1.1.................... moves to amend H.F. No. 3234 as follows:
1.2Delete everything after the enacting clause and insert:


1.5    Section 1. Minnesota Statutes 2009 Supplement, section 144.0724, subdivision 11,
1.6is amended to read:
1.7    Subd. 11. Nursing facility level of care. (a) For purposes of medical assistance
1.8payment of long-term care services, a recipient must be determined, using assessments
1.9defined in subdivision 4, to meet one of the following nursing facility level of care criteria:
1.10(1) the person requires formal clinical monitoring at least once per day;
1.11(1) (2) the person needs the assistance of another person or constant supervision to
1.12begin and complete at least four of the following activities of living: bathing, bed mobility,
1.13dressing, eating, grooming, toileting, transferring, and walking;
1.14(2) (3) the person needs the assistance of another person or constant supervision
1.15to begin and complete toileting, transferring, or positioning and the assistance cannot
1.16be scheduled;
1.17(3) (4) the person has significant difficulty with memory, using information, daily
1.18decision making, or behavioral needs that require intervention;
1.19(4) (5) the person has had a qualifying nursing facility stay of at least 90 days;
1.20(6) the person meets the nursing facility level of care criteria determined 90 days
1.21after admission or on the first quarterly assessment after admission, whichever is later; or
1.22(5) (7) the person is determined to be at risk for nursing facility admission or
1.23readmission through a face-to-face long-term care consultation assessment as specified
1.24in section 256B.0911, subdivision 3a, 3b, or 4d, by a county, tribe, or managed care
1.25organization under contract with the Department of Human Services. The person is
2.1considered at risk under this clause if the person currently lives alone or will live alone
2.2upon discharge and also meets one of the following criteria:
2.3(i) the person has experienced a fall resulting in a fracture;
2.4(ii) the person has been determined to be at risk of maltreatment or neglect,
2.5including self-neglect; or
2.6(iii) the person has a sensory impairment that substantially impacts functional ability
2.7and maintenance of a community residence.
2.8(b) The assessment used to establish medical assistance payment for nursing facility
2.9services must be the most recent assessment performed under subdivision 4, paragraph
2.10(b), that occurred no more than 90 calendar days before the effective date of medical
2.11assistance eligibility for payment of long-term care services. In no case shall medical
2.12assistance payment for long-term care services occur prior to the date of the determination
2.13of nursing facility level of care.
2.14(c) The assessment used to establish medical assistance payment for long-term care
2.15services provided under sections 256B.0915 and 256B.49 and alternative care payment
2.16for services provided under section 256B.0913 must be the most recent face-to-face
2.17assessment performed under section 256B.0911, subdivision 3a, 3b, or 4d, that occurred
2.18no more than 60 calendar days before the effective date of medical assistance eligibility
2.19for payment of long-term care services.

2.20    Sec. 2. Minnesota Statutes 2008, section 245A.03, is amended by adding a subdivision
2.21to read:
2.22    Subd. 9. Permitted services by an individual who is related. Notwithstanding
2.23subdivision 2, paragraph (a), clause (1), and subdivision 7, an individual who is related to a
2.24person receiving supported living services may provide licensed services to that person if:
2.25(1) the person who receives supported living services received these services in a
2.26residential site on July 1, 2005;
2.27(2) the services under clause (1) were provided in a corporate foster care setting for
2.28adults and were funded by the developmental disabilities home and community-based
2.29services waiver defined in section 256B.092;
2.30(3) the individual who is related obtains and maintains both a license under
2.31chapter 245B and an adult foster care license under Minnesota Rules, parts 9555.5105
2.32to 9555.6265; and
2.33(4) the individual who is related is not the guardian of the person receiving supported
2.34living services.
2.35EFFECTIVE DATE.This section is effective the day following final enactment.

3.1    Sec. 3. Minnesota Statutes 2009 Supplement, section 256B.0625, subdivision 19c,
3.2is amended to read:
3.3    Subd. 19c. Personal care. Medical assistance covers personal care assistance
3.4services provided by an individual who is qualified to provide the services according to
3.5subdivision 19a and sections 256B.0651 to 256B.0656, provided in accordance with a
3.6plan, and supervised by a qualified professional.
3.7"Qualified professional" means a mental health professional as defined in section 245.462,
3.8subdivision 18 , or 245.4871, subdivision 27; or a registered nurse as defined in sections
3.9148.171 to 148.285, a licensed social worker as defined in section 148B.21 sections
3.10148D.010 and 148D.055, or a qualified developmental disabilities specialist under section
3.11245B.07, subdivision 4 . The qualified professional shall perform the duties required in
3.12section 256B.0659.

3.13    Sec. 4. Minnesota Statutes 2009 Supplement, section 256B.0651, is amended by
3.14adding a subdivision to read:
3.15    Subd. 17. Recipient protection. (a) Providers of home care services must provide
3.16each recipient with a copy of the home care bill of rights under section 144A.44 at
3.17least 30 days prior to terminating services to a recipient, if the termination results from
3.18provider sanctions under section 256B.064, such as a payment withhold, a suspension of
3.19participation, or a termination of participation. If a home care provider determines it is
3.20unable to continue providing services to a recipient, the provider must notify the recipient,
3.21the recipient's responsible party, and the commissioner 30 days prior to terminating
3.22services to the recipient because of an action under section 256B.064, and must assist the
3.23recipient in transitioning to another home care provider of the recipient's choice.
3.24    (b) In the event of a payment withhold from a home care provider, a suspension
3.25or a termination of participation of a home care provider under section 256B.064, the
3.26commissioner may inform the Office of Ombudsman for Long-Term Care and the lead
3.27agencies for all recipients with active service agreements with the provider. At the
3.28commissioner's request, the lead agencies must contact recipients to ensure that the
3.29recipients are continuing to receive needed care, and that the recipients have been given
3.30free choice of provider if they transfer to another home care provider. In addition, the
3.31commissioner or the commissioner's delegate may directly notify recipients who receive
3.32care from the provider that payments have been withheld or that the provider's participation
3.33in medical assistance has been suspended or terminated, if the commissioner determines
3.34that notification is necessary to protect the welfare of the recipients. For purposes of this
3.35subdivision, "lead agencies" means counties, tribes, and managed care organizations.

4.1    Sec. 5. Minnesota Statutes 2009 Supplement, section 256B.0652, subdivision 6,
4.2is amended to read:
4.3    Subd. 6. Authorization; personal care assistance and qualified professional.
4.4(a) All personal care assistance services, supervision by a qualified professional, and
4.5additional services beyond the limits established in subdivision 11, must be authorized
4.6by the commissioner or the commissioner's designee before services begin except for the
4.7assessments established in subdivision 11 and section 256B.0911. The authorization for
4.8personal care assistance and qualified professional services under section 256B.0659 must
4.9be completed within 30 days after receiving a complete request.
4.10(b) The amount of personal care assistance services authorized must be based
4.11on the recipient's home care rating. The home care rating shall be determined by the
4.12commissioner or the commissioner's designee based on information submitted to the
4.13commissioner identifying the following:
4.14(1) total number of dependencies of activities of daily living as defined in section
4.15256B.0659 ;
4.16(2) number presence of complex health-related needs as defined in section
4.17256B.0659 ; and
4.18(3) number presence of behavior descriptions as defined in section 256B.0659.
4.19(c) The methodology to determine total time for personal care assistance services for
4.20each home care rating is based on the median paid units per day for each home care rating
4.21from fiscal year 2007 data for the personal care assistance program. Each home care rating
4.22has a base level of hours assigned. Additional time is added through the assessment and
4.23identification of the following:
4.24(1) 30 additional minutes per day for a dependency in each critical activity of daily
4.25living as defined in section 256B.0659;
4.26(2) 30 additional minutes per day for each complex health-related function as
4.27defined in section 256B.0659; and
4.28(3) 30 additional minutes per day for each behavior issue as defined in section
4.29256B.0659 .
4.30(d) A limit of 96 units of qualified professional supervision may be authorized for
4.31each recipient receiving personal care assistance services. A request to the commissioner
4.32to exceed this total in a calendar year must be requested by the personal care provider
4.33agency on a form approved by the commissioner.

4.34    Sec. 6. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 10,
4.35is amended to read:
5.1    Subd. 10. Responsible party; duties; delegation. (a) A responsible party shall
5.2enter into a written agreement with a personal care assistance provider agency, on a form
5.3determined by the commissioner, to perform the following duties:
5.4(1) be available while care is provided in a method agreed upon by the individual
5.5or the individual's legal representative and documented in the recipient's personal care
5.6assistance care plan;
5.7(2) monitor personal care assistance services to ensure the recipient's personal care
5.8assistance care plan is being followed; and
5.9(3) review and sign personal care assistance time sheets after services are provided
5.10to provide verification of the personal care assistance services.
5.11Failure to provide the support required by the recipient must result in a referral to the
5.12county common entry point.
5.13(b) Responsible parties who are parents of minors or guardians of minors or
5.14incapacitated persons may delegate the responsibility to another adult who is not the
5.15personal care assistant during a temporary absence of at least 24 hours but not more
5.16than six months. The person delegated as a responsible party must be able to meet the
5.17definition of the responsible party. The responsible party must ensure that the delegate
5.18performs the functions of the responsible party, is identified at the time of the assessment,
5.19and is listed on the personal care assistance care plan. The responsible party must
5.20communicate to the personal care assistance provider agency about the need for a delegate
5.21delegated responsible party, including the name of the delegated responsible party, dates
5.22the delegated responsible party will be living with the recipient, and contact numbers.

5.23    Sec. 7. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 11,
5.24is amended to read:
5.25    Subd. 11. Personal care assistant; requirements. (a) A personal care assistant
5.26must meet the following requirements:
5.27(1) be at least 18 years of age with the exception of persons who are 16 or 17 years
5.28of age with these additional requirements:
5.29(i) supervision by a qualified professional every 60 days; and
5.30(ii) employment by only one personal care assistance provider agency responsible
5.31for compliance with current labor laws;
5.32(2) be employed by a personal care assistance provider agency;
5.33(3) enroll with the department as a personal care assistant after clearing a background
5.34study. Except as provided in subdivision 11a, before a personal care assistant provides
5.35services, the personal care assistance provider agency must initiate a background study on
6.1the personal care assistant under chapter 245C, and the personal care assistance provider
6.2agency must have received a notice from the commissioner that the personal care assistant
6.3is:
6.4(i) not disqualified under section 245C.14; or
6.5(ii) is disqualified, but the personal care assistant has received a set aside of the
6.6disqualification under section 245C.22;
6.7(4) be able to effectively communicate with the recipient and personal care
6.8assistance provider agency;
6.9(5) be able to provide covered personal care assistance services according to the
6.10recipient's personal care assistance care plan, respond appropriately to recipient needs,
6.11and report changes in the recipient's condition to the supervising qualified professional
6.12or physician;
6.13(6) not be a consumer of personal care assistance services;
6.14(7) maintain daily written records including, but not limited to, time sheets under
6.15subdivision 12;
6.16(8) effective January 1, 2010, complete standardized training as determined by the
6.17commissioner before completing enrollment. Personal care assistant training must include
6.18successful completion of the following training components: basic first aid, vulnerable
6.19adult, child maltreatment, OSHA universal precautions, basic roles and responsibilities of
6.20personal care assistants including information about assistance with lifting and transfers
6.21for recipients, emergency preparedness, orientation to positive behavioral practices, fraud
6.22issues, and completion of time sheets. Upon completion of the training components,
6.23the personal care assistant must demonstrate the competency to provide assistance to
6.24recipients;
6.25(9) complete training and orientation on the needs of the recipient within the first
6.26seven days after the services begin; and
6.27(10) be limited to providing and being paid for up to 310 hours per month of personal
6.28care assistance services regardless of the number of recipients being served or the number
6.29of personal care assistance provider agencies enrolled with.
6.30(b) A legal guardian may be a personal care assistant if the guardian is not being paid
6.31for the guardian services and meets the criteria for personal care assistants in paragraph (a).
6.32(c) Effective January 1, 2010, persons who do not qualify as a personal care assistant
6.33include parents and stepparents of minors, spouses, paid legal guardians, family foster
6.34care providers, except as otherwise allowed in section 256B.0625, subdivision 19a, or
6.35staff of a residential setting.
6.36EFFECTIVE DATE.This section is effective retroactively from July 1, 2009.

7.1    Sec. 8. Minnesota Statutes 2009 Supplement, section 256B.0659, is amended by
7.2adding a subdivision to read:
7.3    Subd. 11a. Exception to personal care assistant; requirements. The personal care
7.4assistant for a recipient may be allowed to enroll with a different personal care assistant
7.5provider agency upon initiation of a new background study according to chapter 245C, if
7.6all of the following are met:
7.7(1) the commissioner determines that a change in enrollment or affiliation of the
7.8personal care assistant is needed in order to assure continuity of services and protect the
7.9health and safety of the recipient;
7.10(2) the chosen agency has been continuously enrolled as a personal care assistance
7.11provider agency for at least two years;
7.12(3) the recipient chooses to transfer to the personal care assistance provider agency;
7.13(4) the personal care assistant has been continuously enrolled with the former
7.14personal care assistance provider agency since the last background study was completed;
7.15and
7.16(5) the personal care assistant continues to meet requirements of subdivision 11,
7.17excluding paragraph (a), clause (3).
7.18EFFECTIVE DATE.This section is effective retroactively from July 1, 2009.

7.19    Sec. 9. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 13,
7.20is amended to read:
7.21    Subd. 13. Qualified professional; qualifications. (a) The qualified professional
7.22must be employed by work for a personal care assistance provider agency and meet the
7.23definition under section 256B.0625, subdivision 19c. Before a qualified professional
7.24provides services, the personal care assistance provider agency must initiate a background
7.25study on the qualified professional under chapter 245C, and the personal care assistance
7.26provider agency must have received a notice from the commissioner that the qualified
7.27professional:
7.28    (1) is not disqualified under section 245C.14; or
7.29    (2) is disqualified, but the qualified professional has received a set aside of the
7.30disqualification under section 245C.22.
7.31    (b) The qualified professional shall perform the duties of training, supervision, and
7.32evaluation of the personal care assistance staff and evaluation of the effectiveness of
7.33personal care assistance services. The qualified professional shall:
7.34    (1) develop and monitor with the recipient a personal care assistance care plan based
7.35on the service plan and individualized needs of the recipient;
8.1    (2) develop and monitor with the recipient a monthly plan for the use of personal
8.2care assistance services;
8.3    (3) review documentation of personal care assistance services provided;
8.4    (4) provide training and ensure competency for the personal care assistant in the
8.5individual needs of the recipient; and
8.6    (5) document all training, communication, evaluations, and needed actions to
8.7improve performance of the personal care assistants.
8.8    (c) Effective January 1, 2010, the qualified professional shall complete the provider
8.9training with basic information about the personal care assistance program approved
8.10by the commissioner within six months of the date hired by a personal care assistance
8.11provider agency. Qualified professionals who have completed the required trainings
8.12training as an employee with a worker from a personal care assistance provider agency do
8.13not need to repeat the required trainings training if they are hired by another agency, if
8.14they have completed the training within the last three years.

8.15    Sec. 10. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 21,
8.16is amended to read:
8.17    Subd. 21. Requirements for initial enrollment of personal care assistance
8.18provider agencies. (a) All personal care assistance provider agencies must provide, at the
8.19time of enrollment as a personal care assistance provider agency in a format determined
8.20by the commissioner, information and documentation that includes, but is not limited to,
8.21the following:
8.22(1) the personal care assistance provider agency's current contact information
8.23including address, telephone number, and e-mail address;
8.24(2) proof of surety bond coverage in the amount of $50,000 or ten percent of the
8.25provider's payments from Medicaid in the previous year, whichever is less;
8.26(3) proof of fidelity bond coverage in the amount of $20,000;
8.27(4) proof of workers' compensation insurance coverage;
8.28(5) proof of liability insurance;
8.29(5) (6) a description of the personal care assistance provider agency's organization
8.30identifying the names of all owners, managing employees, staff, board of directors, and
8.31the affiliations of the directors, owners, or staff to other service providers;
8.32(6) (7) a copy of the personal care assistance provider agency's written policies
8.33and procedures including: hiring of employees; training requirements; service delivery;
8.34and employee and consumer safety including process for notification and resolution
9.1of consumer grievances, identification and prevention of communicable diseases, and
9.2employee misconduct;
9.3(7) (8) copies of all other forms the personal care assistance provider agency uses in
9.4the course of daily business including, but not limited to:
9.5(i) a copy of the personal care assistance provider agency's time sheet if the time
9.6sheet varies from the standard time sheet for personal care assistance services approved
9.7by the commissioner, and a letter requesting approval of the personal care assistance
9.8provider agency's nonstandard time sheet;
9.9(ii) the personal care assistance provider agency's template for the personal care
9.10assistance care plan; and
9.11(iii) the personal care assistance provider agency's template for the written
9.12agreement in subdivision 20 for recipients using the personal care assistance choice
9.13option, if applicable;
9.14(8) (9) a list of all trainings training and classes that the personal care assistance
9.15provider agency requires of its staff providing personal care assistance services;
9.16(9) (10) documentation that the personal care assistance provider agency and staff
9.17have successfully completed all the training required by this section;
9.18(10) (11) documentation of the agency's marketing practices;
9.19(11) (12) disclosure of ownership, leasing, or management of all residential
9.20properties that is used or could be used for providing home care services; and
9.21(12) (13) documentation that the agency will use the following percentages of
9.22revenue generated from the medical assistance rate paid for personal care assistance
9.23services for employee personal care assistant wages and benefits: 72.5 percent of revenue
9.24in the personal care assistance choice option and 72.5 percent of revenue from other
9.25personal care assistance providers.
9.26(b) Personal care assistance provider agencies shall provide the information specified
9.27in paragraph (a) to the commissioner at the time the personal care assistance provider
9.28agency enrolls as a vendor or upon request from the commissioner. The commissioner
9.29shall collect the information specified in paragraph (a) from all personal care assistance
9.30providers beginning July 1, 2009.
9.31(c) All personal care assistance provider agencies shall complete mandatory training
9.32as determined by the commissioner before enrollment as a provider. Personal care
9.33assistance provider agencies are required to send all owners, qualified professionals
9.34employed by the agency, and all other managing employees to the initial and subsequent
9.35trainings training. Personal care assistance provider agency billing staff shall complete
9.36training about personal care assistance program financial management. This training is
10.1effective July 1, 2009. Any personal care assistance provider agency enrolled before that
10.2date shall, if it has not already, complete the provider training within 18 months of July 1,
10.32009. Any new owners, new qualified professionals, and new managing employees are
10.4required to complete mandatory training as a requisite of hiring.

10.5    Sec. 11. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 30,
10.6is amended to read:
10.7    Subd. 30. Notice of service changes to recipients. The commissioner must provide:
10.8(1) by October 31, 2009, information to recipients likely to be affected that (i)
10.9describes the changes to the personal care assistance program that may result in the
10.10loss of access to personal care assistance services, and (ii) includes resources to obtain
10.11further information; and
10.12(2) notice of changes in medical assistance home care personal care assistant
10.13services to each affected recipient at least 30 days before the effective date of the change
10.14for changes that occur on or after December 1, 2009, and prior to January 1, 2012.
10.15Effective January 1, 2012, a notice of at least ten days before the effective date of the
10.16change is required.
10.17The notice shall include how to get further information on the changes, how to get help to
10.18obtain other services, a list of community resources, and appeal rights. Notwithstanding
10.19section 256.045, a recipient may request continued services pending appeal within the
10.20time period allowed to request an appeal.

10.21    Sec. 12. Minnesota Statutes 2009 Supplement, section 256B.0911, subdivision 1a,
10.22is amended to read:
10.23    Subd. 1a. Definitions. For purposes of this section, the following definitions apply:
10.24(a) "Long-term care consultation services" means:
10.25(1) assistance in identifying services needed to maintain an individual in the most
10.26inclusive environment;
10.27(2) providing recommendations on cost-effective community services that are
10.28available to the individual;
10.29(3) development of an individual's person-centered community support plan;
10.30(4) providing information regarding eligibility for Minnesota health care programs;
10.31(5) face-to-face long-term care consultation assessments, which may be completed
10.32in a hospital, nursing facility, intermediate care facility for persons with developmental
10.33disabilities (ICF/DDs), regional treatment centers, or the person's current or planned
10.34residence;
11.1(6) federally mandated screening to determine the need for a institutional level of
11.2care under section 256B.0911, subdivision 4, paragraph (a);
11.3(7) determination of home and community-based waiver service eligibility including
11.4level of care determination for individuals who need an institutional level of care as
11.5defined under section 144.0724, subdivision 11, or 256B.092, service eligibility including
11.6state plan home care services identified in section 256B.0625, subdivisions 6, 7, and 19,
11.7paragraphs (a) and (c), and 256B.0657, based on assessment and support plan development
11.8with appropriate referrals, including the option for consumer directed community supports;
11.9(8) providing recommendations for nursing facility placement when there are no
11.10cost-effective community services available; and
11.11(9) assistance to transition people back to community settings after facility
11.12admission.
11.13(b) "Long-term care options counseling" means the services provided by the linkage
11.14lines as mandated by sections 256.01 and 256.975, subdivision 7, and also includes
11.15telephone assistance and follow up once a long-term care consultation assessment has
11.16been completed.
11.17(c) "Minnesota health care programs" means the medical assistance program under
11.18chapter 256B and the alternative care program under section 256B.0913.
11.19(d) "Lead agencies" means counties or a collaboration of counties, tribes, and health
11.20plans administering long-term care consultation assessment and support planning services.

11.21    Sec. 13. Minnesota Statutes 2009 Supplement, section 256B.0911, subdivision 2b,
11.22is amended to read:
11.23    Subd. 2b. Certified assessors. (a) Beginning January 1, 2011, each lead agency
11.24shall use certified assessors who have completed training and the certification processes
11.25determined by the commissioner in subdivision 2c. Certified assessors shall demonstrate
11.26best practices in assessment and support planning including person-centered planning
11.27principals and have a common set of skills that must ensure consistency and equitable
11.28access to services statewide. Assessors must be part of a multidisciplinary team of
11.29professionals that includes public health nurses, social workers, and other professionals
11.30as defined in paragraph (b). For persons with complex health care needs, a public health
11.31nurse or registered nurse from a multidisciplinary team must be consulted. A lead agency
11.32may choose in accordance with departmental policies to contract with a qualified, certified
11.33assessor to conduct assessments and reassessments on behalf of the lead agency.
11.34(b) Certified assessors are persons with a minimum of a bachelor's degree in social
11.35work, nursing with a public health nursing certificate, or other closely related field with at
12.1least one year of home and community-based experience or a two-year registered nursing
12.2degree with at least three years of home and community-based experience that have
12.3received training and certification specific to assessment and consultation for long-term
12.4care services in the state.

12.5    Sec. 14. Minnesota Statutes 2009 Supplement, section 256B.0911, subdivision 3a,
12.6is amended to read:
12.7    Subd. 3a. Assessment and support planning. (a) Persons requesting assessment,
12.8services planning, or other assistance intended to support community-based living,
12.9including persons who need assessment in order to determine waiver or alternative care
12.10program eligibility, must be visited by a long-term care consultation team within 15
12.11calendar days after the date on which an assessment was requested or recommended. After
12.12January 1, 2011, these requirements also apply to personal care assistance services, private
12.13duty nursing, and home health agency services, on timelines established in subdivision 5.
12.14Face-to-face assessments must be conducted according to paragraphs (b) to (i).
12.15    (b) The county may utilize a team of either the social worker or public health nurse,
12.16or both. After January 1, 2011, lead agencies shall use certified assessors to conduct the
12.17assessment in a face-to-face interview. The consultation team members must confer
12.18regarding the most appropriate care for each individual screened or assessed.
12.19    (c) The assessment must be comprehensive and include a person-centered
12.20assessment of the health, psychological, functional, environmental, and social needs of
12.21referred individuals and provide information necessary to develop a support plan that
12.22meets the consumers needs, using an assessment form provided by the commissioner.
12.23    (d) The assessment must be conducted in a face-to-face interview with the person
12.24being assessed and the person's legal representative, as required by legally executed
12.25documents, and other individuals as requested by the person, who can provide information
12.26on the needs, strengths, and preferences of the person necessary to develop a support plan
12.27that ensures the person's health and safety, but who is not a provider of service or has any
12.28financial interest in the provision of services.
12.29    (e) The person, or the person's legal representative, must be provided with written
12.30recommendations for community-based services, including consumer directed options,
12.31or institutional care that include documentation that the most cost-effective alternatives
12.32available were offered to the individual. For purposes of this requirement, "cost-effective
12.33alternatives" means community services and living arrangements that cost the same as or
12.34less than institutional care.
13.1    (f) If the person chooses to use community-based services, the person or the person's
13.2legal representative must be provided with a written community support plan, regardless
13.3of whether the individual is eligible for Minnesota health care programs. A person may
13.4request assistance in identifying community supports without participating in a complete
13.5assessment. Upon a request for assistance identifying community support, the person must
13.6be transferred or referred to the services available under sections 256.975, subdivision 7,
13.7and 256.01, subdivision 24, for telephone assistance and follow up.
13.8    (g) The person has the right to make the final decision between institutional
13.9placement and community placement after the recommendations have been provided,
13.10except as provided in subdivision 4a, paragraph (c).
13.11    (h) The team must give the person receiving assessment or support planning, or
13.12the person's legal representative, materials, and forms supplied by the commissioner
13.13containing the following information:
13.14    (1) the need for and purpose of preadmission screening if the person selects nursing
13.15facility placement;
13.16    (2) the role of the long-term care consultation assessment and support planning in
13.17waiver and alternative care program eligibility determination;
13.18    (3) information about Minnesota health care programs;
13.19    (4) the person's freedom to accept or reject the recommendations of the team;
13.20    (5) the person's right to confidentiality under the Minnesota Government Data
13.21Practices Act, chapter 13;
13.22    (6) the long-term care consultant's decision regarding the person's need for
13.23institutional level of care as determined under criteria established in section 144.0724,
13.24subdivision 11 , or 256B.092; and
13.25    (7) the person's right to appeal the decision regarding the need for nursing facility
13.26level of care or the county's final decisions regarding public programs eligibility according
13.27to section 256.045, subdivision 3.
13.28    (i) Face-to-face assessment completed as part of eligibility determination for
13.29the alternative care, elderly waiver, community alternatives for disabled individuals,
13.30community alternative care, and traumatic brain injury waiver programs under sections
13.31256B.0915 , 256B.0917, and 256B.49 is valid to establish service eligibility for no more
13.32than 60 calendar days after the date of assessment. The effective eligibility start date
13.33for these programs can never be prior to the date of assessment. If an assessment was
13.34completed more than 60 days before the effective waiver or alternative care program
13.35eligibility start date, assessment and support plan information must be updated in a
13.36face-to-face visit and documented in the department's Medicaid Management Information
14.1System (MMIS). The effective date of program eligibility in this case cannot be prior to
14.2the date the updated assessment is completed.

14.3    Sec. 15. Minnesota Statutes 2009 Supplement, section 256B.0911, subdivision 3b,
14.4is amended to read:
14.5    Subd. 3b. Transition assistance. (a) A long-term care consultation team shall
14.6provide assistance to persons residing in a nursing facility, hospital, regional treatment
14.7center, or intermediate care facility for persons with developmental disabilities who
14.8request or are referred for assistance. Transition assistance must include assessment,
14.9community support plan development, referrals to long-term care options counseling
14.10under section 256B.975, subdivision 10, for community support plan implementation
14.11and to Minnesota health care programs, including home and community-based waiver
14.12services and the consumer directed options through the waivers, and referrals to programs
14.13that provide assistance with housing. Transition assistance must also include information
14.14about the Centers for Independent Living and the Senior LinkAge Line, and about other
14.15organizations that can provide assistance with relocation efforts, and information about
14.16contacting these organizations to obtain their assistance and support.
14.17    (b) The county shall develop transition processes with institutional social workers
14.18and discharge planners to ensure that:
14.19    (1) persons admitted to facilities receive information about transition assistance
14.20that is available;
14.21    (2) the assessment is completed for persons within ten working days of the date of
14.22request or recommendation for assessment; and
14.23    (3) there is a plan for transition and follow-up for the individual's return to the
14.24community. The plan must require notification of other local agencies when a person
14.25who may require assistance is screened by one county for admission to a facility located
14.26in another county.
14.27    (c) If a person who is eligible for a Minnesota health care program is admitted to a
14.28nursing facility, the nursing facility must include a consultation team member or the case
14.29manager in the discharge planning process.

14.30    Sec. 16. Minnesota Statutes 2008, section 256B.0911, subdivision 4d, is amended to
14.31read:
14.32    Subd. 4d. Preadmission screening of individuals under 65 years of age. (a)
14.33It is the policy of the state of Minnesota to ensure that individuals with disabilities or
14.34chronic illness are served in the most integrated setting appropriate to their needs and have
15.1the necessary information to make informed choices about home and community-based
15.2service options.
15.3(b) Individuals under 65 years of age who are admitted to a nursing facility from a
15.4hospital must be screened prior to admission as outlined in subdivisions 4a through 4c.
15.5(c) Individuals under 65 years of age who are admitted to nursing facilities with
15.6only a telephone screening must receive a face-to-face assessment from the long-term
15.7care consultation team member of the county in which the facility is located or from the
15.8recipient's county case manager within 40 calendar days of admission.
15.9(d) Individuals under 65 years of age who are admitted to a nursing facility
15.10without preadmission screening according to the exemption described in subdivision 4b,
15.11paragraph (a), clause (3), and who remain in the facility longer than 30 days must receive
15.12a face-to-face assessment within 40 days of admission.
15.13(e) At the face-to-face assessment, the long-term care consultation team member or
15.14county case manager must perform the activities required under subdivision 3b.
15.15(f) For individuals under 21 years of age, a screening interview which recommends
15.16nursing facility admission must be face-to-face and approved by the commissioner before
15.17the individual is admitted to the nursing facility.
15.18(g) In the event that an individual under 65 years of age is admitted to a nursing
15.19facility on an emergency basis, the county must be notified of the admission on the
15.20next working day, and a face-to-face assessment as described in paragraph (c) must be
15.21conducted within 40 calendar days of admission.
15.22(h) At the face-to-face assessment, the long-term care consultation team member or
15.23the case manager must present information about home and community-based options,
15.24including consumer directed options, so the individual can make informed choices. If the
15.25individual chooses home and community-based services, the long-term care consultation
15.26team member or case manager must complete a written relocation plan within 20 working
15.27days of the visit. The plan shall describe the services needed to move out of the facility
15.28and a time line for the move which is designed to ensure a smooth transition to the
15.29individual's home and community.
15.30(i) An individual under 65 years of age residing in a nursing facility shall receive a
15.31face-to-face assessment at least every 12 months to review the person's service choices
15.32and available alternatives unless the individual indicates, in writing, that annual visits are
15.33not desired. In this case, the individual must receive a face-to-face assessment at least
15.34once every 36 months for the same purposes.
16.1(j) Notwithstanding the provisions of subdivision 6, the commissioner may pay
16.2county agencies directly for face-to-face assessments for individuals under 65 years of age
16.3who are being considered for placement or residing in a nursing facility.

16.4    Sec. 17. Minnesota Statutes 2008, section 256B.69, is amended by adding a
16.5subdivision to read:
16.6    Subd. 29. Contract with a housing with services facility. (a) A managed care
16.7plan shall accept, as a provider of customized living services or 24-hour customized
16.8living services under this section and section 256B.0915, a housing with services facility,
16.9without regard to whether the facility meets the physical plant standards of the managed
16.10care plan, if:
16.11(1) the housing with services facility was established through the conversion of an
16.12existing 26-bed nursing facility;
16.13(2) the facility has been awarded a community services development grant under
16.14section 256.9754 to construct a new, replacement housing with services facility on a site
16.15adjacent to the converted facility;
16.16(3) the replacement facility will meet the physical plant standards of the managed
16.17care plan; and
16.18(4) the converted facility will be demolished once the replacement facility is fully
16.19operational.
16.20(b) The managed care plan shall also accept the replacement housing with services
16.21facility as a provider of customized living services or 24-hour customized living services,
16.22as long as all criteria for participation as a plan provider are met.
16.23EFFECTIVE DATE.This section is effective the day following final enactment.

16.24    Sec. 18. Minnesota Statutes 2008, section 626.557, subdivision 9a, is amended to read:
16.25    Subd. 9a. Evaluation and referral of reports made to common entry point unit.
16.26The common entry point must screen the reports of alleged or suspected maltreatment for
16.27immediate risk and make all necessary referrals as follows:
16.28(1) if the common entry point determines that there is an immediate need for
16.29adult protective services, the common entry point agency shall immediately notify the
16.30appropriate county agency;
16.31(2) if the report contains suspected criminal activity against a vulnerable adult, the
16.32common entry point shall immediately notify the appropriate law enforcement agency;
16.33(3) if the report references alleged or suspected maltreatment and there is no
16.34immediate need for adult protective services, the common entry point shall notify refer all
17.1reports of alleged or suspected maltreatment to the appropriate lead agency as soon as
17.2possible, but in any event no longer than two working days; and
17.3(4) if the report does not reference alleged or suspected maltreatment, the common
17.4entry point may determine whether the information will be referred; and
17.5(5) (4) if the report contains information about a suspicious death, the common entry
17.6point shall immediately notify the appropriate law enforcement agencies, the local medical
17.7examiner, and the ombudsman established under section 245.92. Law enforcement
17.8agencies shall coordinate with the local medical examiner and the ombudsman as provided
17.9by law.

17.10    Sec. 19. ELDERLY WAIVER CONVERSION.
17.11Notwithstanding Minnesota Statutes, section 256B.0915, subdivision 3b, a person
17.12age 65 or older with an MT home care rating on January 1, 2010, is eligible for the
17.13elderly waiver program and shall be considered a conversion for purposes of accessing
17.14monthly budget caps equal to no more than their monthly spending under the personal
17.15care assistance program on January 1, 2010.

17.16    Sec. 20. DIRECTION TO COMMISSIONER; CONSULTATION WITH
17.17STAKEHOLDERS.
17.18The commissioner shall consult with stakeholders experienced in using and
17.19providing services through the consumer directed community supports option during
17.20the identification of data to be used in future development of an individualized budget
17.21methodology for the home and community-based waivers under the new comprehensive
17.22assessment.


17.25    Section 1. Minnesota Statutes 2009 Supplement, section 256B.0653, subdivision 3,
17.26is amended to read:
17.27    Subd. 3. Home health aide visits. (a) Home health aide visits must be provided
17.28by a certified home health aide using a written plan of care that is updated in compliance
17.29with Medicare regulations. A home health aide shall provide hands-on personal care,
17.30perform simple procedures as an extension of therapy or nursing services, and assist in
17.31instrumental activities of daily living as defined in section 256B.0659, including ensuring
17.32that the person gets to medical appointments if identified in the written plan of care. Home
17.33health aide visits must be provided in the recipient's home.
18.1(b) All home health aide visits must have authorization under section 256B.0652.
18.2The commissioner shall limit home health aide visits to no more than one visit per day
18.3per recipient.
18.4(c) Home health aides must be supervised by a registered nurse or an appropriate
18.5therapist when providing services that are an extension of therapy.

18.6    Sec. 2. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 1,
18.7is amended to read:
18.8    Subdivision 1. Definitions. (a) For the purposes of this section, the terms defined in
18.9paragraphs (b) to (p) (r) have the meanings given unless otherwise provided in text.
18.10(b) "Activities of daily living" means grooming, dressing, bathing, transferring,
18.11mobility, positioning, eating, and toileting.
18.12(c) "Behavior," effective January 1, 2010, means a category to determine the home
18.13care rating and is based on the criteria found in this section. "Level I behavior" means
18.14physical aggression towards self, others, or destruction of property that requires the
18.15immediate response of another person.
18.16(d) "Complex health-related needs," effective January 1, 2010, means a category to
18.17determine the home care rating and is based on the criteria found in this section.
18.18(e) "Critical activities of daily living," effective January 1, 2010, means transferring,
18.19mobility, eating, and toileting.
18.20(f) "Dependency in activities of daily living" means a person requires assistance to
18.21begin and complete one or more of the activities of daily living.
18.22(g) "Extended personal care assistance service" means personal care assistance
18.23services included in a service plan under one of the home and community-based services
18.24waivers authorized under sections 256B.049, 256B.0915, and 256B.092, subdivision
18.255, which exceed the amount, duration, and frequency of the state plan personal care
18.26assistance services for participants who:
18.27(1) need assistance provided periodically during a week, but less than daily, will
18.28not be able to remain in their home without such assistance, and other replacement
18.29services are more expensive or are not available when personal care assistance services
18.30are to be terminated; or
18.31(2) need additional personal care assistance services beyond the amount authorized
18.32by the state plan personal care assistance assessment in order to assure that their safety,
18.33health, and welfare are provided for in their homes.
19.1(h) "Health-related procedures and tasks" means procedures and tasks that can
19.2be delegated or assigned by a licensed health care professional under state law to be
19.3performed by a personal care assistant.
19.4(h) (i) "Instrumental activities of daily living" means activities to include meal
19.5planning and preparation; basic assistance with paying bills; shopping for food, clothing,
19.6and other essential items; performing household tasks integral to the personal care
19.7assistance services; communication by telephone and other media; and traveling, including
19.8to medical appointments and to participate in the community.
19.9(i) (j) "Managing employee" has the same definition as Code of Federal Regulations,
19.10title 42, section 455.
19.11(j) (k) "Qualified professional" means a professional providing supervision of
19.12personal care assistance services and staff as defined in section 256B.0625, subdivision
19.1319c .
19.14(k) (l) "Personal care assistance provider agency" means a medical assistance
19.15enrolled provider that provides or assists with providing personal care assistance services
19.16and includes a personal care assistance provider organization, personal care assistance
19.17choice agency, class A licensed nursing agency, and Medicare-certified home health
19.18agency.
19.19(l) (m) "Personal care assistant" or "PCA" means an individual employed by a
19.20personal care assistance agency who provides personal care assistance services.
19.21(m) (n) "Personal care assistance care plan" means a written description of personal
19.22care assistance services developed by the personal care assistance provider according
19.23to the service plan.
19.24(n) (o) "Responsible party" means an individual who is capable of providing the
19.25support necessary to assist the recipient to live in the community.
19.26(o) (p) "Self-administered medication" means medication taken orally, by injection
19.27or insertion, or applied topically without the need for assistance.
19.28(p) (q) "Service plan" means a written summary of the assessment and description of
19.29the services needed by the recipient.
19.30(r) "Wages and benefits" means wages and salaries, the employer's share of FICA
19.31taxes, Medicare taxes, state and federal unemployment taxes, workers' compensation,
19.32mileage reimbursement, health and dental insurance, life insurance, disability insurance,
19.33long-term care insurance, uniform allowance, contributions to employee retirement
19.34accounts.

20.1    Sec. 3. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 3,
20.2is amended to read:
20.3    Subd. 3. Noncovered personal care assistance services. (a) Personal care
20.4assistance services are not eligible for medical assistance payment under this section
20.5when provided:
20.6(1) by the recipient's spouse, parent of a recipient under the age of 18, paid legal
20.7guardian, licensed foster provider, except as allowed under section 256B.0651, subdivision
20.810 , or responsible party;
20.9(2) in lieu of other staffing options in a residential or child care setting;
20.10(3) solely as a child care or babysitting service; or
20.11(4) without authorization by the commissioner or the commissioner's designee.
20.12(b) The following personal care services are not eligible for medical assistance
20.13payment under this section when provided in residential settings:
20.14(1) effective January 1, 2010, when the provider of home care services who is not
20.15related by blood, marriage, or adoption owns or otherwise controls the living arrangement,
20.16including licensed or unlicensed services; or
20.17(2) when personal care assistance services are the responsibility of a residential or
20.18program license holder under the terms of a service agreement and administrative rules.
20.19(c) Other specific tasks not covered under paragraph (a) or (b) that are not eligible
20.20for medical assistance reimbursement for personal care assistance services under this
20.21section include:
20.22(1) sterile procedures;
20.23(2) injections of fluids and medications into veins, muscles, or skin;
20.24(3) home maintenance or chore services;
20.25(4) homemaker services not an integral part of assessed personal care assistance
20.26services needed by a recipient;
20.27(5) application of restraints or implementation of procedures under section 245.825;
20.28(6) instrumental activities of daily living for children under the age of 18, except
20.29when immediate attention is needed for health or hygiene reasons integral to the personal
20.30care services or traveling to medical appointments and the need is listed in the service
20.31plan by the assessor; and
20.32(7) assessments for personal care assistance services by personal care assistance
20.33provider agencies or by independently enrolled registered nurses.

20.34    Sec. 4. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 4,
20.35is amended to read:
21.1    Subd. 4. Assessment for personal care assistance services; limitations. (a) An
21.2assessment as defined in subdivision 3a must be completed for personal care assistance
21.3services.
21.4(b) The following limitations apply to the assessment:
21.5(1) a person must be assessed as dependent in an activity of daily living based on the
21.6person's ongoing need, on a daily basis, for:
21.7(i) cuing and constant supervision to complete the task; or
21.8(ii) hands-on assistance to complete the task; and
21.9(2) a child may not be found to be dependent in an activity of daily living if because
21.10of the child's age an adult would either perform the activity for the child or assist the child
21.11with the activity. Assistance needed is the assistance appropriate for a typical child of
21.12the same age.
21.13(c) Assessment for complex health-related needs must meet the criteria in this
21.14paragraph. During the assessment process, a recipient qualifies as having complex
21.15health-related needs if the recipient has one or more of the interventions that are ordered by
21.16a physician, specified in a personal care assistance care plan, and found in the following:
21.17(1) tube feedings requiring:
21.18(i) a gastro/jejunostomy tube; or
21.19(ii) continuous tube feeding lasting longer than 12 hours per day;
21.20(2) wounds described as:
21.21    (i) stage III or stage IV;
21.22    (ii) multiple wounds;
21.23    (iii) requiring sterile or clean dressing changes or a wound vac; or
21.24    (iv) open lesions such as burns, fistulas, tube sites, or ostomy sites that require
21.25specialized care;
21.26    (3) parenteral therapy described as:
21.27    (i) IV therapy more than two times per week lasting longer than four hours for
21.28each treatment; or
21.29    (ii) total parenteral nutrition (TPN) daily;
21.30    (4) respiratory interventions including:
21.31    (i) oxygen required more than eight hours per day;
21.32    (ii) respiratory vest more than one time per day;
21.33    (iii) bronchial drainage treatments more than two times per day;
21.34    (iv) sterile or clean suctioning more than six times per day;
21.35    (v) dependence on another to apply respiratory ventilation augmentation devices
21.36such as BiPAP and CPAP; and
22.1    (vi) ventilator dependence under section 256B.0652;
22.2    (5) insertion and maintenance of catheter including:
22.3(i) sterile catheter changes more than one time per month;
22.4(ii) clean self-catheterization more than six times per day; or
22.5(iii) bladder irrigations;
22.6(6) bowel program more than two times per week requiring more than 30 minutes to
22.7perform each time;
22.8(7) neurological intervention including:
22.9(i) seizures more than two times per week and requiring significant physical
22.10assistance to maintain safety; or
22.11(ii) swallowing disorders diagnosed by a physician and requiring specialized
22.12assistance from another on a daily basis; and
22.13(8) other congenital or acquired diseases creating a need for significantly increased
22.14direct hands-on assistance and interventions in six to eight activities of daily living.
22.15(d) An assessment of behaviors must meet the criteria in this paragraph. A recipient
22.16qualifies as having a need for assistance due to behaviors if the recipient's behavior requires
22.17assistance at least four times per week and shows one or more of the following behaviors:
22.18(1) physical aggression towards self or others, or destruction of property that requires
22.19the immediate response of another person;
22.20(2) increased vulnerability due to cognitive deficits or socially inappropriate
22.21behavior; or
22.22(3) verbally aggressive and resistive to care.

22.23    Sec. 5. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 11,
22.24is amended to read:
22.25    Subd. 11. Personal care assistant; requirements. (a) A personal care assistant
22.26must meet the following requirements:
22.27(1) be at least 18 years of age with the exception of persons who are 16 or 17 years
22.28of age with these additional requirements:
22.29(i) supervision by a qualified professional every 60 days; and
22.30(ii) employment by only one personal care assistance provider agency responsible
22.31for compliance with current labor laws;
22.32(2) be employed by a personal care assistance provider agency;
22.33(3) enroll with the department as a personal care assistant after clearing a background
22.34study. Before a personal care assistant provides services, the personal care assistance
22.35provider agency must initiate a background study on the personal care assistant under
23.1chapter 245C, and the personal care assistance provider agency must have received a
23.2notice from the commissioner that the personal care assistant is:
23.3(i) not disqualified under section 245C.14; or
23.4(ii) is disqualified, but the personal care assistant has received a set aside of the
23.5disqualification under section 245C.22;
23.6(4) be able to effectively communicate with the recipient and personal care
23.7assistance provider agency;
23.8(5) be able to provide covered personal care assistance services according to the
23.9recipient's personal care assistance care plan, respond appropriately to recipient needs,
23.10and report changes in the recipient's condition to the supervising qualified professional
23.11or physician;
23.12(6) not be a consumer of personal care assistance services;
23.13(7) maintain daily written records including, but not limited to, time sheets under
23.14subdivision 12;
23.15(8) effective January 1, 2010, complete standardized training as determined
23.16by the commissioner before completing enrollment. The training must be available
23.17in languages other than English and to those who need accommodations due to
23.18disabilities. Personal care assistant training must include successful completion of the
23.19following training components: basic first aid, vulnerable adult, child maltreatment,
23.20OSHA universal precautions, basic roles and responsibilities of personal care assistants
23.21including information about assistance with lifting and transfers for recipients, emergency
23.22preparedness, orientation to positive behavioral practices, fraud issues, and completion of
23.23time sheets. Upon completion of the training components, the personal care assistant must
23.24demonstrate the competency to provide assistance to recipients;
23.25(9) complete training and orientation on the needs of the recipient within the first
23.26seven days after the services begin; and
23.27(10) be limited to providing and being paid for up to 310 hours per month of personal
23.28care assistance services regardless of the number of recipients being served or the number
23.29of personal care assistance provider agencies enrolled with. The number of hours worked
23.30per day shall not be disallowed by the department unless in violation of the law.
23.31(b) A legal guardian may be a personal care assistant if the guardian is not being paid
23.32for the guardian services and meets the criteria for personal care assistants in paragraph (a).
23.33(c) Effective January 1, 2010, persons who do not qualify as a personal care assistant
23.34include parents and stepparents of minors, spouses, paid legal guardians, family foster
23.35care providers, except as otherwise allowed in section 256B.0625, subdivision 19a, or
23.36staff of a residential setting.

24.1    Sec. 6. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 13,
24.2is amended to read:
24.3    Subd. 13. Qualified professional; qualifications. (a) The qualified professional
24.4must be employed by a personal care assistance provider agency and meet the definition
24.5under section 256B.0625, subdivision 19c. Before a qualified professional provides
24.6services, the personal care assistance provider agency must initiate a background study on
24.7the qualified professional under chapter 245C, and the personal care assistance provider
24.8agency must have received a notice from the commissioner that the qualified professional:
24.9(1) is not disqualified under section 245C.14; or
24.10(2) is disqualified, but the qualified professional has received a set aside of the
24.11disqualification under section 245C.22.
24.12(b) The qualified professional shall perform the duties of training, supervision, and
24.13evaluation of the personal care assistance staff and evaluation of the effectiveness of
24.14personal care assistance services. The qualified professional shall:
24.15(1) develop and monitor with the recipient a personal care assistance care plan based
24.16on the service plan and individualized needs of the recipient;
24.17(2) develop and monitor with the recipient a monthly plan for the use of personal
24.18care assistance services;
24.19(3) review documentation of personal care assistance services provided;
24.20(4) provide training and ensure competency for the personal care assistant in the
24.21individual needs of the recipient; and
24.22(5) document all training, communication, evaluations, and needed actions to
24.23improve performance of the personal care assistants.
24.24(c) Effective January July 1, 2010, the qualified professional shall complete the
24.25provider training with basic information about the personal care assistance program
24.26approved by the commissioner within six months of the date hired by a personal care
24.27assistance provider agency. Qualified professionals who have completed the required
24.28trainings as an employee with a personal care assistance provider agency do not need to
24.29repeat the required trainings if they are hired by another agency, if they have completed the
24.30training within the last three years. The required training shall be available in languages
24.31other than English and to those who need accommodations due to disabilities, online or
24.32by electronic remote connection, and provide for competency testing to demonstrate an
24.33understanding of the content without attending in-person training. A qualified professional
24.34is allowed to be employed and is not subject to the training requirement until the training is
24.35offered online or through remote electronic connection. A qualified professional employed
24.36by a personal care assistance provider agency certified for participation in Medicare as
25.1a home health agency is exempt from the training required in this subdivision. The
25.2commissioner shall assure there is a mechanism in place to verify the identity of persons
25.3completing the competency testing electronically.

25.4    Sec. 7. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 14,
25.5is amended to read:
25.6    Subd. 14. Qualified professional; duties. (a) Effective January 1, 2010, all personal
25.7care assistants must be supervised by a qualified professional.
25.8(b) Through direct training, observation, return demonstrations, and consultation
25.9with the staff and the recipient, the qualified professional must ensure and document
25.10that the personal care assistant is:
25.11(1) capable of providing the required personal care assistance services;
25.12(2) knowledgeable about the plan of personal care assistance services before services
25.13are performed; and
25.14(3) able to identify conditions that should be immediately brought to the attention of
25.15the qualified professional.
25.16(c) The qualified professional shall evaluate the personal care assistant within the first
25.1714 days of starting to provide regularly scheduled services for a recipient except for the
25.18personal care assistance choice option under subdivision 19, paragraph (a), clause (4). For
25.19this initial evaluation, the qualified professional shall evaluate the personal care assistance
25.20services for a recipient through direct observation of a personal care assistant's work.
25.21Subsequent visits to evaluate the personal care assistance services provided to a recipient
25.22do not require direct observation of each personal care assistant's work and shall occur:
25.23(1) at least every 90 days thereafter for the first year of a recipient's services; and
25.24(2) every 120 days after the first year of a recipient's service or whenever needed for
25.25response to a recipient's request for increased supervision of the personal care assistance
25.26staff; and
25.27(3) after the first 180 days of a recipient's service, supervisory visits may alternate
25.28between unscheduled phone or Internet technology and in-person visits, unless the
25.29in-person visits are needed according to the care plan.
25.30(d) Communication with the recipient is a part of the evaluation process of the
25.31personal care assistance staff.
25.32(e) At each supervisory visit, the qualified professional shall evaluate personal care
25.33assistance services including the following information:
25.34(1) satisfaction level of the recipient with personal care assistance services;
25.35(2) review of the month-to-month plan for use of personal care assistance services;
26.1(3) review of documentation of personal care assistance services provided;
26.2(4) whether the personal care assistance services are meeting the goals of the service
26.3as stated in the personal care assistance care plan and service plan;
26.4(5) a written record of the results of the evaluation and actions taken to correct any
26.5deficiencies in the work of a personal care assistant; and
26.6(6) revision of the personal care assistance care plan as necessary in consultation
26.7with the recipient or responsible party, to meet the needs of the recipient.
26.8(f) The qualified professional shall complete the required documentation in the
26.9agency recipient and employee files and the recipient's home, including the following
26.10documentation:
26.11(1) the personal care assistance care plan based on the service plan and individualized
26.12needs of the recipient;
26.13(2) a month-to-month plan for use of personal care assistance services;
26.14(3) changes in need of the recipient requiring a change to the level of service and the
26.15personal care assistance care plan;
26.16(4) evaluation results of supervision visits and identified issues with personal care
26.17assistance staff with actions taken;
26.18(5) all communication with the recipient and personal care assistance staff; and
26.19(6) hands-on training or individualized training for the care of the recipient.
26.20(g) The documentation in paragraph (f) must be done on agency forms.
26.21(h) The services that are not eligible for payment as qualified professional services
26.22include:
26.23(1) direct professional nursing tasks that could be assessed and authorized as skilled
26.24nursing tasks;
26.25(2) supervision of personal care assistance completed by telephone;
26.26(3) agency administrative activities;
26.27(4) training other than the individualized training required to provide care for a
26.28recipient; and
26.29(5) any other activity that is not described in this section.

26.30    Sec. 8. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 18,
26.31is amended to read:
26.32    Subd. 18. Personal care assistance choice option; generally. (a) The
26.33commissioner may allow a recipient of personal care assistance services to use a fiscal
26.34intermediary to assist the recipient in paying and accounting for medically necessary
26.35covered personal care assistance services. Unless otherwise provided in this section, all
27.1other statutory and regulatory provisions relating to personal care assistance services apply
27.2to a recipient using the personal care assistance choice option.
27.3(b) Personal care assistance choice is an option of the personal care assistance
27.4program that allows the recipient who receives personal care assistance services to be
27.5responsible for the hiring, training, scheduling, and firing of personal care assistants
27.6according to the terms of the written agreement with the personal care assistance choice
27.7agency required under subdivision 20, paragraph (a). This program offers greater control
27.8and choice for the recipient in who provides the personal care assistance service and when
27.9the service is scheduled. The recipient or the recipient's responsible party must choose a
27.10personal care assistance choice provider agency as a fiscal intermediary. This personal
27.11care assistance choice provider agency manages payroll, invoices the state, is responsible
27.12for all payroll-related taxes and insurance, and is responsible for providing the consumer
27.13training and support in managing the recipient's personal care assistance services.

27.14    Sec. 9. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 19,
27.15is amended to read:
27.16    Subd. 19. Personal care assistance choice option; qualifications; duties. (a)
27.17Under personal care assistance choice, the recipient or responsible party shall:
27.18(1) recruit, hire, schedule, and terminate personal care assistants and a qualified
27.19professional according to the terms of the written agreement required under subdivision
27.2020, paragraph (a);
27.21(2) develop a personal care assistance care plan based on the assessed needs
27.22and addressing the health and safety of the recipient with the assistance of a qualified
27.23professional as needed;
27.24(3) orient and train the personal care assistant with assistance as needed from the
27.25qualified professional;
27.26(4) effective January 1, 2010, supervise and evaluate the personal care assistant with
27.27the qualified professional, who is required to visit the recipient at least every 180 days;
27.28(5) monitor and verify in writing and report to the personal care assistance choice
27.29agency the number of hours worked by the personal care assistant and the qualified
27.30professional;
27.31(6) engage in an annual face-to-face reassessment to determine continuing eligibility
27.32and service authorization; and
27.33(7) use the same personal care assistance choice provider agency if shared personal
27.34assistance care is being used.
27.35(b) The personal care assistance choice provider agency shall:
28.1(1) meet all personal care assistance provider agency standards;
28.2(2) enter into a written agreement with the recipient, responsible party, and personal
28.3care assistants;
28.4(3) not be related as a parent, child, sibling, or spouse to the recipient, qualified
28.5professional, or the personal care assistant; and
28.6(4) ensure arm's-length transactions without undue influence or coercion with the
28.7recipient and personal care assistant.
28.8(c) The duties of the personal care assistance choice provider agency are to:
28.9(1) be the employer of the personal care assistant and the qualified professional for
28.10employment law and related regulations including, but not limited to, purchasing and
28.11maintaining workers' compensation, unemployment insurance, surety and fidelity bonds,
28.12and liability insurance, and submit any or all necessary documentation including, but not
28.13limited to, workers' compensation and unemployment insurance;
28.14(2) bill the medical assistance program for personal care assistance services and
28.15qualified professional services;
28.16(3) request and complete background studies that comply with the requirements for
28.17personal care assistants and qualified professionals;
28.18(4) pay the personal care assistant and qualified professional based on actual hours
28.19of services provided;
28.20(5) withhold and pay all applicable federal and state taxes;
28.21(6) verify and keep records of hours worked by the personal care assistant and
28.22qualified professional;
28.23(7) make the arrangements and pay taxes and other benefits, if any, and comply with
28.24any legal requirements for a Minnesota employer;
28.25(8) enroll in the medical assistance program as a personal care assistance choice
28.26agency; and
28.27(9) enter into a written agreement as specified in subdivision 20 before services
28.28are provided.

28.29    Sec. 10. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 20,
28.30is amended to read:
28.31    Subd. 20. Personal care assistance choice option; administration. (a) Before
28.32services commence under the personal care assistance choice option, and annually
28.33thereafter, the personal care assistance choice provider agency, recipient, or responsible
28.34party, each personal care assistant, and the qualified professional and the recipient or
28.35responsible party shall enter into a written agreement. The annual agreement must be
29.1provided to the recipient or responsible party, each personal care assistant, and the
29.2qualified professional when completed, and include at a minimum:
29.3(1) duties of the recipient, qualified professional, personal care assistant, and
29.4personal care assistance choice provider agency;
29.5(2) salary and benefits for the personal care assistant and the qualified professional;
29.6(3) administrative fee of the personal care assistance choice provider agency and
29.7services paid for with that fee, including background study fees;
29.8(4) grievance procedures to respond to complaints;
29.9(5) procedures for hiring and terminating the personal care assistant; and
29.10(6) documentation requirements including, but not limited to, time sheets, activity
29.11records, and the personal care assistance care plan.
29.12(b) Effective January 1, 2010, except for the administrative fee of the personal care
29.13assistance choice provider agency as reported on the written agreement, the remainder
29.14of the rates paid to the personal care assistance choice provider agency must be used to
29.15pay for the salary and benefits for the personal care assistant or the qualified professional.
29.16The provider agency must use a minimum of 72.5 percent of the revenue generated by
29.17the medical assistance rate for personal care assistance services for employee personal
29.18care assistant wages and benefits.
29.19(c) The commissioner shall deny, revoke, or suspend the authorization to use the
29.20personal care assistance choice option if:
29.21(1) it has been determined by the qualified professional or public health nurse that
29.22the use of this option jeopardizes the recipient's health and safety;
29.23(2) the parties have failed to comply with the written agreement specified in this
29.24subdivision;
29.25(3) the use of the option has led to abusive or fraudulent billing for personal care
29.26assistance services; or
29.27(4) the department terminates the personal care assistance choice option.
29.28(d) The recipient or responsible party may appeal the commissioner's decision in
29.29paragraph (c) according to section 256.045. The denial, revocation, or suspension to
29.30use the personal care assistance choice option must not affect the recipient's authorized
29.31level of personal care assistance services.

29.32    Sec. 11. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 21,
29.33is amended to read:
29.34    Subd. 21. Requirements for initial enrollment of personal care assistance
29.35provider agencies. (a) All personal care assistance provider agencies must provide, at the
30.1time of enrollment as a personal care assistance provider agency in a format determined
30.2by the commissioner, information and documentation that includes, but is not limited to,
30.3the following:
30.4(1) the personal care assistance provider agency's current contact information
30.5including address, telephone number, and e-mail address;
30.6(2) proof of surety bond coverage in the amount of $50,000 or ten percent of the
30.7provider's payments from Medicaid in the previous year, whichever is less;
30.8(3) proof of fidelity bond coverage in the amount of $20,000;
30.9(4) proof of workers' compensation insurance coverage;
30.10(5) a description of the personal care assistance provider agency's organization
30.11identifying the names of all owners, managing employees, staff, board of directors, and
30.12the affiliations of the directors, owners, or staff to other service providers;
30.13(6) a copy of the personal care assistance provider agency's written policies and
30.14procedures including: hiring of employees; training requirements; service delivery;
30.15and employee and consumer safety including process for notification and resolution
30.16of consumer grievances, identification and prevention of communicable diseases, and
30.17employee misconduct;
30.18(7) copies of all other forms the personal care assistance provider agency uses in
30.19the course of daily business including, but not limited to:
30.20(i) a copy of the personal care assistance provider agency's time sheet if the time
30.21sheet varies from the standard time sheet for personal care assistance services approved
30.22by the commissioner, and a letter requesting approval of the personal care assistance
30.23provider agency's nonstandard time sheet;
30.24(ii) the personal care assistance provider agency's template for the personal care
30.25assistance care plan; and
30.26(iii) the personal care assistance provider agency's template for the written
30.27agreement in subdivision 20 for recipients using the personal care assistance choice
30.28option, if applicable;
30.29(8) a list of all trainings and classes that the personal care assistance provider agency
30.30requires of its staff providing personal care assistance services;
30.31(9) documentation that the personal care assistance provider agency and staff have
30.32successfully completed all the training required by this section;
30.33(10) documentation of the agency's marketing practices;
30.34(11) disclosure of ownership, leasing, or management of all residential properties
30.35that is used or could be used for providing home care services; and
31.1(12) documentation that the agency will use the following percentages of revenue
31.2generated from the medical assistance rate paid for personal care assistance services
31.3for employee personal care assistant wages and benefits: 72.5 percent of revenue in the
31.4personal care assistance choice option and 72.5 percent of revenue from other personal
31.5care assistance providers; and
31.6(13) documentation that the agency does not burden recipients' free exercise of their
31.7right to choose service providers by requiring personal care assistants to sign an agreement
31.8not to work with any particular PCA recipient or for another personal care assistance
31.9provider agency after leaving the agency.
31.10(b) Personal care assistance provider agencies shall provide the information specified
31.11in paragraph (a) to the commissioner at the time the personal care assistance provider
31.12agency enrolls as a vendor or upon request from the commissioner. The commissioner
31.13shall collect the information specified in paragraph (a) from all personal care assistance
31.14providers beginning July 1, 2009.
31.15(c) All personal care assistance provider agencies shall require all employees in
31.16management and supervisory positions and owners of the agency who are active in the
31.17day-to-day management and operations of the agency to complete mandatory training as
31.18determined by the commissioner before enrollment of the agency as a provider. Personal
31.19care assistance provider agencies are required to send all owners, qualified professionals
31.20employed by the agency, and all other managing employees to the initial and subsequent
31.21trainings. Employees in management and supervisory positions and owners who are
31.22active in the day-to-day operations of an agency who have completed the required training
31.23as an employee with a personal care assistance provider agency do not need to repeat
31.24the required training if they are hired by another agency, if they have completed the
31.25training within the past three years. By September 1, 2010, the required training must be
31.26available in languages other than English and to those who need accommodations due
31.27to disabilities, online or by electronic remote connection, and provide for competency
31.28testing. Personal care assistance provider agency billing staff shall complete training
31.29about personal care assistance program financial management. This training is effective
31.30July 1, 2009. Any personal care assistance provider agency enrolled before that date
31.31shall, if it has not already, complete the provider training within 18 months of July 1,
31.322009. Any new owners, new qualified professionals, and new managing or employees in
31.33management and supervisory positions involved in the day-to-day operations are required
31.34to complete mandatory training as a requisite of hiring working for the agency. Personal
31.35care assistance provider agencies certified for participation in Medicare as home health
31.36agencies are exempt from the training required in this subdivision.

32.1    Sec. 12. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 27,
32.2is amended to read:
32.3    Subd. 27. Personal care assistance provider agency; ventilator training. (a) The
32.4personal care assistance provider agency is required to provide training for the personal
32.5care assistant responsible for working with a recipient who is ventilator dependent. All
32.6training must be administered by a respiratory therapist, nurse, or physician. Qualified
32.7professional supervision by a nurse must be completed and documented on file in the
32.8personal care assistant's employment record and the recipient's health record. If offering
32.9personal care services to a ventilator-dependent recipient, the personal care assistance
32.10provider agency shall demonstrate and document the ability to:
32.11(1) train the personal care assistant;
32.12(2) supervise the personal care assistant in ventilator operation and maintenance the
32.13care of a ventilator-dependent recipient; and
32.14(3) supervise the recipient and responsible party in ventilator operation and
32.15maintenance the care of a ventilator-dependent recipient; and
32.16(4) provide documentation of training and supervision in clauses (1) to (3) upon
32.17request.
32.18(b) A personal care assistant shall not undertake any clinical services, patient
32.19assessment, patient evaluation, or clinical education regarding the ventilator or the patient
32.20on the ventilator. These services may only be provided by health care professionals
32.21licensed or registered in this state.
32.22(c) A personal care assistant may only perform tasks associated with ventilator
32.23maintenance that are approved by the Board of Medical Practice in consultation with the
32.24Respiratory Care Practitioner Advisory Council and the Department of Human Services.
32.25(d) Personal care assistance provider agencies certified for participation in
32.26Medicare as home health agencies are exempt from providing the training required
32.27in this subdivision.

32.28    Sec. 13. Minnesota Statutes 2009 Supplement, section 256B.0659, subdivision 30,
32.29is amended to read:
32.30    Subd. 30. Notice of service changes to recipients. The commissioner must provide:
32.31(1) by October 31, 2009, information to recipients likely to be affected that (i)
32.32describes the changes to the personal care assistance program that may result in the
32.33loss of access to personal care assistance services, and (ii) includes resources to obtain
32.34further information; and
33.1(2) notice of changes in medical assistance home care services to each affected
33.2recipient at least 30 days before the effective date of the change.
33.3The notice shall include how to get further information on the changes, how to get help to
33.4obtain other services, a list of community resources, and appeal rights. Notwithstanding
33.5section 256.045, a recipient may request continued services pending appeal within the
33.6time period allowed to request an appeal; and
33.7(3) a service agreement authorizing personal care assistance hours of service at
33.8the previously authorized level, throughout the appeal process period, when a recipient
33.9requests services pending an appeal."
33.10Amend the title accordingly