1.1.................... moves to amend H.F. No. 1020, the delete everything amendment
1.2(H1020DE2-1), as follows:
1.3Page 9, after line 8, insert:

1.4    "Sec. 11. Minnesota Statutes 2010, section 256B.0911, subdivision 3a, is amended to
1.5read:
1.6    Subd. 3a. Assessment and support planning. (a) Persons requesting assessment,
1.7services planning, or other assistance intended to support community-based living,
1.8including persons who need assessment in order to determine waiver or alternative care
1.9program eligibility, must be visited by a long-term care consultation team within 15
1.10calendar days after the date on which an assessment was requested or recommended. After
1.11January 1, 2011, these requirements also apply to personal care assistance services, private
1.12duty nursing, and home health agency services, on timelines established in subdivision 5.
1.13Face-to-face assessments must be conducted according to paragraphs (b) to (i).
1.14    (b) The county may utilize a team of either the social worker or public health nurse,
1.15or both. After January 1, 2011, lead agencies shall use certified assessors to conduct the
1.16assessment in a face-to-face interview. The consultation team members must confer
1.17regarding the most appropriate care for each individual screened or assessed.
1.18    (c) The assessment must be comprehensive and include a person-centered
1.19assessment of the health, psychological, functional, environmental, and social needs of
1.20referred individuals and provide information necessary to develop a support plan that
1.21meets the consumers needs, using an assessment form provided by the commissioner.
1.22    (d) The assessment must be conducted in a face-to-face interview with the person
1.23being assessed and the person's legal representative, as required by legally executed
1.24documents, and other individuals as requested by the person, who can provide information
1.25on the needs, strengths, and preferences of the person necessary to develop a support plan
1.26that ensures the person's health and safety, but who is not a provider of service or has any
1.27financial interest in the provision of services. For persons who are to be assessed for
2.1elderly waiver customized living services under section 256B.0915, with the permission
2.2of the person being assessed or the person's designated or legal representative, the client's
2.3current or proposed provider of services may submit a copy of the provider's nursing
2.4assessment or written report outlining their recommendations regarding the client's care
2.5needs. The person conducting the assessment will notify the provider of the date by which
2.6this information is to be submitted. This information shall be provided to the person
2.7conducting the assessment prior to the assessment.
2.8    (e) The person, or the person's legal representative, must be provided with written
2.9recommendations for community-based services, including consumer-directed options,
2.10or institutional care that include documentation that the most cost-effective alternatives
2.11available were offered to the individual. For purposes of this requirement, "cost-effective
2.12alternatives" means community services and living arrangements that cost the same as or
2.13less than institutional care.
2.14    (f) If the person chooses to use community-based services, the person or the person's
2.15legal representative must be provided with a written community support plan, regardless
2.16of whether the individual is eligible for Minnesota health care programs. A person may
2.17request assistance in identifying community supports without participating in a complete
2.18assessment. Upon a request for assistance identifying community support, the person must
2.19be transferred or referred to the services available under sections 256.975, subdivision 7,
2.20and 256.01, subdivision 24, for telephone assistance and follow up.
2.21    (g) The person has the right to make the final decision between institutional
2.22placement and community placement after the recommendations have been provided,
2.23except as provided in subdivision 4a, paragraph (c).
2.24    (h) The team must give the person receiving assessment or support planning, or
2.25the person's legal representative, materials, and forms supplied by the commissioner
2.26containing the following information:
2.27    (1) the need for and purpose of preadmission screening if the person selects nursing
2.28facility placement;
2.29    (2) the role of the long-term care consultation assessment and support planning in
2.30waiver and alternative care program eligibility determination;
2.31    (3) information about Minnesota health care programs;
2.32    (4) the person's freedom to accept or reject the recommendations of the team;
2.33    (5) the person's right to confidentiality under the Minnesota Government Data
2.34Practices Act, chapter 13;
3.1    (6) the long-term care consultant's decision regarding the person's need for
3.2institutional level of care as determined under criteria established in section 144.0724,
3.3subdivision 11 , or 256B.092; and
3.4    (7) the person's right to appeal the decision regarding the need for nursing facility
3.5level of care or the county's final decisions regarding public programs eligibility according
3.6to section 256.045, subdivision 3.
3.7    (i) Face-to-face assessment completed as part of eligibility determination for
3.8the alternative care, elderly waiver, community alternatives for disabled individuals,
3.9community alternative care, and traumatic brain injury waiver programs under sections
3.10256B.0915 , 256B.0917, and 256B.49 is valid to establish service eligibility for no more
3.11than 60 calendar days after the date of assessment. The effective eligibility start date
3.12for these programs can never be prior to the date of assessment. If an assessment was
3.13completed more than 60 days before the effective waiver or alternative care program
3.14eligibility start date, assessment and support plan information must be updated in a
3.15face-to-face visit and documented in the department's Medicaid Management Information
3.16System (MMIS). The effective date of program eligibility in this case cannot be prior to
3.17the date the updated assessment is completed.

3.18    Sec. 12. Minnesota Statutes 2010, section 256B.0915, subdivision 3e, is amended to
3.19read:
3.20    Subd. 3e. Customized living service rate. (a) Payment for customized living
3.21services shall be a monthly rate authorized by the lead agency within the parameters
3.22established by the commissioner. The payment agreement must delineate the amount of
3.23each component service included in the recipient's customized living service plan. The
3.24lead agency, with input from the provider of customized living services, shall ensure that
3.25there is a documented need within the parameters established by the commissioner for all
3.26component customized living services authorized.
3.27(b) The payment rate must be based on the amount of component services to be
3.28provided utilizing component rates established by the commissioner. Counties and tribes
3.29shall use tools issued by the commissioner to develop and document customized living
3.30service plans and rates.
3.31(c) Component service rates must not exceed payment rates for comparable elderly
3.32waiver or medical assistance services and must reflect economies of scale. Customized
3.33living services must not include rent or raw food costs.
3.34    (d) The individualized monthly authorized payment for the customized living
3.35service plan shall not exceed 50 percent of the greater of either the statewide or any
4.1of the geographic groups' weighted average monthly nursing facility rate of the case
4.2mix resident class to which the elderly waiver eligible client would be assigned under
4.3Minnesota Rules, parts 9549.0050 to 9549.0059, less the maintenance needs allowance
4.4as described in subdivision 1d, paragraph (a), until the July 1 of the state fiscal year in
4.5which the resident assessment system as described in section 256B.438 for nursing
4.6home rate determination is implemented. Effective on July 1 of the state fiscal year in
4.7which the resident assessment system as described in section 256B.438 for nursing
4.8home rate determination is implemented and July 1 of each subsequent state fiscal year,
4.9the individualized monthly authorized payment for the services described in this clause
4.10shall not exceed the limit which was in effect on June 30 of the previous state fiscal year
4.11updated annually based on legislatively adopted changes to all service rate maximums for
4.12home and community-based service providers.
4.13    (e) Customized living services are delivered by a provider licensed by the
4.14Department of Health as a class A or class F home care provider and provided in a
4.15building that is registered as a housing with services establishment under chapter 144D.

4.16    Sec. 13. Minnesota Statutes 2010, section 256B.0915, subdivision 3h, is amended to
4.17read:
4.18    Subd. 3h. Service rate limits; 24-hour customized living services. (a) The
4.19payment rate for 24-hour customized living services is a monthly rate authorized by the
4.20lead agency within the parameters established by the commissioner of human services.
4.21The payment agreement must delineate the amount of each component service included
4.22in each recipient's customized living service plan. The lead agency, with input from
4.23the provider of customized living services, shall ensure that there is a documented need
4.24within the parameters established by the commissioner for all component customized
4.25living services authorized. The lead agency shall not authorize 24-hour customized living
4.26services unless there is a documented need for 24-hour supervision.
4.27(b) For purposes of this section, "24-hour supervision" means that the recipient
4.28requires assistance due to needs related to one or more of the following:
4.29    (1) intermittent assistance with toileting, positioning, or transferring;
4.30    (2) cognitive or behavioral issues;
4.31    (3) a medical condition that requires clinical monitoring; or
4.32    (4) for all new participants enrolled in the program on or after January 1, 2011,
4.33and all other participants at their first reassessment after January 1, 2011, dependency
4.34in at least two of the following activities of daily living as determined by assessment
4.35under section 256B.0911: bathing; dressing; grooming; walking; or eating; and needs
5.1medication management and at least 50 hours of service per month. The lead agency shall
5.2ensure that the frequency and mode of supervision of the recipient and the qualifications
5.3of staff providing supervision are described and meet the needs of the recipient.
5.4(c) The payment rate for 24-hour customized living services must be based on the
5.5amount of component services to be provided utilizing component rates established by the
5.6commissioner. Counties and tribes will use tools issued by the commissioner to develop
5.7and document customized living plans and authorize rates.
5.8(d) Component service rates must not exceed payment rates for comparable elderly
5.9waiver or medical assistance services and must reflect economies of scale.
5.10(e) The individually authorized 24-hour customized living payments, in combination
5.11with the payment for other elderly waiver services, including case management, must not
5.12exceed the recipient's community budget cap specified in subdivision 3a. Customized
5.13living services must not include rent or raw food costs.
5.14(f) The individually authorized 24-hour customized living payment rates shall not
5.15exceed the 95 percentile of statewide monthly authorizations for 24-hour customized
5.16living services in effect and in the Medicaid management information systems on March
5.1731, 2009, for each case mix resident class under Minnesota Rules, parts 9549.0050
5.18to 9549.0059, to which elderly waiver service clients are assigned. When there are
5.19fewer than 50 authorizations in effect in the case mix resident class, the commissioner
5.20shall multiply the calculated service payment rate maximum for the A classification by
5.21the standard weight for that classification under Minnesota Rules, parts 9549.0050 to
5.229549.0059, to determine the applicable payment rate maximum. Service payment rate
5.23maximums shall be updated annually based on legislatively adopted changes to all service
5.24rates for home and community-based service providers.
5.25    (g) Notwithstanding the requirements of paragraphs (d) and (f), the commissioner
5.26may establish alternative payment rate systems for 24-hour customized living services in
5.27housing with services establishments which are freestanding buildings with a capacity of
5.2816 or fewer, by applying a single hourly rate for covered component services provided
5.29in either:
5.30    (1) licensed corporate adult foster homes; or
5.31    (2) specialized dementia care units which meet the requirements of section 144D.065
5.32and in which:
5.33    (i) each resident is offered the option of having their own apartment; or
5.34    (ii) the units are licensed as board and lodge establishments with maximum capacity
5.35of eight residents, and which meet the requirements of Minnesota Rules, part 9555.6205,
5.36subparts 1, 2, 3, and 4, item A.

6.1    Sec. 14. Minnesota Statutes 2010, section 256B.0915, subdivision 6, is amended to
6.2read:
6.3    Subd. 6. Implementation of care plan. Each elderly waiver client, and the
6.4client's provider of services, shall be provided a copy of a written care plan that meets
6.5the requirements outlined in section 256B.0913, subdivision 8. The care plan must be
6.6implemented by the county of service when it is different than the county of financial
6.7responsibility. The county of service administering waivered services must notify the
6.8county of financial responsibility of the approved care plan."
6.9Renumber the sections in sequence and correct the internal references
6.10Amend the title accordingly