2021 Legislative Update

2021 LEGISLATIVE UPDATE A R E P O RT O N T H E F I RST Y E A R O F T H E 9 2

ND

L E G I S LAT I V E S E SS I O N

7851 Metro Parkway, Suite 200 Bloomington, MN 55425 952-854-2844 / 1-800-462-0024 www.careproviders.org

2021 LEGISLATIVE UPDATE A report to the membership on the first year of the 92nd Legislative Session Patti Cullen, CAE President/CEO

Prepared by: Care Providers of Minnesota Advocacy staff

This report does not constitute legal analyses of the changes in law reported herein. For legal opinions on the application of new statutory language to specific fact situations, contact your organization’s legal counsel. This publication may not be reproduced in whole or in part in any form without the written permission of Care Providers of Minnesota. © Care Providers of Minnesota, Inc., 2021

August 16, 2021 Welcome to the 2021 Legislative Update Book! We hope you find the contents useful as a reference to help you understand the laws that passed this year during “regular” and “special” sessions, and to help you prepare for implementation. We encourage you to use the information you find in these pages to talk with your own staff, elected officials, customers, family members, and community leaders about topics of concern for you. We are a bit delayed in pulling together all the details because much of the action in the health and human services area was not completed during the regular session, rather, the summer—once again—became special as legislators were called back into session to complete their work in a special session that ended right before the end of the state’s budget year on June 30, 2021.

The good news is that the legislature DID pass a biennial budget before we experienced a state shutdown and Governor Walz signed the bills into law. The bad news is that the 2020 and 2021 legislative sessions seemed to blur together—we were still talking about the spread of the COVID-19 pandemic and the implications of the killing of George Floyd on policing in 2021, and unfortunately, the discussions didn’t end with the passage of the biennial budget for the next two years. In addition, legislators did not get ALL of the budget issues resolved in time—they “kicked the can down the road” trying to figure out how to divide a pool of money ($250 million) to recognize all of the essential frontline “heroes” by setting up a task force and a date for their recommendations to be completed.

Continuing from 2020, most of the committee hearings during the regular and special sessions were converted to virtual events, and meetings with legislators were done virtually as well—making negotiations and advocacy particularly challenging. The Capitol building itself was closed to the public during the regular session and only opened up in the waning days of the special session.

There continues to be unfinished work from the 2021 legislative session(s), including a recognition that there needs to be a comprehensive plan to address the serious workforce shortage in all sectors but especially in long-term care. We also know the pandemic isn’t over, and there may be a need to revisit some of the COVID-19-related issues, such as payment for ongoing testing and vaccinations. Add to that mix the fact that there is a governor’s race already starting, and several current legislative leaders have announced their intentions to run for that office. We can expect a very interesting fall with the Frontline Worker Task Force recommendations and multiple campaigns competing for media time!

If you have any questions or need more information about anything you find in this book, do not hesitate to contact me at 952-851-2487. You may also access this book and/or individual pages in an electronic version on our website in the “Advocacy” section: www.careproviders.org/advocacy.

Sincerely,

Patti Cullen, CAE President/CEO

Care Providers of Minnesota 7851 Metro Parkway, Suite 200 • Bloomington, MN 55425 • Phone 952/854-2844 • MN Toll-Free 800/462-0024 • Fax 952/854-6214 • www.careproviders.org Leading Members to Excellence

2021 Legislative Update Book Table of Contents I. Session summary .................................................................................................................................. 9 II. Nursing facilities ................................................................................................................................... 17 a. Nursing facility MDS assessment requirements modified .........................................19 b. Significant change in status assessment required when therapy (and isolation) ends ............................................................................................................................................. 29 c. Permanent nursing facility moratorium funding appropriated ................................ 33 III. Assisted living payment ................................................................................................................... 37 a. Permanent funding appropriated for EW, CADI and, BI customized living quality improvement grants .............................................................................................................. 39 b. Home health agency services & home care nursing services to receive annual increases ..................................................................................................................................... 41 c. Housing supports absent days .......................................................................................... 43 d. AL facilities with 80% EW may apply for disproportionate share rate increases ...................................................................................................................................................... 45 e. Legislature increases rates for Elderly Waiver customized living, excludes CADI-CL ...................................................................................................................................... 49 f.

LTC assessment may be temporarily waived for HCBS waiver clients returning from a healthcare facility ....................................................................................................... 51

IV. Assisted living ...................................................................................................................................... 53 a. Assisted living licensure technical changes ................................................................. 55 b. Background studies for licensed assisted living facilities .........................................61 c. CADI customized living providers bear the brunt of unfriendly & restrictive DHS policies ....................................................................................................................................... 63 d. Resident experience surveys in assisted living ............................................................ 71 e. Consumer protections for facilities exempt from assisted living licensure ........ 73 f.

Customized living report ........................................................................................................81

g. Study of exempt facilities .................................................................................................... 83 h. Residential supports customized living report ............................................................ 85 i.

Prorated rent............................................................................................................................. 87

j.

Eviction moratorium phaseout .......................................................................................... 89

k. Outdoor space requirements for assisted living with dementia licenses ............91 l.

Technical language on HWS conversion to assisted living ..................................... 95

m. LTC ombudsman & customized living settings exempted from assisted living licensure ..................................................................................................................................... 97

V. Workforce .............................................................................................................................................. 99 a. Workers’ compensation ........................................................................................................ 101 b. Workers’ Compensation Advisory Council recommendations ............................... 105 c. Unemployment insurance .................................................................................................. 107 d. Background study fees increase for some DHS-enrolled providers ................... 109 e. Background studies—Waivers & modifications; legislative task force .................. 111 VI. Telehealth ............................................................................................................................................. 113 a. Telemedicine ............................................................................................................................ 115 b. Telehealth coverage policy ................................................................................................. 117 c. Telemedicine for county processes ................................................................................. 119 VII. Miscellaneous ..................................................................................................................................... 123 a. MA dental benefit added .................................................................................................... 125 b. 90-day medication ................................................................................................................ 127 c. Regional quality councils for disabilities ....................................................................... 129 d. DHS to proceed with Phase 2 of Waiver Reimagine for under 65 ........................ 133 e. Ombudsperson for American Indian families ............................................................... 135 f.

American Indian Community-Specific Board ................................................................ 137

g. Age-friendly Minnesota ....................................................................................................... 139 h. Mental health summary....................................................................................................... 143 i.

Service & support animals .................................................................................................. 145

j.

Tax conformity ........................................................................................................................ 149

k. Medical cannabis—Smoking raw plant ............................................................................ 151 l.

Tribes included in supplemental service rate definition.......................................... 153

m. More changes for community first services & supports (also known as PCA/CFSS) ............................................................................................................................... 155

SESSION SUMMARY

Session Summary The 2021 Legislative Session actually seemed like an extension of the series of monthly special sessions, the pandemic-shortened 2020 Legislative Session, and the resulting gubernatorial executive orders.

Starting with the declaration of emergency, Governor Walz issued a series of executive orders that helped ease some of the regulatory burdens in long-term care. He also issued others in housing, that limited the ability to evict tenants. A complete list of the executive orders can be found at: https://mn.gov/governor/news/executiveorders.jsp.

Although not an exhaustive list, the executive orders which assisted in long-term care included the following: •

Executive Order 20-11 Securing Federal Authority to Continue Human Services Programs During the COVID-19 Peacetime Emergency

•

Executive Order 20-12 Preserving Access to Human Services Programs During the COVID-19 Peacetime Emergency

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Executive Order 20-13 Authorizing National Guard Assistance to COVID-19 Response

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Executive Order 20-15 Providing Immediate Relief to Small Businesses During

•

Executive Order 20-16 Directing Non-Hospital Entities to Inventory and

the COVID-19 Peacetime Emergency Preserve Vital Medical Equipment During the COVID-19 Peacetime Emergency •

Executive Order 20-23 Authorizing Minnesota Health-Related Licensing Boards to Modify Requirements During the COVID-19 Peacetime Emergency

•

Executive Order 20-28 Allowing Out-of-State Mental Health Providers to Render Telehealth Aid and Permitting Certain Licensing Boards to Provide License and Registration Relief During the COVID-19 Peacetime Emergency

•

Executive Order 20-32 Ensuring that Healthcare Providers Can Respond Quickly and Safely During the COVID-19 Peacetime Emergency

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Executive Order 20-46 Authorizing Out-of-State Healthcare Professionals to Render Aid in Minnesota during the COVID-19 Peacetime Emergency

•

Executive Order 20-51 Requiring Facilities to Prioritize Surgeries and Procedures and Provide Safe Environment during COVID-19 Peacetime Emergency

•

Housing Eviction o

Executive Order 20-14 Suspending Evictions and Writs of Recovery During the COVID-19 Peacetime Emergency

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o

Executive Order 20-73 Clarifying Executive Order 20-14 Suspending Evictions and Writs of Recovery During the COVID-19 Peacetime Emergency

o

Executive Order 20-79 Modifying the Suspension of Evictions and Writs of Recovery During the COVID-19 Peacetime Emergency

Clearly, legal and lawmaking issues in 2020 and 2021 were far from “normal” process.

Once the legislature was no longer in regular session, by law, the governor had to call them back into special session each time he extended his emergency powers.

This meant that the legislators would return monthly to, at a minimum, vote on the extension of the emergency powers. This reconvening meant that legislators, advocates, and executive branch (in our case primarily MDH and DHS) could continue to work on concepts that were introduced, but unfinished, during the regular session. These topics included a potential delay of the assisted living licensure, increased assisted living regulations, and technical changes to the assisted living laws.

Elections In the midst of the pandemic, we held the November 2020 elections. With the domination of the presidential election and the presence of COVID-19, Minnesota held elections for both the Minnesota Senate and the Minnesota House of Representatives. After the June civil unrest in Minneapolis following the police murder of George Floyd, the election dynamics took on additional dynamics. With the some of the local and national discourse devolving into Black Lives Matter versus Blue Lives Matter, the national election became increasingly contentious.

In the end, Minnesota retained the same balance of power, with the DFL retaining a slim majority for control of the Minnesota House, and the Republicans retaining a one seat majority and control of the Senate. Governor Walz was not up for election, so he retained his position. Then, an announcement that surprised some in the political world, DFL Senators Tom Bakk (Cook) and David Tomassoni (Hibbing) announced that they were leaving the DFL and forming an independent caucus that would primarily caucus toward the GOP. DFLer Tom Bakk had been the majority and minority leader for the DFL Senate in recent terms, and had recently been ousted from the DFL minority leader by Susan Kent (DFL-Woodbury).

Following the elections, the state had one more “special session” which was required if the governor were to extend the peacetime emergency. During this

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December special session, the legislature did pass several important technical changes to the assisted living licensure laws.

Regular session begins Amidst the pandemic, January marked the start of the 2021 Legislative Session.

The session had a very different feeling from the start. In the first place, both the House and the Senate began with “virtual” hearings, where we used technology of “zoom” as well as the House and Senate multimedia stations to attend and watch the hearings. Although they had been having virtual hearings during the interim special sessions, the feeling of participation was very distant.

Session also had a different flavor because in a typical year, legislators would begin meeting with various lobbyists after elections in November and December— but this year, everything being virtual made meetings challenging.

Although the state had received better (less of a deficit than previously anticipated) fiscal news in the November forecast, the legislature is constitutionally-required to balance to the February forecast. The Minnesota February budget forecast showed a significantly improved economic environment for the state. There is a surplus of $940 million for the balance of the state's current budget cycle, an improvement of $546 million from the November forecast.

The projected surplus for the 2022–23 budget, which takes effect July 1, is $1.6 billion, a change from the $1.27 billion deficit projected in the November forecast.

This budget news allowed the legislators and the governor a sigh of relief. This forecast did not include the federal money that was sent to the state from the American Recovery Act stimulus—that accounting would take place later in the session and add extra wrinkles to end of session negotiations.

While the legislature began zoom and virtual hearings, much of the early floor debate revolved around the governor’s emergency powers. Because of the ongoing public health emergency associated with ongoing COVID-19, Governor Walz had retained his emergency powers. The Senate majority and the House minority wanted to end the governor’s emergency powers. After multiple lengthy floor debates at different times of the session, the moves to limit the governor’s powers failed repeatedly.

Hearings were conducted virtually, which meant time limitations, remote testimony, and general lack of personal interaction. As the session wore on, legislators started to find their way and hearings became more routine. As with most sessions, the work starts to take shape as the governor introduces their proposed budget and the legislators start to have hearings on proposals. The legislators

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begin introducing their own bills and the bills begin making stops in the different committees of jurisdiction. Ultimately, the bills end in the last committee of jurisdiction and may be “laid over for possible inclusion” in an omnibus bill.

This year, as the hearings were taking place, the legislators found out there would be an influx of federal stimulus money. Although they had an estimate of the amount, they lacked the regulatory guidance implementation. Without the guidance, legislators lacked the ability to allocate the federal funds. The guidance finally arrived in late April, which did not give them much time to finalize their budget bills.

As the session came closer to the end, it became apparent that the end of session influx of federal money was making the finalization of the financial side of omnibus bills difficult, and would make finishing by the constitutionally-mandated timeframe difficult, if not impossible. Nevertheless, both the House and the Senate passed their respective omnibus bills and moved to conference committees.

Ultimately, and too near the end of session to finish on time, the House, Senate, and governor announced a “global agreement” on financial numbers, which would determine how much each committee had to balance their spending. However, the policy issues would remain unresolved and in need of further negotiation. There were plentiful policy issues which the two bodies did not agree. These issues included: clean car standards, voter ID measures, and especially public safety reforms (resulting from the George Floyd murder and the summer civil unrest).

Because the governor planned to extend his emergency powers in the middle of June, the legislators need to be called back into session in the middle of June to vote on this extension. In anticipation of the June special session, legislators began “working group” negotiations to resolve differences in omnibus bills as they sought to avert a government shutdown at the end of the state fiscal year of June 30.

This year, unlike the past, because of the 2017 Minnesota Supreme Court Case, which held that the legislature and not the courts must allocate the money, there were many questions about how to determine who would be deemed essential providers and how or if any money could be spent after the June 30 end of fiscal year. This looming question infused a bit more urgency into the end of session and averting a state shutdown.

Ultimately, the legislators reconvened June 14 and marched toward passage of final budgets and resolution of the policy questions. As they moved closer to the deadline, legislators and the governor arrived at agreements on many of the

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smaller budget bills. As these bills were brought to the House floor, because the minority party had not been included in the final decision making, the proposals had extended floor debates which were designed to slow down the process and make even the smaller budget bills subject to lengthy debate and emphasize the lack of process and participation of the minority party and lack transparency for public participation.

Ultimately, the governor and the legislators resolved all of their budget bills and many of their policy differences and passed the final omnibus bill, the tax bill, in the early morning hours on July 1, narrowly averting a shutdown. Following passage of the tax omnibus bill and all other omnibus bills, the House adjourned sine die. The Senate on the other hand, continued to meet as they wanted to hold a “confirmation hearing” on a couple of Governor Walz’s appointees. Frustrated by some actions of the administration, the Senate threatened to reject the confirmations. Eventually, the Senate did adjourn. There is an anticipated special session in September, that would include the report from the “hero pay bonus” working group.

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NURSING FACILITIES

Nursing facility MDS assessment requirements modified 2021, 1st Special Session HF33/SF37 Chapter 7, Article 3, Sections 12–19 HHS omnibus bill Effective: Day following final enactment Short description In addition to clarifying several definitions, the Minnesota Department of Health language that is adopted changes to reconsiderations, audit disclosure, and short stay rates.

Summary The language adopted makes changes to reconsiderations, audit disclosure, and short stay rates.

Reconsiderations •

Allows reconsideration of any items changed during the audit process

•

Reorganizes the subdivision for requests initiated by the resident or a representative and for requests submitted by the facility and makes technical changes

•

For requests initiated by the resident or a representative, language specifying what must accompany the reconsideration request is eliminated, language specifying what the facility must submit is reorganized, and the consequence when a facility fails to provide the required information is specified

•

For requests initiated by the facility, the facility is required to provide the resident or a representative with notice of the request, the request is required to be submitted within a certain timeframe and permits rather than requires the commissioner to deny the reconsideration request if the facility fails to provide the required information

•

Requirements for transmitting the reconsideration classification notice to the nursing facility and to the resident or representative are established

Short stays •

A facility is not required to submit an admission assessment for a resident admitted to and discharged from the facility on the same day; when an admission assessment is not submitted, the case mix classification is the rate with a case mix index of 1.0

Notice of resident reimbursement case mix classification •

A nursing facility that is submitting a modified assessment must notify the resident within 3 business days after distribution of the classification notice to the resident

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Implications Nursing facilities need to update their policies and procedures to account for the above changes. According to the Minnesota Department of Health (https://bit.ly/3rbmW1i), following statute changes to 144.0724 are effective immediately.

Short stays: For facilities that elect to complete an admission assessment for all admissions, when a resident is admitted and discharged from the facility on the same day, an admission assessment is not required.

Request for Reconsideration of resident classification:

•

A reconsideration can now be requested for any RUG classification or quality indicator item(s) changed during an audit

•

All reconsideration requests, facility and resident/resident representative initiated, should be faxed to the Case Mix Review Program at 1-866-898-5082 or 1-800-3104924

•

The process for reconsideration requests initiated by the resident or resident’s representative has been revised to include the following:

•

The resident or the resident's representative must submit, in writing, a reconsideration request to the facility administrator within 30 days of receipt of the resident case mix classification notice; within three business days of receiving the request, the nursing facility must submit to the Case Mix Review Program: a completed Request for Reconsideration Form (https://bit.ly/3seL83G), a copy of the resident or resident representative’s written request, and all documentation used to support the MDS coding of the assessment being reconsidered

•

A copy of the MDS assessment is no longer required when submitting a request for reconsideration

Bill language https://www.revisor.mn.gov/laws/2021/1/Session+Law/Chapter/7/ Sec. 12. Minnesota Statutes 2020, section 144.0724, subdivision 1, is amended to read: Subdivision 1. Resident reimbursement case mix classifications. The commissioner of health shall establish resident reimbursement case mix classifications based upon the assessments of residents of nursing homes and boarding care homes conducted under this section and according to section 256R.17.

Sec. 13. Minnesota Statutes 2020, section 144.0724, subdivision 2, is amended to read:

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Subd. 2. Definitions. For purposes of this section, the following terms have the meanings given. (a) "Assessment reference date" or "ARD" means the specific end point for lookback periods in the MDS assessment process. This look-back period is also called the observation or assessment period. (b) "Case mix index" means the weighting factors assigned to the RUG-IV classifications. (c) "Index maximization" means classifying a resident who could be assigned to more than one category, to the category with the highest case mix index. (d) "Minimum Data Set" or "MDS" means a core set of screening, clinical assessment, and functional status elements, that include common definitions and coding categories specified by the Centers for Medicare and Medicaid Services and designated by the Minnesota Department of Health. (e) "Representative" means a person who is the resident's guardian or conservator, the person authorized to pay the nursing home expenses of the resident, a representative of the Office of Ombudsman for Long-Term Care whose assistance has been requested, or any other individual designated by the resident. (f) "Resource utilization groups" or "RUG" means the system for grouping a nursing facility's residents according to their clinical and functional status identified in data supplied by the facility's Minimum Data Set. (g) "Activities of daily living" means grooming, includes personal hygiene, dressing, bathing, transferring, bed mobility, positioning, locomotion, eating, and toileting. (h) "Nursing facility level of care determination" means the assessment process that results in a determination of a resident's or prospective resident's need for nursing facility level of care as established in subdivision 11 for purposes of medical assistance payment of long-term care services for: (1) nursing facility services under section 256B.434 or chapter 256R; (2) elderly waiver services under chapter 256S; (3) CADI and BI waiver services under section 256B.49; and (4) state payment of alternative care services under section 256B.0913.

Sec. 14. Minnesota Statutes 2020, section 144.0724, subdivision 3a, is amended to read: Subd. 3a. Resident reimbursement case mix classifications beginning January 1, 2012. (a) Beginning January 1, 2012, resident reimbursement case mix classifications shall be based on the Minimum Data Set, version 3.0 assessment instrument, or its successor version mandated by the Centers for Medicare and Medicaid Services that nursing CARE PROVIDERS OF MINNESOTA

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facilities are required to complete for all residents. The commissioner of health shall establish resident classifications according to the RUG-IV, 48 group, resource utilization groups. Resident classification must be established based on the individual items on the Minimum Data Set, which must be completed according to the Long Term Care Facility Resident Assessment Instrument User's Manual Version 3.0 or its successor issued by the Centers for Medicare and Medicaid Services. (b) Each resident must be classified based on the information from the Minimum Data Set according to general categories as defined in the Case Mix Classification Manual for Nursing Facilities issued by the Minnesota Department of Health.

Sec. 15. Minnesota Statutes 2020, section 144.0724, subdivision 5, is amended to read: Subd. 5. Short stays. (a) A facility must submit to the commissioner of health an admission assessment for all residents who stay in the facility 14 days or less., unless the resident is admitted and discharged from the facility on the same day, in which case the admission assessment is not required. When an admission assessment is not submitted, the case mix classification shall be the rate with a case mix index of 1.0. (b) Notwithstanding the admission assessment requirements of paragraph (a), a facility may elect to accept a short stay rate with a case mix index of 1.0 for all facility residents who stay 14 days or less in lieu of submitting an admission assessment.

Facilities shall make this election annually. (c) Nursing facilities must elect one of the options described in paragraphs (a) and (b) by reporting to the commissioner of health, as prescribed by the commissioner. The election is effective on July 1 each year.

Sec. 16. Minnesota Statutes 2020, section 144.0724, subdivision 7, is amended to read: Subd. 7. Notice of resident reimbursement case mix classification. (a) The commissioner of health shall provide to a nursing facility a notice for each resident of the reimbursement classification established under subdivision 1. The notice must inform the resident of the case mix classification that was assigned, the opportunity to review the documentation supporting the classification, the opportunity to obtain clarification from the commissioner, and the opportunity to request a reconsideration of the classification and the address and telephone number of the Office of Ombudsman for Long-Term Care.

The commissioner must transmit the notice of resident classification by electronic means to the nursing facility. A The nursing facility is responsible for the distribution of the notice to each resident, to the person responsible for the payment of the resident's nursing home expenses, or to another person designated by the resident or the resident's representative. This notice must be distributed within three working business CARE PROVIDERS OF MINNESOTA

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days after the facility's receipt of the electronic file of notice of case mix classifications from the commissioner of health. (b) If a facility submits a modification to the most recent assessment used to establish a case mix classification conducted under subdivision 3 that results modifying assessment resulting in a change in the case mix classification, the facility shall give must provide a written notice to the resident or the resident's representative about regarding the item or items that was were modified and the reason for the modification modifications. The notice of modified assessment may must be provided at the same time that the resident or resident's representative is provided the resident's modified notice of classification within three business days after distribution of the resident case mix classification notice.

Sec. 17. Minnesota Statutes 2020, section 144.0724, subdivision 8, is amended to read: Subd. 8. Request for reconsideration of resident classifications. (a) The resident, or resident's representative, or the nursing facility or boarding care home may request that the commissioner of health reconsider the assigned reimbursement case mix classification and any item or items changed during the audit process. The request for reconsideration must be submitted in writing to the commissioner within 30 days of the day the resident or the resident's representative receives the resident classification notice of health. (b) For reconsideration requests initiated by the resident or the resident's representative: (1) The resident or the resident's representative must submit in writing a reconsideration request to the facility administrator within 30 days of receipt of the resident classification notice. The written request for reconsideration must include the name of the resident, the name and address of the facility in which the resident resides, the reasons for the reconsideration, and documentation supporting the request. The documentation accompanying the reconsideration request is limited to a copy of the MDS that determined the classification and other documents that would support or change the MDS findings.

(2) Within three business days of receiving the reconsideration request, the nursing facility must submit to the commissioner of health a completed reconsideration request form, a copy of the resident's or resident's representative's written request, and all supporting documentation used to complete the assessment being considered. If the facility fails to provide the required information, the reconsideration will be completed with the information submitted and the facility cannot make further reconsideration requests on this classification.

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(b) (3) Upon written request and within three business days, the nursing facility must give the resident or the resident's representative a copy of the assessment form being reconsidered and the other all supporting documentation that was given to the commissioner of health used to support complete the assessment findings. The nursing facility shall also provide access to and a copy of other information from the resident's record that has been requested by or on behalf of the resident to support a resident's reconsideration request. A copy of any requested material must be provided within three working days of receipt of a written request for the information. Notwithstanding any law to the contrary, the facility may not charge a fee for providing copies of the requested documentation. If a facility fails to provide the material required documents within this time, it is subject to the issuance of a correction order and penalty assessment under sections 144.653 and 144A.10. Notwithstanding those sections, any correction order issued under this subdivision must require that the nursing facility immediately comply with the request for information, and that as of the date of the issuance of the correction order, the facility shall forfeit to the state a $100 fine for the first day of noncompliance, and an increase in the $100 fine by $50 increments for each day the noncompliance continues. (c) in addition to the information required under paragraphs (a) and (b), a reconsideration request from a nursing facility must contain the following information: (i) the date the reimbursement classification notices were received by the facility; (ii) the date the classification notices were distributed to the resident or the resident's representative; and (iii) For reconsideration requests initiated by the facility: (1) The facility is required to inform the resident or the resident's representative in writing that a reconsideration of the resident's case mix classification is being requested.

The notice must inform the resident or the resident's representative: (i) of the date and reason for the reconsideration request; (ii) of the potential for a classification and subsequent rate change; (iii) of the extent of the potential rate change; (iv) that copies of the request and supporting documentation are available for review; and (v) that the resident or the resident's representative has the right to request a reconsideration.

(2) Within 30 days of receipt of the audit exit report or resident classification notice, the facility must submit to the commissioner of health a completed reconsideration request form, all supporting documentation used to complete the assessment being reconsidered, and a copy of a the notice sent to informing the resident or to the resident's representative. This notice must inform the resident or the resident's representative that a reconsideration of the resident's classification is being requested, the reason for the request, that the resident's rate will change if the request is approved

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by the commissioner, the extent of the change, that copies of the facility's request and supporting documentation are available for review, and that the resident also has the right to request a reconsideration.

(3) If the facility fails to provide the required information listed in item (iii) with the reconsideration request, the commissioner may request that the facility provide the information within 14 calendar days., the reconsideration request must may be denied if the information is then not provided, and the facility may not make further reconsideration requests on that specific reimbursement this classification. (d) Reconsideration by the commissioner must be made by individuals not involved in reviewing the assessment, audit, or reconsideration that established the disputed classification. The reconsideration must be based upon the assessment that determined the classification and upon the information provided to the commissioner of health under paragraphs (a) and (b) to (c). If necessary for evaluating the reconsideration request, the commissioner may conduct on-site reviews. Within 15 working business days of receiving the request for reconsideration, the commissioner shall affirm or modify the original resident classification. The original classification must be modified if the commissioner determines that the assessment resulting in the classification did not accurately reflect characteristics of the resident at the time of the assessment. The resident and the nursing facility or boarding care home shall be notified within five working days after the decision is made. The commissioner must transmit the reconsideration classification notice by electronic means to the nursing facility. The nursing facility is responsible for the distribution of the notice to the resident or the resident's representative. The notice must be distributed by the nursing facility within three business days after receipt. A decision by the commissioner under this subdivision is the final administrative decision of the agency for the party requesting reconsideration. (e) The resident case mix classification established by the commissioner shall be the classification that which applies to the resident while the request for reconsideration is pending. If a request for reconsideration applies to an assessment used to determine nursing facility level of care under subdivision 4, paragraph (c), the resident shall continue to be eligible for nursing facility level of care while the request for reconsideration is pending. (f) The commissioner may request additional documentation regarding a reconsideration necessary to make an accurate reconsideration determination.

Sec. 18. Minnesota Statutes 2020, section 144.0724, subdivision 9, is amended to read: Subd. 9. Audit authority. (a) The commissioner shall audit the accuracy of resident assessments performed under section 256R.17 through any of the following: desk audits; on-site review of residents and their records; and interviews with staff, residents, or

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residents' families. The commissioner shall reclassify a resident if the commissioner determines that the resident was incorrectly classified. (b) The commissioner is authorized to conduct on-site audits on an unannounced basis. (c) A facility must grant the commissioner access to examine the medical records relating to the resident assessments selected for audit under this subdivision. The commissioner may also observe and speak to facility staff and residents. (d) The commissioner shall consider documentation under the time frames for coding items on the minimum data set as set out in the Long-Term Care Facility Resident Assessment Instrument User's Manual published by the Centers for Medicare and Medicaid Services. (e) The commissioner shall develop an audit selection procedure that includes the following factors: (1) Each facility shall be audited annually. If a facility has two successive audits in which the percentage of change is five percent or less and the facility has not been the subject of a special audit in the past 36 months, the facility may be audited biannually. A stratified sample of 15 percent, with a minimum of ten assessments, of the most current assessments shall be selected for audit. If more than 20 percent of the RUG-IV classifications are changed as a result of the audit, the audit shall be expanded to a second 15 percent sample, with a minimum of ten assessments. If the total change between the first and second samples is 35 percent or greater, the commissioner may expand the audit to all of the remaining assessments.

(2) If a facility qualifies for an expanded audit, the commissioner may audit the facility again within six months. If a facility has two expanded audits within a 24-month period, that facility will be audited at least every six months for the next 18 months.

(3) The commissioner may conduct special audits if the commissioner determines that circumstances exist that could alter or affect the validity of case mix classifications of residents. These circumstances include, but are not limited to, the following: (i) frequent changes in the administration or management of the facility; (ii) an unusually high percentage of residents in a specific case mix classification; (iii) a high frequency in the number of reconsideration requests received from a facility; (iv) frequent adjustments of case mix classifications as the result of reconsiderations or audits; (v) a criminal indictment alleging provider fraud; (vi) other similar factors that relate to a facility's ability to conduct accurate assessments;

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(vii) an atypical pattern of scoring minimum data set items; (viii) nonsubmission of assessments; (ix) late submission of assessments; or (x) a previous history of audit changes of 35 percent or greater. (f) Within 15 working days of completing the audit process, the commissioner shall make available electronically the results of the audit to the facility. If the results of the audit reflect a change in the resident's case mix classification, a case mix classification notice will be made available electronically to the facility, using the procedure in subdivision 7, paragraph (a). The notice must contain the resident's classification and a statement informing the resident, the resident's authorized representative, and the facility of their right to review the commissioner's documents supporting the classification and to request a reconsideration of the classification. This notice must also include the address and telephone number of the Office of Ombudsman for Long-Term Care. If the audit results in a case mix classification change, the commissioner must transmit the audit classification notice by electronic means to the nursing facility within 15 business days of completing an audit. The nursing facility is responsible for distribution of the notice to each resident or the resident's representative. This notice must be distributed by the nursing facility within three business days after receipt. The notice must inform the resident of the case mix classification assigned, the opportunity to review the documentation supporting the classification, the opportunity to obtain clarification from the commissioner, the opportunity to request a reconsideration of the classification, and the address and telephone number of the Office of Ombudsman for Long-Term Care.

Sec. 19. Minnesota Statutes 2020, section 144.0724, subdivision 12, is amended to read: Subd. 12. Appeal of nursing facility level of care determination. (a) A resident or prospective resident whose level of care determination results in a denial of long-term care services can appeal the determination as outlined in section 256B.0911, subdivision 3a, paragraph (h), clause (9). (b) The commissioner of human services shall ensure that notice of changes in eligibility due to a nursing facility level of care determination is provided to each affected recipient or the recipient's guardian at least 30 days before the effective date of the change. The notice shall include the following information: (1) how to obtain further information on the changes; (2) how to receive assistance in obtaining other services; (3) a list of community resources; and (4) appeal rights.

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A recipient who meets the criteria in section 256B.0922, subdivision 2, paragraph (a), clauses (1) and (2), may request continued services pending appeal within the time period allowed to request an appeal under section 256.045, subdivision 3, paragraph (i).

This paragraph is in effect for appeals filed between January 1, 2015, and December 31, 2016.

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Significant change in status assessment required when therapy (and isolation) ends 2021, 1st Special Session HF33/SF37 Chapter 7, Article 13, Section 1 HHS omnibus bill Effective: August 1, 2021, and applies to all assessments with an assessment reference date of August 1, 2021, or later (Note bill language uses July 1, 2021, but the state agencies determined that a July 1, 2021 implementation was not possible) Short description Effective for all MDS’ with therapy and isolation end dates on or after August 1, 2021, a significant change in status assessment (SCSA) is required when all speech, occupational, and physical therapies have ended. The assessment reference date (ARD) of this assessment must be set on day eight after all therapy services have ended. The last day therapy was provided is considered day 0 when determining the ARD of the SCSA. A significant change in status assessment (SCSA) is also required when isolation for an infectious disease has ended. The ARD of this assessment must be set on day 15 after isolation has ended. The last day of isolation precautions is considered day 0 when determining the ARD of the SCSA. Summary The proposal to require a significant change in status assessment (SCSA) when therapy (and isolation) ends was not new. For the previous 4-5 years, legislators had received complaints from constituents who believed the nursing facility was charging a higher case mix classification rate, even though the associated services ended earlier during the stay. Bill language was introduced in previous years. However, the recent HHH Blue Ribbon Commission reviewed and recommended the strategy as one way to reduce Medicaid expenditures. Governor Walz included the policy change in his recent budget, and the Minnesota Senate and House of Representatives adopted without modifying.

MDH hosted a 2021 CMR Program Statute Changes webinar on July 22, 2021 (https://bit.ly/3f2yuPY), where the following clarifications were provided to the following statement (from page 2): •

All Medicaid participating facilities are required to complete a significant change in status assessment (SCSA) when all skilled therapy or strict isolation services end regardless of the resident’s payer source or RUG classification.

Is the SCSA necessary if no rehab or ES1 classification (page 6)?

According to MDH, If the resident does not have a rehab or isolation classification, a SCSA would not be required at the end of skilled therapy or isolation.

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•

If the resident is receiving skilled therapy or strict isolation services and this is impacting the resident’s RUG-IV classification, the SCSA is required

•

A resident receiving isolation services may have an ES1 or a CA1 classification depending on their ADL score

•

Anytime the resident has a state rehab classification (RAA, RAB, RAC, RAD, and RAE) the SCSA is required

Skilled vs. unskilled therapy services (page 10) •

•

Skilled Therapy Services: •

are medically necessary;

•

are ordered by a MD, PA, or NP;

•

require the skills, knowledge, and judgement of a qualified therapist;

•

are based on a qualified therapist’s assessment and treatment plan;

•

are documented in the medical record; and

•

are care planned and periodically evaluated

Therapy services that don’t meet these requirements are considered unskilled—An SCSA is not required when unskilled therapy services end

During July 22, 2021, webinar, it was communicated that the significant change in status assessment (SCSA) is not required following the end of isolation or therapy if there is no impact on the RUG classification. For example, if there is no MDS on record coding therapy, then there would not be a requirement to do a SCSA for end of therapy.

Implications Besides making sure their processes comply with the new state requirements, nursing facilities must contend with two other implications: 1.

For some nursing facilities, the new SCSA requirement will result in a reduction in annual revenue due to the reclassification of residents to a lower case mix classification

2. For all nursing facilities, the consequences of a late and missed SCSA are very significant: a. The penalty rate, AAA, will be assigned for all late or missed assessments b. The penalty rate will be assigned from the time the assessment was due, the ARD, until the 1st of the month following submission and acceptance of the late assessment into the QIES ASAP system Bill language https://www.revisor.mn.gov/laws/2021/1/Session+Law/Chapter/7/ Section 1. Minnesota Statutes 2020, section 144.0724, subdivision 4, is amended to read:

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Subd. 4. Resident assessment schedule. (a) A facility must conduct and electronically submit to the commissioner of health federal database MDS assessments that conform with the assessment schedule defined by Code of Federal Regulations, title 42, section 483.20, and published by the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services, in the Long Term Care Facility Resident Assessment Instrument User's Manual, version 3.0, and subsequent updates when or its successor issued by the Centers for Medicare and Medicaid Services. The commissioner of health may substitute successor manuals or question and answer documents published by the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services, to replace or supplement the current version of the manual or document. (b) The assessments required under the Omnibus Budget Reconciliation Act of 1987 (OBRA) used to determine a case mix classification for reimbursement include the following: (1) a new admission comprehensive assessment, which must have an assessment reference date (ARD) within 14 calendar days after admission, excluding readmissions; (2) an annual comprehensive assessment, which must have an assessment reference date (ARD) ARD within 92 days of the a previous quarterly review assessment and the or a previous comprehensive assessment, which must occur at least once every 366 days; (3) a significant change in status comprehensive assessment, which must be completed have an ARD within 14 days of the identification of after the facility determines, or should have determined, that there has been a significant change in the resident's physical or mental condition, whether an improvement or a decline, and regardless of the amount of time since the last significant change in status comprehensive assessment or quarterly review assessment; (4) all a quarterly assessments review assessment must have an assessment reference date (ARD) ARD within 92 days of the ARD of the previous quarterly review assessment or a previous comprehensive assessment; (5) any significant correction to a prior comprehensive assessment, if the assessment being corrected is the current one being used for RUG classification; and (6) any significant correction to a prior quarterly review assessment, if the assessment being corrected is the current one being used for RUG classification.; (7) a required significant change in status assessment when: (i) all speech, occupational, and physical therapies have ended. The ARD of this assessment must be set on day eight after all therapy services have ended; and (ii) isolation for an infectious disease has ended. The ARD of this assessment must be set on day 15 after isolation has ended; and

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(8) any modifications to the most recent assessments under clauses (1) to (7). (c) In addition to the assessments listed in paragraph (b), the assessments used to determine nursing facility level of care include the following: (1) preadmission screening completed under section 256.975, subdivisions 7a to 7c, by the Senior LinkAge Line or other organization under contract with the Minnesota Board on Aging; and (2) a nursing facility level of care determination as provided for under section 256B.0911, subdivision 4e, as part of a face-to-face long-term care consultation assessment completed under section 256B.0911, by a county, tribe, or managed care organization under contract with the Department of Human Services.

EFFECTIVE DATE. This section is effective July 1, 2021 and applies to all assessments with an assessment reference date of July 1, 2021, or later.

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Permanent nursing facility moratorium funding appropriated 2021, 1st Special Session HF33/SF37 Chapter 7, Article 13, Sections 2–3 HHS omnibus bill Effective: July 1, 2021 Short description Permanent funding for nursing facility projects funded by an exception to the nursing facility moratorium was appropriated.

Summary Care Providers of Minnesota introduced legislation requesting $10 million per biennium appropriated by the state to fund nursing facility projects including those in response to the demands of the pandemic (e.g., private rooms). The legislature responded with a sizeable portion of the request and most importantly made future rounds permanent.

During the biennium beginning July 1, 2021, and during each biennium thereafter, the commissioner of health may approve moratorium exception projects for which the full biennial state share of Medicaid costs does not exceed $4,000,000, plus any carryover of previous appropriations for this purpose.

Because the state need only appropriate funds to cover the state’s share of the amortized cost of the project, a relatively small appropriation generates a sizable return in construction projects. Seven nursing facilities with projects totaling $91,617,774 were approved under the 2019 moratorium round at an annual cost of $1,165,578 to the state general fund.

Implications In 2019, the legislature adopted a Fair Rental Value (FRV) property rate system for nursing facility moratorium exception projects. This important reform was based on research funded by the 2015 payment reform bill and has created an important mechanism to ensure much needed investments in infrastructure and physical plant improvements in the state’s outdated and aging nursing homes.

A Fair Rental Value (FRV) property rate system establishes a price for use of space regardless of actual accounting cost, where: •

The state is essentially leasing the facility for the use of their Medicaid patients

•

The rental rate is based on an index related to capital costs

•

The total replacement cost, current depreciated value and square footage determined by the appraisal is used to determine facility value

•

Price is facility value times rental rate adjusted to a per day payment

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In addition to allowing for the funding of projects, an important aspect of the language adopted is that since funding is guaranteed for each future biennium, nursing facilities will be able to thoughtfully plan their requests.

Bill language https://www.revisor.mn.gov/laws/2021/1/Session+Law/Chapter/7/ Sec. 2. Minnesota Statutes 2020, section 144A.073, subdivision 2, is amended to read: Subd. 2. Request for proposals. At the authorization by the legislature of additional medical assistance expenditures for exceptions to the moratorium on nursing homes, the commissioner shall publish in the State Register a request for proposals for nursing home and certified boarding care home projects for conversion, relocation, renovation, replacement, upgrading, or addition. The public notice of this funding and the request for proposals must specify how the approval criteria will be prioritized by the commissioner. The notice must describe the information that must accompany a request and state that proposals must be submitted to the commissioner within 150 days of the date of publication. The notice must include the amount of the legislative appropriation available for the additional costs to the medical assistance program of projects approved under this section. If money is appropriated, the commissioner shall initiate the application and review process described in this section at least once each biennium. A second application and review process must occur if remaining funds are either greater than $300,000 or more than 50 percent of the baseline appropriation for the biennium.

Authorized funds may be awarded in full in the first review process of the biennium.

Appropriated funds not encumbered within a biennium shall carry forward to the following biennium. To be considered for approval, a proposal must include the following information: (1) whether the request is for renovation, replacement, upgrading, conversion, addition, or relocation; (2) a description of the problems the project is designed to address; (3) a description of the proposed project; (4) an analysis of projected costs of the nursing facility proposed project, including: (i) initial construction and remodeling costs; (ii) site preparation costs; (iii) equipment and technology costs; (iv) financing costs, the current estimated long-term financing costs of the proposal, which is to include details of any proposed funding mechanism already arranged or being considered, including estimates of the amount and sources of money, CARE PROVIDERS OF MINNESOTA

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reserves if required, annual payments schedule, interest rates, length of term, closing costs and fees, insurance costs, any completed marketing study or underwriting review; and (v) estimated operating costs during the first two years after completion of the project; (5) for proposals involving replacement of all or part of a facility, the proposed location of the replacement facility and an estimate of the cost of addressing the problem through renovation; (6) for proposals involving renovation, an estimate of the cost of addressing the problem through replacement; (7) the proposed timetable for commencing construction and completing the project; (8) a statement of any licensure or certification issues, such as certification survey deficiencies; (9) the proposed relocation plan for current residents if beds are to be closed according to section 144A.161; and (10) other information required by permanent rule of the commissioner of health in accordance with subdivisions 4 and 8.

Sec. 3. Minnesota Statutes 2020, section 144A.073, is amended by adding a subdivision to read: Subd. 17. Moratorium exception funding. (a) During the biennium beginning July 1, 2021, and during each biennium thereafter, the commissioner of health may approve moratorium exception projects under this section for which the full biennial state share of medical assistance costs does not exceed $4,000,000, plus any carryover of previous appropriations for this purpose. (b) For the purposes of this subdivision, "biennium" has the meaning given in section 16A.011, subdivision 6.

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ASSISTED LIVING PAYMENT

Permanent funding appropriated for EW, CADI and, BI customized living quality improvement grants 2021, 1st Special Session HF33/SF37 Chapter 7, Article 13, Section 10 HHS omnibus bill Effective: July 1, 2021 Short description $500,000 per year is available for Elderly Waiver (EW), Community Access for Disability Inclusion (CADI), and Brain Injury (BI) waiver providers of customized living (CL) for quality improvement grants.

Summary The proposal modifies legislation passed in 2019. Importantly, to be eligible, at least 75% of the clients served by the provider must be waiver participants.

Statute directs the Minnesota Department of Human Services (DHS) to evaluate and select proposals with the following policy objectives in mind: •

Provide more efficient, higher quality services

•

Encourage home and community-based services providers to innovate

•

Equip home and community-based services providers with organizational tools and expertise to improve their quality

•

Incentivize home and community-based services providers to invest in better services

•

Disseminate successful performance improvement strategies statewide

Implications EW, CADI, and BI providers of CL service that meet the threshold of waivered clients served, should consider applying for the grant.

When DHS formally announces the grant process, Care Providers of Minnesota will communicate to the membership.

Bill language https://www.revisor.mn.gov/laws/2021/1/Session+Law/Chapter/7/

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Home health agency services & home care nursing services to receive annual increases 2021, 1st Special Session HF33/SF37 Chapter 7, Article 13, Sections 11–12 HHS omnibus bill Effective: July 1, 2021, or upon federal approval, whichever occurs later, for services delivered on or after January 1, 2022 Short description Home health agency services and home care nursing services payment rates will receive annual inflationary adjustments.

Summary The Minnesota Department of Human Services (DHS) is instructed to use the federal Centers for Medicare & Medicaid Services (CMS) home health agency market basket indices to annually adjust the payment rates.

Implications Typically, Home health agency services and home care nursing services are Medicarecertified home health agencies with a comprehensive homecare license that deliver state plan services.

Bill language https://www.revisor.mn.gov/laws/2021/1/Session+Law/Chapter/7/ Sec. 11. Minnesota Statutes 2020, section 256B.0653, is amended by adding a subdivision to read: Subd. 8. Payment rates for home health agency services. The commissioner shall annually adjust payments for home health agency services to reflect the change in the federal Centers for Medicare and Medicaid Services Home Health Agency Market Basket.

The commissioner shall use the indices as forecasted for the midpoint of the prior rate year to the midpoint of the current rate year.

EFFECTIVE DATE. This section is effective July 1, 2021, or upon federal approval, whichever occurs later, for services delivered on or after January 1, 2022. The commissioner of human services shall notify the revisor of statutes when federal approval is obtained.

Sec. 12. Minnesota Statutes 2020, section 256B.0654, is amended by adding a subdivision to read:

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Subd. 5. Payment rates for home care nursing services. The commissioner shall annually adjust payments for home care nursing services to reflect the change in the federal Centers for Medicare and Medicaid Services Home Health Agency Market Basket.

The commissioner shall use the indices as forecasted for the midpoint of the prior rate year to the midpoint of the current rate year.

EFFECTIVE DATE. This section is effective July 1, 2021, or upon federal approval, whichever occurs later, for services delivered on or after January 1, 2022. The commissioner of human services shall notify the revisor of statutes when federal approval is obtained.

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Housing supports absent days 2021, 1st Special Session HF33/SF37 Chapter 7, Article 13, Section 57 HHS omnibus bill Effective: July 1, 2021 Short description If a person is temporarily absent due to admission at a residential behavioral health facility, inpatient hospital, or nursing facility for a period of time exceeding the limits of absent days, an agency may request an absence day limit exception, not to exceed 92 days, in order to continue housing support payments until the person is discharged.

Summary Housing support payment for absence days is limited to 18 calendar days per incident, not to exceed 60 days in a calendar year. With this bill, for persons temporarily absent due to admission at a residential behavioral health facility, inpatient hospital, or nursing facility, an agency must continue to pay an additional 74 days per incident, not to exceed a total of 92 days in a calendar year. Agencies are allowed to request an absence day limit exception in certain circumstances.

Implications Housing support settings should incorporate the expansion of the client absent days benefit into their policies and procedures.

Bill language https://www.revisor.mn.gov/laws/2021/1/Session+Law/Chapter/7/ Sec. 57. Minnesota Statutes 2020, section 256I.05, is amended by adding a subdivision to read: Subd. 2a. Absent days. (a) When a person receiving housing support is temporarily absent and the absence is reported in advance to the agency's social service staff, the agency must continue to pay on behalf of the person the applicable rate for housing support. Advance reporting is not required for absences due to crisis, illness, or injury.

The limit on payments for absence days under this paragraph is 18 calendar days per incident, not to exceed 60 days in a calendar year. (b) An agency must continue to pay an additional 74 days per incident, not to exceed a total of 92 days in a calendar year, for a person who is temporarily absent due to admission at a residential behavioral health facility, inpatient hospital, or nursing facility.

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(c) If a person is temporarily absent due to admission at a residential behavioral health facility, inpatient hospital, or nursing facility for a period of time exceeding the limits described in paragraph (b), the agency may request in a format prescribed by the commissioner an absence day limit exception to continue housing support payments until the person is discharged.

EFFECTIVE DATE. This section is effective July 1, 2021.

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AL facilities with 80% EW may apply for disproportionate share rate increases 2021, 1st Special Session HF33/SF37 Chapter 7, Article 13, Sections 61–62 HHS omnibus bill Effective: October 1, 2021, or upon federal approval, whichever is later, and applies to services provided on or after July 1, 2022, or on or after the date upon which federal approval is obtained, whichever is later Short description Assisted living facilities with an Elderly Waiver (EW) customized living (CL) census of 80% may apply and receive a rate floor of $119 per resident per day.

Summary Since at least 2010, providers have had to balance serving the EW-CL residents with the underfunding of this Medicaid program. For settings that serve a high proportion of EWCL residents, providers have experienced difficulty with meeting the needs of the residents. For the past couple of years, the legislature has discussed how to address the issue.

The process is set up by statute: •

Applications must be submitted annually between October 1 and October 31—the Minnesota Department of Human Services (DHS) will create the application materials

•

The applicant must use the percentage the census of EW participants residing in the facility on October 1 of the application year

•

By November 15 of the application year, DHS will designate assisted living facilities as a disproportionate share facility that successfully submit the required application and elderly waiver participants accounting for 80% of their census

DHS will establish a rate floor equal to $119 per resident per day for 24-hour customized living services provided in a designated disproportionate share facility.

Implications Assisted living facilities with an 80% or higher share of EW-CL residents will want to plan on reviewing the application materials and guidance from the DHS, and determine whether or not to apply. Presumably, the rate floor of $119 per resident per day will provide most if not all applicants with additional revenue.

Bill language https://www.revisor.mn.gov/laws/2021/1/Session+Law/Chapter/7/

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Sec. 61. Minnesota Statutes 2020, section 256S.203, is amended to read: 256S.203 CUSTOMIZED LIVING SERVICES; MANAGED CARE RATES. Subdivision 1. Capitation payments. The commissioner shall must adjust the elderly waiver capitation payment rates for managed care organizations paid to reflect the monthly service rate limits for customized living services and 24-hour customized living services established under section 256S.202 and the rate adjustments for disproportionate share facilities under section 256S.205.

Subd. 2. Reimbursement rates. Medical assistance rates paid to customized living providers by managed care organizations under this chapter shall must not exceed the monthly service rate limits and component rates as determined by the commissioner under sections 256S.15 and 256S.20 to 256S.202, plus any rate adjustment under section 256S.205.

Sec. 62. [256S.205] CUSTOMIZED LIVING SERVICES; DISPROPORTIONATE SHARE RATE ADJUSTMENTS. Subdivision 1. Definitions. (a) For the purposes of this section, the terms in this subdivision have the meanings given. (b) "Application year" means a year in which a facility submits an application for designation as a disproportionate share facility. (c) "Assisted living facility" or "facility" means an assisted living facility licensed under chapter 144G. (d) "Disproportionate share facility" means an assisted living facility designated by the commissioner under subdivision 4.

Subd. 2. Rate adjustment application. An assisted living facility may apply to the commissioner for designation as a disproportionate share facility. Applications must be submitted annually between October 1 and October 31. The applying facility must apply in a manner determined by the commissioner. The applying facility must document as a percentage the census of elderly waiver participants residing in the facility on October 1 of the application year.

Subd. 3. Rate adjustment eligibility criteria. Only facilities with a census of at least 80 percent elderly waiver participants on October 1 of the application year are eligible for designation as a disproportionate share facility.

Subd. 4. Designation as a disproportionate share facility. By November 15 of each application year, the commissioner must designate as a disproportionate share facility a facility that complies with the application requirements of subdivision 2 and meets the eligibility criteria of subdivision 3.

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Subd. 5. Rate adjustment; rate floor. (a) Notwithstanding the 24-hour customized living monthly service rate limits under section 256S.202, subdivision 2, and the component service rates established under section 256S.201, subdivision 4, the commissioner must establish a rate floor equal to $119 per resident per day for 24-hour customized living services provided in a designated disproportionate share facility for the purpose of ensuring the minimal level of staffing required to meet the health and safety needs of elderly waiver participants. (b) The commissioner must adjust the rate floor at least annually in the manner described under section 256S.18, subdivisions 5 and 6. (c) The commissioner shall not implement the rate floor under this section if the customized living rates established under sections 256S.21 to 256S.215 will be implemented at 100 percent on January 1 of the year following an application year.

Subd. 6. Budget cap disregard. The value of the rate adjustment under this section must not be included in an elderly waiver client's monthly case mix budget cap.

EFFECTIVE DATE. This section is effective October 1, 2021, or upon federal approval, whichever is later, and applies to services provided on or after July 1, 2022, or on or after the date upon which federal approval is obtained, whichever is later. The commissioner of human services shall notify the revisor of statutes when federal approval is obtained.

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Legislature increases rates for Elderly Waiver customized living, excludes CADI-CL 2021, 1st Special Session HF33/SF37 Chapter 7, Article 13, Sections 63–64 HHS omnibus bill Effective: This section is effective January 1, 2022, or upon federal approval, whichever is later Short description The rates and rate components for Elderly Waiver (EW) and EW customized living (CL), EW foster care, Alternative Care (AC), and Essential Community Supports (ECS) supports will be increased, on average, by an estimated 3%. A different formula is used for Community Access for Disability Inclusion (CADI) CL, which results in nominal increase.

Summary In 2017, the legislature adopted a Care Providers of Minnesota proposal to blend 10% of a new payment rate methodology for certain rates used by the Elderly Waiver (EW) and EW Customized Living (CL), Community Access for Disability Inclusion (CADI) Customized Living (CL), EW foster care, Alternative Care (AC), and Essential Community Supports (ECS) programs with 90% of the existing rates on January 1, 2019.

The 2021 legislature increased the blend to 18.8% of the new payment methodology and 81.2% of the 2017 rates for EW, EW-CL, AC, and ECS. As a result, beginning January 1, 2022, the service rates used will increase by an average of 3%. It is assumed that the increased will be phased in as clients are reassessed during the year. Since each service rate is calculated separately, the actual increase will differ and is not known.

CADI-CL will see a nominal rate increase based on 10% of the new value and 90% of the 2017 rates.

Implications EW, EW-CL, AC, and ECS providers will see an increase to the service rates used to establish the monthly payments received beginning January 1, 2022, as clients are reassessed.

Bill language https://www.revisor.mn.gov/laws/2021/1/Session+Law/Chapter/7/ Sec. 63. Minnesota Statutes 2020, section 256S.21, is amended to read: 256S.21 RATE SETTING; APPLICATION. The payment methodologies in sections 256S.2101 to 256S.215 apply to elderly waiver, elderly waiver customized living, and elderly waiver foster care, and elderly waiver residential care under this CARE PROVIDERS OF MINNESOTA

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chapter,; alternative care under section 256B.0913,; essential community supports under section 256B.0922,; and community access for disability inclusion customized living and brain injury customized living under section 256B.49.

EFFECTIVE DATE. This section is effective January 1, 2022, or upon federal approval, whichever is later. The commissioner of human services shall inform the revisor of statutes when federal approval is obtained.

Sec. 64. Minnesota Statutes 2020, section 256S.2101, is amended to read: 256S.2101 RATE SETTING; PHASE-IN. Subdivision 1. Phase-in for disability waiver customized living rates. All rates and rate components for services listed in section 256S.21 community access for disability inclusion customized living and brain injury customized living under section 256B.4914 shall be the sum of ten percent of the rates calculated under sections 256S.211 to 256S.215 and 90 percent of the rates calculated using the rate methodology in effect as of June 30, 2017.

Subd. 2. Phase-in for elderly waiver rates. Except for home-delivered meals as described in section 256S.215, subdivision 15, all rates and rate components for elderly waiver, elderly waiver customized living, and elderly waiver foster care under this chapter; alternative care under section 256B.0913; and essential community supports under section 256B.0922 shall be the sum of 18.8 percent of the rates calculated under sections 256S.211 to 256S.215, and 81.2 percent of the rates calculated using the rate methodology in effect as of June 30, 2017. The rate for home-delivered meals shall be the sum of the service rate in effect as of January 1, 2019, and the increases described in section 256S.215, subdivision 15.

EFFECTIVE DATE. This section is effective January 1, 2022, or upon federal approval, whichever is later. The commissioner of human services shall inform the revisor of statutes when federal approval is obtained.

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LTC assessment may be temporarily waived for HCBS waiver clients returning from a healthcare facility 2021, Regular Session HF2128/SF2360 Chapter 30, Article 12, Section 2 HHS omnibus bill Effective: Upon federal approval (the commissioner shall notify the revisor of statutes when federal approval is obtained) Short description A Medicaid beneficiary receiving home and community-based services who returns in less than 120 days from a healthcare facility stay is not required to have a long-term care assessment and support planning.

Summary The statute guiding Minnesota’s long-term care assessment and support planning is changed by adding language to allow a person who receives HCBS and temporarily enters a hospital, institution of mental disease, nursing facility, intensive residential treatment services program, transitional care unit, or inpatient substance use disorder treatment setting for 121 days or less may return to the community under the same waiver services without requiring an assessment or reassessment, unless the person’s annual reassessment is otherwise due.

The new language does not change the annual long-term care consultation reassessment requirements, payment for institutional or treatment services, Medicaid financial eligibility, or any other law.

Implications The Medicaid beneficiaries impacted by this change include those receiving services under the Elderly, CADI, Alternative Care, and Disability waivers.

Providers of customized living will want to monitor their clients upon return from healthcare facilities to make sure that the assessment of record still matches the client’s health needs.

For Elderly Waiver beneficiaries, Minnesota statute 256R defines “change-in-condition reassessments,” where: (a)

The lead agency shall conduct a change-in-condition reassessment before the annual reassessment if a participant's condition changed due to a major health event, an emerging need or risk, or a worsening health condition, or when the current services do not meet the participant's needs.

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(b)

A change-in-condition reassessment may be initiated by the lead agency, may be requested by the participant, or may be requested on the participant's behalf by another party, such as a service provider.

(c)

The lead agency shall: (1) complete a change-in-condition reassessment no later than 20 calendar days from the date of a request; (2) conduct a change-incondition reassessment in a timely manner and expedite urgent requests; and (3) evaluate urgent requests based on the participant's needs and the risk to the participant if a change-in-condition reassessment is not completed.

Bill language https://www.revisor.mn.gov/laws/2021/0/Session+Law/Chapter/30/ Sec. 2. Minnesota Statutes 2020, section 256B.0911, subdivision 3a, is amended to read: Subd. 3a. Assessment and support planning. (n) If a person who receives home and community-based waiver services under section 256B.0913, 256B.092, or 256B.49 or chapter 256S temporarily enters for 121 days or fewer a hospital, institution of mental disease, nursing facility, intensive residential treatment services program, transitional care unit, or inpatient substance use disorder treatment setting, the person may return to the community with home and communitybased waiver services under the same waiver, without requiring an assessment or reassessment under this section, unless the person's annual reassessment is otherwise due. Nothing in this paragraph shall change annual long-term care consultation reassessment requirements, payment for institutional or treatment services, medical assistance financial eligibility, or any other law.

EFFECTIVE DATE. This section is effective upon federal approval. The commissioner shall notify the revisor of statutes when federal approval is obtained.

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ASSISTED LIVING

Assisted living licensure technical changes 2020, 7th Special Session HF19/SF27 Chapter 1, Article 6 Effective: Various Short description Technical changes to various assisted living licensure requirements.

Summary In anticipation of the transition to assisted living licensure, Care Providers of Minnesota staff worked with Minnesota Department of Health (MDH), Minnesota Department of Human Services (DHS), advocates, and other provider groups to identify technical changes to the assisted living licensure law. Although they covered multiple topic areas, these changes were necessary to smooth the application and transition to assisted living licensure that was set to begin in May of 2021 for the August 1, 2021, effective date of licensure.

The following is a list of the sections and a short summary of the language change: •

Section 1: Technical changes to 626.557 language—Language mistakenly omitted from licensure enactment clarifying the application of the applicability and liability of the reporting of vulnerable adults statute

•

Section 2: Amounts—This language clarifies the license fees applicable to the various categories

•

Section 3: Technical 626.557 language—Language mistakenly omitted from licensure enactment clarifying the application of the applicability and liability of the reporting of vulnerable adults statute

•

Section 4: Campus setting—Clarifies the definition of the assisted living facility campus to mean: o

a single building having two or more addresses, located on the same property with a single property identification number;

o

two or more buildings, each with a separate address, located on the same

o

two or more buildings at different addresses, located on properties with

property with a single property identification number; or different property identification numbers, that share a portion of a legal property boundary

•

Section 5: Technical AL definition—This change eliminated a redundancy and added an exempt category for any establishment that exclusively or primarily serves as a shelter or temporary shelter for victims of domestic or any other form of violence

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•

Section 6: Technical license—A technical change that added a definition for assisted living facility license: "Assisted living facility license" or "license" that means a certificate issued by the commissioner under section 144G.10 that authorizes the licensee to manage, control, and operate an assisted living facility for a specified period of time and in accordance with the terms of the license, this chapter, and the rules of the commissioner

•

Section 7: Assisted living services—A technical change to use the term “specialized” rather than “modified” diet

•

Section 8: Direct ownership interest language—A technical change to clarify that legal entity rather than organization

•

Section 9: Resident definition—A technical change that clarified that it resident means an adult rather than a person

•

Section 10: License required—Technical changes that added further clarification to the license requirement by stating the following: License required. (a)(1) Beginning August 1, 2021, no assisted living facility may operate in Minnesota unless it is licensed under this chapter.

(2) No facility or building on a campus may provide assisted living services until obtaining the required license under paragraphs (c) to (e). (b) The licensee is legally responsible for the management, control, and operation of the facility, regardless of the existence of a management agreement or subcontract. Nothing in this chapter shall in any way affect the rights and remedies available under other law. (c) Upon approving an application for an assisted living facility license, the commissioner shall issue a single license for each building that is operated by the licensee as an assisted living facility and is located at a separate address, except as provided under paragraph (d) or (e). (d) Upon approving an application for an assisted living facility license, the commissioner may issue a single license for two or more buildings on a campus that are operated by the same licensee as an assisted living facility.

An assisted living facility license for a campus must identify the address and licensed resident capacity of each building located on the campus in which assisted living services are provided. (e) Upon approving an application for an assisted living facility license, the commissioner may: (1) issue a single license for two or more buildings on a campus that are operated by the same licensee as an assisted living facility with dementia care, provided the assisted living facility for dementia care license for a campus identifies the buildings operating as assisted living facilities with dementia care; or

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(2) issue a separate assisted living facility with dementia care license for a building that is on a campus and that is operating as an assisted living facility with dementia care.

•

Section 11: AL director license required—A technical change that clarifies that an assisted living director is required in assisted living by stating that each assisted living facility must employ an assisted living director licensed or permitted by the Board of Executives for Long-Term Services & Supports (BELTSS)

•

Section 12: Facility license transition periods—These changes clarified the various transition periods for the following:

•

o

New construction and building permits

o

Registered housing with services establishments, converting to AL license

o

Current comprehensive home care providers

o

Conversion to licensure and the renewal periods as well as prorated licenses

Section 13: On-call RN 24/7—Clarified that one of the requirements to be a licensed assisted living facility included providing staff access to an on-call registered nurse 24 hours per day, seven days per week

•

Section 14: Infection control—Clarified the infection control requirements to state the following: Infection control program. (a) All assisted living facilities must establish and maintain an infection control program that complies with accepted health care, medical, and nursing standards for infection control. (b) The facility's infection control program must be consistent with current guidelines from the national Centers for Disease Control and Prevention (CDC) for infection prevention and control in long-term care facilities and, as applicable, for infection prevention and control in assisted living facilities. (c) The facility must maintain written evidence of compliance with this subdivision.

•

Section 15: TB prevention and control—Clarified that the facility must maintain written evidence of compliance with the tuberculosis prevention and control

•

Section 16: Communicable diseases—Clarified that a facility must follow current state requirements for prevention, control, and reporting of communicable diseases as defined in Minnesota Rules, parts 4605.7040, 4605.7044, 4605.7050, 4605.7075, 4605.7080, and 4605.7090

•

Section 17: Fire protections—Clarified many of the fire protections and physical environment codes: Fire protection and physical environment. (a) Each assisted living facility must comply with the State Fire Code in Minnesota Rules, chapter 7511, and for dwellings or sleeping units, as defined in the State Fire Code: (i) provide smoke alarms in each room used for sleeping purposes;

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(ii) provide smoke alarms outside each separate sleeping area in the immediate vicinity of bedrooms; (iii) provide smoke alarms on each story within a dwelling unit, including basements, but not including crawl spaces and unoccupied attics; (iv) where more than one smoke alarm is required within an individual dwelling unit or sleeping unit, interconnect all smoke alarms so that actuation of one alarm causes all alarms in the individual dwelling unit or sleeping unit to operate; and (v) ensure the power supply for existing smoke alarms complies with the State Fire Code, except that newly introduced smoke alarms in existing buildings may be battery operated; (2) portable fire extinguishers installed and tested in accordance with the NFPA Standard 10; and install and maintain portable fire extinguishers in accordance with the State Fire Code; (3) install portable fire extinguishers having a minimum 2-A:10-B:C rating within Group R-3 occupancies, as defined by the State Fire Code, located so that the travel distance to the nearest fire extinguisher does not exceed 75 feet, and maintained in accordance with the State Fire Code; and (3) (4) keep the physical environment, including walls, floors, ceiling, all furnishings, grounds, systems, and equipment that is kept in a continuous state of good repair and operation with regard to the health, safety, comfort, and well-being of the residents in accordance with a maintenance and repair program. (b) Fire drills in assisted living facilities shall be conducted in accordance with the residential board and care requirements in the Life Safety Code, except that fire drills in secured dementia care units shall be conducted in accordance with section 144G.81, subdivision 2. Each assisted living facility shall develop and maintain fire safety and evacuation plans. The plans shall include but are not limited to: (1) location and number of resident sleeping rooms; (2) employee actions to be taken in the event of a fire or similar emergency; (3) fire protection procedures necessary for residents; and (4) procedures for resident movement, evacuation, or relocation during a fire or similar emergency including the identification of unique or unusual resident needs for movement or evacuation. (c) Employees of assisted living facilities shall receive training on the fire safety and evacuation plans upon hiring and at least twice per year thereafter.

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(d) Fire safety and evacuation plans shall be readily available at all times within the facility. (e) Residents who are capable of assisting in their own evacuation shall be trained on the proper actions to take in the event of a fire to include movement, evacuation, or relocation. The training shall be made available to residents at least once per year. (f) Evacuation drills are required for employees twice per year per shift with at least one evacuation drill every other month. Evacuation of the residents is not required. Fire alarm system activation is not required to initiate the evacuation drill. (c) (g) Existing construction or elements, including assisted living facilities that were registered as housing with services establishments under chapter 144D prior to August 1, 2021, shall be permitted to be continued continue in use provided such use does not constitute a distinct hazard to life. Any existing elements that an authority having jurisdiction deems a distinct hazard to life must be corrected. The facility must document in the facility's records any actions taken to comply with a correction order, and must submit to the commissioner for review and approval prior to correction.

•

Section 18: Design requirements—Clarified that all assisted living facilities with six or more residents must meet the provisions relevant to assisted living facilities in the 2018 edition of the “Facility Guideline for Design and Construction of Residential Health Care and Support Facilities” and adopted rules; that the standard must be met for all new licenses or new construction

•

Section 19: Life Safety Code—Clarified that all assisted living facilities with six or more residents must meet the applicable provisions of the 2018 edition of the “NFPA Standard 101, Life Safety Code, Residential Board and Care Occupancies chapter,” and that the minimum design standard shall be met for all new licenses or new construction

•

Section 20: Contract required—Technical correction that stated that assisted living facilities may not offer or provide housing or assisted living services to an individual unless it has a written contract

•

Section 21: Burden of proof—Technical clarification regarding the burden of proof for appeals of termination to include clause 4, and that the resident bears the burden of proof to establish by a preponderance of the evidence that the termination was not permissible if the appeal is brought under clauses 2 or 3

•

Section 22: AL with dementia care—Adds the correct 2018 Life Safety Code reference to the assisted living facilities with dementia care and secured dementia care units and new construction

•

Section 23: Technical vulnerable adults 626.557 language

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•

Section 24: Appropriates money to the Board of Executives for Long-Term Services & Supports for board operations—A one-time appropriation with the understanding the fees will pay for ongoing expenses

•

Section 25: Revisor instructions—Instructions to clean up the language if there were minor technical issues with the new language or cross references

Implications These changes were effective before the transition to assisted living licensure to clarify some of the more technical parts of the change to assisted living licensure. If you became licensed, you are subject to these changes.

Bill language https://www.revisor.mn.gov/laws/2020/7/Session+Law/Chapter/1/

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Background studies for licensed assisted living facilities 2021, 1st Special Session HF33/SF37 Chapter 7, Article 2, Section 17, Subdivision 5a HHS omnibus bill Effective: July 1, 2021 Short description Adds licensed assisted living and assisted living with dementia to the list of providers who are required to conduct background studies on all staff.

Implications Under the housing with services and arranged home care model of assisted living, some housing with services staff may not have had background studies completed. This update aligns with the new licensed assisted living statute which requires all staff of a licensed assisted living to have background studies completed.

Bill language https://www.revisor.mn.gov/laws/2021/1/Session+Law/Chapter/7/ Sec. 17. Minnesota Statutes 2020, section 245C.03, is amended to read: 245C.03 BACKGROUND STUDY; INDIVIDUALS TO BE STUDIED. Subd. 5a. Facilities serving children or adults licensed or regulated by the Department of Health. (a) The commissioner shall conduct background studies of: (1) individuals providing services who have direct contact, as defined under section 245C.02, subdivision 11, with patients and residents in hospitals, boarding care homes, outpatient surgical centers licensed under sections 144.50 to 144.58; nursing homes and home care agencies licensed under chapter 144A; assisted living facilities and assisted living facilities with dementia care licensed under chapter 144G; and board and lodging establishments that are registered to provide supportive or health supervision services under section 157.17; (2) individuals specified in subdivision 2 who provide direct contact services in a nursing home or a home care agency licensed under chapter 144A; an assisted living facility or assisted living facility with dementia care licensed under chapter 144G; or a boarding care home licensed under sections 144.50 to 144.58. If the individual undergoing a study resides outside of Minnesota, the study must include a check for substantiated findings of maltreatment of adults and children in the individual's state of residence when the state makes the information available;

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(3) all other employees in assisted living facilities or assisted living facilities with dementia care licensed under chapter 144G, nursing homes licensed under chapter 144A, and boarding care homes licensed under sections 144.50 to 144.58. A disqualification of an individual in this section shall disqualify the individual from positions allowing direct contact with or access to patients or residents receiving services. "Access" means physical access to a client or the client's personal property without continuous, direct supervision as defined in section 245C.02, subdivision 8, when the employee's employment responsibilities do not include providing direct contact services; (4) individuals employed by a supplemental nursing services agency, as defined under section 144A.70, who are providing services in health care facilities; and (5) controlling persons of a supplemental nursing services agency, as defined by section 144A.70. (b) If a facility or program is licensed by the Department of Human Services and the Department of Health and is subject to the background study provisions of this chapter, the Department of Human Services is solely responsible for the background studies of individuals in the jointly licensed program.

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CADI customized living providers bear the brunt of unfriendly & restrictive DHS policies 2021, 1st Special Session HF33/SF37 Chapter 7, Article 13, Sections 18, 29, 30, 43 & 64 HHS omnibus bill Effective: Various Short description More restrictions and disincentives to providing customized living (CL) to Community Access for Disability Inclusion (CADI) waiver recipients were added to statute.

Summary The 2021 legislature modified CADI customized living by doing the following: •

Directing the DHS to develop and implement residential support services criteria that limit eligibility for community residential services, customized living services, and 24-hour customized living services

•

Establishing a moratorium on enrolling after June 30, 2021, certain new customized living settings serving in a single-family home four or fewer participants in the Brain Injury (BI) or CADI waivers

•

Clarifies that the customized living rate floor under section 256S.205 does not apply to customized living services reimbursed by CADI and BI

•

Prohibiting the authorization of more than 24-hours of support in a daily unit of customized living services

•

Directing DHS to establish an acuity-based input limit for service rate calculations

•

Excludes CADI CL from the rate increases provided to Elderly Waiver and Alternative Care

Implications DHS continues to make the provision of customized living to the under 65 population more difficult. Taken together with the recent state transition plan tiers, the states near intransigence on exceptions to assisted living licensure, and these legislative changes, the implications are that: 1.

DHS is not supportive of CADI CL; and

2. DHS is forcing providers of CADI CL into the provision of Integrated Community Support (ICS) services, even though it is not clear if ICS works for this population Bill language Chapter 7: https://www.revisor.mn.gov/laws/2021/1/Session+Law/Chapter/7/ Sec. 18. Minnesota Statutes 2020, section 256B.092, is amended by adding a subdivision to read:

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Subd. 11a. Residential support services criteria. (a) For the purposes of this subdivision, "residential support services" means the following residential support services reimbursed under section 256B.4914: community residential services, customized living services, and 24-hour customized living services. (b) In order to increase independent living options for people with disabilities and in accordance with section 256B.4905, subdivisions 3 and 4, and consistent with section 245A.03, subdivision 7, the commissioner must establish and implement criteria to access residential support services. The criteria for accessing residential support services must prohibit the commissioner from authorizing residential support services unless at least all of the following conditions are met: (1) the individual has complex behavioral health or complex medical needs; and (2) the individual's service planning team has considered all other available residential service options and determined that those options are inappropriate to meet the individual's support needs.

Nothing in this subdivision shall be construed as permitting the commissioner to establish criteria prohibiting the authorization of residential support services for individuals described in the statewide priorities established in subdivision 12, the transition populations in subdivision 13, and the licensing moratorium exception criteria under section 245A.03, subdivision 7, paragraph (a). (c) Individuals with active service agreements for residential support services on the date that the criteria for accessing residential support services become effective are exempt from the requirements of this subdivision, and the exemption from the criteria for accessing residential support services continues to apply for renewals of those service agreements.

EFFECTIVE DATE. This section is effective 90 days following federal approval. The commissioner of human services shall notify the revisor of statutes when federal approval is obtained.

Sec. 29. Minnesota Statutes 2020, section 256B.49, is amended by adding a subdivision to read: Subd. 28. Customized living moratorium for brain injury and community access for disability inclusion waivers. (a) Notwithstanding section 245A.03, subdivision 2, paragraph (a), clause (23), to prevent new development of customized living settings that otherwise meet the residential program definition under section 245A.02, subdivision 14, the commissioner shall not enroll new customized living settings serving four or fewer people in a single-family home to deliver customized living services as defined under the brain injury or community access for disability inclusion waiver plans under this section. (b) The commissioner may approve an exception to paragraph (a) when an existing customized living setting changes ownership at the same address.

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(c) Customized living settings operational on or before June 30, 2021, are considered existing customized living settings. (d) For any new customized living settings serving four or fewer people in a singlefamily home to deliver customized living services as defined in paragraph (a) and that was not operational on or before June 30, 2021, the authorizing lead agency is financially responsible for all home and community-based service payments in the setting. (e) For purposes of this subdivision, "operational" means customized living services are authorized and delivered to a person in the customized living setting.

EFFECTIVE DATE. This section is effective July 1, 2021. This section applies only to customized living services as defined under the brain injury or community access for disability inclusion waiver plans under Minnesota Statutes, section 256B.49.

Sec. 30. Minnesota Statutes 2020, section 256B.49, is amended by adding a subdivision to read: Subd. 29. Residential support services criteria. (a) For the purposes of this subdivision, "residential support services" means the following residential support services reimbursed under section 256B.4914: community residential services, customized living services, and 24-hour customized living services. (b) In order to increase independent living options for people with disabilities and in accordance with section 256B.4905, subdivisions 3 and 4, and consistent with section 245A.03, subdivision 7, the commissioner must establish and implement criteria to access residential support services. The criteria for accessing residential support services must prohibit the commissioner from authorizing residential support services unless at least all of the following conditions are met: (1) the individual has complex behavioral health or complex medical needs; and (2) the individual's service planning team has considered all other available residential service options and determined that those options are inappropriate to meet the individual's support needs.

Nothing in this subdivision shall be construed as permitting the commissioner to establish criteria prohibiting the authorization of residential support services for individuals described in the statewide priorities established in subdivision 12, the transition populations in subdivision 13, and the licensing moratorium exception criteria under section 245A.03, subdivision 7, paragraph (a). (c) Individuals with active service agreements for residential support services on the date that the criteria for accessing residential support services become effective are exempt from the requirements of this subdivision, and the exemption from the criteria for accessing residential support services continues to apply for renewals of those service agreements.

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EFFECTIVE DATE. This section is effective 90 days following federal approval. The commissioner of human services shall notify the revisor of statutes when federal approval is obtained.

Sec. 43. Minnesota Statutes 2020, section 256B.4914, subdivision 6, is amended to read: Subd. 6. Payments for residential support services. (a) For purposes of this subdivision, residential support services includes 24-hour customized living services, community residential services, customized living services, family residential services, foster care services, integrated community supports, and supportive living services daily. (b) Payments for community residential services, corporate foster care services, corporate supportive living services daily, family residential services, and family foster care services must be calculated as follows: (1) determine the number of shared staffing and individual direct staff hours to meet a recipient's needs provided on site or through monitoring technology; (2) personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics Minnesota-specific rates or rates derived by the commissioner as provided in subdivision 5; (3) except for subdivision 5, paragraph (a), clauses (4) and (21) to (23), multiply the result of clause (2) by the product of one plus the competitive workforce factor in subdivision 5, paragraph (b), clause (1); (4) for a recipient requiring customization for deaf and hard-of-hearing language accessibility under subdivision 12, add the customization rate provided in subdivision 12 to the result of clause (3); (5) multiply the number of shared and individual direct staff hours provided on site or through monitoring technology and nursing hours by the appropriate staff wages; (6) multiply the number of shared and individual direct staff hours provided on site or through monitoring technology and nursing hours by the product of the supervision span of control ratio in subdivision 5, paragraph (b), clause (2), and the appropriate supervision wage in subdivision 5, paragraph (a), clause (21); (7) combine the results of clauses (5) and (6), excluding any shared and individual direct staff hours provided through monitoring technology, and multiply the result by one plus the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (b), clause (3). This is defined as the direct staffing cost; (8) for employee-related expenses, multiply the direct staffing cost, excluding any shared and individual direct staff hours provided through monitoring technology, by one plus the employee-related cost ratio in subdivision 5, paragraph (b), clause (4);

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(9) for client programming and supports, the commissioner shall add $2,179; and (10) for transportation, if provided, the commissioner shall add $1,680, or $3,000 if customized for adapted transport, based on the resident with the highest assessed need. (c) The total rate must be calculated using the following steps: (1) subtotal paragraph (b), clauses (8) to (10), and the direct staffing cost of any shared and individual direct staff hours provided through monitoring technology that was excluded in clause (8); (2) sum the standard general and administrative rate, the program-related expense ratio, and the absence and utilization ratio; (3) divide the result of clause (1) by one minus the result of clause (2). This is the total payment amount; and (4) adjust the result of clause (3) by a factor to be determined by the commissioner to adjust for regional differences in the cost of providing services. (d) The payment methodology for customized living, and 24-hour customized living, and residential care services must be the customized living tool. Revisions to The commissioner shall revise the customized living tool must be made to reflect the services and activities unique to disability-related recipient needs., and adjust for regional differences in the cost of providing services. The rate adjustments described in section 256S.205 do not apply to rates paid under this section. Customized living and 24-hour customized living rates determined under this section shall not include more than 24 hours of support in a daily unit. The commissioner shall establish the following acuitybased customized living tool input limits, based on case mix, for customized living and 24hour customized living rates determined under this section: (1) no more than two hours of mental health management per day for people assessed for case mixes A, D, and G; (2) no more than four hours of activities of daily living assistance per day for people assessed for case mix B; and (3) no more than six hours of activities of daily living assistance per day for people assessed for case mix D. (e) Payments for integrated community support services must be calculated as follows: (1) the base shared staffing shall must be eight hours divided by the number of people receiving support in the integrated community support setting; (2) the individual staffing hours shall must be the average number of direct support hours provided directly to the service recipient;

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(3) the personnel hourly wage rate must be based on the most recent Bureau of Labor Statistics Minnesota-specific rates or rates derived by the commissioner as provided in subdivision 5; (4) except for subdivision 5, paragraph (a), clauses (4) and (21) to (23), multiply the result of clause (3) by the product of one plus the competitive workforce factor in subdivision 5, paragraph (b), clause (1); (5) for a recipient requiring customization for deaf and hard-of-hearing language accessibility under subdivision 12, add the customization rate provided in subdivision 12 to the result of clause (4); (6) multiply the number of shared and individual direct staff hours in clauses (1) and (2) by the appropriate staff wages; (7) multiply the number of shared and individual direct staff hours in clauses (1) and (2) by the product of the supervisory span of control ratio in subdivision 5, paragraph (b), clause (2), and the appropriate supervisory wage in subdivision 5, paragraph (a), clause (21); (8) combine the results of clauses (6) and (7) and multiply the result by one plus the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (b), clause (3). This is defined as the direct staffing cost; (9) for employee-related expenses, multiply the direct staffing cost by one plus the employee-related cost ratio in subdivision 5, paragraph (b), clause (4); and (10) for client programming and supports, the commissioner shall add $2,260.21 divided by 365. (f) The total rate must be calculated as follows: (1) add the results of paragraph (e), clauses (9) and (10); (2) add the standard general and administrative rate, the program-related expense ratio, and the absence and utilization factor ratio; (3) divide the result of clause (1) by one minus the result of clause (2). This is the total payment amount; and (4) adjust the result of clause (3) by a factor to be determined by the commissioner to adjust for regional differences in the cost of providing services. (g) The payment methodology for customized living and 24-hour customized living services must be the customized living tool. The commissioner shall revise the customized living tool to reflect the services and activities unique to disability-related recipient needs and adjust for regional differences in the cost of providing services. (h) (g) The number of days authorized for all individuals enrolling in residential services must include every day that services start and end.

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EFFECTIVE DATE. This section is effective January 1, 2022, or upon federal approval, whichever is later, except the fifth sentence in paragraph (d) is effective January 1, 2022. The commissioner of human services shall notify the revisor of statutes when federal approval is obtained.

Sec. 64. Minnesota Statutes 2020, section 256S.2101, is amended to read: 256S.2101 RATE SETTING; PHASE-IN. Subdivision 1. Phase-in for disability waiver customized living rates. All rates and rate components for services listed in section 256S.21 community access for disability inclusion customized living and brain injury customized living under section 256B.4914 shall be the sum of ten percent of the rates calculated under sections 256S.211 to 256S.215 and 90 percent of the rates calculated using the rate methodology in effect as of June 30, 2017.

Subd. 2. Phase-in for elderly waiver rates. Except for home-delivered meals as described in section 256S.215, subdivision 15, all rates and rate components for elderly waiver, elderly waiver customized living, and elderly waiver foster care under this chapter; alternative care under section 256B.0913; and essential community supports under section 256B.0922 shall be the sum of 18.8 percent of the rates calculated under sections 256S.211 to 256S.215, and 81.2 percent of the rates calculated using the rate methodology in effect as of June 30, 2017. The rate for home-delivered meals shall be the sum of the service rate in effect as of January 1, 2019, and the increases described in section 256S.215, subdivision 15.

EFFECTIVE DATE. This section is effective January 1, 2022, or upon federal approval, whichever is later. The commissioner of human services shall inform the revisor of statutes when federal approval is obtained.

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Resident experience surveys in assisted living 2021, 1st Special Session HF33/SF37 Chapter 7, Article 13, Sections 24–25 HHS omnibus bill Effective: Day following final enactment Short description Providers must provide key contact information of clients when requested for the purposes of conducing consumer surveys for home and community-based services. In addition, a resident experience survey for assisted living facility residents and families will be developed.

Summary The commissioner may now request contact information of clients and associated key representatives for purposes of conducting consumer surveys for home and communitybased services. Providers are now required to furnish contact information available to the provider and to provide notice to clients and associated key representatives that their contact information has been provided to the commissioner.

Also, the commissioner is required to develop and administer a resident experience survey for assisted living facility residents and a family survey for families of assisted living facility residents. Money appropriated to the commissioner to administer the resident experience survey and family survey is available in either fiscal year of the biennium in which it is appropriated.

Implications Care Providers of Minnesota has not identified any implications and will watch for any that may arise.

Bill language https://www.revisor.mn.gov/laws/2021/1/Session+Law/Chapter/7/ Sec. 24. Minnesota Statutes 2020, section 256B.439, is amended by adding a subdivision to read: Subd. 3c. Contact information for consumer surveys for home and communitybased services. For purposes of conducting the consumer surveys under subdivision 3a, the commissioner may request contact information of clients and associated key representatives. Providers must furnish the contact information available to the provider and must provide notice to clients and associated key representatives that their contact information has been provided to the commissioner.

EFFECTIVE DATE. This section is effective the day following final enactment.

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Sec. 25. Minnesota Statutes 2020, section 256B.439, is amended by adding a subdivision to read: Subd. 3d. Resident experience survey and family survey for assisted living facilities. The commissioner shall develop and administer a resident experience survey for assisted living facility residents and a family survey for families of assisted living facility residents. Money appropriated to the commissioner to administer the resident experience survey and family survey is available in either fiscal year of the biennium in which it is appropriated.

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Consumer protections for facilities exempt from assisted living licensure 2021, 1st Special Session HF33/SF37 Chapter 7, Article 13, Sections 60 & 65 HHS omnibus bill Effective: August 1, 2021 Short description During negotiations regarding assisted living licensure, certain settings were exempted from licensure. The advocates wanted to ensure that the consumer protections that existed under the housing with services registration, would continue in some form for the exempt settings.

To deliver customized living services or 24-hour customized living services customized living services providers must have: 1.

an assisted living license; or

2.

be licensed as a comprehensive home care provider and delivering services in an exempted setting.

Summary As of August 1, 2021, housing with services statutes are repealed. Transferring the housing with services protections to 325F.722 will ensure that they apply to the settings which are exempt from assisted living licensure.

•

Subdivision 1: Clarifies the definitions to whom these protections apply

•

Subdivision 2: Carries the contract requirements from housing with services over to the settings which are exempt from assisted living licensure

•

Subdivision 3: Carries the housing with services termination of contract provisions over to the settings which are exempt from assisted living licensure

•

Subdivision 4: Carries the housing with services emergency planning requirements over to the settings which are exempt from assisted living licensure

•

Subdivision 5: Carries the housing with services training in dementia requirements over to the settings which are exempt from assisted living licensure

•

Subdivision 6: Carries the housing with services manager requirements over to the settings which are exempt from assisted living licensure

•

Subdivision 7: Carries the housing with services prohibition of use of restraints over to the settings which are exempt from assisted living licensure

•

Subdivision 8: Carries the housing with services requirements to comply with Minnesota Statutes 504B and not required obtain a lodging license under Minnesota Statutes 157 and related rules

•

Subdivision 9: Creates a new remedy for violation of the requirements by ensuring the state agency make a good faith effort to resolve disputes before seeking

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attorney general enforcement, and not allowing a private right of action for enforcement Prior to August 1, 2021, providers of customized living satisfied the Minnesota Department of Human Services (DHS) enrollment requirements by with a comprehensive home care license. As of August 1, 2021, most of these providers are enrolled with DHS as a customized living provider via their assisted living license.

Throughout the development and codification of assisted living licensure, it was understood and agreed by stakeholders, that there was a small cohort of niche providers of customized living who should not be required to license as assisted living. These housing with services settings utilize a comprehensive home care license to provide services to a population with some or all the following characteristics: •

Homelessness

•

HIV positive

•

Mental health needs

•

Chemical dependency

Both DHS and members of the legislature opposed creating an exemption.

However, several Association members persistently pursued the issue and ultimately prevailed in adding an additional exemption.

To provide customized living services and be exempt from the assisted living license, a provider must: 1.

be licensed as a comprehensive home care provider under chapter 144A;

2. be delivering services in a setting exempted from assisted living facility licensure under section 144G.08, subdivision 7, clauses (10) to (13), which are: (a)

housing financed pursuant to sections 462A.37 and 462A.375, units financed with low-income housing tax credits pursuant to United States Code, title 26, section 42, and units financed by the Minnesota Housing Finance Agency that are intended to serve individuals with disabilities or individuals who are homeless, except for those developments that market or hold themselves out as assisted living facilities and provide assisted living services;

(b)

rental housing developed under United States Code, title 42, section 1437, or United States Code, title 12, section 1701q;

(c)

rental housing designated for occupancy by only elderly or elderly and disabled residents under United States Code, title 42, section 1437e, or rental housing for qualifying families under Code of Federal Regulations, title 24, section 983.56;

(d)

rental housing funded under United States Code, title 42, chapter 89, or United States Code, title 42, section 8011;

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3. meet standards in the federally approved home and community-based waiver plans under this chapter or section 256B.49.

Implications Most settings providing customized living do so by obtaining an assisted living license and meeting the federal HCBS standards.

A small group of providers may enroll as a customized living provider if they meet one of four exemptions (see above). Importantly, these settings must meet the federal HCBS standards and follow: •

the comprehensive home care provider requirements under Minnesota Statures 144A; and

•

the added consumer protection statute at 325F.722 (see bill language).

Assisted living settings exempt from licensure, will continue to have to follow the rules that were previously followed for the housing with services registrations.

Bill language https://www.revisor.mn.gov/laws/2021/1/Session+Law/Chapter/7/ Sec. 60. Minnesota Statutes 2020, section 256S.20, subdivision 1, is amended to read: Subdivision 1. Customized living services provider requirements. Only a provider licensed by the Department of Health as a comprehensive home care provider may provide (a) To deliver customized living services or 24-hour customized living services, a provider must: (1) be licensed as an assisted living facility under chapter 144G; or (2) be licensed as a comprehensive home care provider under chapter 144A, be delivering services in a setting exempted from assisted living facility licensure under section 144G.08, subdivision 7, clauses (10) to (13), and meet standards in the federally approved home and community-based waiver plans under this chapter or section 256B.49. A licensed home care provider is subject to section 256B.0651, subdivision 14. (b) Settings exempted from assisted living facility licensure under section 144G.08, subdivision 7, clauses (10) to (13), must comply with section 325F.722.

EFFECTIVE DATE. This section is effective August 1, 2021.

Sec. 65. [325F.722] CONSUMER PROTECTIONS FOR EXEMPT SETTINGS. Subdivision 1. Definitions. (a) For the purposes of this section, the following terms have the meanings given.

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(b) "Exempt setting" means a setting that is exempted from assisted living facility licensure under section 144G.08, subdivision 7, clauses (10) to (13). (c) "Resident" means a person residing in an exempt setting.

Subd. 2. Contracts. (a) Every exempt setting must execute a written contract with a resident or the resident's representative and must operate in accordance with the terms of the contract. The resident or the resident's representative must be given a complete copy of the contract and all supporting documents and attachments and any changes whenever changes are made. (b) The contract must include at least the following elements in itself or through supporting documents or attachments: (1) the name, street address, and mailing address of the exempt setting; (2) the name and mailing address of the owner or owners of the exempt setting and, if the owner or owners are not natural persons, identification of the type of business entity of the owner or owners; (3) the name and mailing address of the managing agent, through management agreement or lease agreement, of the exempt setting, if different from the owner or owners; (4) the name and address of at least one natural person who is authorized to accept service of process on behalf of the owner or owners and managing agent; (5) a statement identifying the license number of the home care provider that provides services to some or all of the residents and that is either the setting itself or another entity with which the setting has an arrangement; (6) the term of the contract; (7) an itemization and description of the housing and, if applicable, services to be provided to the resident; (8) a conspicuous notice informing the resident of the policy concerning the conditions under which and the process through which the contract may be modified, amended, or terminated; (9) a description of the exempt setting's complaint resolution process available to residents including the toll-free complaint line for the Office of Ombudsman for Long-Term Care; (10) the individual designated as the resident's representative, if any; (11) the exempt setting's referral procedures if the contract is terminated; (12) a statement regarding the ability of a resident to receive services from providers with whom the exempt setting does not have an arrangement;

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(13) a statement regarding the availability of public funds for payment for residence or services; and (14) a statement regarding the availability of and contact information for long-term care consultation services under section 256B.0911 in the county in which the exempt setting is located. (c) The contract must include a statement regarding: (1) the ability of a resident to furnish and decorate the resident's unit within the terms of the lease; (2) a resident's right to access food at any time; (3) a resident's right to choose the resident's visitors and times of visits; (4) a resident's right to choose a roommate if sharing a unit; and (5) a resident's right to have and use a lockable door to the resident's unit. The exempt setting must provide the locks on the unit. Only a staff member with a specific need to enter the unit shall have keys, and advance notice must be given to the resident before entrance by the staff member, when possible. (d) A restriction of a resident's rights under this subdivision is allowed only if determined necessary for health and safety reasons identified by a home care provider's registered nurse in an initial assessment or reassessment, as defined under section 144A.4791, subdivision 8, and documented in the written service plan under section 144A.4791, subdivision 9. Any restrictions of those rights for people served under section 256B.49 and chapter 256S must be documented in the resident's coordinated service and support plan, as defined under sections 256B.49, subdivision 15, and 256S.10. (e) The contract and related documents executed by each resident or resident's representative must be maintained by the exempt setting in files from the date of execution until three years after the contract is terminated.

Subd. 3. Termination of contract. An exempt setting must include with notice of termination of contract information about how to contact the ombudsman for long-term care, including the address and telephone number, along with a statement of how to request problem-solving assistance.

Subd. 4. Emergency planning. (a) Each exempt setting must meet the following requirements: (1) have a written emergency disaster plan that contains a plan for evacuation, addresses elements of sheltering in place, identifies temporary relocation sites, and details staff assignments in the event of a disaster or an emergency; (2) prominently post an emergency disaster plan; (3) provide building emergency exit diagrams to all residents upon signing a contract; CARE PROVIDERS OF MINNESOTA

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(4) post emergency exit diagrams on each floor; and (5) have a written policy and procedure regarding missing residents. (b) Each exempt setting must provide emergency and disaster training to all staff during the initial staff orientation and annually thereafter and must make emergency and disaster training available to all residents annually. Staff who have not received emergency and disaster training are allowed to work only when trained staff are also working on site. (c) Each exempt setting location must conduct and document a fire drill or other emergency drill at least once every six months. To the extent possible, drills must be coordinated with local fire departments or other community emergency resources.

Subd. 5. Training in dementia. (a) If an exempt setting has a special program or special care unit for residents with Alzheimer's disease or other dementias whether in a segregated or general unit, employees of the setting must meet the following training requirements: (1) supervisors of direct care staff must have completed at least eight hours of initial training on topics specified under paragraph (b) within 120 working hours of the employment start date, and must complete at least two hours of training on topics related to dementia care for each 12 months of employment thereafter; (2) direct care employees must have completed at least eight hours of initial training on topics specified under paragraph (b) within 160 working hours of the employment start date. Until this initial training is complete, an employee must not provide direct care unless there is another employee on site who has completed the initial eight hours of training on topics related to dementia care and who can act as a resource and assist if issues arise. A trainer of the requirements under paragraph (b), or a supervisor meeting the requirements in clause (1), must be available for consultation with the new employee until the training requirement is complete. Direct care employees must complete at least two hours of training on topics related to dementia care for each 12 months of employment thereafter; (3) staff who do not provide direct care, including maintenance, housekeeping, and food service staff, must have completed at least four hours of initial training on topics specified under paragraph (b) within 160 working hours of the employment start date, and must complete at least two hours of training on topics related to dementia care for each 12 months of employment thereafter; and (4) new employees may satisfy the initial training requirements under clauses (1) to (3) by producing written proof of previously completed required training within the past 18 months. (b) Areas of required training include: (1) an explanation of Alzheimer's disease and related disorders;

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(2) assistance with activities of daily living; (3) problem-solving with challenging behaviors; and (4) communication skills. (c) The setting must provide to residents, and prospective residents upon request, in written or electronic form, a description of the training program, the categories of employees trained, the frequency of training, and the basic topics covered.

Subd. 6. Manager requirements. (a) The person primarily responsible for oversight and management of the exempt setting, as designated by the owner, must obtain at least 30 hours of continuing education every two years of employment as the manager in topics relevant to the operations of the setting and the needs of its residents. Continuing education earned to maintain a professional license, such as a nursing home administrator license, assisted living facility director license, nursing license, social worker license, or real estate license, can be used to complete this requirement. (b) New managers may satisfy the initial dementia training requirements by producing written proof of previously completed required training within the past 18 months.

Subd. 7. Restraints. Residents must be free from any physical or chemical restraints imposed for purposes of discipline or convenience.

Subd. 8. Other laws. Each exempt setting must comply with chapter 504B, and must obtain and maintain all other licenses, permits, registrations, or other required governmental approvals. An exempt setting is not required to obtain a lodging license under chapter 157 and related rules.

Subd. 9. Remedy. A state agency must make a good faith effort to reasonably resolve any dispute with an exempt setting before seeking any additional enforcement actions regarding the exempt setting's compliance with the requirements of this section.

No private right of action may be maintained as provided under section 8.31, subdivision 3a.

EFFECTIVE DATE. This section is effective August 1, 2021.

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Customized living report 2021, 1st Special Session HF33/SF37 Chapter 7, Article 13, Section 66 HHS omnibus bill Effective: August 1, 2021 Short description Requires the commissioner of human services submit a report to the chairs and ranking minority members regarding several issues in customized living.

Summary The change requires a report by the commissioner of human services regarding the prevalence of customized living services 256B.49, supplanting the provision of residential services and supports licensed under Minnesota Statutes, chapter 245D, and provided in settings licensed under Minnesota Statutes, chapter 245A. It further requires recommendations regarding the continuation of the moratorium on home and community-based services customized living settings under Minnesota Statutes, section 256B.49, subdivision 28. It requires the commissioner to report other policy recommendations to ensure that customized living services are being provided in a manner consistent with the policy objectives of the foster care licensing moratorium under Minnesota Statutes, section 245A.03, subdivision 7.

It also requires that the commissioner provide recommendations for needed statutory changes to implement the transition from existing four-person or fewer customized living settings to corporate adult foster care or community residential settings.

Finally, the commissioner of health shall provide the commissioner of human services with the required data to complete the report and implement the moratorium on home and community-based services customized living settings under Minnesota Statutes, section 256B.49, subdivision 28. The data must include, at a minimum, each registered housing with services establishment under Minnesota Statutes, chapter 144D, enrolled as a customized living setting to deliver customized living services as defined under the brain injury or community access for disability inclusion waiver plans under Minnesota Statutes, section 256B.49.

Implications Although there are not implications for your business at this time, this report will likely be a legislative discussion in 2022 as there are payment implications for our providers.

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Bill language https://www.revisor.mn.gov/laws/2021/1/Session+Law/Chapter/7/ Sec. 66. DIRECTION TO THE COMMISSIONER; CUSTOMIZED LIVING REPORT. (a) By January 15, 2022, the commissioner of human services shall submit a report to the chairs and ranking minority members of the legislative committees with jurisdiction over human services policy and finance. The report must include the commissioner's: (1) assessment of the prevalence of customized living services provided under Minnesota Statutes, section 256B.49, supplanting the provision of residential services and supports licensed under Minnesota Statutes, chapter 245D, and provided in settings licensed under Minnesota Statutes, chapter 245A; (2) recommendations regarding the continuation of the moratorium on home and community-based services customized living settings under Minnesota Statutes, section 256B.49, subdivision 28; (3) other policy recommendations to ensure that customized living services are being provided in a manner consistent with the policy objectives of the foster care licensing moratorium under Minnesota Statutes, section 245A.03, subdivision 7; and (4) recommendations for needed statutory changes to implement the transition from existing four-person or fewer customized living settings to corporate adult foster care or community residential settings. (b) The commissioner of health shall provide the commissioner of human services with the required data to complete the report in paragraph (a) and implement the moratorium on home and community-based services customized living settings under Minnesota Statutes, section 256B.49, subdivision 28. The data must include, at a minimum, each registered housing with services establishment under Minnesota Statutes, chapter 144D, enrolled as a customized living setting to deliver customized living services as defined under the brain injury or community access for disability inclusion waiver plans under Minnesota Statutes, section 256B.49.

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Study of exempt facilities 2021, 1st Special Session HF33/SF37 Chapter 7, Article 13, Section 71 HHS omnibus bill Effective: August 1, 2021 Short description Despite the legislature and provider objections, the Department of Human Services (DHS) opposed the continuation of customized living payments in settings which were exempt from assisted living licensure. In order to agree to continue to pay customized living in exempt settings, and as a way to keep the conversation going, DHS required a study of the payment of customized living rates to the exempt settings.

Summary The commissioner of human services shall review policies and provider standards for customized living services provided in settings identified in Minnesota Statutes, section 256S.20, subdivision 1, paragraph (a), clause (2), in consultation with stakeholders. The commissioner may provide recommendations to the chairs and ranking minority members of the legislative committees and divisions with jurisdiction over customized living services by February 15, 2022, regarding appropriate regulatory oversight and payment policies for customized living services delivered in these settings.

Implications Exempt providers will need to be prepared to participate in the study and make the case for ongoing payment of customized living rates in their settings.

Bill language https://www.revisor.mn.gov/laws/2021/1/Session+Law/Chapter/7/ Sec. 71. DIRECTION TO COMMISSIONER; PROVIDER STANDARDS FOR CUSTOMIZED LIVING SERVICES IN EXEMPT SETTINGS. The commissioner of human services shall review policies and provider standards for customized living services provided in settings identified in Minnesota Statutes, section 256S.20, subdivision 1, paragraph (a), clause (2), in consultation with stakeholders.

The commissioner may provide recommendations to the chairs and ranking minority members of the legislative committees and divisions with jurisdiction over customized living services by February 15, 2022, regarding appropriate regulatory oversight and payment policies for customized living services delivered in these settings.

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Residential supports customized living report 2021, 1st Special Session HF33/SF37 Chapter 7, Article 13, Section 76 HHS omnibus bill Effective: July 1, 2021 Short description Data must now be collected the implementation of residential support services under the Medical Assistance disability waivers, and a report must be submitted back to the legislature with outlined data.

Summary The commissioner is now required to collect data on the implementation of residential support services under the Medical Assistance disability waivers and by January 15, 2024, or 18 months after federal approval, whichever is later. Then, a report is to be submitted to the legislative committees with jurisdiction over health and human services containing an analysis of the collected data and recommendations. The bill outlines specific information that must be included in the report.

Implications Care Providers of Minnesota has not identified any implications and will watch for any that may arise.

Bill language https://www.revisor.mn.gov/laws/2021/1/Session+Law/Chapter/7/ Sec. 76. DIRECTION TO COMMISSIONER OF HUMAN SERVICES; RESIDENTIAL SUPPORT SERVICES CRITERIA REPORT. The commissioner must collect data on the implementation of residential support services criteria under Minnesota Statutes, sections 256B.092, subdivision 11a, and 256B.49, subdivision 29, and by January 15, 2024, or 18 months following federal approval, whichever is later, submit to the chairs and ranking minority members of the legislative committees and divisions with jurisdiction over health and human services a report containing an analysis of the collected data and recommendations. The report must include data on shifts in the home and community-based service system for people who access services in their own home and in nonprovider-controlled settings. The report must also include recommended modifications to the criteria that align with disability waiver reconfiguration and individual support range implementation.

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Prorated rent 2021, 1st Special Session HF4/SF16 Chapter 8, Article 2, Section 11 Housing bill Effective: September 1, 2021 Short description Prohibits the tenant from being charged more than the prorated amount of rent for the last month of rent if the lease requires the tenant to move out before the last day of the month.

Summary If a tenant’s lease ends on a date that is prior to the end of the month, the landlord must prorate the rent for only the days then tenant is living in the setting. If rent is prepaid for the month and a tenant moves out prior to the end of the month, the landlord must reimburse the tenant for the days after they have moved out. A landlord must calculate prorated days based on the actual number of days for the said month of lease termination.

Implications Landlords will be held responsible for calculating prorated days accurately and may be held accountable for reimbursing any tenant if necessary.

Bill language https://www.revisor.mn.gov/laws/2021/1/Session+Law/Chapter/8/ Sec. 11. [504B.116] PRORATED RENT REQUIRED. (a) When a lease term for a residential unit ends on a date before the last day of the final month, the amount of rent to be paid for the final month owed for the final month of rent must be prorated at the average daily rate for that month so that the tenant only pays for the actual number of days that occupancy is allowed. This provision applies to all leases, including leases requiring the last month of rent to be paid in advance. Any attempted waiver of this section by a landlord and tenant, by contract or otherwise, shall be void and unenforceable. (b) For purposes of this section, prorated rent must be calculated using the actual number of calendar days for the calendar month in which the lease expires.

EFFECTIVE DATE. This section is effective September 1, 2021, and applies to leases entered into on or after that date.

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Eviction moratorium phaseout 2021, 1st Special Session HF4/SF16 Chapter 8, Article 5 Housing bill Effective: Day following final enactment Short description Eviction moratorium phaseout Summary This article ends the governor’s orders that prevent evictions and lease terminations during the COVID-19 peacetime emergency and provides temporary provisions for tenants to avoid eviction and lease terminations in certain situations. The majority of the provisions of this article last for 105 days after enactment and there is a requirement that landlords provide notice to tenants who may be eligible for an eviction due to nonpayment of rent during that time. All of the provisions of this article are effective immediately upon enactment.

Implications The following is a list of the sections and a short summary of the implications: •

Section 1: Executive orders 20-14, 20-73 & 20-79 void—Ends the executive orders issued by the governor during the COVID-19 peacetime emergencies related to housing, including the eviction moratorium and related orders on nonrenewal of leases

•

Section 2: Eviction moratorium phaseout—Prohibits some of the activities consistent with the prior executive orders that limited evictions and nonrenewal of leases during the peacetime emergency; the continuation of these prohibitions vary in how long they last but include the following: o

Prohibiting a landlord from terminating or failing to renew a lease for 105 days after enactment, except in cases where the tenant is endangering others, engaging in certain criminal activities, materially violating the lease, or when the tenant requests the termination of the lease—this provision has an exception that allows a landlord to terminate or not renew a lease 45 days after enactment if the tenant has failed to pay rent and is not eligible for the COVID-19 emergency rental assistance program

o

Prohibiting a landlord from filing an eviction action for 105 days after enactment, except in cases where the tenant is endangering others, significant damage to property, or engaging in certain criminal

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activities; evictions are allowed 15 days after enactment for situations where a tenant materially violates the lease—this provision has an exception that allows a landlord to file an eviction 75 days after enactment if the tenant has failed to pay rent and is not eligible for the COVID-19 emergency rental assistance program; if a tenant has not paid rent and refuses to apply for the COVID-19 rental assistance program, a landlord can proceed on an eviction o

Prohibits the termination of a residential rental agreement, delivering a default notice, or filing an eviction action on a tenant of a manufactured home park except when the tenant has endangered others, causes substantial damage to property, or fails to comply with state and local laws

o

The phaseout prohibits last for 105 days except as otherwise noted, and a tenant who owed rent or fees to a landlord during the peacetime emergency or during the phaseout time period, continues to owe the rent and fees due; there is one extension for the eviction moratorium beyond the 105 days in section 4 below

•

Section 3: COVID-19 emergency rental assistance notification—Requires a landlord to provide a notice to a tenant 15 days before filing an eviction if the eviction is for nonpayment of rent during the 105 days following enactment; the notice must inform the tenant that the governor’s eviction moratorium has ended, that they may be subject to an eviction, the amount the tenant owes, and where the tenant can get information on rental assistance; a court could stay the eviction if the notice is not provided

•

Section 4: Evictions; pending applications for rental assistance—Prohibits an eviction for nonpayment of rent against a tenant who has a pending application or rental assistance from the federal COVID-19 emergency rental assistance funding; the tenant should provide the proof of pending application and any information on the delay of the application to the landlord and to the court if an eviction is filed; unlike the other eviction prohibitions above, this section lasts until June 1, 2022

Bill language https://www.revisor.mn.gov/laws/2021/1/Session+Law/Chapter/8/

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Outdoor space requirements for assisted living with dementia licenses 2021, Regular Session HF2128/SF2360 Chapter 30, Article 3, Section 20 (amending 144G.84) HHS omnibus bill Effective: August 1, 2021 Short description The assisted living statutes contained an unworkable requirement for those facilities wanting a dementia care license to provide access to secured outdoor space and walkways that would allow residents to enter and return without staff assistance. This was going to create a huge problem for assisted living facilities desiring a dementia care conversion license. Therefore, the requirement was deleted and replaced with a requirement to provide regular access to outdoor space in accordance with the resident’s document care plan.

Implications Licensed assisted living facilities with a dementia care license will need to ensure residents with dementia are assessed to determine each person’s level of interest to have time spent outdoors, and within reason, accommodate such person-centered preference in an activity plan.

Bill language https://www.revisor.mn.gov/laws/2021/0/Session+Law/Chapter/30/ Sec. 20. Minnesota Statutes 2020, section 144G.84, is amended to read: 144G.84 SERVICES FOR RESIDENTS WITH DEMENTIA. (a) In addition to the minimum services required in section 144G.41, an assisted living facility with dementia care must also provide the following services: (1) assistance with activities of daily living that address the needs of each resident with dementia due to cognitive or physical limitations. These services must meet or be in addition to the requirements in the licensing rules for the facility. Services must be provided in a person-centered manner that promotes resident choice, dignity, and sustains the resident's abilities; (2) nonpharmacological practices that are person-centered and evidence-informed; (3) services to prepare and educate persons living with dementia and their legal and designated representatives about transitions in care and ensuring complete, timely communication between, across, and within settings; and

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(4) services that provide residents with choices for meaningful engagement with other facility residents and the broader community. (b) Each resident must be evaluated for activities according to the licensing rules of the facility. In addition, the evaluation must address the following: (1) past and current interests; (2) current abilities and skills; (3) emotional and social needs and patterns; (4) physical abilities and limitations; (5) adaptations necessary for the resident to participate; and (6) identification of activities for behavioral interventions. (c) An individualized activity plan must be developed for each resident based on their activity evaluation. The plan must reflect the resident's activity preferences and needs. (d) A selection of daily structured and non-structured activities must be provided and included on the resident's activity service or care plan as appropriate. Daily activity options based on resident evaluation may include but are not limited to: (1) occupation or chore related tasks; (2) scheduled and planned events such as entertainment or outings; (3) spontaneous activities for enjoyment or those that may help defuse a behavior; (4) one-to-one activities that encourage positive relationships between residents and staff such as telling a life story, reminiscing, or playing music; (5) spiritual, creative, and intellectual activities; (6) sensory stimulation activities; (7) physical activities that enhance or maintain a resident's ability to ambulate or move; and (8) a resident's individualized activity plan for regular outdoor activities activity. (e) Behavioral symptoms that negatively impact the resident and others in the assisted living facility with dementia care must be evaluated and included on the service or care plan. The staff must initiate and coordinate outside consultation or acute care when indicated. (f) Support must be offered to family and other significant relationships on a regularly scheduled basis but not less than quarterly. (g) Access to secured outdoor space and walkways that allow residents to enter and return without staff assistance must be provided. Existing housing with services establishments registered under chapter 144D prior to August 1, 2021, that obtain an CARE PROVIDERS OF MINNESOTA

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assisted living facility license must provide residents with regular access to outdoor space. A licensee with new construction on or after August 1, 2021, or a new licensee that was not previously registered under chapter 144D prior to August 1, 2021, must provide regular access to secured outdoor space on the premises of the facility. A resident's access to outdoor space must be in accordance with the resident's documented care plan.

EFFECTIVE DATE. This section is effective August 1, 2021.

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Technical language on HWS conversion to assisted living 2021, Regular Session HF2128/SF2360 Chapter 30, Article 3, Section 50, Subdivision 4 HHS omnibus bill Effective: Retroactively to December 17, 2020 Short description This language specifies that a housing with services (HWS) establishment, intending to convert to an assisted living license, must apply for the conversion by June 1, 2021, and be licensed by August 1, 2021.

Summary HWS settings intending to convert to the new assisted living license must follow the directions of MDH for the conversion of licensure to assure a new assisted living license is obtained by August 1, 2021. Because providers are changing license types, notifications of the changes need to be given to residents at least 60 days in advance of the change.

Notices must include the following: •

Whether or not the HWS establishment intends to convert to an assisted living licensed facility

•

When the HWS setting will no longer be providing housing with services

•

The contact information of who a resident can get a hold of if they have questions

•

The contact information for the Office of Ombudsman for Long-Term Care and the Office of Ombudsman for Mental Health & Developmental Disabilities

•

The notice must also be given to a resident’s case manager if a resident has one

After August 1, 2021, any HWS establishment that has not converted to an assisted living licensed facility is prohibited from providing assisted living services.

Implications Care Providers of Minnesota staff will watch for implications to providers if the necessary application and notifications are not followed.

Bill language https://www.revisor.mn.gov/laws/2021/0/Session+Law/Chapter/30/ Sec. 50. Laws 2020, Seventh Special Session chapter 1, article 6, section 12, subdivision 4, is amended to read: Subd. 4. Housing with services establishment registration; conversion to an assisted living facility license. (a) Housing with services establishments registered under chapter 144D, providing home care services according to chapter 144A to at least one resident, and intending to provide assisted living services on or after August 1, 2021, must CARE PROVIDERS OF MINNESOTA

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submit an application for an assisted living facility license in accordance with section 144G.12 no later than June 1, 2021. The commissioner shall consider the application in accordance with section 144G.16 144G.15. (b) Notwithstanding the housing with services contract requirements identified in section 144D.04, any existing housing with services establishment registered under chapter 144D that does not intend to convert its registration to an assisted living facility license under this chapter must provide written notice to its residents at least 60 days before the expiration of its registration, or no later than May 31, 2021, whichever is earlier.

The notice must: (1) state that the housing with services establishment does not intend to convert to an assisted living facility; (2) include the date when the housing with services establishment will no longer provide housing with services; (3) include the name, e-mail address, and phone number of the individual associated with the housing with services establishment that the recipient of home care services may contact to discuss the notice; (4) include the contact information consisting of the phone number, e-mail address, mailing address, and website for the Office of Ombudsman for Long-Term Care and the Office of Ombudsman for Mental Health and Developmental Disabilities; and (5) for residents who receive home and community-based waiver services under section 256B.49 and chapter 256S, also be provided to the resident's case manager at the same time that it is provided to the resident. (c) A housing with services registrant that obtains an assisted living facility license, but does so under a different business name as a result of reincorporation, and continues to provide services to the recipient, is not subject to the 60-day notice required under paragraph (b). However, the provider must otherwise provide notice to the recipient as required under sections 144D.04 and 144D.045, as applicable, and section 144D.09. (d) All registered housing with services establishments providing assisted living under sections 144G.01 to 144G.07 prior to August 1, 2021, must have an assisted living facility license under this chapter. (e) Effective August 1, 2021, any housing with services establishment registered under chapter 144D that has not converted its registration to an assisted living facility license under this chapter is prohibited from providing assisted living services.

EFFECTIVE DATE. This section is effective retroactively from December 17, 2020.

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LTC ombudsman & customized living settings exempted from assisted living licensure 2021, Regular Session HF2128/SF2360 Chapter 30, Article 12, Section 1 HHS omnibus bill Effective: August 1, 2021 Short description Enrolled providers of customized living that are exempt assisted living licensure fall under the definition of long-term facility, as it relates to the Office of the Ombudsman for LongTerm Care.

Summary Certain customized living providers serving Medicaid beneficiaries under the age of 65 were exempted by the 2021 legislature from needing an assisted living license. Once this was agreed to, the focus of discussion was how to make sure that Minnesota statutes offers definition and oversight of those exempted providers.

Implications By including these exempted settings in the definition of long-term care facility, the Office of the Ombudsman for Long-Term Care is granted the authority to, among other things, mediate or advocate on behalf of these clients.

Bill language https://www.revisor.mn.gov/laws/2021/0/Session+Law/Chapter/30/ Section 1. Minnesota Statutes 2020, section 256.9741, subdivision 1, is amended to read: Subdivision 1. Long-term care facility. "Long-term care facility" means a nursing home licensed under sections 144A.02 to 144A.10; a boarding care home licensed under sections 144.50 to 144.56; an assisted living facility or an assisted living facility with dementia care licensed under chapter 144G; or a licensed or registered residential setting that provides or arranges for the provision of home care services; or a setting defined under section 144G.08, subdivision 7, clauses (10) to (13), that provides or arranges for the provision of home care services.

EFFECTIVE DATE. This section is effective August 1, 2021.

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WORKFORCE

Workers’ Compensation Advisory Council recommendations 2020, 7th Special Session HF19/SF27 Chapter 1, Article 2 Effective: December 17, 2020, for most provisions; Section 2, Subd. 2 effective January 1, 2022; Section 8, Subd. 22 effective January 4, 2021 Short description Workers’ Compensation Advisory Council recommendations adopted.

Summary This legislation adopts recommendations made by the Workers’ Compensation Advisory Council in 2020 related to: implementation of the Workers’ Compensation Modernization Program (known as Work Comp Campus); Department of Commerce proposals related to self-insurers; occupations entitled to occupational disease presumptions; payment to the estate of a deceased employee using a simplified process; application of the workers’ compensation pharmacy fee schedule to second-injury claims reimbursed by the Special Compensation Fund; and access to workers’ compensation insurance coverage data for insurance verification purposes Implications The following is a list of the sections and a short summary of the changes: •

Section 1, Subd. 4: Strikes the language that currently would allow a workers’ compensation standard group self-insurer to maintain a negative balance in its common claims fund

•

Section 2, Subd. 2: Limits the discount rate that may be applied to estimates of future workers’ compensation liabilities of self-insurers for the purposes of setting the self-insurer’s security posting requirement

•

Section 3, Subd. 5: Prohibits the discounting of future workers’ compensation liabilities for self-insured entities that have exited the selfinsurance program

•

Section 4, Subd. 13: Strikes the language that currently would allow a workers’ compensation commercial group self-insurer to maintain a negative balance in its common claims fund

•

Section 5, Subd. 2: Limits the discount rate that may be applied to estimates of future workers’ compensation liabilities of commercial selfinsurer groups for the purposes of setting the security posting requirement

•

Section 6, Subd. 15: Adds correctional officers employed by cities and counties and security counselors employed by cities, counties and the state

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in the list of occupations for which myocarditis, coronary sclerosis, pneumonia or its sequel and infectious or communicable diseases are presumed to be occupational diseases due to employment, if certain conditions are met; clarifies the occupations covered by the post-traumatic stress disorder (PTSD) presumption consistent with paragraph (b); the presumptions are rebuttable by the payer due to substantial factors •

Section 7, Subd. 10: Requires an employer or insurer to be approved by the commissioner as a qualified rehabilitation consultant (QRC) firm and create an account in Work Comp Campus as a firm, to employ a QRC to provide vocational rehabilitation services to an injured worker; requires a plan of supervision signed by the QRC intern’s supervisor to be filed with the intern’s application in Campus; the supervisor must verify the intern’s compliance with all rehabilitation statutes and rules; the intern must verify all rehabilitation documents prepared by the intern were reviewed by the supervisor before they were filed with the commissioner

•

Section 8, Subd. 22: Allows the use of an affidavit of collection or personal property for the $60,000 payment to a deceased employee’s estate where there are no dependents entitled to dependency benefits, no probate of the estate is required and no personal representative has been appointed (Note the maximum amount that can be claimed using this process is $75,000, excluding jointly held property); requires that, within 14 days of notice to the insurer of the death of the employee, the insurer must send notice to the estate, at the deceased employee's last known address, that this payment will be made after receipt of documentation of appointment of a personal representative or an affidavit of collection of personal property and certified death record

•

Section 9, Subd. 1: Prohibits the Special Compensation Fund from reimbursing a payer from the second-injury fund for any medication charges that exceed the pharmacy’s usual and customary charge or the maximum amount payable under the workers’ compensation pharmacy fee schedule

•

Section 10, Subd. 2: Compulsory insurance; self-insurers, technical language change

•

Section 11, Subd. 11: Describes what insurance policy data reported to the Department of Labor and Industry (DLI) by its contractor, the Minnesota Workers’ Compensation Insurance Association (MWCIA), is public and how it may be requested for workers’ compensation insurance verification purposes

•

Section 12: Sets forth requirements for preparing and publishing the annual prompt first action report (currently called the prompt first payment report)

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•

Section 13, Subd. 5: Technical amendments to reflect national standards in electronic reports filed under this section

•

Section 14, Subd. 6: Requires insurers and self-insured employers (insurers) to report to DLI all payments of compensation and attorney fees; and the amounts paid and withheld, whether paid voluntarily or by order; requires reports to be made within 14 days of the date of the first payment, a denial of primary liability, a denial of any part of compensation, a change in the compensation amount or type, commencement of an additional compensation type, reinstatement of compensation after previous discontinuance or final payment of compensation; and adds additional reporting requirements in paragraphs (b) through (g)

•

Section 15, Subd. 9: Clarifies uses that may be made of reports and certain access to division file

•

Section 16, Subd. 9a: Clarifies access to the division file without an authorization and attorney access

•

Section 17, Subd. 5: Technical language deletions regarding form revision and access to documents and data

•

Section 18, Subd. 1: Requires that Campus generate an audit trail when the division file is accessed

•

Section 19, Subd. 3: Clarifies information that is required when creating a Campus account and adds deceased employee’s estate to list of persons who need to create a Campus account; also required program administrator for collective bargaining agreement to create an account to view documents covered by agreement

•

Section 20, Subd. 2: Clarifies proof of service requirements when a party serves a document through an agency’s electronic system; identifies obligations of senders, recipients, and agencies when a party to a claim uses an agency’s electronic system to file a document in the wrong file, or to serve or send a document to a recipient who is not entitled to receive the document

•

Section 21, Subd. 1: Allows for service of workers’ compensation documents by personal service in addition to first class United States mail, except where electronic service is authorized or required

•

Section 22, Subd. 6: Repeals a provision that prohibits a group self-insurer from requiring an employer to provide financial statements certified by a CPA to be approved for group self-insurance

Bill language https://www.revisor.mn.gov/laws/2020/7/Session+Law/Chapter/1/

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Workers’ compensation 2021, Regular Session HF2253/SF2143 Chapter 12 Effective: Various Short description 2021 Workers’ Compensation Advisory Council recommendations, including COVID19 presumption of coverage extension.

Summary This bill adopts the recommendations made by the Workers’ Compensation Advisory Council on March 10, 2021, related to the minimum weekly compensation rate; inpatient hospital and ambulatory surgical center payment; prohibited practices; annual payer reports of prompt first action; subpoenas of Department of Labor & Industry (DLI) employees; penalties for billing injured workers for treatment; and extension of the workers’ compensation COVID-19 presumption through December 31, 2021.

Implications The following is a list of the sections and a short summary of the implications: •

Section 1: Amends Minnesota Statutes, section 176.101, subdivision 1, to provide that the minimum weekly compensation is the lesser of 20% of the maximum compensation rate (instead of $130 a week) or the employee’s actual weekly wage

•

o

Effective for injuries on or after October 1, 2021

Section 2: Amends Minn. Stat. § 176.136 to: provide a penalty payable to the Assigned Risk Safety Account against a healthcare provider that bills an injured worker for treatment in violation of the workers’ compensation law; require notice to the provider before a penalty can be assessed; and require providers to reimburse employees for expenses related to the violation

•

o

Effective for violations on or after August 1, 2021

Sections 3–4: Amends Minn. Stat. § 176.1362 to require use of a new Medicare web-based calculator to calculate the maximum fees payable for workers’ compensation inpatient hospital treatment for discharges on or after October 1, 2021

•

Sections 5–7: Amends Minn. Stat. § 176.1363 related to payment of treatment of work injuries in an Ambulatory Surgery Centers (ASC) to describe the multiple procedure payment reduction rule instead of cross referencing the Medicare regulation; clarify when payment to an ASC is

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based on the ASC’s actual charges instead of the fee schedule amount; and delete an inapplicable cross-reference and a phrase related to payment for services not in the fee schedule o •

Effective for services provided on or after the day following final enactment

Sections 8–9: Amends Minn. Stat. § 176.194 to: clarify application of existing workers’ compensation prohibited practices; add new prohibited practices for providing fraudulent written information to the department or an employee and for failing to pay benefits or correct behavior on a claim if a penalty for the conduct was paid or became a final order; and eliminate warnings before penalizing for specified intentional or egregious prohibited practices

•

o

Effective for violations on or after July 1, 2021

Section 10: Amends Minn. Stat. § 176.223 to delay the first annual report, based on data filed in Work Comp Campus, until March 15, 2022; allow the commissioner to exclude incomplete or unreliable data; and require workers’ compensation payers to electronically file corrected data in Campus by February 15 for the data to be reflected in the annual report

•

o

Effective the day following final enactment

Section 11: Amends Minn. Stat. § 176.351 to prohibit subpoenas of Minnesota Department of Labor & Industry (DLI) employees, unless the department is a party to a claim or enforcement action or provides vocational rehabilitation services to an injured worker

•

o

Effective the day following final enactment

Section 12: Extends the May 1, 2021, sunset date of the current workers’ compensation COVID-19 presumption statute (Minn. Stat. § 176.011, subd. 15 (f)) to 11:59 PM, December 31, 2021.

Bill language https://www.revisor.mn.gov/laws/2021/0/Session+Law/Chapter/12/

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Unemployment insurance 2021, Regular Session SF192/HF135 Chapter 2 Effective: January 30, 2021 Short description This law keeps taxpaying employers’ 2021 experience ratings for unemployment insurance tax rates the same as 2020.

Summary Eliminates expiration date for exclusion of COVID-19-related unemployment claims in calculating future experience rating; adopts a temporary change to experience rating period; amending Laws 2020, Chapter 71, Article 2, Section 24.

Implications The following is a list of the sections and a short summary of the implications: •

Section 1: Provides that unemployment insurance benefits paid as a direct or indirect result of COVID-19 cannot be used to calculate a taxpaying employer’s experience rating for 2021 or any year after

•

Section 2: Keeps taxpaying employers’ 2021 experience ratings the same as calendar year 2020 by modifying the period used to calculate them; the experience rating is calculated each year for a taxpaying employer and is part of their unemployment insurance tax rate o

Generally, the experience rating increases the more unemployment that an employer’s workers experience

o

For 2021, an existing taxpaying employer’s experience rating would be

o

For a new taxpaying employer, their 2021 experience rating would be

based on the 2020 rate calculated for the period ending June 30, 2019 based on the 2020 industry average rate calculated for the period ending June 30, 2019

o •

Means that taxpaying employers will not see a tax increase from their experience rating for 2021 as a result of increased unemployment

Section 3: Keeps taxable wages used to calculate a taxpaying employer’s experience rating for 2021 the same as calendar year 2020. Includes wages up to $35,000

Bill language https://www.revisor.mn.gov/laws/2021/0/Session+Law/Chapter/2/

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Section 1. Laws 2020, chapter 71, article 2, section 24, is amended to read: Sec. 24. COMPUTATION OF FUTURE TAX RATE; EFFECT OF PAYMENT FROM TRUST FUND. Notwithstanding Minnesota Statutes, section 268.047, subdivision 1, unemployment insurance benefits paid as a result of an applicant not being able to work directly or indirectly as a result of the COVID-19 pandemic will not be used in computing the future unemployment insurance tax rate of a taxpaying employer. This section expires December 31, 2020. Unemployment insurance benefits paid under this section must not be used in any experience rating computation required under Minnesota Statutes, section 268.051, subdivision 3, in any calendar year that occurs following enactment of this section.

EFFECTIVE DATE. This section is effective the day following final enactment.

Sec. 2. CALENDAR YEAR 2021 TEMPORARY EMPLOYER EXPERIENCE RATING. For calendar year 2021, the experience rate computed for each taxpaying employer under Minnesota Statutes, section 268.051, subdivision 3, that was required to file wage detail reports for the 12-month period ending June 30, 2019, is the ratio obtained by dividing 125 percent of the total unemployment benefits required under Minnesota Statutes, section 268.047, to be used in computing the employer's tax rate during the 48 calendar months ending on June 30, 2019, by the employer's total taxable payroll for that same period. Any taxpaying employer that does not qualify for a calendar year 2021 experience rate under Minnesota Statutes, section 268.051, subdivision 3, must be assigned a tax rate in accordance with Minnesota Statutes, section 268.051, subdivision 5, except that the average experience rating for the employer's industry must use the period specified in this section.

EFFECTIVE DATE. This section is effective the day following final enactment.

Sec. 3. TAXABLE WAGES FOR CALENDAR YEAR 2021. Notwithstanding Minnesota Statutes, section 268.035, subdivision 24, for calendar year 2021, "taxable wages" means those wages paid to an employee in covered employment for up to an amount equal to $35,000.

EFFECTIVE DATE. This section is effective the day following final enactment.

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Background study fees increase for some DHS-enrolled providers 2021, 1st Special Session HF33/SF37 Chapter 7, Article 2, Sections 30, 33, 37 & 42 HHS omnibus bill Effective: July 1, 2021 Short description Background study fees are further defined and increased for certain DHS providers.

Summary The Minnesota Department of Human Services (DHS) is to recover the cost of background studies. The new language provides that the background study fees collected under this section, except as otherwise provided in subdivisions 1c and 1d, must be appropriated to the commissioner for the purpose of conducting background studies under chapter 245C. Additionally, the background study fee charged to supplemental nursing services agencies, unlicensed HCBS providers, and providers of housing support will increase (e.g., may not exceed) from $20 to $42.

Implications Background study fees will increase for supplemental nursing services agencies, unlicensed HCBS providers, and providers of housing support.

Bill language https://www.revisor.mn.gov/laws/2021/1/Session+Law/Chapter/7/ Sec. 30. Minnesota Statutes 2020, section 245C.10, is amended by adding a subdivision to read: Subd. 1b. Background study fees. (a) The commissioner shall recover the cost of background studies. Except as otherwise provided in subdivisions 1c and 1d, the fees collected under this section shall be appropriated to the commissioner for the purpose of conducting background studies under this chapter. Fees under this section are charges under section 16A.1283, paragraph (b), clause (3). (b) Background study fees may include: (1) a fee to compensate the commissioner's authorized fingerprint collection vendor or vendors for obtaining and processing a background study subject's classifiable fingerprints and photograph pursuant to subdivision 1c; and (2) a separate fee under subdivision 1c to complete a review of background-studyrelated records as authorized under this chapter.

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(c) Fees charged under paragraph (b) may be paid in whole or part when authorized by law by a state agency or board; by state court administration; by a service provider, employer, license holder, or other organization that initiates the background study; by the commissioner or other organization with duly appropriated funds; by a background study subject; or by some combination of these sources.

Sec. 33. Minnesota Statutes 2020, section 245C.10, subdivision 2, is amended to read: Subd. 2.Supplemental nursing services agencies. The commissioner shall recover the cost of the background studies initiated by supplemental nursing services agencies registered under section 144A.71, subdivision 1, through a fee of no more than $20 $42 per study charged to the agency. The fees collected under this subdivision are appropriated to the commissioner for the purpose of conducting background studies.

Sec. 37. Minnesota Statutes 2020, section 245C.10, subdivision 6, is amended to read: Subd. 6. Unlicensed home and community-based waiver providers of service to seniors and individuals with disabilities. The commissioner shall recover the cost of background studies initiated by unlicensed home and community-based waiver providers of service to seniors and individuals with disabilities under section 256B.4912 through a fee of no more than $20 $42 per study.

Sec. 42. Minnesota Statutes 2020, section 245C.10, subdivision 11, is amended to read: Subd. 11. Providers of housing support. The commissioner shall recover the cost of background studies initiated by providers of housing support under section 256I.04 through a fee of no more than $20 $42 per study. The fees collected under this subdivision are appropriated to the commissioner for the purpose of conducting background studies.

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Background studies—Waivers & modifications; legislative task force 2021, 1st Special Session HF33/SF37 Chapter 7, Article 2, Sections 71–74 HHS omnibus bill Effective: Day following final enactment Short description Emergency background study transition period and background study task force.

Summary The transition period from emergency studies is increased from 60 days to 365 days. Providers that paid for emergency background studies in NETStudy 2.0 will receive a credit. In addition, DHS is able to contract with more than one authorized fingerprint vendor and may collect fingerprinting fees in the NETStudy 2.0 system and pass them through to the fingerprinting vendor.

A 26-member task force will be convened to review and make recommendations about background study eligibility and disqualifications.

Implications The following is a list of the sections and a short summary of the implications: •

Section 71: Waivers & modifications; federal funding extension—Amends Laws 2020, First Special Session chapter 7, section 1, subdivision 1; adds certain DHS program waivers and modifications that are required to comply with federal law to the list of waivers and modifications that may remain in effect after the peacetime emergency declared by the governor expires, is terminated, or is rescinded by the proper authority; The waivers and modifications may remain in effect for the time period set out in applicable federal law, federally approved waiver, or state plan amendment; makes this section effective the day following final enactment

•

Section 72: Waivers & modifications; 60-day transition period—Amends Laws 2020, First Special Session chapter 7, section 1, subdivision 3; provides that DHS program waivers and modifications related to the peacetime emergency declared by the governor in response to the COVID-19 outbreak that are not otherwise extended may remain in effect for no more than 60 days after peacetime emergency declared by the governor expires, is terminated, or is rescinded by the proper authority; makes this section effective the day following final enactment

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•

Section 73: Waivers & modifications; extension for 365 days—Amends Laws 2020, First Special Session chapter 7, section 1, as amended by Laws 2020, Third Special Session chapter 1, section 3, by adding subd. 5; extends the DHS waiver modifying background study requirements for 365 days after the peacetime emergency declared by the governor expires, is terminated, or is rescinded by the proper authority; makes this section effective the day following final enactment

•

Section 74: Legislative task force; human services background study eligibility—Establishes a legislative task force to review the statutes relating to human services background study eligibility and disqualifications; identifies the task force’s duties, provides the terms of membership, specifies compensation for public members, and establishes administrative requirements; requires the task force to submit an interim written report by March 1, 2022, and a final report by December 16, 2022, to the legislative committees with jurisdiction over human services licensing; specifies that the task force expires upon submission of the final report, or on December 20, 2022, whichever is later; makes this section effective the day following final enactment; specifies expiration of December 31, 2022

Bill language https://www.revisor.mn.gov/laws/2021/1/Session+Law/Chapter/7/

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TELEHEALTH

Telemedicine 2020, 7th Special Session HF19/SF27 Chapter 1, Article 4, Section 1 Effective: Immediately Short description Changes instituted via executive order and passed in statute to allow an increase in the use of telemedicine. This action extended the original expiration date to June 30, 2021.

Summary As a result of the pandemic, a number of changes were instituted via executive order and passed in statute (Laws 2020, Chapter 70, Article 3, Section 1) to allow an increase in the use of telemedicine. This action extended the original expiration date from February 1, 2021, until June 30, 2021.

Implications This change made it possible to keep using telemedicine for a number of processes and procedures until the legislature made more changes during the 2021 Legislative Session.

Bill language https://www.revisor.mn.gov/laws/2020/7/Session+Law/Chapter/1/ Section 1. Laws 2020, chapter 70, article 3, section 1, is amended to read: Section 1. COVERAGE OF TELEMEDICINE SERVICES PROVIDED DIRECTLY TO A PATIENT AT THE PATIENT'S RESIDENCE; RESPONSE TO COVID-19. (a) The definition of "originating site" under Minnesota Statutes, section 62A.671, subdivision 7, includes a patient's residence if the patient is receiving health care services or consultations by means of telemedicine. (b) The definition of "telemedicine" under Minnesota Statutes, section 62A.671, subdivision 9, includes health care services or consultations delivered to a patient at the patient's residence. (c) Under Minnesota Statutes, section 62A.672, subdivision 2, a health carrier shall not exclude or reduce coverage for a health care service or consultation solely because the service or consultation is provided via telemedicine directly to a patient at the patient's residence. (d) "Telemedicine" as defined in Minnesota Statutes, section 256B.0625, subdivision 3b, paragraph (d), includes the delivery of health care services or consultations with a patient at the patient's residence and the licensed health care provider at a distant site.

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(e) This section expires February 1 June 30, 2021.

EFFECTIVE DATE. This section is effective the day following final enactment.

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Telehealth coverage policy 2021, 1st Special Session HF33/SF37 Chapter 7, Article 6 HHS omnibus bill Effective: July 1, 2021, or upon federal approval, whichever is later Short description The legislature established requirements for the coverage of telehealth by health carriers, consolidate statute, and define coverage by Medicaid.

Summary The lengthy telehealth provisions, which includes modifying and consolidating telehealth statute as well as addressing health carrier and Medicaid policy issues, demonstrate the further integration of telehealth into Minnesota’s health care system. Highlights include the following: •

A rewrite the current telehealth coverage statute by changing the terminology from telemedicine to telehealth and by clarifying definitions and coverage requirements

•

When a practitioner prescribes a drug used for medication-assisted therapy for a substance use disorder, the required examination of the patient may be completed via telehealth

•

A clarification that a comprehensive assessment for substance use disorder may be delivered in person or via telehealth

•

A chemical use assessment may be conducted via telehealth

•

A chemical dependency services may be provided via telehealth, and that the use of telehealth must be medically appropriate and must meet the needs of the person being served

•

The medical assistance coverage of services delivered by telehealth is updated: o

The current coverage limitation of three telemedicine services per enrollee

o

Allow the commissioner to establish criteria that a provider must attest to in

per calendar week is removed order to demonstrate the safety and efficacy of delivering a particular service through telehealth

o

Authorizes telehealth visits provided through audio and visual communication to be used to satisfy the face-to-face requirement for reimbursement under methods that apply to FQHCs, rural health clinics, Indian health services, tribal clinics, and community behavioral health clinic if the service would have otherwise qualified for payment if performed in person

o

Permits a provider to document a client’s verbal approval or electronic written approval of the treatment plan or change to the treatment plan in

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lieu of the client’s signature when mental health services or assessments are delivered through telehealth and are based on an individual treatment plan o

The definition of telehealth by updating the definition of healthcare provider and adds several additional professionals who can deliver services by telehealth is modified; it also adds a cross-reference to the definition of originating site, distant site, and store and forward technology

•

Medical assistance to is required to cover telemonitoring services if o

the service is medically appropriate based on the recipient’s medical

o

the recipient’s provider has identified that telemonitoring services would

condition or status; likely prevent the recipient’s admission or readmission to a hospital, emergency room, or nursing facility;

•

o

the recipient is cognitively and physically capable of operating the device or

o

the recipient resides in a setting that is suitable for telemonitoring and not

equipment or has a caregiver who can operate the device or equipment; and in a setting that has healthcare staff on site

The coverage of medication therapy management (MTM) services that are authorized to be delivered through telehealth is expanded

•

The definition of “long term care consultation services” is modified by removing language requiring long-term care consultation assessments to be face-to-face and permits the assessments to be conducted through telehealth

•

All long-term care consultation assessments must be conducted face-to-face unless the assessment is a reassessment meeting certain requirements; remote assessments may be conducted by interactive video or telephone to substitute for face-to-face reassessments if federal approval is received

•

The language requiring assessments to be face-to-face for home and communitybased service waivers for persons with disabilities is removed

Implications Telehealth is becoming more and more integral to long-term care. The big change made this year that providers will need to monitor is the use of interactive video and/or telephone to perform LTC consultation services that are reassessments!

Bill language https://www.revisor.mn.gov/laws/2021/1/Session+Law/Chapter/7/

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Telemedicine for county processes 2021, Regular Session HF2128/SF2360 Chapter 30, Article 7 HHS omnibus bill Effective: August 1, 2021 Short description Changes allowing a county agency to use telemedicine and telecommunication to facilitate applications for county aid.

Summary The law changes several areas of the county process to allow telecommunication and internet telepresence for county processes. It specifically changes to allow telepresence and telecommunication the areas of: •

date of application;

•

submitting applications;

•

providing orientations; and

•

submitting combined application forms.

Implications As counties change their processes in light of the pandemic, the use of telemedicine and telepresence became more ubiquitous. If you have some challenges on applications, inquire with the county to see if telepresence or telehealth is an option for applications and forms.

Bill language https://www.revisor.mn.gov/laws/2021/0/Session+Law/Chapter/30/ Section 1. Minnesota Statutes 2020, section 256J.08, subdivision 21, is amended to read: Subd. 21. Date of application. "Date of application" means the date on which the county agency receives an applicant's signed application as a signed written application, an application submitted by telephone, or an application submitted through Internet telepresence.

Sec. 2. Minnesota Statutes 2020, section 256J.09, subdivision 3, is amended to read: Subd. 3. Submitting application form. (a) A county agency must offer, in person or by mail, the application forms prescribed by the commissioner as soon as a person makes a written or oral inquiry. At that time, the county agency must:

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(1) inform the person that assistance begins with on the date that the signed application is received by the county agency either as a signed written application; an application submitted by telephone; or an application submitted through Internet telepresence; or on the date that all eligibility criteria are met, whichever is later; (2) inform a person that the person may submit the application by telephone or through Internet telepresence; (3) inform a person that when the person submits the application by telephone or through Internet telepresence, the county agency must receive a signed written application within 30 days of the date that the person submitted the application by telephone or through Internet telepresence; (2) (4) inform the person that any delay in submitting the application will reduce the amount of assistance paid for the month of application; (3) (5) inform a person that the person may submit the application before an interview; (4) (6) explain the information that will be verified during the application process by the county agency as provided in section 256J.32; (5) (7) inform a person about the county agency's average application processing time and explain how the application will be processed under subdivision 5; (6) (8) explain how to contact the county agency if a person's application information changes and how to withdraw the application; (7) (9) inform a person that the next step in the application process is an interview and what a person must do if the application is approved including, but not limited to, attending orientation under section 256J.45 and complying with employment and training services requirements in sections 256J.515 to 256J.57; (8) (10) inform the person that the an interview must be conducted. The interview may be conducted face-to-face in the county office or at a location mutually agreed upon, through Internet telepresence, or at a location mutually agreed upon by telephone; (9) inform a person who has received MFIP or DWP in the past 12 months of the option to have a face-to-face, Internet telepresence, or telephone interview; (10) (11) explain the child care and transportation services that are available under paragraph (c) to enable caregivers to attend the interview, screening, and orientation; and (11) (12) identify any language barriers and arrange for translation assistance during appointments, including, but not limited to, screening under subdivision 3a, orientation under section 256J.45, and assessment under section 256J.521. (b) Upon receipt of a signed application, the county agency must stamp the date of receipt on the face of the application. The county agency must process the application

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within the time period required under subdivision 5. An applicant may withdraw the application at any time by giving written or oral notice to the county agency. The county agency must issue a written notice confirming the withdrawal. The notice must inform the applicant of the county agency's understanding that the applicant has withdrawn the application and no longer wants to pursue it. When, within ten days of the date of the agency's notice, an applicant informs a county agency, in writing, that the applicant does not wish to withdraw the application, the county agency must reinstate the application and finish processing the application. (c) Upon a participant's request, the county agency must arrange for transportation and child care or reimburse the participant for transportation and child care expenses necessary to enable participants to attend the screening under subdivision 3a and orientation under section 256J.45.

Sec. 3. Minnesota Statutes 2020, section 256J.45, subdivision 1, is amended to read: Subdivision 1. County agency to provide orientation. A county agency must provide a face-to-face an orientation to each MFIP caregiver unless the caregiver is: (1) a single parent, or one parent in a two-parent family, employed at least 35 hours per week; or (2) a second parent in a two-parent family who is employed for 20 or more hours per week provided the first parent is employed at least 35 hours per week.

The county agency must inform caregivers who are not exempt under clause (1) or (2) that failure to attend the orientation is considered an occurrence of noncompliance with program requirements, and will result in the imposition of a sanction under section 256J.46. If the client complies with the orientation requirement prior to the first day of the month in which the grant reduction is proposed to occur, the orientation sanction shall be lifted.

Sec. 4. Minnesota Statutes 2020, section 256J.95, subdivision 5, is amended to read: Subd. 5. Submitting application form. The eligibility date for the diversionary work program begins with on the date that the signed combined application form (CAF) is received by the county agency either as a signed written application; an application submitted by telephone; or an application submitted through Internet telepresence; or on the date that diversionary work program eligibility criteria are met, whichever is later. The county agency must inform an applicant that when the applicant submits the application by telephone or through Internet telepresence, the county agency must receive a signed written application within 30 days of the date that the applicant submitted the application by telephone or through Internet telepresence. The county agency must inform the applicant that any delay in submitting the application will reduce the benefits paid for the month of application. The county agency must inform a person that an

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application may be submitted before the person has an interview appointment. Upon receipt of a signed application, the county agency must stamp the date of receipt on the face of the application. The applicant may withdraw the application at any time prior to approval by giving written or oral notice to the county agency. The county agency must follow the notice requirements in section 256J.09, subdivision 3, when issuing a notice confirming the withdrawal.

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MISCELLANEOUS

MA dental benefit added 2021, 1st Special Session HF33/SF37 Chapter 7, Article 1, Section 7, Subdivision 9 HHS omnibus bill Effective: July 1, 2021, or upon federal approval, whichever is later Short description Medical Assistance will cover the dental service, nonsurgical treatment for periodontal disease, for nonpregnant adults.

Summary The Medical Assistance coverage of dental services for nonpregnant adults, now covers the nonsurgical treatment for periodontal disease, including scaling and root planing once every two years for each quadrant, and routine periodontal maintenance procedures. This expansion of coverage also applies to the MinnesotaCare program.

Implications Presumably, this change will benefit seniors enrolled in Medicaid.

According to the National Institutes of Health: Prevalence of Periodontal Disease •

17.20% of seniors age 65 and over have periodontal disease.

•

Older seniors, Black and Hispanic seniors, current smokers, and those with lower incomes and less education are more likely to have periodontal disease.

Prevalence of Severe Periodontal disease •

10.58% of seniors 65 and over have moderate or severe periodontal disease.

•

Older seniors, Black and Hispanic seniors, current smokers, and those with lower incomes and less education are more likely to have moderate/severe periodontal disease.

Bill language https://www.revisor.mn.gov/laws/2021/1/Session+Law/Chapter/7/ Sec. 7. Minnesota Statutes 2020, section 256B.0625, subdivision 9, is amended to read: Subd. 9. Dental services. (a) Medical assistance covers dental services. (b) Medical assistance dental coverage for nonpregnant adults is limited to the following services:

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(1) comprehensive exams, limited to once every five years; (2) periodic exams, limited to one per year; (3) limited exams; (4) bitewing x-rays, limited to one per year; (5) periapical x-rays; (6) panoramic x-rays, limited to one every five years except (1) when medically necessary for the diagnosis and follow-up of oral and maxillofacial pathology and trauma or (2) once every two years for patients who cannot cooperate for intraoral film due to a developmental disability or medical condition that does not allow for intraoral film placement; (7) prophylaxis, limited to one per year; (8) application of fluoride varnish, limited to one per year; (9) posterior fillings, all at the amalgam rate; (10) anterior fillings; (11) endodontics, limited to root canals on the anterior and premolars only; (12) removable prostheses, each dental arch limited to one every six years; (13) oral surgery, limited to extractions, biopsies, and incision and drainage of abscesses; (14) palliative treatment and sedative fillings for relief of pain; and (15) full-mouth debridement, limited to one every five years.; and (16) nonsurgical treatment for periodontal disease, including scaling and root planing once every two years for each quadrant, and routine periodontal maintenance procedures.

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90-day medication 2021, 1st Special Session HF33/SF37 Chapter 7, Article 1, Section 8, Subdivision 13 HHS omnibus bill Effective: January 1, 2022 Short description Directs DHS to publish a list of approved medical assistance medications that can be provided in 90-day supplies (instead of the maximum 34-day supply). Does not include controlled substances.

Summary Minnesota Statutes 2020, section 256B.0625, subdivision 13 (b), is amended to read: (a) Medical assistance covers drugs, except for fertility drugs when specifically used to enhance fertility, if prescribed by a licensed practitioner and dispensed by a licensed pharmacist, by a physician enrolled in the medical assistance program as a dispensing physician, or by a physician, a physician assistant, or an advanced practice registered nurse employed by or under contract with a community health board as defined in section 145A.02, subdivision 5, for the purposes of communicable disease control. (b) The dispensed quantity of a prescription drug must not exceed a 34-day supply, unless authorized by the commissioner. or the drug appears on the 90-day supply list published by the commissioner. The 90-day supply list shall be published by the commissioner on the department's website. The commissioner may add to, delete from, and otherwise modify the 90-day supply list after providing public notice and the opportunity for a 15-day public comment period. The 90-day supply list may include cost-effective generic drugs and shall not include controlled substances.

Implications Once a list of eligible medications is published, refills may be needed less often, and orders can be requested for 90-day fills.

Bill language https://www.revisor.mn.gov/laws/2021/1/Session+Law/Chapter/7/

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Regional quality councils for disabilities 2021, 1st Special Session HF33/SF37 Chapter 7, Article 13, Sections 20–22 HHS omnibus bill Effective: July 1, 2021 Short description This new addition amends § 256B.097, by adding subd. 7-9 which now requires the commissioner to maintain the regional quality councils, including specifying membership of the regional quality councils, and it gives each regional quality council the authority to hire staff. Also included is a list the duties of each regional quality council and allows each regional quality council to engage in quality improvement initiatives.

Summary Regional quality councils will be maintained to support the efforts and initiatives of regional quality councils to drive systems and social change to promote inclusion of people who have disabilities. The goal is to improve person-centered outcomes in disability services and identify or enhance quality of life indicators for people who have disabilities. The bill outlines how the makeup of the regional quality councils should be comprised to include individuals with disabilities and key stakeholders. The bill also outlines the duties of each regional quality council and includes 13 different areas each regional quality council will include as a part of their meetings, goals and outcomes.

Implications Care Providers of Minnesota has not identified any implications of this requirement.

Bill language https://www.revisor.mn.gov/laws/2021/1/Session+Law/Chapter/7/ Sec. 20. Minnesota Statutes 2020, section 256B.097, is amended by adding a subdivision to read: Subd. 7. Regional quality councils and systems improvement. The commissioner of human services shall maintain the regional quality councils initially established under Minnesota Statutes 2020, section 256B.097, subdivision 4. The regional quality councils shall: (1) support efforts and initiatives that drive overall systems and social change to promote inclusion of people who have disabilities in the state of Minnesota; (2) improve person-centered outcomes in disability services; and (3) identify or enhance quality of life indicators for people who have disabilities.

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Sec. 21. Minnesota Statutes 2020, section 256B.097, is amended by adding a subdivision to read: Subd. 8. Membership and staff. (a) Regional quality councils shall be comprised of key stakeholders including, but not limited to: (1) individuals who have disabilities; (2) family members of people who have disabilities; (3) disability service providers; (4) disability advocacy groups; (5) lead agency staff; and (6) staff of state agencies with jurisdiction over special education and disability services. (b) Membership in a regional quality council must be representative of the communities in which the council operates, with an emphasis on individuals with lived experience from diverse racial and cultural backgrounds. (c) Each regional quality council may hire staff to perform the duties assigned in subdivision 9.

Sec. 22. Minnesota Statutes 2020, section 256B.097, is amended by adding a subdivision to read: Subd. 9. Duties. (a) Each regional quality council shall: (1) identify issues and barriers that impede Minnesotans who have disabilities from optimizing choice of home and community-based services; (2) promote informed-decision making, autonomy, and self-direction; (3) analyze and review quality outcomes and critical incident data, and immediately report incidents of life safety concerns to the Department of Human Services Licensing Division; (4) inform a comprehensive system for effective incident reporting, investigation, analysis, and follow-up; (5) collaborate on projects and initiatives to advance priorities shared with state agencies, lead agencies, educational institutions, advocacy organizations, community partners, and other entities engaged in disability service improvements; (6) establish partnerships and working relationships with individuals and groups in the regions; (7) identify and implement regional and statewide quality improvement projects; (8) transform systems and drive social change in alignment with the disability rights and disability justice movements identified by leaders who have disabilities;

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(9) provide information and training programs for persons who have disabilities and their families and legal representatives on formal and informal support options and quality expectations; (10) make recommendations to state agencies and other key decision-makers regarding disability services and supports; (11) submit every two years a report to legislative committees with jurisdiction over disability services on the status, outcomes, improvement priorities, and activities in the region; (12) support people by advocating to resolve complaints between the counties, providers, persons receiving services, and their families and legal representatives; and (13) recruit, train, and assign duties to regional quality council teams, including council members, interns, and volunteers, taking into account the skills necessary for the team members to be successful in this work. (b) Each regional quality council may engage in quality improvement initiatives related to, but not limited to: (1) the home and community-based services waiver programs for persons with developmental disabilities under section 256B.092, subdivision 4, or section 256B.49, including brain injuries and services for those persons who qualify for nursing facility level of care or hospital facility level of care and any other services licensed under chapter 245D; (2) home care services under section 256B.0651; (3) family support grants under section 252.32; (4) consumer support grants under section 256.476; (5) semi-independent living services under section 252.275; and (6) services provided through an intermediate care facility for persons with developmental disabilities. (c) Each regional quality council's work must be informed and directed by the needs and desires of persons who have disabilities in the region in which the council operates.

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DHS to proceed with Phase 2 of Waiver Reimagine for under 65 2021, 1st Special Session HF33/SF37 Chapter 7, Article 13, Sections 26, 31–41, 73 HHS omnibus bill Effective: July 1, 2024, or 90 days after federal approval, whichever is later Short description The Minnesota Department of Human Services (DHS) is required to seek federal approval to implement no sooner than July 1, 2024, a two-waiver program structure serving persons who are determined by a certified assessor to require the levels of care provided in a nursing facility, hospital, neurobehavioral hospital, or an intermediate care facility for persons with developmental disabilities, and an individual resource allocation methodology for the medical assistance home and community-based waivers. The legislation also includes new language concerning standards for an informed decisionmaking process.

Summary DHS continues to move the Waiver Reimagine initiative forward. This language authorizes DHS to begin Phase 2 for home and community-based services (HCBS) for persons with disabilities under the age of 65.

According to DHS, during the 2021 1st Special Session, the Minnesota Legislature authorized DHS to implement the next phase of the Waiver Reimagine project to support and expand informed choices and informed decision making by: •

Reshaping the four current disability waiver programs into a two-waiver structure

•

Transitioning to individualized budgets for people who use disability waivers

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Increasing access to and options for self-directed services

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Developing a web-based online support-planning tool for people with disabilities and families; the tool will provide information about their assessment, support plan, services, budgets, and resources to help them plan for services

Phase 2 public engagement DHS will continue consulting with people who receive services and other interested parties over the next several years on different aspects of the project. We will notify people who receive services and other interested parties about specific engagement opportunities as they are available. As part of the Phase 2 authorization, the legislature created the Waiver Reimagine Advisory Committee, which to help DHS implement these changes. DHS will share more information about this committee, including how to apply for membership, in late summer/fall 2021.

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Tentative Phase 2 project timelines In addition to the ongoing policy and system development already under way to support Phase 2, DHS plans to complete the following work: •

Fall 2021: Develop work plans and organize the Waiver Reimagine Advisory Committee

•

2022: Develop waiver amendment language and receive feedback from interested parties

•

2023: Conduct public comment on waiver amendments, submit waiver amendments to the federal government, develop policies and procedural guidance

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2024 and later: Begin rolling implementation of individual budgets and two-waiver system

Implications DHS continues to move forward with the consolidation of the four waivers providing services to the under 65 population with disabilities.

Providers of these services should enroll in the education and training options provided

by DHS on Waiver Reimagine. The resources tab found at: https://bit.ly/3iBMORm provides a list of presentations and documents.

Care Providers of Minnesota will monitor the Waiver Reimagine Advisory Committee.

Members are encouraged to apply when announced by the Minnesota Office of the Secretary of State.

Bill language https://www.revisor.mn.gov/laws/2021/1/Session+Law/Chapter/7/

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Ombudsperson for American Indian Families 2021, 1st Special Session HF33/SF37 Chapter 7, Article 14 , Section 1 HHS omnibus bill Effective: August 1, 2021 Short description In recognition of the sovereign status of Indian Tribes and the unique laws and standards involved in protecting Indian children, this section creates the Office of the Ombudsperson for American Indian Families and gives the ombudsperson the powers and duties necessary to effectively carry out the functions of the office.

Summary Subdivision 7 outlines the powers of the Office of the Ombudsperson for American Indian Families and includes the following: (1) The ombudsperson shall monitor agency compliance with all laws governing child protection and placement, public education, and housing issues related to child protection that impact American Indian children and their families. In particular, the ombudsperson shall monitor agency compliance with sections 260.751 to 260.835; section 260C.193, subdivision 3; and section 260C.215.

(2) The ombudsperson shall work with local state courts to ensure that: (i) court officials, public policy makers, and service providers are trained in cultural competency. The ombudsperson shall document and monitor court activities to heighten awareness of diverse belief systems and family relationships; (ii) qualified expert witnesses from the appropriate American Indian community, including Tribal advocates, are used as court advocates and are consulted in placement decisions that involve American Indian children; and (iii) guardians ad litem and other individuals from American Indian communities are recruited, trained, and used in court proceedings to advocate on behalf of American Indian children.

(3) The ombudsperson shall primarily work on behalf of American Indian children and families, but shall also work on behalf of any Minnesota children and families as the ombudsperson deems necessary and appropriate. (b) The ombudsperson has the authority to investigate decisions, acts, and other matters of an agency, program, or facility providing protection or placement services to American Indian children. In carrying out this authority and the duties in paragraph (a), the ombudsperson has the power to:

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(1) prescribe the methods by which complaints are made, reviewed, and acted upon; (2) determine the scope and manner of investigations; (3) investigate, upon a complaint or upon personal initiative, any action of any agency; (4) request and be given access to any information in the possession of any agency deemed necessary for the discharge of responsibilities. The ombudsperson is authorized to set reasonable deadlines within which an agency must respond to requests for information. Data obtained from any agency under this clause retains the classification that the data has under section 13.02 and the ombudsperson shall maintain and disseminate the data according to chapter 13; (5) examine the records and documents of an agency; (6) enter and inspect, during normal business hours, premises within the control of an agency; and (7) subpoena any agency personnel to appear, testify, or produce documentation or other evidence that the ombudsperson deems relevant to a particular matter under investigation, and petition the appropriate state court to seek enforcement of the subpoena. Any witness at a hearing or for an investigation has the same privileges of a witness in the courts or under the laws of this state.

The ombudsperson may compel individuals who are not agency personnel to testify or produce evidence according to procedures developed by the advisory board. (c) The ombudsperson may apply for grants and accept gifts, donations, and appropriations for training relating to the duties of the ombudsperson. Grants, gifts, donations, and appropriations received by the ombudsperson shall be used for training. The ombudsperson may seek and apply for grants to develop new programs and initiatives and to continue existing programs and initiatives. These funds may not be used for operating expenses for the Office of the Ombudsperson for American Indian Families.

Implications For members who work with or serve indigenous communities or persons, the roles and functions of the Ombudsperson for American Indian Families may develop to include older adults as well as children. Keeping updated on the roles and duties of this ombudsperson as they develop will continue to be important.

Bill language https://www.revisor.mn.gov/laws/2021/1/Session+Law/Chapter/7/

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American Indian Community-Specific Board 2021, 1st Special Session HF33/SF37 Chapter 7, Article 14 , Section 2 HHS omnibus bill Effective: August 1, 2021 Short description In recognition of the sovereign status of Indian Tribes and the unique laws and standards involved in protecting Indian children, this section enables an American Indian Community-Specific Board to advise and assist the Office of the Ombudsperson for American Indian Families.

Summary Subdivision 5 outlines the powers of the American Indian Community-Specific Board in relation to Office of the Ombudsperson for American Indian Families and includes the following: Subd. 5. Duties. (a) The board shall appoint the Ombudsperson for American Indian Families and shall advise and assist the ombudsperson in various ways, including, but not limited to: (1) selecting matters for attention; (2) developing policies, plans, and programs to carry out the ombudsperson's functions and powers; (3) attending policy meetings when requested by the ombudsperson; (4) establishing protocols for working with American Indian communities; (5) developing procedures for the ombudsperson's use of the subpoena power to compel testimony and evidence from individuals who are not agency personnel; and (6) making reports and recommendations for changes designed to improve standards of competence, efficiency, justice, and protection of rights. (b) The board shall not make individual case recommendations.

Implications For members who work with or serve indigenous communities or persons, the roles and functions of the Ombudsperson for American Indian Families may develop to include older adults as well as children. Keeping updated on the roles and duties of this ombudsperson as they develop will continue to be important.

Bill language https://www.revisor.mn.gov/laws/2021/1/Session+Law/Chapter/7/

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Age-Friendly Minnesota 2021, 1st Special Session HF33/SF37 Chapter 7, Article 17, Sections 2 & 8 HHS omnibus bill Effective: July 1, 2021 Short description Minnesota’s Council on an Age-Friendly Minnesota is extended through 2024 and money was appropriated to pay for staff and grants through June 2024.

Summary The Governor’s Council on an Age-Friendly Minnesota was established by Executive Order 19-38 in 2019 (https://bit.ly/3s5JKjR). The council was set to expire on January 1, 2022, and was extended during the 2021 Regular Session through October 1, 2022. Further action was taken in the 2021 First Special Session to extend the existing council through June 30, 2024, (Section 2) and to authorize funding for age-friendly community grants and technical assistance (Section 8).

Implications The purpose of the Governor’s Council on an Age-Friendly Minnesota is to coordinate state and private sector partners to ensure Minnesota is an age-friendly state. There are nine specific state agencies and boards as voting council members, along with six additional public members. The current council has established a timeframe to implement their work which includes development of the state’s master plan and prioritizing the technical assistance grants. Below is the timeline for the workplan through mid-2022, as well as a summary of the funding use during the upcoming years.

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Bill language https://www.revisor.mn.gov/laws/2021/1/Session+Law/Chapter/7/ Sec. 2. Laws 2021, chapter 30, article 12, section 5, is amended to read: Sec. 5. GOVERNOR'S COUNCIL ON AN AGE-FRIENDLY MINNESOTA. The Governor's Council on an Age-Friendly Minnesota, established in Executive Order 19-38, shall: (1) work to advance age-friendly policies; and (2) coordinate state, local, and private partners' collaborative work on emergency preparedness, with a focus on older adults, communities, and persons in zip codes most impacted by the COVID-19 pandemic. The Governor's Council on an Age-Friendly Minnesota is extended and expires October 1, 2022 June 30, 2024.

Sec. 8. AGE-FRIENDLY MINNESOTA. Subdivision 1. Age-friendly community grants. (a) This act includes $0 in fiscal year 2022 and $875,000 in fiscal year 2023 for age-friendly community grants. The commissioner of human services, in collaboration with the Minnesota Board on Aging and the Governor's Council on an Age-Friendly Minnesota, established in Executive Order 19-38, shall develop the age-friendly community grant program to help communities, including cities, counties, other municipalities, tribes, and collaborative efforts, to become agefriendly communities, with an emphasis on structures, services, and community features necessary to support older adult residents over the next decade, including but not limited to: (1) coordination of health and social services; (2) transportation access; (3) safe, affordable places to live; CARE PROVIDERS OF MINNESOTA

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(4) reducing social isolation and improving wellness; (5) combating ageism and racism against older adults; (6) accessible outdoor space and buildings; (7) communication and information technology access; and (8) opportunities to stay engaged and economically productive.

The general fund base in this act for this purpose is $875,000 in fiscal year 2024 and $0 in fiscal year 2025. (b) All grant activities must be completed by March 31, 2024. (c) This subdivision expires June 30, 2024.

Subd. 2. Technical assistance grants. (a) This act includes $0 in fiscal year 2022 and $575,000 in fiscal year 2023 for technical assistance grants. The commissioner of human services, in collaboration with the Minnesota Board on Aging and the Governor's Council on an Age-Friendly Minnesota, established in Executive Order 19-38, shall develop the agefriendly technical assistance grant program. The general fund base in this act for this purpose is $575,000 in fiscal year 2024 and $0 in fiscal year 2025. (b) All grant activities must be completed by March 31, 2024. (c) This subdivision expires June 30, 2024.

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Mental health summary 2021, 1st Special Session HF33/SF37 Chapter 7, various articles & sections HHS omnibus bill Effective: Various Short description A number of important changes for persons with mental health issues and providers of their services were incorporated into the final HHS omnibus bill.

Summary •

Mental health workforce: Expanding our mental health workforce, increase its diversity, and have it be more culturally informed were key priorities; there is a funding increase for loan forgiveness programs and expanding it to LADCs, cultural and regional diversity standards for licensing boards, including cultural competency in continuing education standards for mental health professionals, paying for BIPOC mental health professionals to become supervisors, creating a Culturally-Informed and Culturally-Responsive Mental Health Task Force, and other key items

•

Sober home study: Commissions a study to increase access to sober homes, ensure that sober home residents have basic consumer protections, and consider whether statewide oversight of sober homes is appropriate

•

Crisis teams: Requires 911 to include referrals to mobile mental health crisis teams where available

•

Telehealth: Key changes include removing the weekly cap on telehealth visits under public health programs, allowing for people to access telehealth services through a telephone or other audio-only platforms through July 1, 2023, ensuring that telehealth services are reimbursed at the same rate as in person treatment, and other changes

•

Homelessness: Substantial investment in emergency shelters and housing supports (GRH) providers that benefit people experiencing homelessness

•

Mobile crisis: Appropriates over $16 million in one-time funding over three years to expand access to mobile crisis services

•

Dental care: Restores the coverage of periodontal dental surgery under Medical Assistance—this will reduce the reliance on emergency dental care and will be especially beneficial for people with mental illnesses whose medications cause drymouth

•

911 workgroup: This workgroup (which includes a mental health provider) will look at training and standards for 911

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•

CADI waiver: Bill to suspend, not terminate, the CADI waiver when someone is hospitalized or in residential treatment (See additional article on CADI changes for more information)

For more specific information, you can go to National Association of Mental Illness (NAMI) website: https://namimn.org/advocacy-and-laws/legislative-updates/.

Implications If you provide services to those who have mental health Issues, you should be aware of the changes in mental health policy and payment.

Bill language https://www.revisor.mn.gov/laws/2021/1/Session+Law/Chapter/7/

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Service & support animals 2021, 1st Special Session HF4/SF16 Chapter 8, Article 2, Section 10 Housing bill Effective: July 1, 2021 Short description Permits a landlord to require a tenant to provide supporting documentation for service or support animals (defined) for which a tenant requests a reasonable accommodation.

Implications Upon a landlord's request, the tenant must provide supporting documentation from a licensed professional confirming the tenant's disability and the relationship between the tenant's disability and the need for a service or support animal. A landlord must not require the tenant to disclose or provide access to medical records or medical providers or provide any other information or documentation of a person's physical or mental disability.

A landlord must not require a tenant with a reasonable accommodation under this section to pay an additional fee, charge, or deposit for the service or support animal. A tenant is liable to the landlord for any damage to the premises caused by the service or support animal.

If a tenant violates this request, the landlord may deny the tenant's rental application or request for a service or support animal.

Bill language https://www.revisor.mn.gov/laws/2021/1/Session+Law/Chapter/8/ Sec. 10. [504B.113] SERVICE AND SUPPORT ANIMAL DOCUMENTATION. Subdivision 1. Definitions. (a) For purposes of this section, the following terms have the meanings given. (b) "Service animal" has the meaning given in Code of Federal Regulations, title 28, section 36.104, as amended. (c) "Support animal" means an animal that: (1) provides emotional support that alleviates one or more identified symptoms or effects of a person's disability; and (2) does not need to be trained to perform a specific disability-related task. (d) "Tenant" means a current tenant or a prospective tenant. (e) "Licensed professional" means a provider of care who is: CARE PROVIDERS OF MINNESOTA

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(1) a person licensed by the Board of Medical Practice under chapter 147; (2) a physician assistant licensed under chapter 147A; (3) a nurse, as defined in section 148.171, subdivision 9, licensed under chapter 148; (4) a psychologist licensed under chapter 148; (5) a mental health professional licensed under chapter 148B; (6) a social worker licensed under chapter 148E; (7) a counselor licensed under chapter 148F; or (8) any professional listed in clauses (1) to (7) who holds a valid license in any other state, provided the professional has an existing treatment relationship with the tenant requesting a reasonable accommodation.

A licensed professional does not include any person who operates primarily to provide certification for a service or support animal. (f) "Reasonable accommodation" means the granting of a waiver by a landlord of a no-pets or pet-fee policy for a person with a disability consistent with the Fair Housing Act, United States Code, title 42, sections 3601 to 3619, as amended, and section 504 of the Rehabilitation Act of 1973, United States Code, title 29, section 701, as amended. (g) "Disability" has the meaning given in section 363A.03, subdivision 12.

Subd. 2. Request for documentation permitted. (a) A landlord may require a tenant to provide supporting documentation for each service or support animal for which the tenant requests a reasonable accommodation under any provision of law. A landlord must not require supporting documentation from a tenant if the tenant's disability or disability-related need for a service or support animal is readily apparent or already known to the landlord. (b) Upon a landlord's request, the tenant must provide supporting documentation from a licensed professional confirming the tenant's disability and the relationship between the tenant's disability and the need for a service or support animal. A landlord must not require the tenant to disclose or provide access to medical records or medical providers or provide any other information or documentation of a person's physical or mental disability.

Subd. 3. Additional fees or deposits prohibited. A landlord must not require a tenant with a reasonable accommodation under this section to pay an additional fee, charge, or deposit for the service or support animal. A tenant is liable to the landlord for any damage to the premises caused by the service or support animal.

Subd. 4. Prohibited conduct. A tenant must not, directly or indirectly through statements or conduct, knowingly: (1) misrepresent themselves as a person with a disability that requires the use of a service or support animal; or CARE PROVIDERS OF MINNESOTA

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(2) provide fraudulent supporting documentation under this section.

Subd. 5. Penalty. If a tenant violates this section, the landlord may deny the tenant's rental application or request for a service or support animal. Nothing in this section shall be construed to prohibit an eviction action based on a breach of the lease.

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Tax conformity 2021, 1st Special Session HF9/SF26 Chapter 14, Article 1, Section 1 Tax omnibus bill Effective: Various Short description Minnesota doesn’t automatically change its tax laws when the federal government makes changes, and that means that it’s up to the legislature to pick and choose which adjustments in the federal tax code to mirror on a state level. The legislature acted upon many of the tax conformity pieces.

Summary The compromise tax bill fashioned from the omnibus bills that passed the House and Senate conforms to many changes in federal tax law made since late 2019, but not all of them. One is making forgiven Paycheck Protection Program loans tax exempt, as well as unemployment benefits up to $10,200.

Implications For those members who used Paycheck Protection Program loans, the state and federal rules now align. Check with your accountants on the implications for your business.

Bill language https://www.revisor.mn.gov/laws/2021/1/Session+Law/Chapter/14/

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Medical cannabis—Smoking raw plant 2021, Regular Session HF2128/SF2360 Chapter 30, Article 3, Section 29, Subdivision 6 HHS omnibus bill Effective: March 1, 2022 (or at an earlier date if the testing labs and administrative rules are ready sooner) Short description Minnesota’s medical cannabis program previously prohibited providing dried cannabis buds (raw cannabis) as an approved type of medicine. This new law will permit the distribution of dried leaves or plant form and permit combustion/smoking of the dried raw cannabis.

Implications Facilities that permit or accommodate residents use of medicinal cannabis will need to determine if they will permit smoking of the cannabis. Facilities are permitted to deny medical cannabis or limit the forms (pill, liquid, oil, topical, tincture, powder, lozenge, and now dried raw plant) permitted. Dried raw cannabis will be allowed for registered patients who are 21 years or older beginning either on March 1, 2022, or at an earlier date if the testing labs and administrative rules are ready sooner.

Bill language https://www.revisor.mn.gov/laws/2021/0/Session+Law/Chapter/30/ Sec. 29. Minnesota Statutes 2020, section 152.22, subdivision 6, is amended to read: Subd. 6. Medical cannabis. (a) "Medical cannabis" means any species of the genus cannabis plant, or any mixture or preparation of them, including whole plant extracts and resins, and is delivered in the form of: (1) liquid, including, but not limited to, oil; (2) pill; (3) vaporized delivery method with use of liquid or oil but which does not require the use of dried leaves or plant form; or; (4) combustion with use of dried raw cannabis; or (4) (5) any other method, excluding smoking, approved by the commissioner. (b) This definition includes any part of the genus cannabis plant prior to being processed into a form allowed under paragraph (a), that is possessed by a person while that person is engaged in employment duties necessary to carry out a requirement under sections 152.22 to 152.37 for a registered manufacturer or a laboratory under contract CARE PROVIDERS OF MINNESOTA

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with a registered manufacturer. This definition also includes any hemp acquired by a manufacturer by a hemp grower as permitted under section 152.29, subdivision 1, paragraph (b).

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Tribes included in supplemental service rate definition 2021, Regular Session HF2128/ SF2360 Chapter 30, Article 12, Section 3 HHS omnibus bill Effective: Day following final enactment Short description By using agency instead of county, Minnesota’s tribes are included in the statute governing the Housing Supports program’s supplementary service rates.

Summary Tribes may negotiate the supplementary service rates and are now included in the costneutral housing support allocation option.

Implications The change may allow for providers serving tribal beneficiaries to negotiate and work directly with the tribe.

Bill language https://www.revisor.mn.gov/laws/2021/0/Session+Law/Chapter/30/

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More changes for Community First Services & Supports (also known as PCA/CFSS) 2021, Regular Session HF2128/ SF2360 Chapter 30, Article 13, Sections 57–82 HHS omnibus bill Effective: July 1, 2021 Short description Many policy changes and clarifications were made to the Community First Services & Supports (aka PCA / CFSS) program.

Summary With CFSS services to have officially replaced PCA services in June 2021, the Minnesota legislature added many clarifications to statute, including the following: •

Managed care plans are to use processes, forms, documentation, data reporting, and other policies consistent with MA fee-for-service or DHS contract requirements for community first services and supports (CFSS)

•

The supports purchased under CFSS are not considered home care services

•

Clarifies the definitions of “activities of daily living,” “complex health-related needs,” “CFSS service delivery plan,” “dependency,” “extended CFSS,” “level I behavior,” “medication assistance,” “participant’s representative,” and “shared services”

•

CFSS service delivery plans must meet the needs identified in the developmental disabilities waiver coordinated service and support plan; the CFSS service delivery plan to describe the units or dollar amount available to the participant

•

Modifications are made to the prohibitions for CFSS support workers who are the parent, stepparent, or legal guardian of a participant under age 18, or who are a participant’s spouse

•

The timeline is extended for agency providers to provide a termination of services notice to a participant from ten calendar days to 30 calendar days before the proposed termination of service

•

Additional changes are made to exceptions, non-covered services, worker competencies and training, provider enrollment, budget model requirements, financial management, participant’s representative responsibilities, and other modifications

Implications Providers of PCA services that intend to enroll as providers of CFSS will need to understand and implement the changes. Presumably, DHS is offering training for consumers, lead agencies, and providers.

Bill language https://www.revisor.mn.gov/laws/2021/0/Session+Law/Chapter/30/

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