p>Editor’s Note: This is the second of a three-part series explaining the ins and outs of the various laws and policies put in place by the legislature as they came out of the 2001 session. This month’s Part 2 has to do with the community supports that allow people to get out and stay out of institutions and live independently in the community. The final installment will elaborate on all of the “other” provisions that don’t fit into the first two categories.
Provider Cost-of-Living Increase:
Health and Human Services providers in long-term care and community support services received a 3% cost-of-living allowance (COLA) increase for each year of the biennium. Intermediate Care Facilities for persons with mental retardation or a related condition (ICF-MR) and Day Training and Habilitation programs were given a 3.5% increase each year.
Consumer Support Grant (CSG) Program
The Consumer Support Grant program is a state-funded program which allows persons to “trade in” their Medical Assistance (MA) home care or other community support services funded by MA, and obtain a grant equal to the amount of state funds (currently, that is 49 percent, which is the amount of MA funds that are provided by the state) in their MA services.
As part of their biennial budget, the Department of Human Services (DHS) proposed major changes to the state-funded Consumer Support Grant program and estimated millions of dollars in savings if those changes were adopted by the Legislature. The DHS Consumer Support Grant proposal was amended in several significant ways during the session. Projected savings from changing the CSG program were used to fund other initiatives in the Health and Human Services budget, but the program will remain available to those who need it under the following circumstances:
1. DHS had proposed a limit of 200 persons for the CSG program. Rather than capping the program at 200, the Legislature changed the way individual grant amounts are determined. Beginning July 1, 2001, new persons will be limited to grants based on a formula using the statewide average use of personal care assistant (PCA) hours and the individual home care rating category assigned as part of a home care assessment.
2. Two-hundred “exception grants” will be available for distribution to persons with exceptional needs as determined by the county. These exception grants will be provided on a first-come/first-serve basis by DHS based upon the date of county request. The exception grants will be limited to the average authorization provided for persons in each home care rating category, but not reduced by the statewide average utilization percentage as in number 1 above. The 200 exception grants include those individuals who are “grandfathered in” at current grant amounts described in number 3 below.
3. All persons who had consumer support grants before July 1st 2001 can continue at the grant amount in effect on June 30, 2001. As these individuals leave the CSG program, those grants will be available for distribution as “exception grants” in number 2 above.
4. The CSG program is required to be offered to all Minnesotans by July 1, 2002. Counties will no longer be able to block participation by refusing to offer the program.
Targeted Case Management
Three new types of targeted case management have been added to the Medical Assistance benefit set:
1. Targeted case management for persons under 65 in nursing homes who want to relocate to community services. This type of case management can only be provided by a county or an entity under contract with the county unless the county does not provide a case manager within 20 days after a written request from a nursing home resident. If a county fails to provide a case manager to a person in a nursing home, a private agency can provide “relocation targeted case management.” Relocation targeted case management is effective July 1, 2001 and is available for only six months to help an individual move out of a nursing home.
2. Home care targeted case management which can be provided by a private or a public entity based upon the person’s choice. Home care targeted case management is ongoing whereas targeted case management for persons in nursing homes is only provided for six months while the person moves out of the nursing home and into community services (#1 above). Home care targeted case management only becomes effective January 1, 2003.
3. Targeted case management for vulnerable adults and persons with developmental disabilities who are not receiving waiver funding was sought by counties to fill a gap in funding. This third type of case management for vulnerable adults is funded with county funds used to match federal Medicaid funds. The new type of case management and funding is effective January 1, 2002
Personal Care Assistant (PCA) Services
Several important changes occurred effective July 1, 2001 for personal care assistant services.
1. Language limiting PCA (or Private Duty Nursing) services outside the home to circumstances in which “the recipient’s health and safety would be jeopardized” has been deleted. This means that there should be no question about where in the community PCA or PDN services can be delivered.
2. A legal guardian is allowed to provide personal care services if granted a hardship waiver. This option would have been eliminated on July 1, 2001, but the sunset date was removed so that non-corporate legal guardians of adults can continue to be paid as PCAs.
3. Instrumental activities of daily living are now allowed as PCA activities. These additional activities will not result in any added hours of PCA service. Instrumental activities of daily living include “meal planning and preparation, managing finances, shopping for food, clothing and other essential items, performing essential household chores, communication by telephone and other media, and getting around and participating in the community.”
4. All services provided by a PCA must relate to activities of daily living, health-related functions, behavior intervention and redirection.
5. Health-related tasks performed by a PCA must be under the supervision of either a qualified professional or a physician. Nurse supervision is no longer required.
6. Shared PCA services can be supervised by the recipient or responsible party or a qualified professional.
7. The fiscal agent option for PCA services is renamed the “Fiscal Intermediary Option.”
MA Home Care Changes to Private Duty Nursing (PDN)
A number of changes have been made to the MA home care statute which affect nursing supervision and private duty nursing:
1. Complex and regular private duty nursing care are defined and became effective July 1, 2001. Complex care is private duty nursing provided to recipients who are ventilator-dependent or would meet criteria for inpatient hospital ICU level of care and regular PDN care is provided to all others eligible for nursing services. These definitions apply to both RNs and LPNs.
2. Private Duty Nurse rates increased July 1, 2001 an average of 8.5% in addition to the 3% provider COLA describe above.
3. Up to nine skilled nurse visits are now available without prior authorization (previous limit was five visits). Also, DHS or the public health nurse may authorize up to two skilled nurse visits per day.
Private Duty Nursing Services Provided by Parents, Spouses, or Legal Guardians, Hardship Criteria
A new section of law allows payment for “extraordinary services” that require “specialized nursing skill” and are provided by nurses who are parents of minor children, spouses or legal guardians under hardship conditions including:
1. The services are not legally required to be provided by parents, spouses or legal guardians,
2. Services are necessary to prevent hospitalization of the recipient, and
3. The recipient is eligible for MA home care or waivered services, and hardship criteria are met, including that the parent, spouse or legal guardian resigns from a job to provide nursing, goes from full time to part time, takes a leave without pay, or because of labor conditions and special needs the individual is unable to obtain needed private duty nursing services.
4. The family member nurse may not be paid for more than 50% of the total approved nursing hours, or 8 hours a day whichever is less up to a maximum of 40 hours per week.
5. Criminal background checks are required.
Changes to Pre-admission Screening for Individuals Under 65 Years of Age Considered for Nursing Home Placement
Changes require that individuals under 65 years of age admitted to nursing facilities must be screened prior to admission. If an individual under 65 is admitted to an nursing facility with only a telephone screening, they must receive a face-to-face assessment within 20 working days. If the individual is under 21 years of age, the Commissioner of Human Services must approve the admission before the individual is admitted to a nursing facility. If a person is admitted on an emergency basis, the county must be notified on the next working day and the face-to-face assessment must occur within 20 working days.
At the face-to-face assessment, information about home and community-based options must be provided to the individual. If the individual chooses home and community-based services, a relocation plan must be completed within 20 working days of the visit. Individuals living in nursing homes who are under 65 years of age must receive a face-to-face assessment with information about alternatives at least once every 12 months, unless the person indicates in writing that they do not want annual assessments, in which case a face-to-face assessment must occur once every 36 months.
The Commissioner is allowed to pay county agencies for the face-to-face assessments for individuals who are under 65 years of age, eligible for Medical Assistance, and considering nursing home placement.
Changes to Home and Community Waiver for Persons with TBI
DHS is required to amend the Traumatic Brain Injury (TBI) waiver to include persons with acquired or degenerative disease diagnosis where cognitive impairment is present. Multiple Sclerosis is given as an example of one of the conditions to be newly covered under the TBI waiver. DHS will have to submit the change for federal approval, so the effective date is uncertain.
Correction: Due to an editing error in last month’s Legislative Review article, the date reported as the effective date for the change in the “Asset Protection During Illness” component of the MA-EPD program was incorrect. The correct effective date for that change is November 1, 2001.