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A bill for an act
relating to human services; modifying personal care assistance and community
first services and supports to include certain medication injections; amending
Minnesota Statutes 2024, section 256B.0659, subdivisions 2, 3; Minnesota Statutes
2025 Supplement, section 256B.85, subdivisions 2, 16.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Section 1.
Minnesota Statutes 2024, section 256B.0659, subdivision 2, is amended to read:
Subd. 2.
Personal care assistance services; covered services.
(a) The personal care
assistance services eligible for payment include services and supports furnished to an
individual, as needed, to assist in:
(1) activities of daily living;
(2) health-related procedures and tasks;
(3) observation and redirection of behaviors; and
(4) instrumental activities of daily living.
(b) Activities of daily living include the following covered services:
(1) dressing, including assistance with choosing, application, and changing of clothing
and application of special appliances, wraps, or clothing;
(2) grooming, including assistance with basic hair care, oral care, shaving, applying
cosmetics and deodorant, and care of eyeglasses and hearing aids. Nail care is included,
except for recipients who are diabetic or have poor circulation;
(3) bathing, including assistance with basic personal hygiene and skin care;
(4) eating, including assistance with hand washing and application of orthotics required
for eating, transfers, and feeding;
(5) transfers, including assistance with transferring the recipient from one seating or
reclining area to another;
(6) mobility, including assistance with ambulation, including use of a wheelchair.
Mobility does not include providing transportation for a recipient;
(7) positioning, including assistance with positioning or turning a recipient for necessary
care and comfort; and
(8) toileting, including assistance with helping recipient with bowel or bladder elimination
and care including transfers, mobility, positioning, feminine hygiene, use of toileting
equipment or supplies, cleansing the perineal area, inspection of the skin, and adjusting
clothing.
(c) Health-related procedures and tasks include the following covered services:
(1) range of motion and passive exercise to maintain a recipient's strength and muscle
functioning;
(2) assistance with self-administered medication as defined by this section, including
reminders to take medication, bringing medication to the recipient, and assistance with
opening medication under the direction of the recipient or responsible party, including
medications given through a nebulizer;
(3) interventions for seizure disorders, including monitoring and observation; and
(4) other activities considered within the scope of the personal care service and meeting
the definition of health-related procedures and tasks under this section.
(d) A personal care assistant may provide health-related procedures and tasks associated
with the complex health-related needs of a recipient if the procedures and tasks meet the
definition of health-related procedures and tasks under this section and the personal care
assistant is trained by a qualified professional and demonstrates competency to safely
complete the procedures and tasks. Delegation of health-related procedures and tasks and
all training must be documented in the personal care assistance care plan and the recipient's
and personal care assistant's files. A personal care assistant must not determine the medication
dose or time for medication
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, unless the requirements under paragraph (f) are met
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.
(e)
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Effective January 1, 2010,
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For a personal care assistant to provide the health-related
procedures and tasks of tracheostomy suctioning and services to recipients on ventilator
support there must be:
(1) delegation and training by a registered nurse, advanced practice registered nurse,
licensed respiratory therapist, physician assistant, or physician;
(2) utilization of clean rather than sterile procedure;
(3) specialized training about the health-related procedures and tasks and equipment,
including ventilator operation and maintenance;
(4) individualized training regarding the needs of the recipient; and
(5) supervision by a qualified professional who is a registered nurse.
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(f) For a personal care assistant to provide the health-related procedure and task of
medication injection to a recipient, the following requirements must be met:
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(1) a registered nurse or advanced practice registered nurse delegates this task and
provides training to the personal care assistant;
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(2) the personal care assistant receives individualized training regarding the needs of
the recipient; and
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(3) the personal care assistant is supervised by a qualified professional who is a registered
nurse.
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(f) Effective January 1, 2010,
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(g)
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A personal care assistant may observe and redirect the
recipient for episodes where there is a need for redirection due to behaviors. Training of
the personal care assistant must occur based on the needs of the recipient, the personal care
assistance care plan, and any other support services provided.
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(g)
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(h)
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Instrumental activities of daily living under subdivision 1, paragraph (i).
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EFFECTIVE DATE.
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This section is effective upon federal approval.
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Sec. 2.
Minnesota Statutes 2024, section 256B.0659, subdivision 3, is amended to read:
Subd. 3.
Noncovered personal care assistance services.
(a) Personal care assistance
services are not eligible for medical assistance payment under this section when provided:
(1) by the recipient's spouse, parent of a recipient under the age of 18, paid legal guardian,
licensed foster provider, except as allowed under section
256B.0652, subdivision 10
, or
responsible party;
(2) in order to meet staffing or license requirements in a residential or child care setting;
(3) solely as a child care or babysitting service; or
(4) without authorization by the commissioner or the commissioner's designee.
(b) The following personal care services are not eligible for medical assistance payment
under this section when provided in residential settings:
(1) when the provider of home care services who is not related by blood, marriage, or
adoption owns or otherwise controls the living arrangement, including licensed or unlicensed
services; or
(2) when personal care assistance services are the responsibility of a residential or
program license holder under the terms of a service agreement and administrative rules.
(c) Other specific tasks not covered under paragraph (a) or (b) that are not eligible for
medical assistance reimbursement for personal care assistance services under this section
include:
(1) sterile procedures;
(2) injections of fluids and medications into veins, muscles, or skin
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, except when the
requirements of subdivision 2, paragraph (f), are met
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;
(3) home maintenance or chore services;
(4) homemaker services not an integral part of assessed personal care assistance services
needed by a recipient;
(5) application of restraints or implementation of procedures under section
245.825
;
(6) instrumental activities of daily living for children under the age of 18, except when
immediate attention is needed for health or hygiene reasons integral to the personal care
services and the need is listed in the service plan by the assessor; and
(7) assessments for personal care assistance services by personal care assistance provider
agencies or by independently enrolled registered nurses.
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EFFECTIVE DATE.
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This section is effective upon federal approval.
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Sec. 3.
Minnesota Statutes 2025 Supplement, section 256B.85, subdivision 2, is amended
to read:
Subd. 2.
Definitions.
(a) For the purposes of this section and section
256B.851
, the terms
defined in this subdivision have the meanings given.
(b) "Activities of daily living" or "ADLs" means:
(1) dressing, including assistance with choosing, applying, and changing clothing and
applying special appliances, wraps, or clothing;
(2) grooming, including assistance with basic hair care, oral care, shaving, applying
cosmetics and deodorant, and care of eyeglasses and hearing aids. Grooming includes nail
care, except for recipients who are diabetic or have poor circulation;
(3) bathing, including assistance with basic personal hygiene and skin care;
(4) eating, including assistance with hand washing and applying orthotics required for
eating or feeding;
(5) transfers, including assistance with transferring the participant from one seating or
reclining area to another;
(6) mobility, including assistance with ambulation and use of a wheelchair. Mobility
does not include providing transportation for a participant;
(7) positioning, including assistance with positioning or turning a participant for necessary
care and comfort; and
(8) toileting, including assistance with bowel or bladder elimination and care, transfers,
mobility, positioning, feminine hygiene, use of toileting equipment or supplies, cleansing
the perineal area, inspection of the skin, and adjusting clothing.
(c) "Agency-provider model" means a method of CFSS under which a qualified agency
provides services and supports through the agency's own employees and policies. The agency
must allow the participant to have a significant role in the selection and dismissal of support
workers of their choice for the delivery of their specific services and supports.
(d) "Behavior" means a description of a need for services and supports used to determine
the home care rating and additional service units. The presence of Level I behavior is used
to determine the home care rating.
(e) "Budget model" means a service delivery method of CFSS that allows the use of a
service budget and assistance from a financial management services (FMS) provider for a
participant to directly employ support workers and purchase supports and goods.
(f) "Complex health-related needs" means an intervention listed in clauses (1) to (8) that
has been ordered by a physician, advanced practice registered nurse, or physician's assistant
and is specified in an assessment summary, including:
(1) tube feedings requiring:
(i) a gastrojejunostomy tube; or
(ii) continuous tube feeding lasting longer than 12 hours per day;
(2) wounds described as:
(i) stage III or stage IV;
(ii) multiple wounds;
(iii) requiring sterile or clean dressing changes or a wound vac; or
(iv) open lesions such as burns, fistulas, tube sites, or ostomy sites that require specialized
care;
(3) parenteral therapy described as:
(i) IV therapy more than two times per week lasting longer than four hours for each
treatment; or
(ii) total parenteral nutrition (TPN) daily;
(4) respiratory interventions, including:
(i) oxygen required more than eight hours per day;
(ii) respiratory vest more than one time per day;
(iii) bronchial drainage treatments more than two times per day;
(iv) sterile or clean suctioning more than six times per day;
(v) dependence on another to apply respiratory ventilation augmentation devices such
as BiPAP and CPAP; and
(vi) ventilator dependence under section
256B.0651
;
(5) insertion and maintenance of catheter, including:
(i) sterile catheter changes more than one time per month;
(ii) clean intermittent catheterization, and including self-catheterization more than six
times per day; or
(iii) bladder irrigations;
(6) bowel program more than two times per week requiring more than 30 minutes to
perform each time;
(7) neurological intervention, including:
(i) seizures more than two times per week and requiring significant physical assistance
to maintain safety; or
(ii) swallowing disorders diagnosed by a physician, advanced practice registered nurse,
or physician's assistant and requiring specialized assistance from another on a daily basis;
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and
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(8) medication injections if the following requirements are met:
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(i) a registered nurse or advanced practice registered nurse delegates this task and provides
training to the support worker;
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(ii) the support worker receives individualized training regarding the needs of the
participant; and
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(iii) the support worker is supervised by a registered nurse; and
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(8)
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(9)
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other congenital or acquired diseases creating a need for significantly increased
direct hands-on assistance and interventions in six to eight activities of daily living.
(g) "Community first services and supports" or "CFSS" means the assistance and supports
program under this section needed for accomplishing activities of daily living, instrumental
activities of daily living, and health-related tasks through hands-on assistance to accomplish
the task or constant supervision and cueing to accomplish the task, or the purchase of goods
as defined in subdivision 7, clause (3), that replace the need for human assistance.
(h) "Community first services and supports service delivery plan" or "CFSS service
delivery plan" means a written document detailing the services and supports chosen by the
participant to meet assessed needs that are within the approved CFSS service authorization,
as determined in subdivision 8. Services and supports are based on the support plan identified
in sections
256B.092, subdivision 1b
, and
256S.10
.
(i) "Consultation services" means assisting a participant in making informed choices
about CFSS services in general and self-directed tasks in particular, and in developing a
person-centered CFSS service delivery plan to achieve quality service outcomes.
(j) "Critical activities of daily living" means transferring, mobility, eating, and toileting.
(k) "Dependency" in activities of daily living means a person requires hands-on assistance
or constant supervision and cueing to accomplish one or more of the activities of daily living
every day or on the days during the week that the activity is performed; however, a child
must not be found to be dependent in an activity of daily living if, because of the child's
age, an adult would either perform the activity for the child or assist the child with the
activity and the assistance needed is the assistance appropriate for a typical child of the
same age.
(l) "Extended CFSS" means CFSS services and supports provided under CFSS that are
included in the CFSS service delivery plan through one of the home and community-based
services waivers and as approved and authorized under chapter 256S and sections
256B.092,
subdivision 5
, and
256B.49
, which exceed the amount, duration, and frequency of the state
plan CFSS services for participants. Extended CFSS excludes the purchase of goods.
(m) "Financial management services provider" or "FMS provider" means a qualified
organization required for participants using the budget model under subdivision 13 that is
an enrolled provider with the department to provide vendor fiscal/employer agent financial
management services (FMS).
(n) "Health-related procedures and tasks" means procedures and tasks related to the
specific assessed health needs of a participant that can be taught or assigned by a
state-licensed health care or mental health professional and performed by a support worker.
(o) "Instrumental activities of daily living" means activities related to living independently
in the community, including but not limited to: meal planning, preparation, and cooking;
shopping for food, clothing, or other essential items; laundry; housecleaning; assistance
with medications; managing finances; communicating needs and preferences during activities;
arranging supports; and assistance with traveling around and participating in the community,
including traveling to medical appointments. For purposes of this paragraph, traveling
includes driving and accompanying the recipient in the recipient's chosen mode of
transportation and according to the individual CFSS service delivery plan.
(p) "Lead agency" has the meaning given in section 256B.0911, subdivision 10.
(q) "Legal representative" means parent of a minor, a court-appointed guardian, or
another representative with legal authority to make decisions about services and supports
for the participant. Other representatives with legal authority to make decisions include but
are not limited to a health care agent or an attorney-in-fact authorized through a health care
directive or power of attorney.
(r) "Level I behavior" means physical aggression toward self or others or destruction of
property that requires the immediate response of another person.
(s) "Medication assistance" means providing verbal or visual reminders to take regularly
scheduled medication, and includes any of the following supports listed in clauses (1) to
(3) and other types of assistance, except that a support worker must not determine medication
dose or time for medication or inject medications into veins, muscles, or skin
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unless the
requirements under paragraph (f), clause (8), are met
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:
(1) under the direction of the participant or the participant's representative, bringing
medications to the participant including medications given through a nebulizer, opening a
container of previously set-up medications, emptying the container into the participant's
hand, opening and giving the medication in the original container to the participant, or
bringing to the participant liquids or food to accompany the medication;
(2) organizing medications as directed by the participant or the participant's representative;
and
(3) providing verbal or visual reminders to perform regularly scheduled medications.
(t) "Participant" means a person who is eligible for CFSS.
(u) "Participant's representative" means a parent, family member, advocate, or other
adult authorized by the participant or participant's legal representative, if any, to serve as a
representative in connection with the provision of CFSS. If the participant is unable to assist
in the selection of a participant's representative, the legal representative shall appoint one.
(v) "Person-centered planning process" means a process that is directed by the participant
to plan for CFSS services and supports.
(w) "Service budget" means the authorized dollar amount used for the budget model or
for the purchase of goods.
(x) "Shared services" means the provision of CFSS services by the same CFSS support
worker to two or three participants who voluntarily enter into a written agreement to receive
services at the same time, in the same setting, and through the same agency-provider or
FMS provider.
(y) "Support worker" means a qualified and trained employee of the agency-provider
as required by subdivision 11b or of the participant employer under the budget model as
required by subdivision 14 who has direct contact with the participant and provides services
as specified within the participant's CFSS service delivery plan.
(z) "Unit" means the increment of service based on hours or minutes identified in the
service agreement.
(aa) "Vendor fiscal employer agent" means an agency that provides financial management
services.
(bb) "Wages and benefits" means the hourly wages and salaries, the employer's share
of FICA taxes, Medicare taxes, state and federal unemployment taxes, workers' compensation,
mileage reimbursement, health and dental insurance, life insurance, disability insurance,
long-term care insurance, uniform allowance, contributions to employee retirement accounts,
or other forms of employee compensation and benefits.
(cc) "Worker training and development" means services provided according to subdivision
18a for developing workers' skills as required by the participant's individual CFSS service
delivery plan that are arranged for or provided by the agency-provider or purchased by the
participant employer. These services include training, education, direct observation and
supervision, and evaluation and coaching of job skills and tasks, including supervision of
health-related tasks or behavioral supports.
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EFFECTIVE DATE.
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This section is effective upon federal approval.
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Sec. 4.
Minnesota Statutes 2025 Supplement, section 256B.85, subdivision 16, is amended
to read:
Subd. 16.
Support workers requirements.
(a) Support workers shall:
(1) enroll with the department as a support worker after a background study under chapter
245C has been completed and the support worker has received a notice from the
commissioner that the support worker:
(i) is not disqualified under section
245C.14
; or
(ii) is disqualified, but has received a set-aside of the disqualification under section
245C.22
;
(2) have the ability to effectively communicate with the participant or the participant's
representative;
(3) have the skills and ability to provide the services and supports according to the
participant's CFSS service delivery plan and respond appropriately to the participant's needs;
(4) complete the basic standardized CFSS training as determined by the commissioner
before completing enrollment. The training must be available in languages other than English
and to those who need accommodations due to disabilities. CFSS support worker training
must include successful completion of the following training components: basic first aid,
vulnerable adult, child maltreatment, OSHA universal precautions, basic roles and
responsibilities of support workers including information about basic body mechanics,
emergency preparedness, orientation to positive behavioral practices, orientation to
responding to a mental health crisis, fraud issues, time cards and documentation, and an
overview of person-centered planning and self-direction. Upon completion of the training
components, the support worker must pass the certification test to provide assistance to
participants;
(5) complete employer-directed training and orientation on the participant's individual
needs;
(6) maintain the privacy and confidentiality of the participant; and
(7) not independently determine the medication dose or time for medications for the
participant
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, unless the requirements of subdivision 2, paragraph (f), clause (8), are met
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.
(b) The commissioner may deny or terminate a support worker's provider enrollment
and provider number if the support worker:
(1) does not meet the requirements in paragraph (a);
(2) fails to provide the authorized services required by the employer;
(3) has been intoxicated by alcohol or drugs while providing authorized services to the
participant or while in the participant's home;
(4) has manufactured or distributed drugs while providing authorized services to the
participant or while in the participant's home; or
(5) has been excluded as a provider by the commissioner of human services, or by the
United States Department of Health and Human Services, Office of Inspector General, from
participation in Medicaid, Medicare, or any other federal health care program.
(c) A support worker may appeal in writing to the commissioner to contest the decision
to terminate the support worker's provider enrollment and provider number.
(d) A support worker must not provide or be paid for more than 310 hours of CFSS per
month, regardless of the number of participants the support worker serves or the number
of agency-providers or participant employers by which the support worker is employed.
The department shall not disallow the number of hours per day a support worker works
unless it violates other law.
(e) CFSS qualify for an enhanced rate or budget if the support worker providing the
services:
(1) provides services, within the scope of CFSS described in subdivision 7, to a participant
who qualifies for ten or more hours per day of CFSS; and
(2) satisfies the current requirements of Medicare for training and competency or
competency evaluation of home health aides or nursing assistants, as provided in the Code
of Federal Regulations, title 42, section 483.151 or 484.36, or alternative state-approved
training or competency requirements. This paragraph expires upon the effective date of
paragraph (f).
(f) Effective January 1, 2026, or upon federal approval, whichever is later, CFSS qualify
for an enhanced rate or budget if the support worker providing the services:
(1) provides services, within the scope of CFSS described in subdivision 7, to a participant
who qualifies for ten or more hours per day of CFSS; and
(2) satisfies the current requirements of Medicare for training and competency or
competency evaluation of home health aides or nursing assistants, as provided in the Code
of Federal Regulations, title 42, section 483.151 or 484.36, or alternative state-approved
training or competency requirements.
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EFFECTIVE DATE.
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This section is effective upon federal approval.
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