Minnesota 2023-2024 Regular Session

Minnesota Senate Bill SF903 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	1.1 A bill for an act
2	2	1.2 relating to human services; establishing care evaluation as a covered medical
3	3	1.3 assistance home care service; modifying medical assistance homemaker rates;
4	4	1.4 requiring a report; amending Minnesota Statutes 2022, sections 256B.0651,
5	5	1.5 subdivisions 1, 2; 256B.0652, subdivision 11; 256B.0653, subdivisions 1, 6, by
6	6	1.6 adding a subdivision; 256B.0654, by adding a subdivision; 256B.4912, by adding
7	7	1.7 a subdivision; 256B.85, subdivision 8; 256S.18, subdivision 1; 256S.2101,
8	8	1.8 subdivision 2, by adding subdivisions; 256S.212, by adding a subdivision.
9	9	1.9BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
10	10	1.10 Section 1. Minnesota Statutes 2022, section 256B.0651, subdivision 1, is amended to read:
11	11	1.11 Subdivision 1.Definitions.(a) For the purposes of sections 256B.0651 to 256B.0654
12	12	1.12and 256B.0659, the terms in paragraphs (b) to (g) this subdivision have the meanings given.
13	13	1.13 (b) "Activities of daily living" has the meaning given in section 256B.0659, subdivision
14	14	1.141, paragraph (b).
15	15	1.15 (c) "Assessment" means a review and evaluation of a recipient's need for home care
16	16	1.16services conducted in person.
17	17	1.17 (d) "Care evaluation" means a face-to-face evaluation of a person to develop, update,
18	18	1.18or review a recipient's plan of care for home care services, except personal care assistance.
19	19	1.19 (e) "Home care services" means medical assistance covered services that are home health
20	20	1.20agency services, including skilled nurse visits; home health aide visits; physical therapy,
21	21	1.21occupational therapy, respiratory therapy, and language-speech pathology therapy; home
22	22	1.22care nursing; and personal care assistance.
23	23	1.23 (e) (f) "Home residence," effective January 1, 2010, means a residence owned or rented
24	24	1.24by the recipient either alone, with roommates of the recipient's choosing, or with an unpaid
25	25	1Section 1.
26	26	23-01028 as introduced01/12/23 REVISOR AGW/AD
27	27	SENATE
28	28	STATE OF MINNESOTA
29	29	S.F. No. 903NINETY-THIRD SESSION
30	30	(SENATE AUTHORS: HOFFMAN, Mann, Abeler, Fateh and Xiong)
31	31	OFFICIAL STATUSD-PGDATE
32	32	Introduction and first reading01/27/2023
33	33	Referred to Human Services 2.1responsible party or legal representative; or a family foster home where the license holder
34	34	2.2lives with the recipient and is not paid to provide home care services for the recipient except
35	35	2.3as allowed under sections 256B.0652, subdivision 10, and 256B.0654, subdivision 4.
36	36	2.4 (f) (g) "Medically necessary" has the meaning given in Minnesota Rules, parts 9505.0170
37	37	2.5to 9505.0475.
38	38	2.6 (g) (h) "Ventilator-dependent" means an individual who receives mechanical ventilation
39	39	2.7for life support at least six hours per day and is expected to be or has been dependent on a
40	40	2.8ventilator for at least 30 consecutive days.
41	41	2.9 Sec. 2. Minnesota Statutes 2022, section 256B.0651, subdivision 2, is amended to read:
42	42	2.10 Subd. 2.Services covered.Home care services covered under this section and sections
43	43	2.11256B.0652 to 256B.0654 and 256B.0659 include:
44	44	2.12 (1) nursing services under sections 256B.0625, subdivision 6a, and 256B.0653;
45	45	2.13 (2) home care nursing services under sections 256B.0625, subdivision 7, and 256B.0654;
46	46	2.14 (3) home health services under sections 256B.0625, subdivision 6a, and 256B.0653;
47	47	2.15 (4) personal care assistance services under sections 256B.0625, subdivision 19a, and
48	48	2.16256B.0659;
49	49	2.17 (5) supervision of personal care assistance services provided by a qualified professional
50	50	2.18under sections 256B.0625, subdivision 19a, and 256B.0659;
51	51	2.19 (6) face-to-face assessments by county public health nurses for personal care assistance
52	52	2.20services under sections 256B.0625, subdivision 19a, and 256B.0659; and
53	53	2.21 (7) service updates and review reviews by county public health nurses of temporary
54	54	2.22increases for personal care assistance services by the county public health nurse for services
55	55	2.23under sections 256B.0625, subdivision 19a, and 256B.0659; and
56	56	2.24 (8) care evaluations under sections 256B.0625, subdivisions 6a and 7; 256B.0653; and
57	57	2.25256B.0654.
58	58	2.26 Sec. 3. Minnesota Statutes 2022, section 256B.0652, subdivision 11, is amended to read:
59	59	2.27 Subd. 11.Limits on services without authorization.During a calendar year a recipient
60	60	2.28may receive the following home care services during a calendar year without authorization:
61	61	2.29 (1) up to two face-to-face assessments to determine a recipient's need for personal care
62	62	2.30assistance services;
63	63	2Sec. 3.
64	64	23-01028 as introduced01/12/23 REVISOR AGW/AD 3.1 (2) one service update done to determine a recipient's need for personal care assistance
65	65	3.2services; and
66	66	3.3 (3) up to nine face-to-face visits that may include only skilled nurse visits or care
67	67	3.4evaluations.
68	68	3.5 Sec. 4. Minnesota Statutes 2022, section 256B.0653, subdivision 1, is amended to read:
69	69	3.6 Subdivision 1.Scope.This section applies to home health agency services including
70	70	3.7home health aide, skilled nursing visits, physical therapy, occupational therapy, respiratory
71	71	3.8therapy, and speech-language pathology therapy, and care evaluations.
72	72	3.9 Sec. 5. Minnesota Statutes 2022, section 256B.0653, subdivision 6, is amended to read:
73	73	3.10 Subd. 6.Noncovered home health agency services.The following are not eligible for
74	74	3.11payment under medical assistance as a home health agency service:
75	75	3.12 (1) telehomecare skilled nurses services that is communication between the home care
76	76	3.13nurse and recipient that consists solely of a telephone conversation, facsimile, electronic
77	77	3.14mail, or a consultation between two health care practitioners;
78	78	3.15 (2) the following skilled nurse visits:
79	79	3.16 (i) for the purpose of monitoring medication compliance with an established medication
80	80	3.17program for a recipient;
81	81	3.18 (ii) administering or assisting with medication administration, including injections,
82	82	3.19prefilling syringes for injections, or oral medication setup of an adult recipient, when, as
83	83	3.20determined and documented by the registered nurse, the need can be met by an available
84	84	3.21pharmacy or the recipient or a family member is physically and mentally able to
85	85	3.22self-administer or prefill a medication;
86	86	3.23 (iii) services done for the sole purpose of supervision of the home health aide or personal
87	87	3.24care assistant;
88	88	3.25 (iv) services done for the sole purpose to train other home health agency workers;
89	89	3.26 (v) services done for the sole purpose of blood samples or lab draw when the recipient
90	90	3.27is able to access these services outside the home; and
91	91	3.28 (vi) Medicare evaluation or administrative nursing visits required by Medicare, except
92	92	3.29as provided in subdivision 9, paragraph (a);
93	93	3Sec. 5.
94	94	23-01028 as introduced01/12/23 REVISOR AGW/AD 4.1 (3) home health aide visits when the following activities are the sole purpose for the
95	95	4.2visit: companionship, socialization, household tasks, transportation, and education;
96	96	4.3 (4) home care therapies provided in other settings such as a clinic or as an inpatient or
97	97	4.4when the recipient can access therapy outside of the recipient's residence; and
98	98	4.5 (5) home health agency services without qualifying documentation of a face-to-face
99	99	4.6encounter as specified in subdivision 7.
100	100	4.7 Sec. 6. Minnesota Statutes 2022, section 256B.0653, is amended by adding a subdivision
101	101	4.8to read:
102	102	4.9 Subd. 9.Care evaluations.(a) Notwithstanding the coverage limitation in subdivision
103	103	4.106, clause (2), item (vi), medical assistance covers care evaluations as a home health service
104	104	4.11under section 256B.0625, subdivision 6a, provided that the recipient's home health services
105	105	4.12are not covered under the Medicare program or any other insurance held by the recipient.
106	106	4.13 (b) The reimbursement rate for care evaluations under this section must equal ... percent
107	107	4.14of the medical assistance reimbursement rate for a skilled nursing visit.
108	108	4.15 (c) Care evaluations under this section must occur during a start-of-care visit, a
109	109	4.16resumption-of-care visit, or a recertification visit. Care evaluations under this section must
110	110	4.17be provided by a registered nurse whenever the recipient's plan of care involves nursing
111	111	4.18tasks or medically oriented tasks requiring skilled nursing visits or home health aide visits.
112	112	4.19If the service recipient's plan of care involves only home care therapy, an appropriate therapist
113	113	4.20may conduct a care evaluation under this section.
114	114	4.21 Sec. 7. Minnesota Statutes 2022, section 256B.0654, is amended by adding a subdivision
115	115	4.22to read:
116	116	4.23 Subd. 6.Care evaluations.(a) Medical assistance covers care evaluations as a home
117	117	4.24care nursing service under section 256B.0625, subdivision 7, provided the recipient's home
118	118	4.25care nursing services are not covered by the Medicare program or any other insurance held
119	119	4.26by the recipient.
120	120	4.27 (b) The reimbursement rate for care evaluations under this section must equal ... percent
121	121	4.28of the medical assistance reimbursement rate for a skilled nursing visit.
122	122	4.29 (c) Care evaluations under this section must occur during a start-of-care visit, a
123	123	4.30resumption-of-care visit, or a recertification visit. Care evaluations under this section must
124	124	4.31be provided by a registered nurse.
125	125	4Sec. 7.
126	126	23-01028 as introduced01/12/23 REVISOR AGW/AD 5.1 Sec. 8. Minnesota Statutes 2022, section 256B.4912, is amended by adding a subdivision
127	127	5.2to read:
128	128	5.3 Subd. 16.Rates established by the commissioner.For homemaker services eligible
129	129	5.4for reimbursement under the developmental disabilities waiver, the brain injury waiver, the
130	130	5.5community alternative care waiver, and the community access for disability inclusion waiver,
131	131	5.6the commissioner must establish rates equal to the rates established under sections 256S.21
132	132	5.7to 256S.215 for the corresponding homemaker services.
133	133	5.8 EFFECTIVE DATE.This section is effective January 1, 2024.
134	134	5.9 Sec. 9. Minnesota Statutes 2022, section 256B.85, subdivision 8, is amended to read:
135	135	5.10 Subd. 8.Determination of CFSS service authorization amount.(a) All community
136	136	5.11first services and supports must be authorized by the commissioner or the commissioner's
137	137	5.12designee before services begin. The authorization for CFSS must be completed as soon as
138	138	5.13possible following an assessment but no later than 40 calendar days from the date of the
139	139	5.14assessment.
140	140	5.15 (b) The amount of CFSS authorized must be based on the participant's home care rating
141	141	5.16described in paragraphs (d) and (e) and any additional service units for which the participant
142	142	5.17qualifies as described in paragraph (f).
143	143	5.18 (c) The home care rating shall be determined by the commissioner or the commissioner's
144	144	5.19designee based on information submitted to the commissioner identifying the following for
145	145	5.20a participant:
146	146	5.21 (1) the total number of dependencies of activities of daily living;
147	147	5.22 (2) the presence of complex health-related needs; and
148	148	5.23 (3) the presence of Level I behavior.
149	149	5.24 (d) The methodology to determine the total service units for CFSS for each home care
150	150	5.25rating is based on the median paid units per day for each home care rating from fiscal year
151	151	5.262007 data for the PCA program.
152	152	5.27 (e) Each home care rating is designated by the letters P through Z and EN and has the
153	153	5.28following base number of service units assigned:
154	154	5.29 (1) P home care rating requires Level I behavior or one to three dependencies in ADLs
155	155	5.30and qualifies the person for five service units;
156	156	5Sec. 9.
157	157	23-01028 as introduced01/12/23 REVISOR AGW/AD 6.1 (2) Q home care rating requires Level I behavior and one to three dependencies in ADLs
158	158	6.2and qualifies the person for six service units;
159	159	6.3 (3) R home care rating requires a complex health-related need and one to three
160	160	6.4dependencies in ADLs and qualifies the person for seven service units;
161	161	6.5 (4) S home care rating requires four to six dependencies in ADLs and qualifies the person
162	162	6.6for ten service units;
163	163	6.7 (5) T home care rating requires four to six dependencies in ADLs and Level I behavior
164	164	6.8and qualifies the person for 11 service units;
165	165	6.9 (6) U home care rating requires four to six dependencies in ADLs and a complex
166	166	6.10health-related need and qualifies the person for 14 service units;
167	167	6.11 (7) V home care rating requires seven to eight dependencies in ADLs and qualifies the
168	168	6.12person for 17 service units;
169	169	6.13 (8) W home care rating requires seven to eight dependencies in ADLs and Level I
170	170	6.14behavior and qualifies the person for 20 service units;
171	171	6.15 (9) Z home care rating requires seven to eight dependencies in ADLs and a complex
172	172	6.16health-related need and qualifies the person for 30 service units; and
173	173	6.17 (10) EN home care rating includes ventilator dependency as defined in section 256B.0651,
174	174	6.18subdivision 1, paragraph (g). A person who meets the definition of ventilator-dependent
175	175	6.19and the EN home care rating and utilize a combination of CFSS and home care nursing
176	176	6.20services is limited to a total of 96 service units per day for those services in combination.
177	177	6.21Additional units may be authorized when a person's assessment indicates a need for two
178	178	6.22staff to perform activities. Additional time is limited to 16 service units per day.
179	179	6.23 (f) Additional service units are provided through the assessment and identification of
180	180	6.24the following:
181	181	6.25 (1) 30 additional minutes per day for a dependency in each critical activity of daily
182	182	6.26living;
183	183	6.27 (2) 30 additional minutes per day for each complex health-related need; and
184	184	6.28 (3) 30 additional minutes per day for each behavior under this clause that requires
185	185	6.29assistance at least four times per week:
186	186	6.30 (i) level I behavior that requires the immediate response of another person;
187	187	6Sec. 9.
188	188	23-01028 as introduced01/12/23 REVISOR AGW/AD 7.1 (ii) increased vulnerability due to cognitive deficits or socially inappropriate behavior;
189	189	7.2or
190	190	7.3 (iii) increased need for assistance for participants who are verbally aggressive or resistive
191	191	7.4to care so that the time needed to perform activities of daily living is increased.
192	192	7.5 (g) The service budget for budget model participants shall be based on:
193	193	7.6 (1) assessed units as determined by the home care rating; and
194	194	7.7 (2) an adjustment needed for administrative expenses.
195	195	7.8 Sec. 10. Minnesota Statutes 2022, section 256S.18, subdivision 1, is amended to read:
196	196	7.9 Subdivision 1.Case mix classifications.(a) The elderly waiver case mix classifications
197	197	7.10A to K shall be the resident classes A to K established under Minnesota Rules, parts
198	198	7.119549.0058 and 9549.0059.
199	199	7.12 (b) A participant assigned to elderly waiver case mix classification A must be reassigned
200	200	7.13to elderly waiver case mix classification L if an assessment or reassessment performed
201	201	7.14under section 256B.0911 determines that the participant has:
202	202	7.15 (1) no dependencies in activities of daily living; or
203	203	7.16 (2) up to two dependencies in bathing, dressing, grooming, walking, or eating when the
204	204	7.17dependency score in eating is three or greater.
205	205	7.18 (c) A participant must be assigned to elderly waiver case mix classification V if the
206	206	7.19participant meets the definition of ventilator-dependent in section 256B.0651, subdivision
207	207	7.201, paragraph (g).
208	208	7.21 Sec. 11. Minnesota Statutes 2022, section 256S.2101, subdivision 2, is amended to read:
209	209	7.22 Subd. 2.Phase-in for elderly waiver rates.Except for home-delivered meals as
210	210	7.23described in section 256S.215, subdivision 15 the services in subdivisions 3 and 4, all rates
211	211	7.24and rate components for elderly waiver, elderly waiver customized living, and elderly waiver
212	212	7.25foster care under this chapter; alternative care under section 256B.0913; and essential
213	213	7.26community supports under section 256B.0922 shall be the sum of 18.8 percent of the rates
214	214	7.27calculated under sections 256S.211 to 256S.215, and 81.2 percent of the rates calculated
215	215	7.28using the rate methodology in effect as of June 30, 2017. The rate for home-delivered meals
216	216	7.29shall be the sum of the service rate in effect as of January 1, 2019, and the increases described
217	217	7.30in section 256S.215, subdivision 15.
218	218	7Sec. 11.
219	219	23-01028 as introduced01/12/23 REVISOR AGW/AD 8.1 Sec. 12. Minnesota Statutes 2022, section 256S.2101, is amended by adding a subdivision
220	220	8.2to read:
221	221	8.3 Subd. 3.Phase-in for home-delivered meals rate.The home-delivered meals rate for
222	222	8.4elderly waiver under this chapter, alternative care under section 256B.0913, and essential
223	223	8.5community supports under section 256B.0922 must be the sum of the service rate in effect
224	224	8.6as of January 1, 2019, and the increases described in section 256S.215, subdivision 15.
225	225	8.7 Sec. 13. Minnesota Statutes 2022, section 256S.2101, is amended by adding a subdivision
226	226	8.8to read:
227	227	8.9 Subd. 4.Service rates exempt from phase-in.Subdivision 2 does not apply to rates
228	228	8.10for homemaker services described in section 256S.215, subdivisions 9 to 11.
229	229	8.11 EFFECTIVE DATE.This section is effective January 1, 2024.
230	230	8.12 Sec. 14. Minnesota Statutes 2022, section 256S.212, is amended by adding a subdivision
231	231	8.13to read:
232	232	8.14 Subd. 1a.Updating base wages.(a) On January 1, 2024, and every two years thereafter,
233	233	8.15the commissioner shall update the base wages for the services listed in paragraph (b) based
234	234	8.16on the most recently available Bureau of Labor Statistics Minneapolis-St. Paul-Bloomington,
235	235	8.17MN-WI MetroSA data.
236	236	8.18 (b) This subdivision applies to:
237	237	8.19 (1) the homemaker services and assistance with personal care base wage under subdivision
238	238	8.208;
239	239	8.21 (2) the homemaker services and cleaning base wage under subdivision 9;
240	240	8.22 (3) the homemaker services and home management base wage under subdivision 10;
241	241	8.23and
242	242	8.24 (4) for the purposes of calculating the registered nurse management and supervision
243	243	8.25factor used to calculate the homemaker services rates under section 256S.215, subdivisions
244	244	8.269 to 11, the registered nurse base wage under subdivision 14.
245	245	8.27 EFFECTIVE DATE.This section is effective January 1, 2024.
246	246	8Sec. 14.
247	247	23-01028 as introduced01/12/23 REVISOR AGW/AD 9.1 Sec. 15. DIRECTION TO COMMISSIONER; CARE COORDINATION
248	248	9.2EXPANSION.
249	249	9.3 Subdivision 1.Identifying billable care coordination activities.The commissioner of
250	250	9.4human services must collaborate with interested stakeholders to identify new or existing
251	251	9.5billable medical assistance services for care coordination activities for medical assistance
252	252	9.6home care services. Care coordination activities may include:
253	253	9.7 (1) managing documentation requirements;
254	254	9.8 (2) supporting transitions in care;
255	255	9.9 (3) managing medication;
256	256	9.10 (4) facilitating and sequencing referrals for behavioral and medical health needs;
257	257	9.11 (5) making community referrals for patient and family education and support; and
258	258	9.12 (6) other administrative activities required to effectively meet a person's individualized
259	259	9.13support needs.
260	260	9.14 Subd. 2.Providing guidance regarding existing billable care coordination
261	261	9.15activities.No later than January 1, 2024, the commissioner must issue guidance to home
262	262	9.16care providers regarding existing billable medical assistance services for care coordination
263	263	9.17activities for medical assistance home care services.
264	264	9.18 Subd. 3.Reporting on potential billable care coordination activities.No later than
265	265	9.19February 1, 2024, the commissioner must provide to the chairs and ranking minority members
266	266	9.20of the legislative committees and divisions with jurisdiction over medical assistance home
267	267	9.21care services a report summarizing any potentially billable medical assistance services for
268	268	9.22care coordination activities for medical assistance home care services identified by the
269	269	9.23commissioner and interested stakeholders under subdivision 1.
270	270	9Sec. 15.
271	271	23-01028 as introduced01/12/23 REVISOR AGW/AD