Section 1 (245A.03, subdivision 2) makes a reference to services that will be newly licensed in this bill.

Section 2 (245A.041, subdivision 3) adds a subdivision creating records maintenance and storage requirements for license holders, including service recipient, personnel, program administration, and financial records.

Section 3 (245A.041, subdivision 4) adds a new subdivision listing the requirements on the use of electronic record keeping or electronic signatures.

Section 4 (245A.085) adds a cross-reference.

Section 5 (245A.042) creates a new section requiring Home and Community-Based Waiver and Alternative Care service providers to obtain a license. Application and training requirements for licensure are described, and implementation will begin once an appropriation is received by the Department of Human Services (DHS) to cover the licensing support costs.

Section 6 (245B.02, subdivision 8a) adds a subdivision to define “emergency.”

Section 7 (245B.02, subdivision 10)  removes fires from the definition of “incident;” fires are covered under the definition of “emergency” in section 6.

Section 8 (245B.04, subdivision 1) requires license holders to provide an explanation of rights on an annual basis to service consumers.

Section 9 (245B.04, subdivision 2) adds to the list of a consumer’s service-related rights knowledge of the license holder’s policies and procedures.

Section 10 (245B.04, subdivision 3) adds to the list of a consumer’s protection-related rights:  reasonable observance of cultural, ethnic, and religious practices; freedom from bias and harassment based on race, gender, age, disability, spirituality or sexual orientation;  right to be informed of and use the license holder's grievance policies and procedures; knowledge of the contact information for protection; and advocacy services.

Also allows restriction of certain protection-related rights if the restriction is deemed necessary to ensure the health and safety of the person, and outlines the restriction process, including conditions, consent requirements, and time limits.

Section 11 (245B.05, subdivision 1) requires license holders to justify and document the reason for locking doors to protect the safety of service consumers.

Section 12 (245B.06, subdivision 2) adds and specifies various areas needed to be identified in a person’s risk management plan, including the consumer’s behavior and ability to:  manage various health needs; handle various environments; and recognize and respond to unsafe or hazardous situations. The consumer’s behavior also includes any history of criminal misconduct, physical aggression, or sexual activity through force or coercion.

The license holder must identify specific measures in the risk management plan to reduce and minimize risk.

Section 13 (245B.07, subdivision 5) adds staff responsibilities to license holder staff orientation curriculum.

Section 14 (245B.07, subdivision 7a) adds a subdivision requiring the license holder to ensure that any subcontractors used must meet and maintain compliance with all license requirements.

Section 15 (245B.07, subdivision 9) clarifies that the license holder’s policies and procedures must be available to consumers, consumer’s legal representatives, and case managers.  Employees must be provided training on any policy or procedure changes.

Section 16 (245B.07, subdivision 10) prevents license holders from being the guardian or conservator of a person receiving services, excluding counties or other units of government.

Sections 17 through 26 create Minnesota Statutes, Chapter 245D, “Home and Community-Based Services Standards.”

Section 17 (245D.01) cites Chapter 245D as the “Home and Community-Based Services Standards” or “HCBS Standards.”

Section 18 (245D.02) lists definitions applicable to Chapter 245D.

Section 19 (245D.03) states that the licensing standards in Chapter 245D apply to housing access coordination, respite services, behavioral programming, companion services, personal support, 24-hour emergency assistance and emergency response services, night supervision, homemaker services, independent living skills training, prevocational services, structured day services, and supported employment.

This section details relationships to other standards governing HCBS standards and licenses, along with variances and exemptions to licensure under Chapter 245D.

Section 20 (245D.04) describes the responsibilities of the license holder for ensuring individuals’ rights, the service-related rights of individuals, and the protection-related rights of individuals.

Section 21 (245D.05) states license holder notification and documentation responsibilities for the health services assigned in service plans. The license holder is responsible for the delivery and documentation, outlined in the bill, of medication administration, medication assistance, and medication and treatment issue reporting.  Lists allowable conditions under which  injectable medications can be administered.

Section 22 (245D.06) creates protection standards the license holder must meet while providing services in order to protect health and safety. Incident response and reporting requirements, environment and safety procedures, fire and safety code compliance instructions, and funds and property management authorization are all described. Psychotropic drugs, restraints, and seclusion are prohibited as a substitute for adequate staffing, staff convenience, or as punishment.

Section 23 (245D.07) specifies that the license must provide the services in the service plan in a manner that complies with this chapter and federal waiver plans, and requires the license holder to participate in support team meetings and provide written reports on the individuals’ progress, as requested.

Section 24 (245D.08) creates record-keeping requirements for the license holder. Information collection and maintenance requirements, and protection provisions, are listed for both service recipient records and personnel records. The license holder must also ensure certain people have access to service recipient records.

Section 25 (245D.09) creates staffing standards for license holders, including: supervision over staff who direct service staff; staff qualifications; providing an orientation combining on-the-job training with job function instruction; annual staff training; subcontractor compliance with requirements; and volunteer training, orientation, and supervision.

Section 26 (245D.10) requires license holders to develop policies and procedures to deal with grievances and service suspensions and service terminations. Additional requirements concern the availability of policies and procedures if requested, regular review of policies and procedures, and a 30-day minimum notice of policy and procedure changes.

Section 27 (252.40) sets January 1, 2013, as the expiration date for service principles and rate-setting procedures.

Section 28 (252.41, subdivision 3) removes a reference to county contracts, and sets January 1, 2013, as the effective date.

Section 29 (252.42) removes a reference to a section being repealed, and sets January 1, 2013, as the effective date.

 Section 30 (252.43) removes a reference to a section being repealed, replacing it with a reference to a new section, and sets January 1, 2013, as the effective date.

Section 31 (252.44) removes references to a section being repealed, replacing them with references to a new section, and sets January 1, 2013, as the effective date.

Section 32 (252.45) makes conforming language changes.

Section 33 (252.41, subdivision 2) removes a reference to a section being repealed, replacing it with a reference to a new section, and sets January 1, 2013, as the effective date.

Section 34 (252.41, subdivision 5) makes changes regarding vendor reimbursement to qualified businesses of day training and habilitation services under agreements to provide services.

Section 35 (252.46, subdivision 1a) removes a reference to a section being repealed, replacing it with a reference to a new section, and sets January 1, 2013, as the effective date.

Section 36 (256B.0916, subdivision 2) requires DHS to implement a procedure to adjust waiver allocations under new payment methodologies outlined in section 256B.4913 in order to not increase or decrease the total amount allocated to the counties or tribes.

Section 37 (256B.49, subdivision 16a) removes most of the language of this subdivision requiring DHS to request federal approval for Medical Assistance reimbursement for a variety of services. Language requiring DHS to seek a federal waiver for family adult day services under all disability waivers remains.

Section 38 (256B.49, subdivision 17) requires DHS to implement a procedure to adjust waiver allocations under new payment methodologies outlined in section 256B.4913 in order to not increase or decrease the total amount allocated to the counties or tribes.

Section 39 (256B.4912) modifies the two existing subdivisions and adds an additional five subdivisions.

Subdivision 1 makes language changes and requires human services background studies, beginning July 2012, for staff providing direct services to waiver recipients.

Subdivision 2 makes language changes.

Subdivision 3 requires payment-setting methodologies to accommodate: direct care staffing wages; staffing patterns; program-related expenses; general and administrative expenses; and consideration of recipient intensity.

Subdivision 4 establishes that the payment rate criteria must be based on reasonable, ordinary, and necessary costs, and related to the delivery of client services, and lists nonreimbursable items.

Subdivision 5 eliminates current county and tribal contracts for HCBS waivers, effective January 1, 2013.

Subdivision 6 requires DHS to establish uniform program standards for services identified in Chapter 245D.

Subdivision 7 requires applicants and license holders not enrolled as a Minnesota Health Care Program HCBS waiver provider to ensure that at least one controlling individual completes a one-time training, determined by DHS, before a license is issued.

This section’s effective date is July 1, 2012, except subdivision 6 is effective January 1, 2013, or when DHS receives an appropriation or authorization to collect fees, whichever is later.

Section 40 (256B.4913) creates a new section.

Subdivision 1 applies the payment methodologies under this section to HCBS waiver services, with some exceptions.

Subdivision 2 defines for this section “Commissioner” and “Payment.”

Subdivision 3 lists the applicable services under HCBS waivers, specified in subdivisions 5, 6, and 7.

Subdivision 4 requires DHS to determine the representative personnel and program-related components to meet the individualized service plan for certain individuals with disabilities, which will be used with the individualized assessment information, to determine the amount payable to the provider.

Subdivision 5 sets the methodology for calculating payments for individualized unit-based services. The components of the methodology include: direct staff wages; an individual customization rate if applicable; and respite room and board.

Direct staff wages must come from the Bureau of Labor Statistics job classes, aligned with services provided under the HCBS waiver, including: adult companion; behavioral program analyst; behavioral program professional; behavior program specialist; housing access coordinator; in-home family support; independent living skills direct service; independent living skills professional; night supervision; personal support; respite hourly; supported employment job coach; supported employment job developer; supportive living services; extra transportation attendant; registered nurse; licensed practical nurse; direct primary care; asleep overnight; and supervisor.

Subdivision 6 sets the methodology for calculating payments for day programs. The components of the methodology include: direct staff wages; an individual customization rate if applicable; a facility reasonable use rate; and reimbursement for meals.

Direct staff wages must come from the Bureau of Labor Statistics job classes, aligned with services provided under the HCBS waiver, including: registered nurse; licensed practical nurse; and direct primary care.

Subdivision 7 sets the methodology for calculating payments for residential services. The components of the methodology include: direct staff wages; an individual customization rate if applicable; an employee and program-related expense factor family foster care settings; and individual waiver transportation.

 Direct staff wages must come from the Bureau of Labor Statistics job classes, aligned with services provided under the HCBS waiver, including:  registered nurse; licensed practical nurse; direct primary care; asleep overnight; and supervisor.

Subdivision 8 increases the direct care costs in subdivisions 5, 6, and 7 for persons assessed to have higher medical, mental health, or behavior issue needs.

Subdivision 9 sets transportation payments based on the number of individual and shared trips authorized, distance, and whether or not a lift is required.

Subdivision 10 requires DHS to develop and implement procedures, including notification and reporting requirements, to adjust the values used to calculate payment rates in this section every other year.

Subdivision 11 creates a waiver rates management system to guide DHS in adjusting payment rates beginning in 2013.

Subdivision 12 allows DHS to develop an alternative payment structure for individuals identified with exceptional needs.

Subdivision 13 allows DHS to limit the number of people sharing waiver and day services.

Subdivision 14 states that rates established in this section supersede rates in county contracts.

This section is effective the day following final enactment.

Section 41 (256B.501, subdivision 4b) sets January 1, 2013, as the expiration date for waiver rates and group residential housing rates.

Section 42 (256B.5013, subdivision 1) removing references to a section being repealed.

Section 43 instructs the Office of the Revisor of Statues to make technical changes, effective January 1, 2013.

Section 44 repeals several sections and subdivisions, effective January 1, 2013.

DL/rdr