reglab/statecodes huggingface dataset:
2023 Minnesota Statutes › Chapters 245 - 267 — Public Welfare And Related Activities › Chapter 256R — Nursing Facility Rates › Section 256R.44 — Rate Adjustment For Private Rooms For Medical Necessity.

256R.44 RATE ADJUSTMENT FOR PRIVATE ROOMS FOR MEDICAL NECESSITY.
(a) The amount paid for a private room is 111.5 percent of the established total payment rate for a resident if the resident is a medical assistance recipient and the private room is considered a medical necessity for the resident or others who are affected by the resident's condition, except as provided in Minnesota Rules, part 9549.0060, subpart 11, item C. Conditions requiring a private room must be determined by the resident's attending physician, advanced practice registered nurse, or physician assistant and submitted to the commissioner for approval or denial by the commissioner on the basis of medical necessity.
(b) For a nursing facility with a total property payment rate determined under section 256R.26, subdivision 8, the amount paid for a private room is 111.5 percent of the established total payment rate for a resident if the resident is a medical assistance recipient and the private room is considered a medical necessity for the resident or others who are affected by the resident's condition. Conditions requiring a private room must be determined by the resident's attending physician and submitted to the commissioner for approval or denial by the commissioner on the basis of medical necessity.
History:
2016 c 99 art 1 s 31; 1Sp2019 c 9 art 4 s 24; 2020 c 115 art 4 s 132; 2022 c 58 s 157
2023 Minnesota Statutes › Chapters 245 - 267 — Public Welfare And Related Activities › Chapter 256R — Nursing Facility Rates › Section 256R.45 — Rate Adjustment For Ventilator-dependent Persons.

256R.45 RATE ADJUSTMENT FOR VENTILATOR-DEPENDENT PERSONS.
The commissioner may negotiate with a nursing facility eligible to receive medical assistance payments to provide services to a ventilator-dependent person identified by the commissioner according to criteria developed by the commissioner, including:
(1) nursing facility care has been recommended for the person by a preadmission screening team;
(2) the person has been hospitalized and no longer requires inpatient acute care hospital services; and
(3) the commissioner has determined that necessary services for the person cannot be provided under existing nursing facility rates.
The commissioner may negotiate an adjustment to the operating payment rate for a nursing facility with a resident who is ventilator-dependent, for that resident. The negotiated adjustment must reflect only the actual additional cost of meeting the specialized care needs of a ventilator-dependent person identified by the commissioner for whom necessary services cannot be provided under existing nursing facility rates and which are not otherwise covered under Minnesota Rules, parts 9549.0010 to 9549.0080 or 9505.0170 to 9505.0475. The negotiated payment rate must not exceed 300 percent of the case mix adjusted operating payment rate for the highest case mix classification. The negotiated adjustment shall not affect the payment rate charged to private paying residents under the provisions of section 256R.06, subdivision 2.
History:
2016 c 99 art 1 s 32
2023 Minnesota Statutes › Chapters 245 - 267 — Public Welfare And Related Activities › Chapter 256R — Nursing Facility Rates › Section 256R.46 — Specialized Care Facilities.

256R.46 SPECIALIZED CARE FACILITIES.
(a) The total care-related payment rate limit for specialized care facilities shall be increased by 50 percent.
(b) "Specialized care facilities" are defined as a facility having a program licensed under chapter 245A and Minnesota Rules, chapter 9570, or a facility with 96 beds on January 1, 2015, located in Robbinsdale that specializes in the treatment of Huntington's Disease.
History:
2016 c 99 art 1 s 33
2023 Minnesota Statutes › Chapters 245 - 267 — Public Welfare And Related Activities › Chapter 256R — Nursing Facility Rates › Section 256R.47 — Rate Adjustment For Critical Access Nursing Facilities.

256R.47 RATE ADJUSTMENT FOR CRITICAL ACCESS NURSING FACILITIES.
(a) The commissioner, in consultation with the commissioner of health, may designate certain nursing facilities as critical access nursing facilities. The designation shall be granted on a competitive basis, within the limits of funds appropriated for this purpose.
(b) The commissioner shall request proposals from nursing facilities every two years. Proposals must be submitted in the form and according to the timelines established by the commissioner. In selecting applicants to designate, the commissioner, in consultation with the commissioner of health, and with input from stakeholders, shall develop criteria designed to preserve access to nursing facility services in isolated areas, rebalance long-term care, and improve quality. To the extent practicable, the commissioner shall ensure an even distribution of designations across the state.
(c) For nursing facilities designated as critical access nursing facilities, the commissioner shall allow a supplemental payment above a facility's operating payment rate as determined to be necessary by the commissioner to maintain access to nursing facility services in isolated areas identified in paragraph (b). The commissioner must approve the amounts of supplemental payments through a memorandum of understanding. Supplemental payments to facilities under this section must be in the form of time-limited rate adjustments included in the external fixed costs payment rate under section 256R.25.
(d) Designation of a critical access nursing facility is for a maximum period of up to two years, after which the benefit allowed under paragraph (c) shall be removed. Designated facilities may apply for continued designation.
(e) The memorandum of understanding required by paragraph (c) must state that the designation of a critical access nursing facility must be removed if the facility undergoes a change of ownership as defined in section 144A.06, subdivision 2.
History:
2016 c 99 art 1 s 34; 1Sp2017 c 6 art 3 s 45; 2023 c 61 art 2 s 10
NOTE:
The amendment to this section by Laws 2023, chapter 61, article 2, section 10, is effective upon federal approval. The commissioner of human services shall notify the revisor of statutes when federal approval is obtained. Laws 2023, chapter 61, article 2, section 10, the effective date.
2023 Minnesota Statutes › Chapters 245 - 267 — Public Welfare And Related Activities › Chapter 256R — Nursing Facility Rates › Section 256R.48 — Publicly Owned Facilities.

256R.48 PUBLICLY OWNED FACILITIES.
(a) The commissioner shall allow nursing facilities whose physical plant is owned or whose license is held by a city, county, or hospital district to apply for a higher payment rate under this section if the local governmental entity agrees to pay a specified portion of the nonfederal share of medical assistance costs. Nursing facilities that apply are eligible to select an operating payment rate with a case mix index of 1.0, up to an amount determined by the commissioner to be allowable under the Medicare upper payment limit test. The case mix adjusted rates shall be computed under section 256R.22. The rate increase allowed in this paragraph shall take effect only upon federal approval.
(b) Rates determined under this section shall take effect in accordance with the rate year in section 256R.02, subdivision 41, based on the most recent available cost report.
(c) Eligible nursing facilities that wish to participate under this section shall make an application to the commissioner by September 30 to be allowed participation on the following January 1.
(d) For each participating nursing facility, the public entity that owns the physical plant or is the license holder of the nursing facility shall pay to the state the entire nonfederal share of medical assistance payments received as a result of the difference between the nursing facility's payment rate under this section, and the rates that the nursing facility would otherwise be paid without application of this section under section 256R.21 as determined by the commissioner.
(e) The commissioner may, at any time, reduce the payments under this section based on the commissioner's determination that the payments shall cause nursing facility rates to exceed the state's Medicare upper payment limit or any other federal limitation. If the commissioner determines a reduction is necessary, the commissioner shall reduce all payment rates for participating nursing facilities by a percentage applied to the amount of increase they would otherwise receive under this section and shall notify participating facilities of the reductions. If payments to a nursing facility are reduced, payments under section 256B.19, subdivision 1e, shall be reduced accordingly.
History:
2016 c 99 art 1 s 35
2023 Minnesota Statutes › Chapters 245 - 267 — Public Welfare And Related Activities › Chapter 256R — Nursing Facility Rates › Section 256R.481 — Rate Adjustments For Border City Facilities.

256R.481 RATE ADJUSTMENTS FOR BORDER CITY FACILITIES.
(a) The commissioner shall allow each nonprofit nursing facility located within the boundaries of the city of Breckenridge or Moorhead prior to January 1, 2015, to apply once annually for a rate add-on to the facility's external fixed costs payment rate.
(b) A facility seeking an add-on to its external fixed costs payment rate under this section must apply annually to the commissioner to receive the add-on. A facility must submit the application within 60 calendar days of the effective date of any add-on under this section. The commissioner may waive the deadlines required by this paragraph under extraordinary circumstances.
(c) The commissioner shall provide the add-on to each eligible facility that applies by the application deadline.
(d) The add-on to the external fixed costs payment rate is the difference on January 1 of the median total payment rate for case mix classification PA1 of the nonprofit facilities located in an adjacent city in another state and in cities contiguous to the adjacent city minus the eligible nursing facility's total payment rate for case mix classification PA1 as determined under section 256R.22, subdivision 4.
History:
1Sp2019 c 9 art 4 s 25
2023 Minnesota Statutes › Chapters 245 - 267 — Public Welfare And Related Activities › Chapter 256R — Nursing Facility Rates › Section 256R.51 — Rate Adjustment For Special Dietary Needs.

256R.51 RATE ADJUSTMENT FOR SPECIAL DIETARY NEEDS.
(a) The commissioner shall adjust the rates of a nursing facility that meets the criteria for the special dietary needs of its residents and the requirements in section 31.651 or 31.658. The adjustment for raw food cost shall be the difference between the nursing facility's most recently reported allowable raw food cost per resident day and 115 percent of the median allowable raw food cost per resident day. This amount shall be removed from other care-related costs per resident day as determined in section 256R.23, subdivision 3, and included in the external fixed costs payment rate under section 256R.25.
(b) In calculating a nursing facility's other care-related costs per day for the purposes of comparing to an array, a median, or other statistical measure of nursing facility payment rates used to determine future rate adjustments under this chapter, the commissioner shall exclude adjustments for raw food costs under this section.
History:
2016 c 99 art 1 s 38
2023 Minnesota Statutes › Chapters 245 - 267 — Public Welfare And Related Activities › Chapter 256R — Nursing Facility Rates › Section 256R.53 — Facility Specific Exemptions.

256R.53 FACILITY SPECIFIC EXEMPTIONS.
Subdivision 1.
Nursing facility in Golden Valley.
The operating payment rate for a facility located in the city of Golden Valley at 3915 Golden Valley Road with 44 licensed rehabilitation beds as of January 7, 2015, is the sum of its direct care costs per standardized day, its other care-related costs per resident day, and its other operating costs per day.
Subd. 2.
MS 2018 [Repealed, 1Sp2019 c 9 art 4 s 30]
Subd. 3.
Nursing facility in Red Wing.
(a) The operating payment rate for a facility located in the city of Red Wing at 1412 West 4th Street is the sum of its direct care costs per standardized day, its other care-related costs per resident day, and its other operating costs per day.
(b) This subdivision expires June 30, 2025.
[See Note.]
History:
2016 c 99 art 1 s 40; 2023 c 61 art 2 s 11
NOTE:
Subdivision 3, as added by Laws 2023, chapter 61, article 2, section 11, is effective upon federal approval. The commissioner of human services shall notify the revisor of statutes when federal approval is obtained. Laws 2023, chapter 61, article 2, section 11, the effective date.
2023 Minnesota Statutes › Chapters 245 - 267 — Public Welfare And Related Activities › Chapter 256S — Medical Assistance Elderly Waiver › Section 256S.01 — Generally.

256S.01 GENERALLY.
Subdivision 1.
Authority.
The commissioner is authorized to apply for a home and community-based services waiver for the elderly, authorized under section 1915(c) of the Social Security Act, to obtain federal financial participation to expand the availability of services for persons who are eligible for medical assistance. The commissioner may apply for additional waivers or pursue other federal financial participation that is advantageous to the state for funding home care services for the elderly who are eligible for medical assistance. The provision of waiver services to an elderly person receiving medical assistance must comply with the criteria for service definitions and provider standards approved in the elderly waiver.
Subd. 2.
Transition plan compliance.
The commissioner shall comply with the requirements in the federally approved transition plan for the elderly waiver authorized under this chapter.
Subd. 3.
Services and supports requirements.
(a) Services and supports provided under this chapter must meet the requirements in United States Code, title 42, section 1396n.
(b) Services and supports provided under this chapter must promote consumer choice and be arranged and provided consistent with individualized, written support plans.
Subd. 4.
Payment for services.
Reimbursement for the services provided to a participant under this chapter and under the elderly waiver must be made from the medical assistance account through the invoice processing procedures of the department's Medicaid Management Information System (MMIS), only with the approval of the participant's case manager.
Subd. 5.
Expenditure forecast.
The budget for the state share of the Medicaid expenditures under this chapter must be forecasted with the medical assistance budget, and shall be consistent with the elderly waiver.
Subd. 6.
Immunity; consumer-directed community supports.
The state of Minnesota, or a county, managed care plan, county-based purchasing plan, or tribal government under contract to administer the elderly waiver, is not liable for damages, injuries, or liabilities sustained as a result of the participant, the participant's family, or the participant's authorized representatives purchasing direct supports or goods with funds received through consumer-directed community supports under the elderly waiver. Liabilities include, but are not limited to, workers' compensation liability, Federal Insurance Contributions Act under United States Code, title 26, subtitle c, chapter 21, or Federal Unemployment Tax Act under Internal Revenue Code, chapter 23.
History:
2019 c 54 art 1 s 1; 1Sp2020 c 2 art 2 s 31; 2022 c 98 art 17 s 26
2023 Minnesota Statutes › Chapters 245 - 267 — Public Welfare And Related Activities › Chapter 256S — Medical Assistance Elderly Waiver › Section 256S.03 — Administration By Tribes.

256S.03 ADMINISTRATION BY TRIBES.
Notwithstanding any other state laws or rules, the commissioner may develop a model for tribal management of the elderly waiver and implement this model through a contract between the state and any of the state's federally recognized tribal governments. The model shall include the provision of tribal elderly waiver case management, assessment for personal care assistance, and administrative requirements otherwise carried out by lead agencies but shall not include tribal financial eligibility determination for medical assistance.
History:
2019 c 54 art 1 s 3
2023 Minnesota Statutes › Chapters 245 - 267 — Public Welfare And Related Activities › Chapter 256S — Medical Assistance Elderly Waiver › Section 256S.04 — Limits Of Elderly Waiver Cases.

256S.04 LIMITS OF ELDERLY WAIVER CASES.
The number of elderly waiver participants that a lead agency may serve must be allocated according to the number of elderly waiver cases open on July 1 of each fiscal year. Additional elderly waiver participants may be served with the approval of the commissioner.
History:
2019 c 54 art 1 s 4
2023 Minnesota Statutes › Chapters 245 - 267 — Public Welfare And Related Activities › Chapter 256S — Medical Assistance Elderly Waiver › Section 256S.05 — Eligibility.

256S.05 ELIGIBILITY.
Subdivision 1.
Elderly waiver plan eligibility requirements.
In addition to the requirements of this section, applicants and participants must meet all eligibility requirements in the elderly waiver plan.
Subd. 2.
Nursing facility level of care determination required.
Notwithstanding other assessments identified in section 144.0724, subdivision 4, only assessments conducted according to section 256B.0911 that result in a nursing facility level of care determination at initial and subsequent assessments shall be accepted for purposes of a participant's initial and ongoing participation in the elderly waiver and a service provider's access to service payments under this chapter.
Subd. 3.
Maintenance needs allowance.
Notwithstanding section 256B.056, when applying posteligibility treatment of income rules to the gross income of an elderly waiver participant, unless the participant's income is in excess of the special income standard according to Code of Federal Regulations, title 42, section 435.236, the participant's maintenance needs allowance is the sum of the MSA equivalent rate, as defined in section 256I.03, subdivision 11a, plus the medical assistance personal needs allowance, as described in section 256B.35, subdivision 1, paragraph (a). Each participant's maintenance needs allowance must be adjusted each July 1.
Subd. 4.
Spousal impoverishment policies.
For the purposes of eligibility for elderly waiver services, the commissioner shall apply the spousal impoverishment criteria as authorized under United States Code, title 42, section 1396r-5, and as implemented in sections 256B.0575, 256B.058, and 256B.059, except that a participant with income at or below the special income standard according to Code of Federal Regulations, title 42, section 435.236, shall receive the maintenance needs allowance in subdivision 3.
Subd. 5.
Managed care elderly waiver services.
A participant who is enrolled in a managed care organization is not eligible to receive county-administered fee-for-service elderly waiver services.
History:
2019 c 54 art 1 s 5; 1Sp2021 c 7 art 6 s 25; 2022 c 98 art 17 s 22; 2023 c 70 art 17 s 62
2023 Minnesota Statutes › Chapters 245 - 267 — Public Welfare And Related Activities › Chapter 256S — Medical Assistance Elderly Waiver › Section 256S.06 — Assessments And Reassessments.

256S.06 ASSESSMENTS AND REASSESSMENTS.
Subdivision 1.
Initial assessments.
A lead agency shall provide each participant with an initial long-term care consultation assessment of strengths, informal supports, and need for services according to section 256B.0911.
Subd. 2.
Annual reassessments.
At least every 12 months, a lead agency shall provide each participant with an annual long-term care consultation reassessment according to section 256B.0911, subdivisions 22 to 25.
Subd. 3.
Change-in-condition reassessments.
(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.
(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-in-condition 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.
History:
2019 c 54 art 1 s 6; 2022 c 98 art 17 s 23,24
2023 Minnesota Statutes › Chapters 245 - 267 — Public Welfare And Related Activities › Chapter 256S — Medical Assistance Elderly Waiver › Section 256S.07 — Case Management Administration.

256S.07 CASE MANAGEMENT ADMINISTRATION.
Subdivision 1.
Elderly waiver case management provided by counties and tribes.
For participants not enrolled in a managed care organization, the county of residence or tribe must provide or arrange to provide elderly waiver case management activities under section 256S.09, subdivisions 2 and 3.
Subd. 2.
Elderly waiver case management provided by managed care organizations.
Notwithstanding any requirements in this chapter and in accordance with contract requirements established by the commissioner, for participants enrolled in a managed care organization, the managed care organization must provide or arrange to provide elderly waiver case management activities under section 256S.09, subdivisions 2 and 3.
History:
2019 c 54 art 1 s 7
2023 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 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 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 support plan development. The case manager is responsible for providing oversight of the case aide.
History:
2019 c 54 art 1 s 8; 2022 c 98 art 17 s 26
2023 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 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 support plan under subdivision 3; and
(9) assisting the participant in appeals under section 256.045.
Subd. 3.
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 support plan.
(b) Case managers shall initiate the process of reassessment and review of the participant's 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; 2022 c 98 art 17 s 26
2023 Minnesota Statutes › Chapters 245 - 267 — Public Welfare And Related Activities › Chapter 256S — Medical Assistance Elderly Waiver › Section 256S.10 — Support Plans.

256S.10 SUPPORT PLANS.
Subdivision 1.
Written plan required.
Each participant's case manager shall provide the participant with a copy of the participant's written support plan.
Subd. 2.
Plan development timeline.
Within the timelines established by the commissioner and section 256B.0911, subdivision 29, the case manager must develop with the participant and the participant must sign the participant's individualized written support plan.
Subd. 3.
Plan content.
Each participant's 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; 2022 c 98 art 17 s 25,26
2023 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 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; 2022 c 98 art 17 s 26
2023 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
2023 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
2023 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
2023 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, subdivision 3.
[See Note.]
History:
2019 c 54 art 1 s 15; 2023 c 61 art 2 s 13
NOTE:
The amendment to subdivision 2 by Laws 2023, chapter 61, article 2, section 13, is effective upon federal approval. The commissioner of human services shall notify the revisor of statutes when approval is obtained. Laws 2023, chapter 61, article 2, section 13, the effective date.
2023 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
2023 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
2023 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 caps.
(a) The elderly waiver monthly conversion budget cap for the cost of elderly waiver services 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 must 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 must be adjusted at least annually as described in section 256S.18, subdivision 5.
(d) Conversion budget caps for individuals participating in consumer-directed community supports must be set as described in paragraphs (a) to (c).
[See Note.]
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; 2023 c 61 art 2 s 15
NOTE:
The amendment to subdivision 3 by Laws 2023, chapter 61, article 2, section 15, is effective upon federal approval. The commissioner of human services shall notify the revisor of statutes when approval is obtained. Laws 2023, chapter 61, article 2, section 15, the effective date.
NOTE:
Subdivision 4 is repealed by Laws 2023, chapter 61, article 2, section 43, effective upon federal approval. The commissioner of human services shall notify the revisor of statutes when approval is obtained. Laws 2023, chapter 61, article 2, section 43, the effective date.
2023 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
2023 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
2023 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, 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; 2023 c 50 art 1 s 33
2023 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
2023 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
2023 Minnesota Statutes › Chapters 245 - 267 — Public Welfare And Related Activities › Chapter 256S — Medical Assistance Elderly Waiver › Section 256S.2101 — Rate Setting; Phase-in.

256S.2101 RATE SETTING; PHASE-IN.
Subdivision 1.
Phase-in for disability waiver customized living rates.
All rates and rate components for community access for disability inclusion customized living and brain injury customized living under section 256B.4914 must be the sum of 29.6 percent of the rates calculated under sections 256S.211 to 256S.215 and 70.4 percent of the rates calculated using the rate methodology in effect as of June 30, 2017.
[See Note.]
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.
[See Note.]
History:
2019 c 54 art 1 s 26; 1Sp2021 c 7 art 13 s 64; 2023 c 61 art 1 s 57
NOTE:
The amendment to subdivision 1 by Laws 2023, chapter 61, article 1, section 57, is effective upon federal approval. The commissioner of human services shall notify the revisor of statutes when federal approval is obtained. Laws 2023, chapter 61, article 1, section 57, the effective date.
NOTE:
Subdivision 2 is repealed by Laws 2023, chapter 61, article 2, section 43, effective upon federal approval. The commissioner of human services shall notify the revisor of statutes when approval is obtained. Laws 2023, chapter 61, article 2, section 43, the effective date.