary occupational, physical, and speech and
25.28language therapies, special education, and other services the child and family are receiving;
25.29 (3) family-centered;
25.30 (4) culturally sensitive; and
25.31 (5) individualized based on the child's developmental status and the child's and
25.32family's identified needs.
25.33 (b) The treatment plan must specify the:
25.34 (1) child's goals which are developmentally appropriate, functional, and
25.36 (2) treatment modality;
26.1 (3) treatment intensity;
26.2 (4) setting; and
26.3 (5) level and type of parental or caregiver involvement.
26.4 (c) The treatment must be supervised by a professional with expertise and training in
26.5autism and child development who is a licensed physician, nurse practitioner, or mental
26.7 (d) The treatment plan must be submitted to the commissioner for approval in a
26.8manner determined by the commissioner for this purpose.
26.9 (e) Services authorized must be consistent with the child's approved treatment plan.
26.10 Subd. 7. Ongoing eligibility. (a) An independent progress evaluation conducted
26.11by a licensed mental health professional with expertise and training in autism spectrum
26.12disorder and child development must be completed after each six months of treatment,
26.13or more frequently as determined by the commissioner, to determine if progress is being
26.14made toward achieving generalizable gains and meeting functional goals contained in
26.15the treatment plan.
26.16 (b) The progress evaluation must include:
26.17 (1) the treating provider's report;
26.18 (2) parental or caregiver input;
26.19 (3) an independent observation of the child which can be performed by the child's
26.20licensed special education staff;
26.21 (4) any treatment plan modifications; and
26.22 (5) recommendations for continued treatment services.
26.23 (c) Progress evaluations must be submitted to the commissioner in a manner
26.24determined by the commissioner for this purpose.
26.25 (d) A child who continues to achieve generalizable gains and treatment goals as
26.26specified in the treatment plan is eligible to continue receiving this benefit.
26.27 (e) A child's treatment shall continue during the progress evaluation and during an
26.28appeal if continuation of services pending appeal have been requested pursuant to section
26.29256.045, subdivision 10.
26.30 Subd. 8. Refining the benefit with stakeholders. The commissioner must develop
26.31the implementation details of the benefit in consultation with stakeholders and consider
26.32recommendations from the Health Services Advisory Council, the Department of Human
26.33Services Autism Spectrum Disorder Advisory Council, the Legislative Autism Spectrum
26.34Disorder Task Force, and the Interagency Task Force of the Departments of Health,
26.35Education, and Human Services. The commissioner must release these details for a 30-day
27.1public comment period prior to submission to the federal government for approval. The
27.2implementation details include, but are not limited to, the following components:
27.3 (1) a definition of the qualifications, standards, and roles of the treatment team,
27.4including recommendations after stakeholder consultation on whether board-certified
27.5behavior analysts and other types of professionals trained in autism spectrum disorder and
27.6child development should be added as mental health or other professionals for treatment
27.7supervision or other function under medical assistance;
27.8 (2) development of initial, uniform parameters for comprehensive multidisciplinary
27.9diagnostic assessment information and progress evaluation standards;
27.10 (3) the design of an effective and consistent process for assessing parent and
27.11caregiver capacity to participate in the child's early intervention treatment and methods of
27.12involving the parents in the treatment of the child;
27.13 (4) formulation of a collaborative process in which professionals have opportunities
27.14to collectively inform the comprehensive, multidisciplinary diagnostic assessment and
27.15progress evaluation processes and standards to support quality improvement of early
27.16intensive intervention services;
27.17 (5) coordination of this benefit and its interaction with other services provided by the
27.18Departments of Human Services, Health, and Education;
27.19 (6) evaluation, on an ongoing basis, of research regarding the program and treatment
27.20modalities provided to children under this benefit; and
27.21 (7) determination of the availability of licensed medical and mental health
27.22professionals with expertise and training in autism spectrum disorder throughout the state
27.23in order to assess whether there are sufficient professionals to require involvement of
27.24both a medical and mental health professional to provide access and prevent delay in the
27.25diagnosis and treatment of young children so as to implement subdivision 4, paragraph
27.26(a), and to ensure treatment is effective, timely, and accessible.
27.27 Subd. 9. Revision of treatment options. (a) The commissioner may revise covered
27.28treatment options as needed based on outcome data and other evidence.
27.29 (b) Before the changes become effective, the commissioner must provide public
27.30notice of the changes, the reasons for the change, and a 30-day public comment period
27.31to those who request notice through an electronic list accessible to the public on the
27.32department's Web site.
27.33 Subd. 10. Coordination between agencies. The commissioners of human services
27.34and education must develop the capacity to coordinate services and information including
27.35diagnostic, functional, developmental, medical, and educational assessments; service
27.36delivery; and progress evaluations across health and education sectors.
28.1 Subd. 11. Federal approval of the autism benefit. The provisions of subdivision 9
28.2shall apply to state plan services under Title XIX of the Social Security Act when federal
28.3approval is granted under a 1915(i) waiver or other authority which allows children
28.4eligible for medical assistance through the TEFRA option under section 256B.055,
28.5subdivision 12, to qualify and includes children eligible for medical assistance in families
28.6over 150 percent of the federal poverty guidelines.
28.7 Subd. 12. Local school districts option to continue treatment. (a) A local school
28.8district may contract with the commissioner of human services to pay the state share of
28.9the benefits described under this section to continue this treatment as part of the special
28.10education services offered to all students in the district diagnosed with an autism spectrum
28.12 (b) A local school district may utilize third-party billing to seek reimbursement
28.13for the district for any services paid by the district under this section for which private
28.14insurance coverage was available to the child.
28.15EFFECTIVE DATE.The autism benefit under subdivisions 1 to 7, 9, and 12, is
28.16effective upon federal approval for the benefit under a 1915(i) waiver or other federal
28.17authority needed to meet the requirements of subdivision 11, but no earlier than March 1,
28.182014. Subdivisions 8, 10, and 11 are effective July 1, 2013.
Sec. 3. Minnesota Statutes 2012, section 256B.69, is amended by adding a subdivision
28.21 Subd. 32a. Initiatives to improve early screening, diagnosis, and treatment of
28.22children with autism spectrum disorder and other developmental conditions. (a) The
28.23commissioner shall require managed care plans and county-based purchasing plans, as
28.24a condition of contract, to implement strategies that facilitate access for young children
28.25between the ages of one and three years to periodic developmental and social-emotional
28.26screenings, as recommended by the Minnesota Interagency Developmental Screening
28.27Task Force, and that those children who do not meet milestones are provided access to
28.28appropriate evaluation and assessment, including treatment recommendations, expected to
28.29improve the child's functioning, with the goal of meeting milestones by age five.
28.30 (b) The managed care plans must report the following data annually:
28.31 (1) the number of children who received a diagnostic assessment;
28.32 (2) the total number of children ages one to six with a diagnosis of autism spectrum
28.33disorder who received treatments;
28.34 (3) the number of children identified under clause (2) reported by each 12-month
28.35age group beginning with age one and ending with age six;
29.1 (4) the types of treatments provided to children identified under clause (2) listed by
29.2billing code, including the number of units billed for each child;
29.3 (5) barriers to providing screening, diagnosis, and treatment of young children
29.4between the ages of one and three years and any strategies implemented to address
29.5those barriers; and
29.6 (6) recommendations on how to measure and report on the effectiveness of the
29.7strategies implemented to facilitate access for young children to provide developmental
29.8and social-emotional screening, diagnosis, and treatment.
Sec. 4. NURSING HOME LEVEL OF CARE REPORT.
29.10 (a) The commissioner of human services shall report on the impact of the nursing
29.11home level of care implementation including the following:
29.12 (1) the number of individuals who lost waivered services and medical assistance;
29.13 (2) the result of the loss of services;
29.14 (3) information on where individuals were living before and after the nursing home
29.15level of care changes took effect to show the impact on an individual's ability to maintain
29.16independence in the community; and
29.17 (4) utilization data before and after nursing home level of care implementation for
29.18those who retained medical assistance including which essential community support
29.19and personal care assistant services were used, and to what extent the $400 essential
29.20community support grant was sufficient to meet needs.
29.21 (b) The commissioner of human services shall report to the chairs of the legislative
29.22committees with jurisdiction over health and human services policy and finance with the
29.23information required under paragraph (a) on October 1, 2014, and annually thereafter.
29.25HOME AND COMMUNITY-BASED SERVICES DISABILITY RATE SETTING
Section 1. [256B.4914] HOME AND COMMUNITY-BASED SERVICES
29.27WAIVERS; RATE SETTING.
29.28 Subdivision 1. Application. The payment methodologies in this section apply to
29.29home and community-based services waivers under sections 256B.092 and 256B.49. This
29.30section does not change existing waiver policies and procedures.
29.31 Subd. 2. Definitions. (a) For purposes of this section, the following terms have the
29.32meanings given them, unless the context clearly indicates otherwise.
29.33 (b) "Commissioner" means the commissioner of human services.
30.1 (c) "Component value" means underlying factors that are part of the cost of providing
30.2services that are built into the waiver rates methodology to calculate service rates.
30.3 (d) "Customized living tool" means a methodology for setting service rates which
30.4delineates and documents the amount of each component service included in a recipient's
30.5customized living service plan.
30.6 (e) "Disability Waiver Rates System" means a statewide system which establishes
30.7rates that are based on uniform processes and captures the individualized nature of waiver
30.8services and recipient needs.
30.9 (f) "Lead agency" means a county, partnership of counties, or tribal agency charged
30.10with administering waivered services under sections 256B.092 and 256B.49.
30.11 (g) "Median" means the amount that divides distribution into two equal groups, half
30.12above the median and half below the median.
30.13 (h) "Payment or rate" means reimbursement to an eligible provider for services
30.14provided to a qualified individual based on an approved service authorization.
30.15 (i) "Rates management system" means a web-based software application that uses
30.16a framework and component values, as determined by the commissioner, to establish
30.18 (j) "Recipient" means a person receiving home and community-based services
30.19funded under any of the disability waivers.
30.20 Subd. 3. Applicable services. Applicable services are those authorized under the
30.21state's home and community-based services waivers under sections 256B.092 and 256B.49
30.22including, as defined in the federally approved home and community-based services plan:
30.23 (1) 24-hour customized living;
30.24 (2) adult day care;
30.25 (3) adult day care bath;
30.26 (4) behavioral programming;
30.27 (5) companion services;
30.28 (6) customized living;
30.29 (7) day training and habilitation;
30.30 (8) housing access coordination;
30.31 (9) independent living skills;
30.32 (10) in-home family support;
30.33 (11) night supervision;
30.34 (12) personal support;
30.35 (13) prevocational services;
30.36 (14) residential care services;
31.1 (15) residential support services;
31.2 (16) respite services;
31.3 (17) structured day services;
31.4 (18) supported employment services;
31.5 (19) supported living services;
31.6 (20) transportation services; and
31.7 (21) other services as approved by the federal government in the state home and
31.8community-based services plan.
31.9 Subd. 4. Data collection for rate determination. (a) Rates for all applicable home
31.10and community-based waivered services, including rate exceptions under subdivision 12
31.11are set via the rates management system.
31.12 (b) Only data and information in the rates management system may be used to
31.13calculate an individual's rate.
31.14 (c) Service providers, with information from the community support plan, shall enter
31.15values and information needed to calculate an individual's rate into the rates management
31.16system. These values and information include:
31.17 (1) shared staffing hours;
31.18 (2) individual staffing hours;
31.19 (3) staffing ratios;
31.20 (4) information to document variable levels of service qualification for variable
31.21levels of reimbursement in each framework;
31.22 (5) shared or individualized arrangements for unit-based services, including the
31.23staffing ratio; and
31.24 (6) number of trips and miles for transportation services.
31.25 (d) Updates to individual data shall include:
31.26 (1) data for each individual that is updated annually when renewing service plans; and
31.27 (2) requests by individuals or lead agencies to update a rate whenever there is a
31.28change in an individual's service needs, with accompanying documentation.
31.29 (e) Lead agencies shall review and approve values to calculate the final payment rate
31.30for each individual. Lead agencies must notify the individual and the service provider
31.31of the final agreed upon values and rate. If a value used was mistakenly or erroneously
31.32entered and used to calculate a rate, a provider may petition lead agencies to correct it.
31.33Lead agencies must respond to these requests.
31.34 Subd. 5. Base wage index and standard component values. (a) The base wage
31.35index is established to determine staffing costs associated with providing services to
31.36individuals receiving home and community-based services. For purposes of developing
32.1and calculating the proposed base wage, Minnesota-specific wages taken from job
32.2descriptions and standard occupational classification (SOC) codes from the Bureau of
32.3Labor Statistics, as defined in the most recent edition of the Occupational Handbook shall
32.4be used. The base wage index shall be calculated as follows:
32.5 (1) for residential direct care basic staff, 50 percent of the median wage for personal
32.6and home health aide (SOC code 39-9021); 30 percent of the median wage for nursing
32.7aide (SOC code 31-1012); and 20 percent of the median wage for social and human
32.8services aide (SOC code 21-1093);
32.9 (2) for residential direct care intensive staff, 20 percent of the median wage for home
32.10health aide (SOC code 31-1011); 20 percent of the median wage for personal and home
32.11health aide (SOC code 39-9021); 20 percent of the median wage for nursing aide (SOC code
32.1221-1012); 20 percent of the median wage for psychiatric technician (SOC code 29-2053);
32.13and 20 percent of the median wage for social and human services aide (SOC code 21-1093);
32.14 (3) for day services, 20 percent of the median wage for nursing aide (SOC Code
32.1531-1012); 20 percent of the median wage for psychiatric technician (SOC Code 29-2053);
32.16and 60 percent of the median wage for social and human services code (SOC Code
32.18 (4) for residential asleep overnight staff, the wage will be $7.66 per hour, except
32.19in a family foster care setting the wage is $2.80 per hour;
32.20 (5) for behavior program analyst staff: 100 percent of the median wage for mental
32.21health counselors (SOC code 21-1014);
32.22 (6) for behavior program professional staff: 100 percent of the median wage for
32.23clinical counseling and school psychologist (SOC code 19-3031);
32.24 (7) for behavior program specialist staff: 100 percent of the median wage for
32.25psychiatric technicians (SOC code 29-2053);
32.26 (8) for supportive living services staff: 20 percent of the median wage for nursing
32.27aide (SOC code 31-1012); 20 percent of the median wage for psychiatric technician (SOC
32.28code 29-2053); and 60 percent of the median wage for social and human services aide
32.29(SOC code 21-1093);
32.30 (9) for housing access coordination staff: 50 percent of the median wage for
32.31community and social services specialist (SOC code 21-1099); and 50 percent of the
32.32median wage for social and human services aide (SOC code 21-1093);
32.33 (10) for in-home family support staff: 20 percent of the median wage for nursing
32.34aide (SOC code 31-1012); 30 percent of community social service specialist (SOC code
32.3521-1099); 40 percent of the median wage for social and human services aide (SOC code
33.121-1093); and 10 percent of the median wage for psychiatric technician (SOC code
33.3 (11) for independent living skills staff: 40 percent of the median wage for
33.4community social service specialist (SOC code 21-1099); 50 percent of the median wage
33.5for social and human services aide (SOC code 21-1093); and 10 percent of the median
33.6wage for psychiatric technician (SOC code 29-2053);
33.7 (12) for supported employment staff: 20 percent of the median wage for nursing
33.8aide (SOC code 31-1012); 20 percent of the median wage for psychiatric technician (SOC
33.9code 29-2053); and 60 percent of the median wage for social and human services aide
33.10(SOC code 21-1093);
33.11 (13) for adult companion staff: 50 percent of the median wage for personal and
33.12home care aide (SOC code 39-9021); and 50 percent of the median wage for nursing aides,
33.13orderlies, and attendants (SOC code 31-1012);
33.14 (14) for night supervision staff: 20 percent of the median wage for home health aide
33.15(SOC code 31-1011); 20 percent of the median wage for personal and home health aide
33.16(SOC code 39-9021); 20 percent of the median wage for nursing aide (SOC code 31-1012);
33.1720 percent of the median wage for psychiatric technician (SOC code 29-2053); and 20
33.18percent of the median wage for social and human services aide (SOC code 21-1093);
33.19 (15) for respite staff: 50 percent of the median wage for personal and home care aide
33.20(SOC code 39-9021); and 50 percent of the median wage for nursing aides, orderlies, and
33.21attendants (SOC code 31-1012);
33.22 (16) for personal support staff: 50 percent of the median wage for personal and
33.23home care aide (SOC code 39-9021); and 50 percent of the median wage for nursing
33.24aides, orderlies, and attendants (SOC code 31-1012); and
33.25 (17) for supervisory staff: the basic wage is $17.43 per hour with exception of the
33.26supervisor of behavior analyst and behavior specialists which shall be $30.75 per hour.
33.27 (b) Component values for residential support services, excluding family foster
33.29 (1) supervisory span of control ratio: 11 percent;
33.30 (2) employee vacation, sick, and training allowance ratio: 8.71 percent;
33.31 (3) employee-related cost ratio: 23.6 percent;
33.32 (4) general administrative support ratio: 13.25 percent;
33.33 (5) program-related expense ratio: 1.3 percent; and
33.34 (6) absence and utilization factor ratio: 3.9 percent.
33.35 (c) Component values for family foster care are:
33.36 (1) supervisory span of control ratio: 11 percent;
34.1 (2) employee vacation, sick, and training allowance ratio: 8.71 percent;
34.2 (3) employee-related cost ratio: 23.6 percent;
34.3 (4) general administrative support ratio: 3.3 percent; and
34.4 (5) program-related expense ratio: 1.3 percent.
34.5 (d) Component values for day services for all services are:
34.6 (1) supervisory span of control ratio: 11 percent;
34.7 (2) employee vacation, sick, and training allowance ratio: 8.71 percent;
34.8 (3) employee-related cost ratio: 23.6 percent;
34.9 (4) program plan support ratio: 5.6 percent;
34.10 (5) client programming and support ratio: 10 percent;
34.11 (6) general administrative support ratio: 13.25 percent;
34.12 (7) program-related expense ratio: 1.8 percent; and
34.13 (8) absence and utilization factor ratio: 3.9 percent.
34.14 (e) Component values for unit-based with program services are:
34.15 (1) supervisory span of control ratio: 11 percent;
34.16 (2) employee vacation, sick, and training allowance ratio: 8.71 percent;
34.17 (3) employee-related cost ratio: 23.6 percent;
34.18 (4) program plan supports ratio: 3.1 percent;
34.19 (5) client programming and support ratio: 8.6 percent;
34.20 (6) general administrative support ratio: 13.25 percent;
34.21 (7) program-related expense ratio: 6.1 percent; and
34.22 (8) absence and utilization factor ratio: 3.9 percent.
34.23 (f) Component values for unit-based services without programming except respite
34.25 (1) supervisory span of control ratio: 11 percent;
34.26 (2) employee vacation, sick, and training allowance ratio: 8.71 percent;
34.27 (3) employee-related cost ratio: 23.6 percent;
34.28 (4) program plan support ratio: 3.1 percent;
34.29 (5) client programming and support ratio: 8.6 percent;
34.30 (6) general administrative support ratio: 13.25 percent;
34.31 (7) program-related expense ratio: 6.1 percent; and
34.32 (8) absence and utilization factor ratio: 3.9 percent.
34.33 (g) Component values for unit-based services without programming for respite are:
34.34 (1) supervisory span of control ratio: 11 percent;
34.35 (2) employee vacation, sick, and training allowance ratio: 8.71 percent;
34.36 (3) employee-related cost ratio: 23.6 percent;
35.1 (4) general administrative support ratio: 13.25 percent;
35.2 (5) program-related expense ratio: 6.1 percent; and
35.3 (6) absence and utilization factor ratio: 3.9 percent.
35.4 (h) On July 1, 2017, the commissioner shall update the base wage index in paragraph
35.5(a) based on the wage data by standard occupational code (SOC) from the Bureau of
35.6Labor Statistics available on December 31, 2016. The commissioner shall publish these
35.7updated values and load them into the rate management system. This adjustment shall
35.8occur every five years. For adjustments in 2021 and beyond, the commissioner shall use
35.9the data available on December 31 of the calendar year five years prior.
35.10 (i) On July 1, 2017, the commissioner shall update the framework components in
35.11paragraph (c) for changes in the Consumer Price Index. The commissioner must adjust
35.12these values higher or lower by the percentage change in the Consumer Price Index-All
35.13Items (United States city average) (CPI-U) from January 1, 2014, to January 1, 2017. The
35.14commissioner shall publish these updated values and load them into the rate management
35.15system. This adjustment shall occur every five years. For adjustments in 2021 and
35.16beyond, the commissioner shall use the data available on January 1 of the calendar year
35.17four years prior and January 1 of the current calendar year.
35.18 Subd. 6. Payments for residential support services. (a) Payments for residential
35.19support services, as defined in sections 256B.092, subdivision 11, and 256B.49 subdivision
35.2022, must be calculated as follows:
35.21 (1) determine the number of units of service to meet a recipient's needs;
35.22 (2) personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics
35.23national and Minnesota-specific rates or rates derived by the commissioner as provided in
35.24subdivision 5. This is defined as the direct care rate;
35.25 (3) for a recipient requiring customization for deaf or hard-of-hearing language
35.26accessibility under subdivision 12, add the customization rate provided in subdivision 12
35.27to the result of clause (2). This is defined as the customized direct care rate;
35.28 (4) multiply the number of residential services direct staff hours by the appropriate
35.29staff wage in subdivision 5, paragraph (a), or the customized direct care rate;
35.30 (5) multiply the number of direct staff hours by the product of the supervision span
35.31of control ratio in subdivision 5, paragraph (b), clause (1), and the appropriate supervision
35.32wage in subdivision 5, paragraph (a), clause (17);
35.33 (6) combine the results of clauses (4) and (5), and multiply the result by one plus
35.34the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (b),
35.35clause (2). This is defined as the direct staffing cost;
36.1 (7) for employee-related expenses, multiply the direct staffing cost by one plus the
36.2employee-related cost ratio in subdivision 5, paragraph (b), clause (3);
36.3 (8) for client programming and supports, the commissioner shall add $2,179; and
36.4 (9) for transportation, if provided, the commissioner shall add $1,680, or $3,000 if
36.5customized for adapted transport per year.
36.6 (b) The total rate shall be calculated using the following steps:
36.7 (1) subtotal paragraph (a), clauses (7) to (9);
36.8 (2) sum the standard general and administrative rate, the program-related expense
36.9ratio, and the absence and utilization ratio; and
36.10 (3) divide the result of clause (1) by one minus the result of clause (2). This is
36.11the total payment amount.
36.12 Subd. 7. Payments for day programs. Payments for services with day programs
36.13including adult day care, day treatment and habilitation, prevocational services, and
36.14structured day services must be calculated as follows:
36.15 (1) determine the number of units of service to meet a recipient's needs;
36.16 (2) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
36.17Minnesota-specific rates or rates derived by the commissioner as provided in subdivision 5;
36.18 (3) for a recipient requiring customization for deaf or hard-of-hearing language
36.19accessibility under subdivision 12, add the customization rate provided in subdivision 12
36.20to the result of clause (2). This is defined as the customized direct care rate;
36.21 (4) multiply the number of day program direct staff hours by the appropriate staff
36.22wage in subdivision 5, paragraph (a), or the customized direct care rate;
36.23 (5) multiply the number of day program direct staff hours by the product of the
36.24supervision span of control ratio in subdivision 5, paragraph (d), clause (1), and the
36.25appropriate supervision wage in subdivision 5, paragraph (a), clause (17);
36.26 (6) combine the results of clauses (4) and (5), and multiply the result by one plus
36.27the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (d),
36.28clause (2). This is defined as the direct staffing rate;
36.29 (7) for program plan support, multiply the result of clause (6) by one plus the
36.30program plan support ratio in subdivision 5, paragraph (d), clause (4);
36.31 (8) for employee-related expenses, multiply the result of clause (7) by one plus the
36.32employee-related cost ratio in subdivision 5, paragraph (d), clause (3);
36.33 (9) for client programming and supports, multiply the result of clause (8) by one plus
36.34the client programming and support ratio in subdivision 5, paragraph (d), clause (5);
36.35 (10) for program facility costs, add $8.30 per week with consideration of staffing
36.36ratios to meet individual needs;
37.1 (11) for adult day bath services, add $7.01 per 15 minute unit;
37.2 (12) this is the subtotal rate;
37.3 (13) sum the standard general and administrative rate, the program-related expense
37.4ratio, and the absence and utilization factor ratio;
37.5 (14) divide the result of clause (12) by one minus the result of clause (13). This is
37.6the total payment amount;
37.7 (15) for transportation provided as part of day training and habilitation for an
37.8individual who does not require a lift, add:
37.9 (i) $10.50 for a trip between zero and ten miles for a nonshared ride in a vehicle
37.10without a lift, $8.83 for a shared ride in a vehicle without a lift, and $9.25 for a shared
37.11ride in a vehicle with a lift;
37.12 (ii) $15.75 for a trip between 11 and 20 miles for a nonshared ride in a vehicle
37.13without a lift, $10.58 for a shared ride in a vehicle without a lift, and $11.88 for a shared
37.14ride in a vehicle with a lift;
37.15 (iii) $25.75 for a trip between 21and 50 miles for a nonshared ride in a vehicle
37.16without a lift, $13.92 for a shared ride in a vehicle without a lift, and $16.88 for a shared
37.17ride in a vehicle with a lift; or
37.18 (iv) $33.50 for a trip of 51 miles or more for a nonshared ride in a vehicle without a
37.19lift, $16.50 for a shared ride in a vehicle without a lift, and $20.75 for a shared ride in a
37.20vehicle with a lift;
37.21 (16) for transportation provide as part of day training and habilitation for an
37.22individual who does require a lift, add:
37.23 (i) $19.05 for a trip between zero and ten miles for a nonshared ride in a vehicle with
37.24a lift, and $15.05 for a shared ride in a vehicle with a lift;
37.25 (ii) $32.16 for a trip between 11 and 20 miles for a nonshared ride in a vehicle with a
37.26lift, and $28.16 for a shared ride in a vehicle with a lift;
37.27 (iii) $58.76 for a trip between 21 and 50 miles for a nonshared ride in a vehicle with
37.28a lift, and $58.76 for a shared ride in a vehicle with a lift; or
37.29 (iv) $80.93 for a trip of 51 miles or more for a nonshared ride in a vehicle with a
37.30lift, and $80.93 for a shared ride in a vehicle with a lift.
37.31 Subd. 8. Payments for unit-based services with programming. Payments for
37.32unit-based services with programming, including behavior programming, housing access
37.33coordination, in-home family support, independent living skills training, hourly supported
37.34living services, and supported employment provided to an individual outside of any day or
37.35residential service plan must be calculated as follows, unless the services are authorized
37.36separately under subdivision 6 or 7:
38.1 (1) determine the number of units of service to meet a recipient's needs;
38.2 (2) personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics
38.3Minnesota-specific rates or rates derived by the commissioner as provided in subdivision 5;
38.4 (3) for a recipient requiring customization for deaf or hard-of-hearing language
38.5accessibility under subdivision 12, add the customization rate provided in subdivision 12
38.6to the result of clause (2). This is defined as the customized direct care rate;
38.7 (4) multiply the number of direct staff hours by the appropriate staff wage in
38.8subdivision 5, paragraph (a), or the customized direct care rate;
38.9 (5) multiply the number of direct staff hours by the product of the supervision span
38.10of control ratio in subdivision 5, paragraph (e), clause (1), and the appropriate supervision
38.11wage in subdivision 5, paragraph (a), clause (17);
38.12 (6) combine the results of clauses (4) and (5), and multiply the result by one plus
38.13the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (e),
38.14clause (2). This is defined as the direct staffing rate;
38.15 (7) for program plan support, multiply the result of clause (6) by one plus the
38.16program plan supports ratio in subdivision 5, paragraph (e), clause (4);
38.17 (8) for employee-related expenses, multiply the result of clause (7) by one plus the
38.18employee-related cost ratio in subdivision 5, paragraph (e), clause (3);
38.19 (9) for client programming and supports, multiply the result of clause (8) by one plus
38.20the client programming and supports ratio in subdivision 5, paragraph (e), clause (5);
38.21 (10) this is the subtotal rate;
38.22 (11) sum the standard general and administrative rate, the program-related expense
38.23ratio, and the absence and utilization factor ratio; and
38.24 (12) divide the result of clause (10) by one minus the result of clause (11). This is
38.25the total payment amount.
38.26 Subd. 9. Payments for unit-based services without programming. Payments
38.27for unit-based without program services including night supervision, personal support,
38.28respite, and companion care provided to an individual outside of any day or residential
38.29service plan must be calculated as follows unless the services are authorized separately
38.30under subdivision 6 or 7:
38.31 (1) for all services except respite, determine the number of units of service to meet
38.32a recipient's needs;
38.33 (2) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
38.34Minnesota-specific rate or rates derived by the commissioner as provided in subdivision 5;
39.1 (3) for a recipient requiring customization for deaf or hard-of-hearing language
39.2accessibility under subdivision 12, add the customization rate provided in subdivision 12
39.3to the result of clause (2). This is defined as the customized direct care rate;
39.4 (4) multiply the number of direct staff hours by the appropriate staff wage in
39.5subdivision 5 or the customized direct care rate;
39.6 (5) multiply the number of direct staff hours by the product of the supervision span
39.7of control ratio in subdivision 5, paragraph (f), clause (1), and the appropriate supervision
39.8wage in subdivision 5, paragraph (a), clause (17);
39.9 (6) combine the results of clauses (4) and (5) and multiply the result by one plus
39.10the employee vacation, sick, and training allowance ratio in, subdivision 5, paragraph (f),
39.11clause (2). This is defined as the direct staffing rate;
39.12 (7) for program plan support, multiply the result of clause (6) by one plus the
39.13program plan support ratio in subdivision 5, paragraph (f), clause (4);
39.14 (8) for employee-related expenses, multiply the result of clause (7) by one plus the
39.15employee-related cost ratio in subdivision 5, paragraph (f), clause (3);
39.16 (9) For client programming and supports, multiply the result of clause (8) by one
39.17plus the client programming and support ratio in subdivision 5, paragraph (f), clause (5);
39.18 (10) this is the subtotal rate;
39.19 (11) sum the standard general and administrative rate, the program-related expense
39.20ratio, and the absence and utilization factor ratio;
39.21 (12) divide the result of clause (10) by one minus the result of clause (11). This is
39.22the total payment amount;
39.23 (13) for respite services, determine the number of daily units of service to meet an
39.25 (14) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
39.26Minnesota-specific rate or rates derived by the commissioner as provided in subdivision 5;
39.27 (15) for a recipient requiring deaf or hard-of-hearing customization under
39.28subdivision 12, add the customization rate provided in subdivision 12 to the result of
39.29clause (14). This is defined as the customized direct care rate;
39.30 (16) multiply the number of direct staff hours by the appropriate staff wage in
39.31subdivision 5, paragraph (a);
39.32 (17) multiply the number of direct staff hours by the product of the supervisory span
39.33of control ratio in subdivision 5, paragraph (g), clause (1), and the appropriate supervision
39.34wage in subdivision 5, paragraph (a), clause (17);
40.1 (18) combine the results of clauses (16) and (17) and multiply the result by one plus
40.2the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (g),
40.3clause (2). This is defined as the direct staffing rate;
40.4 (19) for employee-related expenses, multiply the result of clause (18) by one plus
40.5the employee-related cost ratio in subdivision 5, paragraph (g), clause (3).
40.6 (20) this is the subtotal rate;
40.7 (21) sum the standard general and administrative rate, the program-related expense
40.8ratio, and the absence and utilization factor ratio; and
40.9 (22) divide the result of clause (20) by one minus the result of clause (21). This is
40.10the total payment amount.
40.11 Subd. 10. Updating payment values and additional information. (a) The
40.12commissioner shall develop and implement uniform procedures to refine terms and update
40.13or adjust values used to calculate payment rates in this section. For calendar year 2014,
40.14the commissioner shall use the values, terms, and procedures provided in this section.
40.15 (b) The commissioner shall work with stakeholders to assess efficacy of values
40.16and payment rates. The commissioner shall report back to the legislature with proposed
40.17changes for component values and recommendations for revisions on the schedule
40.18provided in paragraphs (c) and (d).
40.19 (c) The commissioner shall work with stakeholders to continue refining a
40.20subset of component values, which are to be referred to as interim values, and report
40.21recommendations to the legislature by February 15, 2014. Interim component values are:
40.22transportation rates for day training and habilitation; transportation for adult day, structured
40.23day, and prevocational services; geographic difference factor; day program facility rate;
40.24services where monitoring technology replaces staff time; shared services for independent
40.25living skills training; and supported employment and billing for indirect services.
40.26 (d) The commissioner shall report and make recommendations to the legislature on:
40.27February 15, 2015, February 15, 2017, February 15, 2019, and February 15, 2021. After
40.282021, reports shall be provided on a four-year cycle.
40.29 (e) The commissioner shall provide a public notice via list serve in October of each
40.30year beginning October 1, 2014. The notice shall contain information detailing legislatively
40.31approved changes in: calculation values including derived wage rates and related employee
40.32and administrative factors; services utilization; county and tribal allocation changes
40.33and; information on adjustments to be made to calculation values and timing of those
40.34adjustments. Information in this notice shall be effective January 1 of the following year.
41.1 Subd. 11. Payment implementation. Upon implementation of the payment
41.2methodologies under this section, those payment rates supersede rates established in county
41.3contracts for recipients receiving waiver services under sections 256B.092 or 256B.49.
41.4 Subd. 12. Customization of rates for individuals. (a) For persons determined to
41.5have higher needs based on being deaf or hard-of-hearing, the direct care costs must be
41.6increased by an adjustment factor prior to calculating the rate under subdivisions 6, 7, 8,
41.7and 9. The customization rate with respect to deaf or hard-of-hearing persons shall be
41.8$2.50 per hour for waiver recipients who meet the respective criteria as determined by
41.10 (b) For the purposes of this section, "Deaf or Hard of Hearing" means:
41.11 (1)(i) the person has a developmental disability and an assessment score which
41.12indicates a hearing impairment that is severe or that the person has no useful hearing;
41.13 (ii) the person has a developmental disability and an expressive communications
41.14score that indicates the person uses single signs or gestures, uses an augmentative
41.15communication aid, or does not have functional communication, or the person's expressive
41.16communications are unknown; and
41.17 (iii) the person has a developmental disability and a communication score which
41.18indicates the person comprehends signs, gestures, and modeling prompts or does not
41.19comprehend verbal, visual, or gestural communication or that the person's receptive
41.20communications score is unknown; or
41.21 (2)(i) the person receives long-term care services and has an assessment score which
41.22indicates they hear only very loud sounds, have no useful hearing, or a determination
41.23cannot be made; and
41.24 (ii) the person receives long-term care services and has an assessment which
41.25indicates the person communicates needs with sign language, symbol board, written
41.26messages, gestures or an interpreter; communicates with inappropriate content; makes
41.27garbled sounds or displays echolalia; or does not communicate needs.
41.28 Subd. 13. Transportation. The commissioner shall require that the purchase
41.29of transportation services be cost-effective and be limited to market rates where the
41.30transportation mode is generally available and accessible.
41.31 Subd. 14. Exceptions. (a) In a format prescribed by the commissioner, lead
41.32agencies must identify individuals with exceptional needs that cannot be met under the
41.33disability waiver rate system. The commissioner shall use that information to evaluate
41.34and, if necessary, approve an alternative payment rate for those individuals.
41.35 (b) Lead agencies must submit exception requests to the state.
41.36 (c) An application for a rate exception may be submitted for the following criteria:
42.1 (1) an individual has service needs that cannot be met through additional units
42.2of service; or
42.3 (2) an individual's rate determined under subdivisions 6, 7, 8, and 9 results in an
42.4individual being discharged.
42.5 (d) Exception requests must include the following information:
42.6 (1) the service needs required by each individual that are not accounted for in
42.7subdivisions 6, 7, 8, and 9;
42.8 (2) the service rate requested and the difference from the rate determined in
42.9subdivisions 6, 7, 8, and 9;
42.10 (3) a basis for the underlying costs used for the rate exception and any accompanying
42.12 (4) the duration of the rate exception; and
42.13 (5) any contingencies for approval.
42.14 (e) Approved rate exceptions shall be managed within lead agency allocations under
42.15sections 256B.092 and 256B.49.
42.16 (f) Individual disability waiver recipients may request that a lead agency submit an
42.17exception request. A lead agency that denies such a request shall notify the individual
42.18waiver recipient of its decision and the reasons for denying the request in writing no later
42.19than 30 days after the individual's request has been made.
42.20 (g) The commissioner shall determine whether to approve or deny an exception
42.21request no more than 30 days after receiving the request. If the commissioner denies the
42.22request, the commissioner shall notify the lead agency and the individual disability waiver
42.23recipient in writing of the reasons for the denial.
42.24 (h) The individual disability waiver recipient may appeal any denial of an exception
42.25request by either the lead agency or the commissioner, pursuant to sections 256.045 and
42.26256.0451. When the denial of an exception request results in the proposed demission of a
42.27waiver recipient from a residential or day habilitation program, the commissioner shall
42.28issue a temporary stay of demission, when requested by the disability waiver recipient,
42.29consistent with the provisions of section 256.045, subdivisions 4a and 6, paragraph (c).
42.30The temporary stay shall remain in effect until the lead agency can provide an informed
42.31choice of appropriate, alternative services to the disability waiver.
42.32 (i) Providers may petition lead agencies to update values that were entered
42.33incorrectly or erroneously into the rate management system, based on past service level
42.34discussions and determination in subdivision 4, without applying for a rate exception.
42.35 Subd. 15. County or tribal allocations. (a) Upon implementation of the Disability
42.36Waiver Rates Management System on January 1, 2014, the commissioner shall establish
43.1a method of tracking and reporting the fiscal impact of the Disability Waiver Rates
43.2Management System on individual lead agencies.
43.3 (b) Beginning January 1, 2014, and continuing through full implementation on
43.4December 31, 2017, the commissioner shall make annual adjustments to lead agencies'
43.5home and community-based waivered service budget allocations to adjust for rate
43.6differences and the resulting impact on county allocations upon implementation of the
43.7disability waiver rates system.
43.8 Subd. 16. Budget neutrality adjustment. The commissioner shall calculate the
43.9total spending for all home and community-based waiver services under the payments as
43.10defined in subdivisions 6, 7, 8, and 9 for all recipients as of July 1, 2013, and compare it to
43.11spending for services defined for subdivisions 6, 7, 8, and 9 under current law. If spending
43.12for services in one particular subdivision differs, there will be a percentage adjustment
43.13to increase or decrease individual rates for the services defined in each subdivision so
43.14aggregate spending matches projections under current law.
43.15 Subd. 17. Implementation. (a) On January 1, 2014, the commissioner shall fully
43.16implement the calculation of rates for waivered services under sections 256B.092 and
43.17256B.49, without additional legislative approval.
43.18 (b) The commissioner shall phase in the application of rates determined in
43.19subdivisions 6 to 9 for two years.
43.20 (c) The commissioner shall preserve rates in effect on December 31, 2013, for
43.21the two-year period.
43.22 (d) The commissioner shall calculate and measure the difference in cost per
43.23individual using the historical rate and the rates under subdivisions 6 to 9, for all
43.24individuals enrolled as of December 31, 2013. This measurement shall occur statewide,
43.25and for individuals in every county.
43.26 The commissioner shall provide the results of this analysis, by county for calendar
43.27year 2014, to the legislative committees with jurisdiction over health and human services
43.28finance by February 15, 2015.
43.29 (e) The commissioner shall calculate the average rate per unit for each service by
43.30county. For individuals enrolled after January 1, 2014, individuals will receive the higher
43.31of the rate produced under subdivisions 6 to 9, or the by-county average rate.
43.32 (f) On January 1, 2016, the rates determined in subdivisions 6 to 9 shall be applied.
Renumber the sections in sequence and correct the internal references
Amend the title accordingly