1.1.................... moves to amend H.F. No. 1114, the first engrossment, as follows:
1.2Delete everything after the enacting clause and insert:

1.3    "Section 1. Minnesota Statutes 2008, section 245A.11, subdivision 2a, is amended to
1.4read:
1.5    Subd. 2a. Adult foster care license capacity. The commissioner shall issue adult
1.6foster care licenses with a maximum licensed capacity of four beds, including nonstaff
1.7roomers and boarders, except that the commissioner may issue a license with a capacity of
1.8five beds, including roomers and boarders, according to paragraphs (a) to (e).
1.9(a) An adult foster care license holder may have a maximum license capacity of five
1.10if all persons in care are age 55 or over and do not have a serious and persistent mental
1.11illness or a developmental disability.
1.12(b) The commissioner may grant variances to paragraph (a) to allow a foster care
1.13provider with a licensed capacity of five persons to admit an individual under the age of 55
1.14if the variance complies with section 245A.04, subdivision 9, and approval of the variance
1.15is recommended by the county in which the licensed foster care provider is located.
1.16(c) The commissioner may grant variances to paragraph (a) to allow the use of a fifth
1.17bed for emergency crisis services for a person with serious and persistent mental illness
1.18or a developmental disability, regardless of age, if the variance complies with section
1.19245A.04, subdivision 9 , and approval of the variance is recommended by the county in
1.20which the licensed foster care provider is located.
1.21(d) Notwithstanding paragraph (a), If the 2009 legislature adopts a rate reduction
1.22that impacts providers of adult foster care services, the commissioner may issue an adult
1.23foster care license with a capacity of five adults if the fifth bed does not increase the
1.24overall statewide capacity of licensed adult foster care beds in homes that are not the
1.25primary residence of the license holder, over the licensed capacity in such homes on July
1.261, 2009, as identified in a plan submitted to the commissioner by the county, when the
2.1capacity is recommended by the county licensing agency of the county in which the
2.2facility is located and if the recommendation verifies that:
2.3(1) the facility meets the physical environment requirements in the adult foster
2.4care licensing rule;
2.5(2) the five-bed living arrangement is specified for each resident in the resident's:
2.6(i) individualized plan of care;
2.7(ii) individual service plan under section 256B.092, subdivision 1b, if required; or
2.8(iii) individual resident placement agreement under Minnesota Rules, part
2.99555.5105, subpart 19, if required;
2.10(3) the license holder obtains written and signed informed consent from each
2.11resident or resident's legal representative documenting the resident's informed choice to
2.12living in the home and that the resident's refusal to consent would not have resulted in
2.13service termination; and
2.14(4) the facility was licensed for adult foster care before March 1, 2003 2009.
2.15(e) The commissioner shall not issue a new adult foster care license under paragraph
2.16(d) after June 30, 2005 2011. The commissioner shall allow a facility with an adult foster
2.17care license issued under paragraph (d) before June 30, 2005 2011, to continue with a
2.18capacity of five adults if the license holder continues to comply with the requirements in
2.19paragraph (d).

2.20    Sec. 2. Minnesota Statutes 2008, section 256B.092, is amended by adding a
2.21subdivision to read:
2.22    Subd. 5b. Revised per diem based on legislated rate reduction. Notwithstanding
2.23sections 252.28, subdivision 3, paragraph (d), if the 2009 legislature adopts a rate reduction
2.24that impacts payment to providers of adult foster care services, the commissioner may
2.25issue adult foster care licenses that permit a capacity of five adults. The application for a
2.26five-bed license must meet the requirements of section 245A.11, subdivision 2a. Prior to
2.27admission of the fifth recipient of adult foster care services, the county must negotiate a
2.28revised per diem rate for room and board and waiver services that reflects the legislated
2.29rate reduction and results in an overall average per diem reduction for all foster care
2.30recipients in that home. The revised per diem must allow the provider to maintain, as
2.31much as possible, the level of services or enhanced services provided in the residence,
2.32while mitigating the losses of the legislated rate reduction.

2.33    Sec. 3. Minnesota Statutes 2008, section 256B.49, subdivision 17, is amended to read:
2.34    Subd. 17. Cost of services and supports. (a) The commissioner shall ensure
2.35that the average per capita expenditures estimated in any fiscal year for home and
3.1community-based waiver recipients does not exceed the average per capita expenditures
3.2that would have been made to provide institutional services for recipients in the absence
3.3of the waiver.
3.4(b) The commissioner shall implement on January 1, 2002, one or more aggregate,
3.5need-based methods for allocating to local agencies the home and community-based
3.6waivered service resources available to support recipients with disabilities in need of
3.7the level of care provided in a nursing facility or a hospital. The commissioner shall
3.8allocate resources to single counties and county partnerships in a manner that reflects
3.9consideration of:
3.10(1) an incentive-based payment process for achieving outcomes;
3.11(2) the need for a state-level risk pool;
3.12(3) the need for retention of management responsibility at the state agency level; and
3.13(4) a phase-in strategy as appropriate.
3.14(c) Until the allocation methods described in paragraph (b) are implemented, the
3.15annual allowable reimbursement level of home and community-based waiver services
3.16shall be the greater of:
3.17(1) the statewide average payment amount which the recipient is assigned under the
3.18waiver reimbursement system in place on June 30, 2001, modified by the percentage of
3.19any provider rate increase appropriated for home and community-based services; or
3.20(2) an amount approved by the commissioner based on the recipient's extraordinary
3.21needs that cannot be met within the current allowable reimbursement level. The
3.22increased reimbursement level must be necessary to allow the recipient to be discharged
3.23from an institution or to prevent imminent placement in an institution. The additional
3.24reimbursement may be used to secure environmental modifications; assistive technology
3.25and equipment; and increased costs for supervision, training, and support services
3.26necessary to address the recipient's extraordinary needs. The commissioner may approve
3.27an increased reimbursement level for up to one year of the recipient's relocation from an
3.28institution or up to six months of a determination that a current waiver recipient is at
3.29imminent risk of being placed in an institution.
3.30(d) Beginning July 1, 2001, medically necessary private duty nursing services will be
3.31authorized under this section as complex and regular care according to sections 256B.0651
3.32and 256B.0653 to 256B.0656. The rate established by the commissioner for registered
3.33nurse or licensed practical nurse services under any home and community-based waiver as
3.34of January 1, 2001, shall not be reduced.
3.35(e) Notwithstanding sections 252.28, subdivision 3, paragraph (d), if the 2009
3.36legislature adopts a rate reduction that impacts payment to providers of adult foster care
4.1services, the commissioner may issue adult foster care licenses that permit a capacity of
4.2five adults. The application for a five-bed license must meet the requirements of section
4.3245A.11, subdivision 2a. Prior to admission of the fifth recipient of adult foster care
4.4services, the county must negotiate a revised per diem rate for room and board and waiver
4.5services that reflects the legislated rate reduction and results in an overall average per
4.6diem reduction for all foster care recipients in that home. The revised per diem must allow
4.7the provider to maintain, as much as possible, the level of services or enhanced services
4.8provided in the residence, while mitigating the losses of the legislated rate reduction.

4.9    Sec. 4. WAIVER.
4.10By December 1, 2009, the commissioner shall request all federal approvals and
4.11waiver amendments to the disability home and community-based waivers to allow properly
4.12licensed adult foster care homes to provide residential services for up to five individuals.

4.13    Sec. 5. REPEALER.
4.14Minnesota Statutes 2008, section 256B.092, subdivision 5a, is repealed.

4.15    Sec. 6. EFFECTIVE DATE.
4.16Sections 1 to 5 are effective July 1, 2009."
4.17Delete the title and insert:
4.19relating to human services; changing capacity requirements for certain residential
4.20programs; requiring the commissioner to request federal waivers;amending
4.21Minnesota Statutes 2008, sections 245A.11, subdivision 2a; 256B.092, by adding
4.22a subdivision; 256B.49, subdivision 17; repealing Minnesota Statutes 2008,
4.23section 256B.092, subdivision 5a."