Personal care assistance and community first services and supports modified to include certain medication injections.

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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