1.1 A bill for an act
1.2 relating to human services; establishing care evaluation as a covered medical
1.3 assistance home care service; modifying medical assistance homemaker rates;
1.4 requiring a report; amending Minnesota Statutes 2022, sections 256B.0651,
1.5 subdivisions 1, 2; 256B.0652, subdivision 11; 256B.0653, subdivisions 1, 6, by
1.6 adding a subdivision; 256B.0654, by adding a subdivision; 256B.4912, by adding
1.7 a subdivision; 256B.85, subdivision 8; 256S.18, subdivision 1; 256S.2101,
1.8 subdivision 2, by adding subdivisions; 256S.212, by adding a subdivision.
1.9BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.10 Section 1. Minnesota Statutes 2022, section 256B.0651, subdivision 1, is amended to read:
1.11 Subdivision 1.Definitions.(a) For the purposes of sections 256B.0651 to 256B.0654
1.12and 256B.0659, the terms in paragraphs (b) to (g) this subdivision have the meanings given.
1.13 (b) "Activities of daily living" has the meaning given in section 256B.0659, subdivision
1.141, paragraph (b).
1.15 (c) "Assessment" means a review and evaluation of a recipient's need for home care
1.16services conducted in person.
1.17 (d) "Care evaluation" means a face-to-face evaluation of a person to develop, update,
1.18or review a recipient's plan of care for home care services, except personal care assistance.
1.19 (e) "Home care services" means medical assistance covered services that are home health
1.20agency services, including skilled nurse visits; home health aide visits; physical therapy,
1.21occupational therapy, respiratory therapy, and language-speech pathology therapy; home
1.22care nursing; and personal care assistance.
1.23 (e) (f) "Home residence," effective January 1, 2010, means a residence owned or rented
1.24by the recipient either alone, with roommates of the recipient's choosing, or with an unpaid
1Section 1.
23-01028 as introduced01/12/23 REVISOR AGW/AD
SENATE
STATE OF MINNESOTA
S.F. No. 903NINETY-THIRD SESSION
(SENATE AUTHORS: HOFFMAN, Mann, Abeler, Fateh and Xiong)
OFFICIAL STATUSD-PGDATE
Introduction and first reading01/27/2023
Referred to Human Services 2.1responsible party or legal representative; or a family foster home where the license holder
2.2lives with the recipient and is not paid to provide home care services for the recipient except
2.3as allowed under sections 256B.0652, subdivision 10, and 256B.0654, subdivision 4.
2.4 (f) (g) "Medically necessary" has the meaning given in Minnesota Rules, parts 9505.0170
2.5to 9505.0475.
2.6 (g) (h) "Ventilator-dependent" means an individual who receives mechanical ventilation
2.7for life support at least six hours per day and is expected to be or has been dependent on a
2.8ventilator for at least 30 consecutive days.
2.9 Sec. 2. Minnesota Statutes 2022, section 256B.0651, subdivision 2, is amended to read:
2.10 Subd. 2.Services covered.Home care services covered under this section and sections
2.11256B.0652 to 256B.0654 and 256B.0659 include:
2.12 (1) nursing services under sections 256B.0625, subdivision 6a, and 256B.0653;
2.13 (2) home care nursing services under sections 256B.0625, subdivision 7, and 256B.0654;
2.14 (3) home health services under sections 256B.0625, subdivision 6a, and 256B.0653;
2.15 (4) personal care assistance services under sections 256B.0625, subdivision 19a, and
2.16256B.0659;
2.17 (5) supervision of personal care assistance services provided by a qualified professional
2.18under sections 256B.0625, subdivision 19a, and 256B.0659;
2.19 (6) face-to-face assessments by county public health nurses for personal care assistance
2.20services under sections 256B.0625, subdivision 19a, and 256B.0659; and
2.21 (7) service updates and review reviews by county public health nurses of temporary
2.22increases for personal care assistance services by the county public health nurse for services
2.23under sections 256B.0625, subdivision 19a, and 256B.0659; and
2.24 (8) care evaluations under sections 256B.0625, subdivisions 6a and 7; 256B.0653; and
2.25256B.0654.
2.26 Sec. 3. Minnesota Statutes 2022, section 256B.0652, subdivision 11, is amended to read:
2.27 Subd. 11.Limits on services without authorization.During a calendar year a recipient
2.28may receive the following home care services during a calendar year without authorization:
2.29 (1) up to two face-to-face assessments to determine a recipient's need for personal care
2.30assistance services;
2Sec. 3.
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
3.2services; and
3.3 (3) up to nine face-to-face visits that may include only skilled nurse visits or care
3.4evaluations.
3.5 Sec. 4. Minnesota Statutes 2022, section 256B.0653, subdivision 1, is amended to read:
3.6 Subdivision 1.Scope.This section applies to home health agency services including
3.7home health aide, skilled nursing visits, physical therapy, occupational therapy, respiratory
3.8therapy, and speech-language pathology therapy, and care evaluations.
3.9 Sec. 5. Minnesota Statutes 2022, section 256B.0653, subdivision 6, is amended to read:
3.10 Subd. 6.Noncovered home health agency services.The following are not eligible for
3.11payment under medical assistance as a home health agency service:
3.12 (1) telehomecare skilled nurses services that is communication between the home care
3.13nurse and recipient that consists solely of a telephone conversation, facsimile, electronic
3.14mail, or a consultation between two health care practitioners;
3.15 (2) the following skilled nurse visits:
3.16 (i) for the purpose of monitoring medication compliance with an established medication
3.17program for a recipient;
3.18 (ii) administering or assisting with medication administration, including injections,
3.19prefilling syringes for injections, or oral medication setup of an adult recipient, when, as
3.20determined and documented by the registered nurse, the need can be met by an available
3.21pharmacy or the recipient or a family member is physically and mentally able to
3.22self-administer or prefill a medication;
3.23 (iii) services done for the sole purpose of supervision of the home health aide or personal
3.24care assistant;
3.25 (iv) services done for the sole purpose to train other home health agency workers;
3.26 (v) services done for the sole purpose of blood samples or lab draw when the recipient
3.27is able to access these services outside the home; and
3.28 (vi) Medicare evaluation or administrative nursing visits required by Medicare, except
3.29as provided in subdivision 9, paragraph (a);
3Sec. 5.
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
4.2visit: companionship, socialization, household tasks, transportation, and education;
4.3 (4) home care therapies provided in other settings such as a clinic or as an inpatient or
4.4when the recipient can access therapy outside of the recipient's residence; and
4.5 (5) home health agency services without qualifying documentation of a face-to-face
4.6encounter as specified in subdivision 7.
4.7 Sec. 6. Minnesota Statutes 2022, section 256B.0653, is amended by adding a subdivision
4.8to read:
4.9 Subd. 9.Care evaluations.(a) Notwithstanding the coverage limitation in subdivision
4.106, clause (2), item (vi), medical assistance covers care evaluations as a home health service
4.11under section 256B.0625, subdivision 6a, provided that the recipient's home health services
4.12are not covered under the Medicare program or any other insurance held by the recipient.
4.13 (b) The reimbursement rate for care evaluations under this section must equal ... percent
4.14of the medical assistance reimbursement rate for a skilled nursing visit.
4.15 (c) Care evaluations under this section must occur during a start-of-care visit, a
4.16resumption-of-care visit, or a recertification visit. Care evaluations under this section must
4.17be provided by a registered nurse whenever the recipient's plan of care involves nursing
4.18tasks or medically oriented tasks requiring skilled nursing visits or home health aide visits.
4.19If the service recipient's plan of care involves only home care therapy, an appropriate therapist
4.20may conduct a care evaluation under this section.
4.21 Sec. 7. Minnesota Statutes 2022, section 256B.0654, is amended by adding a subdivision
4.22to read:
4.23 Subd. 6.Care evaluations.(a) Medical assistance covers care evaluations as a home
4.24care nursing service under section 256B.0625, subdivision 7, provided the recipient's home
4.25care nursing services are not covered by the Medicare program or any other insurance held
4.26by the recipient.
4.27 (b) The reimbursement rate for care evaluations under this section must equal ... percent
4.28of the medical assistance reimbursement rate for a skilled nursing visit.
4.29 (c) Care evaluations under this section must occur during a start-of-care visit, a
4.30resumption-of-care visit, or a recertification visit. Care evaluations under this section must
4.31be provided by a registered nurse.
4Sec. 7.
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
5.2to read:
5.3 Subd. 16.Rates established by the commissioner.For homemaker services eligible
5.4for reimbursement under the developmental disabilities waiver, the brain injury waiver, the
5.5community alternative care waiver, and the community access for disability inclusion waiver,
5.6the commissioner must establish rates equal to the rates established under sections 256S.21
5.7to 256S.215 for the corresponding homemaker services.
5.8 EFFECTIVE DATE.This section is effective January 1, 2024.
5.9 Sec. 9. Minnesota Statutes 2022, section 256B.85, subdivision 8, is amended to read:
5.10 Subd. 8.Determination of CFSS service authorization amount.(a) All community
5.11first services and supports must be authorized by the commissioner or the commissioner's
5.12designee before services begin. The authorization for CFSS must be completed as soon as
5.13possible following an assessment but no later than 40 calendar days from the date of the
5.14assessment.
5.15 (b) The amount of CFSS authorized must be based on the participant's home care rating
5.16described in paragraphs (d) and (e) and any additional service units for which the participant
5.17qualifies as described in paragraph (f).
5.18 (c) The home care rating shall be determined by the commissioner or the commissioner's
5.19designee based on information submitted to the commissioner identifying the following for
5.20a participant:
5.21 (1) the total number of dependencies of activities of daily living;
5.22 (2) the presence of complex health-related needs; and
5.23 (3) the presence of Level I behavior.
5.24 (d) The methodology to determine the total service units for CFSS for each home care
5.25rating is based on the median paid units per day for each home care rating from fiscal year
5.262007 data for the PCA program.
5.27 (e) Each home care rating is designated by the letters P through Z and EN and has the
5.28following base number of service units assigned:
5.29 (1) P home care rating requires Level I behavior or one to three dependencies in ADLs
5.30and qualifies the person for five service units;
5Sec. 9.
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
6.2and qualifies the person for six service units;
6.3 (3) R home care rating requires a complex health-related need and one to three
6.4dependencies in ADLs and qualifies the person for seven service units;
6.5 (4) S home care rating requires four to six dependencies in ADLs and qualifies the person
6.6for ten service units;
6.7 (5) T home care rating requires four to six dependencies in ADLs and Level I behavior
6.8and qualifies the person for 11 service units;
6.9 (6) U home care rating requires four to six dependencies in ADLs and a complex
6.10health-related need and qualifies the person for 14 service units;
6.11 (7) V home care rating requires seven to eight dependencies in ADLs and qualifies the
6.12person for 17 service units;
6.13 (8) W home care rating requires seven to eight dependencies in ADLs and Level I
6.14behavior and qualifies the person for 20 service units;
6.15 (9) Z home care rating requires seven to eight dependencies in ADLs and a complex
6.16health-related need and qualifies the person for 30 service units; and
6.17 (10) EN home care rating includes ventilator dependency as defined in section 256B.0651,
6.18subdivision 1, paragraph (g). A person who meets the definition of ventilator-dependent
6.19and the EN home care rating and utilize a combination of CFSS and home care nursing
6.20services is limited to a total of 96 service units per day for those services in combination.
6.21Additional units may be authorized when a person's assessment indicates a need for two
6.22staff to perform activities. Additional time is limited to 16 service units per day.
6.23 (f) Additional service units are provided through the assessment and identification of
6.24the following:
6.25 (1) 30 additional minutes per day for a dependency in each critical activity of daily
6.26living;
6.27 (2) 30 additional minutes per day for each complex health-related need; and
6.28 (3) 30 additional minutes per day for each behavior under this clause that requires
6.29assistance at least four times per week:
6.30 (i) level I behavior that requires the immediate response of another person;
6Sec. 9.
23-01028 as introduced01/12/23 REVISOR AGW/AD 7.1 (ii) increased vulnerability due to cognitive deficits or socially inappropriate behavior;
7.2or
7.3 (iii) increased need for assistance for participants who are verbally aggressive or resistive
7.4to care so that the time needed to perform activities of daily living is increased.
7.5 (g) The service budget for budget model participants shall be based on:
7.6 (1) assessed units as determined by the home care rating; and
7.7 (2) an adjustment needed for administrative expenses.
7.8 Sec. 10. Minnesota Statutes 2022, section 256S.18, subdivision 1, is amended to read:
7.9 Subdivision 1.Case mix classifications.(a) The elderly waiver case mix classifications
7.10A to K shall be the resident classes A to K established under Minnesota Rules, parts
7.119549.0058 and 9549.0059.
7.12 (b) A participant assigned to elderly waiver case mix classification A must be reassigned
7.13to elderly waiver case mix classification L if an assessment or reassessment performed
7.14under section 256B.0911 determines that the participant has:
7.15 (1) no dependencies in activities of daily living; or
7.16 (2) up to two dependencies in bathing, dressing, grooming, walking, or eating when the
7.17dependency score in eating is three or greater.
7.18 (c) A participant must be assigned to elderly waiver case mix classification V if the
7.19participant meets the definition of ventilator-dependent in section 256B.0651, subdivision
7.201, paragraph (g).
7.21 Sec. 11. Minnesota Statutes 2022, section 256S.2101, subdivision 2, is amended to read:
7.22 Subd. 2.Phase-in for elderly waiver rates.Except for home-delivered meals as
7.23described in section 256S.215, subdivision 15 the services in subdivisions 3 and 4, all rates
7.24and rate components for elderly waiver, elderly waiver customized living, and elderly waiver
7.25foster care under this chapter; alternative care under section 256B.0913; and essential
7.26community supports under section 256B.0922 shall be the sum of 18.8 percent of the rates
7.27calculated under sections 256S.211 to 256S.215, and 81.2 percent of the rates calculated
7.28using the rate methodology in effect as of June 30, 2017. The rate for home-delivered meals
7.29shall be the sum of the service rate in effect as of January 1, 2019, and the increases described
7.30in section 256S.215, subdivision 15.
7Sec. 11.
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
8.2to read:
8.3 Subd. 3.Phase-in for home-delivered meals rate.The home-delivered meals rate for
8.4elderly waiver under this chapter, alternative care under section 256B.0913, and essential
8.5community supports under section 256B.0922 must be the sum of the service rate in effect
8.6as of January 1, 2019, and the increases described in section 256S.215, subdivision 15.
8.7 Sec. 13. Minnesota Statutes 2022, section 256S.2101, is amended by adding a subdivision
8.8to read:
8.9 Subd. 4.Service rates exempt from phase-in.Subdivision 2 does not apply to rates
8.10for homemaker services described in section 256S.215, subdivisions 9 to 11.
8.11 EFFECTIVE DATE.This section is effective January 1, 2024.
8.12 Sec. 14. Minnesota Statutes 2022, section 256S.212, is amended by adding a subdivision
8.13to read:
8.14 Subd. 1a.Updating base wages.(a) On January 1, 2024, and every two years thereafter,
8.15the commissioner shall update the base wages for the services listed in paragraph (b) based
8.16on the most recently available Bureau of Labor Statistics Minneapolis-St. Paul-Bloomington,
8.17MN-WI MetroSA data.
8.18 (b) This subdivision applies to:
8.19 (1) the homemaker services and assistance with personal care base wage under subdivision
8.208;
8.21 (2) the homemaker services and cleaning base wage under subdivision 9;
8.22 (3) the homemaker services and home management base wage under subdivision 10;
8.23and
8.24 (4) for the purposes of calculating the registered nurse management and supervision
8.25factor used to calculate the homemaker services rates under section 256S.215, subdivisions
8.269 to 11, the registered nurse base wage under subdivision 14.
8.27 EFFECTIVE DATE.This section is effective January 1, 2024.
8Sec. 14.
23-01028 as introduced01/12/23 REVISOR AGW/AD 9.1 Sec. 15. DIRECTION TO COMMISSIONER; CARE COORDINATION
9.2EXPANSION.
9.3 Subdivision 1.Identifying billable care coordination activities.The commissioner of
9.4human services must collaborate with interested stakeholders to identify new or existing
9.5billable medical assistance services for care coordination activities for medical assistance
9.6home care services. Care coordination activities may include:
9.7 (1) managing documentation requirements;
9.8 (2) supporting transitions in care;
9.9 (3) managing medication;
9.10 (4) facilitating and sequencing referrals for behavioral and medical health needs;
9.11 (5) making community referrals for patient and family education and support; and
9.12 (6) other administrative activities required to effectively meet a person's individualized
9.13support needs.
9.14 Subd. 2.Providing guidance regarding existing billable care coordination
9.15activities.No later than January 1, 2024, the commissioner must issue guidance to home
9.16care providers regarding existing billable medical assistance services for care coordination
9.17activities for medical assistance home care services.
9.18 Subd. 3.Reporting on potential billable care coordination activities.No later than
9.19February 1, 2024, the commissioner must provide to the chairs and ranking minority members
9.20of the legislative committees and divisions with jurisdiction over medical assistance home
9.21care services a report summarizing any potentially billable medical assistance services for
9.22care coordination activities for medical assistance home care services identified by the
9.23commissioner and interested stakeholders under subdivision 1.
9Sec. 15.
23-01028 as introduced01/12/23 REVISOR AGW/AD