reglab/housing_qa huggingface dataset:
MN Stat § 256S.08 (2021)
2021 Minnesota Statutes|Chapters 245 - 267 — Public Welfare And Related Activities|Chapter 256S — Medical Assistance Elderly Waiver|Section 256S.08 — Case Management Provider Qualifications And Standards.

256S.08 CASE MANAGEMENT PROVIDER QUALIFICATIONS AND STANDARDS. Subdivision 1. Provider requirements. (a) Except as provided in section 256S.07, subdivision 2, elderly waiver case management must be provided by a lead agency or by a private agency that is enrolled as a medical assistance provider. (b) Any private agency that provides case management to a participant must not have a financial interest in the provision of any other services included in the participant's coordinated service and support plan. Subd. 2. Provider enrollment. The commissioner must enroll providers qualified to provide elderly waiver case management under the elderly waiver. The enrollment process must ensure the provider's ability to meet the qualification requirements and standards in this section and other federal and state requirements of this service. Subd. 3. Provider qualifications. Except as provided in section 256S.07, subdivision 2, a case management provider must be an enrolled medical assistance provider who is determined by the commissioner to have the following characteristics: (1) the demonstrated capacity and experience to provide the components of case management to coordinate and link community resources needed by the eligible population; (2) administrative capacity and experience in serving the target population for whom the provider will provide services and in ensuring quality of services under state and federal requirements; (3) a financial management system that provides accurate documentation of services and costs under state and federal requirements; and (4) the capacity to document and maintain individual case records under state and federal requirements. Subd. 4. Delegation of certain case management activities. The lead agency may allow a case manager to delegate certain aspects of the case management activity to a case aide if there is oversight of the case aide by the case manager. The case manager must not delegate those aspects that require professional judgment including assessments, reassessments, and coordinated service and support plan development. Subd. 5. Case aides. A case aide shall provide assistance to the case manager in carrying out administrative activities of the elderly waiver case management function. The case aide must not assume responsibilities that require professional judgment including assessments, reassessments, and coordinated service and support plan development. The case manager is responsible for providing oversight of the case aide. History:   2019 c 54 art 1 s 8
MN Stat § 256S.09 (2021)
2021 Minnesota Statutes|Chapters 245 - 267 — Public Welfare And Related Activities|Chapter 256S — Medical Assistance Elderly Waiver|Section 256S.09 — Case Management Activities.

256S.09 CASE MANAGEMENT ACTIVITIES. Subdivision 1. Choice of case management provider. An eligible participant may choose any qualified provider of elderly waiver case management. Subd. 2. Case management activities. Elderly waiver case management activities provided to or arranged for a participant include: (1) development of the coordinated service and support plan under section 256S.10; (2) informing the participant or the participant's legal guardian or conservator of service options and options for elderly waiver case management and providers; (3) consulting with relevant medical experts or service providers; (4) assisting the participant in identifying potential providers; (5) assisting the participant with gaining access to needed elderly waiver and other state plan services; (6) assisting the participant with gaining access to needed medical, social, educational, and other services regardless of the funding source for the services to which access is gained; (7) coordination of services; (8) ongoing evaluation and monitoring of the provision of services included in the participant's coordinated service and support plan under subdivision 3; and (9) assisting the participant in appeals under section 256.045. Subd. 3. Coordinated service and support plan development, review, and monitoring. (a) Elderly waiver case managers shall collaborate with the participant, the participant's family, the participant's legal representatives, and relevant medical experts and service providers to develop and periodically review the participant's coordinated service and support plan. (b) Case managers shall initiate the process of reassessment and review of the participant's coordinated service and support plan and review the plan at intervals specified in the elderly waiver plan. (c) The case manager's evaluation and monitoring of a participant's services must incorporate at least one annual face-to-face visit by the case manager with each participant. History:   2019 c 54 art 1 s 9
MN Stat § 256S.10 (2021)
2021 Minnesota Statutes|Chapters 245 - 267 — Public Welfare And Related Activities|Chapter 256S — Medical Assistance Elderly Waiver|Section 256S.10 — Coordinated Service And Support Plans.

256S.10 COORDINATED SERVICE AND SUPPORT PLANS. Subdivision 1. Written plan required. Each participant's case manager shall provide the participant with a copy of the participant's written coordinated service and support plan. Subd. 2. Plan development timeline. Within the timelines established by the commissioner and section 256B.0911, subdivision 3a, paragraph (e), the case manager must develop with the participant and the participant must sign the participant's individualized written coordinated service and support plan. Subd. 3. Plan content. Each participant's coordinated service and support plan must: (1) include the participant's need for service and identify service needs that will be or that are met by the participant's relatives, friends, and others, as well as community services used by the general public; (2) include the use of volunteers, religious organizations, social clubs, and civic and service organizations to support the participant in the community; (3) reasonably ensure the health and welfare of the participant; (4) identify the participant's preferences for services as stated by the participant or the participant's legal guardian or conservator; (5) reflect the participant's informed choice between institutional and community-based services, as well as choice of services, supports, and providers, including available elderly waiver case management providers; (6) identify the participant's long-range and short-range goals; (7) identify specific services and the amount, frequency, duration, and cost of the services to be provided to the participant based on assessed needs, preferences, and available resources; (8) include information about the right to appeal decisions under section 256.045; and (9) include the authorized annual and estimated monthly amounts for the services. Subd. 4. Immunity. The lead agency must be held harmless for damages or injuries sustained through the use of volunteers and organizations under subdivision 3, clause (2), including workers' compensation liability. History:  2019 c 54 art 1 s 10,33; 1Sp2019 c 9 art 5 s 49
MN Stat § 256S.11 (2021)
2021 Minnesota Statutes|Chapters 245 - 267 — Public Welfare And Related Activities|Chapter 256S — Medical Assistance Elderly Waiver|Section 256S.11 — Approval Required For Certain State Plan Home Care Services.

256S.11 APPROVAL REQUIRED FOR CERTAIN STATE PLAN HOME CARE SERVICES. Medical assistance funding for the following services for a participant must be approved by the case manager and included in the participant's coordinated service and support plan: (1) skilled nursing services; (2) home care nursing; (3) home health aide services; and (4) personal care assistance services. History:   2019 c 54 art 1 s 11
MN Stat § 256S.12 (2021)
2021 Minnesota Statutes|Chapters 245 - 267 — Public Welfare And Related Activities|Chapter 256S — Medical Assistance Elderly Waiver|Section 256S.12 — Adult Day Services.

256S.12 ADULT DAY SERVICES. Subdivision 1. Adult day services authorization limits. Adult day services may be authorized for up to 48 units, or 12 hours, per day based on the needs of the participant and the participant's family caregivers. Subd. 2. Adult day services bath authorization minimum. If a bath is authorized for a participant receiving adult day services, at least two 15-minute units must be authorized to allow for adequate time to meet the participant's needs. History:   2019 c 54 art 1 s 12
MN Stat § 256S.13 (2021)
2021 Minnesota Statutes|Chapters 245 - 267 — Public Welfare And Related Activities|Chapter 256S — Medical Assistance Elderly Waiver|Section 256S.13 — Individual Community Living Supports.

256S.13 INDIVIDUAL COMMUNITY LIVING SUPPORTS. Subdivision 1. Provider requirements. A provider of individual community living supports must not be the landlord of the participant receiving individual community living supports, nor have any interest in the participant's housing. Subd. 2. Licensing standards. Licensing standards for individual community living supports shall be reviewed jointly by the Departments of Health and Human Services to avoid conflict with provider regulatory standards pursuant to sections 144A.43 to 144A.483 and chapter 245D. Subd. 3. Setting requirements. Individual community living supports must be delivered in a single-family home or apartment that the participant or the participant's family owns or rents, as demonstrated by a lease agreement, and maintains control over the individual unit. Subd. 4. Plan required. A case manager must develop an individual community living support plan in consultation with the participant using a tool developed by the commissioner. Subd. 5. Individual community living support rates. The commissioner shall establish rates and establish mechanisms to align payments with the type and amount of service provided, ensure statewide uniformity for rates, and ensure cost-effectiveness. History:   2019 c 54 art 1 s 13
MN Stat § 256S.14 (2021)
2021 Minnesota Statutes|Chapters 245 - 267 — Public Welfare And Related Activities|Chapter 256S — Medical Assistance Elderly Waiver|Section 256S.14 — Termination Of Elderly Waiver Services.

256S.14 TERMINATION OF ELDERLY WAIVER SERVICES. The case manager must give the participant a ten-day written notice of any denial, reduction, or termination of elderly waiver services. History:   2019 c 54 art 1 s 14
MN Stat § 256S.15 (2021)
2021 Minnesota Statutes|Chapters 245 - 267 — Public Welfare And Related Activities|Chapter 256S — Medical Assistance Elderly Waiver|Section 256S.15 — Establishment Of Elderly Waiver Service Rates And Service Rate Limits.

256S.15 ESTABLISHMENT OF ELDERLY WAIVER SERVICE RATES AND SERVICE RATE LIMITS. Subdivision 1. Statewide service rates and service rate limits. The commissioner shall establish statewide service rates and service rate limits. The commissioner shall publish updated service rates and service rate limits at least annually. Subd. 2. Foster care limit. The elderly waiver payment for the foster care service in combination with the payment for all other elderly waiver services, including case management, must not exceed the monthly case mix budget cap for the participant as specified in sections 256S.18, subdivision 3, and 256S.19, subdivisions 3 and 4. History:   2019 c 54 art 1 s 15
MN Stat § 256S.16 (2021)
2021 Minnesota Statutes|Chapters 245 - 267 — Public Welfare And Related Activities|Chapter 256S — Medical Assistance Elderly Waiver|Section 256S.16 — Authorization Of Elderly Waiver Services And Service Rates.

256S.16 AUTHORIZATION OF ELDERLY WAIVER SERVICES AND SERVICE RATES. A lead agency must use the service rates and service rate limits published by the commissioner to authorize services. History:   2019 c 54 art 1 s 16
MN Stat § 256S.17 (2021)
2021 Minnesota Statutes|Chapters 245 - 267 — Public Welfare And Related Activities|Chapter 256S — Medical Assistance Elderly Waiver|Section 256S.17 — Costs Excluded From Elderly Waiver Service Rates.

256S.17 COSTS EXCLUDED FROM ELDERLY WAIVER SERVICE RATES. Elderly waiver service rates for foster care and customized living must not include room and board, rent, or raw food costs. History:   2019 c 54 art 1 s 17
MN Stat § 256S.19 (2021)
2021 Minnesota Statutes|Chapters 245 - 267 — Public Welfare And Related Activities|Chapter 256S — Medical Assistance Elderly Waiver|Section 256S.19 — Monthly Case Mix Budget Caps; Nursing Facility Residents.

256S.19 MONTHLY CASE MIX BUDGET CAPS; NURSING FACILITY RESIDENTS. Subdivision 1. Requests for elderly waiver monthly conversion budget caps. A participant who is a nursing facility resident when requesting an eligibility determination for elderly waiver services may request an elderly waiver monthly conversion budget cap for the cost of elderly waiver services. Subd. 2. Eligibility for elderly waiver monthly conversion budget caps. Only a participant discharged from a nursing facility after a minimum 30-day stay is eligible under this section for an elderly waiver monthly conversion budget cap. Subd. 3. Calculation of monthly conversion budget cap without consumer-directed community supports. (a) The elderly waiver monthly conversion budget cap for the cost of elderly waiver services without consumer-directed community supports must be based on the nursing facility case mix adjusted total payment rate of the nursing facility where the elderly waiver applicant currently resides for the applicant's case mix classification as determined according to section 256R.17. (b) The elderly waiver monthly conversion budget cap for the cost of elderly waiver services without consumer-directed community supports shall be calculated by multiplying the applicable nursing facility case mix adjusted total payment rate by 365, dividing by 12, and subtracting the participant's maintenance needs allowance. (c) A participant's initially approved monthly conversion budget cap for elderly waiver services without consumer-directed community supports shall be adjusted at least annually as described in section 256S.18, subdivision 5. Subd. 4. Calculation of monthly conversion budget cap with consumer-directed community supports. For the elderly waiver monthly conversion budget cap for the cost of elderly waiver services with consumer-directed community supports, the nursing facility case mix adjusted total payment rate used under subdivision 3 to calculate the monthly conversion budget cap for elderly waiver services without consumer-directed community supports must be reduced by a percentage equal to the percentage difference between the consumer-directed community supports budget limit that would be assigned according to the elderly waiver plan and the corresponding monthly case mix budget cap under this chapter, but not to exceed 50 percent. History:  2019 c 54 art 1 s 19; 1Sp2020 c 2 art 2 s 32
MN Stat § 256S.20 (2021)
2021 Minnesota Statutes|Chapters 245 - 267 — Public Welfare And Related Activities|Chapter 256S — Medical Assistance Elderly Waiver|Section 256S.20 — Customized Living Services; Policy.

256S.20 CUSTOMIZED LIVING SERVICES; POLICY. Subdivision 1. Customized living services provider requirements. (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. Subd. 2.  MS 2020 [Repealed, 1Sp2021 c 7 art 13 s 79] Subd. 3. Documented need required. The lead agency, with input from the provider of customized living services and within the parameters established by the commissioner, shall ensure that there is a documented need for all authorized customized living or 24-hour customized living component services. Subd. 4. 24-hour customized living services eligibility. (a) The lead agency shall not authorize 24-hour customized living services unless the participant receiving customized living services requires assistance, including 24-hour supervision, due to needs related to one or more of the following: (1) intermittent assistance with toileting, positioning, or transferring; (2) cognitive or behavioral issues; (3) a medical condition that requires clinical monitoring; or (4) the need for medication management, at least 50 hours of services per month, and a dependency in at least three of the following activities of daily living as determined by assessment under section 256B.0911: bathing, dressing, grooming, walking, or eating when the dependency score in eating is three or greater. (b) The lead agency must document the need for 24-hour supervision. (c) The lead agency shall ensure that the frequency and mode of supervision of the participant and the qualifications of staff providing supervision are described and meet the needs of the participant. Subd. 5. Billing for additional units of allowable services prohibited. A provider of customized living services or 24-hour customized living services must not bill or otherwise charge a participant or the participant's family for: (1) additional units of any allowable component service beyond those available under the service rate limits described in section 256S.202, or (2) additional units of any allowable component service beyond those component services in the customized living service plan approved by the lead agency. History:  2019 c 54 art 1 s 20; 1Sp2021 c 7 art 13 s 60
MN Stat § 256S.201 (2021)
2021 Minnesota Statutes|Chapters 245 - 267 — Public Welfare And Related Activities|Chapter 256S — Medical Assistance Elderly Waiver|Section 256S.201 — Customized Living Services; Rates.

256S.201 CUSTOMIZED LIVING SERVICES; RATES. Subdivision 1. Authorized customized living service rates. The rates for customized living services and 24-hour customized living services shall be the monthly rates authorized by the lead agency based on the customized living service plan developed within the parameters established by the commissioner and specified in the customized living service plan. Subd. 2. Customized living service plan. The customized living service plan developed by a lead agency must delineate the amount of each component service included in each participant's customized living service plan. Subd. 3. Customized living service rates. The authorized rates for customized living services and 24-hour customized living services must be based on the amount of component services to be provided utilizing component rates established by the commissioner. Counties and tribes shall use tools issued by the commissioner to develop and document customized living service plans and rates. Subd. 4. Component service rates. Component service rates for customized living services and 24-hour customized living services must not exceed rates for comparable elderly waiver or medical assistance services and must reflect economies of scale. History:   2019 c 54 art 1 s 21
MN Stat § 256S.202 (2021)
2021 Minnesota Statutes|Chapters 245 - 267 — Public Welfare And Related Activities|Chapter 256S — Medical Assistance Elderly Waiver|Section 256S.202 — Customized Living Services; Rate Limits.

256S.202 CUSTOMIZED LIVING SERVICES; RATE LIMITS. Subdivision 1. Customized living monthly service rate limits. (a) Except for a participant assigned to case mix classification L, as described in section 256S.18, subdivision 1, paragraph (b), the customized living monthly service rate limit shall not exceed 50 percent of the monthly case mix budget cap, less the maintenance needs allowance, adjusted at least annually in the manner described under section 256S.18, subdivisions 5 and 6. (b) The customized living monthly service rate limit for participants assigned to case mix classification L must be the monthly service rate limit for participants assigned to case mix classification A, reduced by 25 percent. Subd. 2. 24-hour customized living monthly service rate limits. (a) The 24-hour customized living monthly service rate limit is the 95th percentile of statewide monthly authorizations for 24-hour customized living services in effect and in the Medicaid management information systems on March 31, 2009, for each case mix resident class under Minnesota Rules, parts 9549.0051 to 9549.0059, to which elderly waiver service participants are assigned, adjusted at least annually in the manner described under section 256S.18, subdivisions 5 and 6. (b) If there are fewer than 50 authorizations in effect in the case mix resident class, the commissioner shall multiply the calculated 24-hour customized living monthly service rate limit for case mix classification A by the standard weight for that classification under Minnesota Rules, parts 9549.0051 to 9549.0059, to determine the applicable 24-hour customized living monthly service rate limit. History:   2019 c 54 art 1 s 22
MN Stat § 256S.203 (2021)
2021 Minnesota Statutes|Chapters 245 - 267 — Public Welfare And Related Activities|Chapter 256S — Medical Assistance Elderly Waiver|Section 256S.203 — Customized Living Services; Managed Care Rates.

256S.203 CUSTOMIZED LIVING SERVICES; MANAGED CARE RATES. Subdivision 1. Capitation payments. The commissioner 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 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. History:  2019 c 54 art 1 s 23; 1Sp2021 c 7 art 13 s 61
MN Stat § 256S.204 (2021)
2021 Minnesota Statutes|Chapters 245 - 267 — Public Welfare And Related Activities|Chapter 256S — Medical Assistance Elderly Waiver|Section 256S.204 — Alternative Rate System For 24-hour Customized Living Services.

256S.204 ALTERNATIVE RATE SYSTEM FOR 24-HOUR CUSTOMIZED LIVING SERVICES. Notwithstanding the customized living monthly service rate limits under section 256S.202, subdivision 1, 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 may establish alternative rate systems for 24-hour customized living services in housing with services establishments that are freestanding buildings with a capacity of 16 or fewer, by applying a single hourly rate for covered component services provided in either: (1) licensed corporate adult foster homes; or (2) specialized dementia care units that meet the requirements of section 144D.065 and in which: (i) participants are offered the option of having their own apartments; or (ii) the units are licensed as board and lodge establishments with a maximum capacity of eight residents and meet the requirements of Minnesota Rules, part 9555.6205, subparts 1, 2, 3, and 4, item A. History:   2019 c 54 art 1 s 24