Community first services and supports requirements for shared services clarification

A bill for an act

relating to human services; clarifying community first services and supports

requirements for shared services; requiring wage increases for support workers

providing shared services; renumbering community first services and supports

definitions; amending Minnesota Statutes 2024, sections 256B.0659, subdivisions

12, 16, 17, 19; 256B.85, by adding subdivisions; Minnesota Statutes 2025

Supplement, section 256B.85, subdivision 7; proposing coding for new law in

Minnesota Statutes, chapter 256B.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2024, section 256B.0659, subdivision 12, is amended to

read:

Subd. 12.

Documentation of personal care assistance services provided.

(a) Personal

care assistance services for a recipient must be documented daily by each personal care

assistant, on a time sheet form approved by the commissioner. All documentation may be

web-based, electronic, or paper documentation. The completed form must be submitted on

a monthly basis to the provider and kept in the recipient's health record.

(b) The activity documentation must correspond to the personal care assistance care plan

and be reviewed by the qualified professional.

(c) The personal care assistant time sheet must be on a form approved by the

commissioner documenting time the personal care assistant provides services in the home.

The following criteria must be included in the time sheet:

(1) full name of personal care assistant and individual provider number;

(2) provider name and telephone numbers;

(3) full name of recipient and either the recipient's medical assistance identification

number or date of birth;

(4) consecutive dates, including month, day, and year, and arrival and departure times

with a.m. or p.m. notations;

(5) signatures of recipient or the responsible party;

(6) personal signature of the personal care assistant;

(7) any shared
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care
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services
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provided, if applicable;

(8) a statement that it is a federal crime to provide false information on personal care

service billings for medical assistance payments;

(9) dates and location of recipient stays in a hospital, care facility, or incarceration; and

(10) any time spent traveling, as described in subdivision 1, paragraph (i), including

start and stop times with a.m. and p.m. designations, the origination site, and the destination

site.

Sec. 2.

Minnesota Statutes 2024, section 256B.0659, subdivision 16, is amended to read:

Subd. 16.

Shared services.

(a) Medical assistance payments for
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shared
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personal care

assistance services
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that are shared services
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are limited according to this subdivision.

(b)
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Shared service is
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For the purposes of this section, "shared services" means
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the

provision of personal care assistance services by a personal care assistant to two or three

recipients
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,
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who are all
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eligible for medical assistance
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,
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and
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who
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each
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voluntarily enter into

an agreement to receive services at the same time and in the same setting.

(c) For the purposes of this subdivision, "setting" means:

(1) the home residence or family foster care home of one or more of the individual

recipients; or

(2) a child care program licensed under chapter 142B or operated by a local school

district or private school.

(d) Shared
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personal care assistance
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services follow the same criteria for covered services

as subdivision 2.

(e) Noncovered shared
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personal care assistance
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services include the following:

(1) services for more than three recipients by one personal care assistant at one time;

(2) staff requirements for child care programs under chapter 245C;

(3) caring for multiple recipients in more than one setting;

(4) additional units of personal care assistance based on the selection of the option; and

(5) use of more than one personal care assistance provider agency for the shared
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care
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services.

(f) The option of shared
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personal care assistance
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services
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is elected by the recipient or

the responsible party with the assistance of the assessor. The option must be determined

appropriate based on the ages of the recipients, compatibility, and coordination of their

assessed care needs. The recipient or the responsible party, in conjunction with the qualified

professional, shall arrange the setting and grouping of shared services based on the individual

needs and preferences of the recipients. The personal care assistance provider agency shall

offer the recipient or the responsible party the option of shared
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services
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or one-on-one

personal care assistance services or a combination of both. The recipient or the responsible

party may withdraw from participating in a shared services arrangement at any time.

(g) Authorization for the shared service option must be determined by the commissioner

based on the criteria that the shared service is appropriate to meet all of the recipients' needs

and
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their
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the recipients'
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health and safety is maintained. The authorization of shared services

is part of the overall authorization of personal care assistance services. Nothing in this

subdivision must be construed to reduce the total number of hours authorized for an individual

recipient.

(h) A personal care assistant providing shared
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personal care assistance
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services must:

(1) receive training specific for each recipient served; and

(2) follow all required documentation requirements for time and services provided.

(i) A qualified professional shall:

(1) evaluate the ability of the personal care assistant to provide services
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for all of
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to all
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the recipients in a shared setting;

(2) visit the shared setting as
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shared
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services are being provided at least once every six

months or whenever needed for response to a recipient's request for increased supervision

of the personal care assistance staff;

(3) provide ongoing monitoring and evaluation of the effectiveness and appropriateness

of the shared services;

(4) develop a contingency plan with each of the recipients
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which
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that
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accounts for absence

of the recipient in a shared services setting due to illness or other circumstances;

(5) obtain permission from each of the recipients who are sharing a personal care assistant

for number of shared hours for services provided inside and outside the home residence;

and

(6) document the training completed by the personal care assistants specific to the shared

setting and recipients sharing services.

Sec. 3.

Minnesota Statutes 2024, section 256B.0659, subdivision 17, is amended to read:

Subd. 17.

Shared services; rates.

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(a) For the purposes of this subdivision, "additional

revenue for shared services" means the difference between the rate paid to a personal care

assistance provider agency for serving a single recipient and the sum of the rates paid to a

personal care assistance provider agency for shared services provided to more than one

recipient.

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(b) For the purposes of this subdivision, "wages and wage-related costs" means increased

wages and any corresponding increase in the employer's share of FICA taxes, Medicare

taxes, state and federal unemployment taxes, workers' compensation premiums, and

contributions to employee retirement accounts when the contribution is a function of wages.

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(c)
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The commissioner shall provide a rate system for shared
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personal care assistance
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services. For two
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persons
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recipients
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sharing services, the rate paid to a
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personal care

assistance
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provider
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agency for the shared services
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must not exceed one and one-half times

the rate paid for serving a single
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individual, and
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recipient.
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For three
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persons
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recipients
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sharing services, the rate paid to a
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personal care assistance
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provider
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agency for the shared

services
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must not exceed twice the rate paid for serving a single
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individual
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recipient
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. These

rates apply only when all
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of the
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criteria for
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the
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shared
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care personal care assistance service

have been
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services are
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met.

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(d) Of the additional revenue for shared services provided to two recipients, the personal

care assistance provider agency must use ... percent for the purposes specified in paragraph

(e). Of the additional revenue for shared services provided to three recipients, the personal

care assistance provider agency must use ... percent for the purposes specified in paragraph

(e).

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(e) A personal care assistance provider agency must use the percentages of additional

revenue for shared services specified in paragraph (d) for the wages and wage-related costs

of the personal care assistant providing the shared services. The personal care assistance

provider agency must not use additional revenue for shared services to pay for mileage

reimbursements, uniform allowances, health and dental insurance, life insurance, disability

insurance, long-term care insurance, contributions to employee retirement accounts when

the contribution is not a function of wages, or any other employee benefits.

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Sec. 4.

Minnesota Statutes 2024, section 256B.0659, subdivision 19, is amended to read:

Subd. 19.

Personal care assistance choice option; qualifications; duties.

(a) Under

personal care assistance choice, the recipient or responsible party shall:

(1) recruit, hire, schedule, and terminate personal care assistants according to the terms

of the written agreement required under subdivision 20, paragraph (a);

(2) develop a personal care assistance care plan based on the assessed needs and

addressing the health and safety of the recipient with the assistance of a qualified professional

as needed;

(3) orient and train the personal care assistant with assistance as needed from the qualified

professional;

(4) supervise and evaluate the personal care assistant with the qualified professional,

who is required to visit the recipient at least every 180 days;

(5) monitor and verify in writing and report to the personal care assistance choice agency

the number of hours worked by the personal care assistant and the qualified professional;

(6) engage in an annual reassessment as required in subdivision 3a to determine

continuing eligibility and service authorization;

(7) use the same personal care assistance choice provider agency if shared
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personal

assistance care is
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services are
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being used; and

(8) ensure that a personal care assistant driving the recipient under subdivision 1,

paragraph (i), has a valid driver's license and the vehicle used is registered and insured

according to Minnesota law.

(b) The personal care assistance choice provider agency shall:

(1) meet all personal care assistance provider agency standards;

(2) enter into a written agreement with the recipient, responsible party, and personal

care assistants;

(3) not be related as a parent, child, sibling, or spouse to the recipient or the personal

care assistant; and

(4) ensure arm's-length transactions without undue influence or coercion with the recipient

and personal care assistant.

(c) The duties of the personal care assistance choice provider agency are to:

(1) be the employer of the personal care assistant and the qualified professional for

employment law and related regulations including but not limited to purchasing and

maintaining workers' compensation, unemployment insurance, surety and fidelity bonds,

and liability insurance, and submit any or all necessary documentation including but not

limited to workers' compensation, unemployment insurance, and labor market data required

under section
256B.4912, subdivision 1a
;

(2) bill the medical assistance program for personal care assistance services and qualified

professional services;

(3) request and complete background studies that comply with the requirements for

personal care assistants and qualified professionals;

(4) pay the personal care assistant and qualified professional based on actual hours of

services provided;

(5) withhold and pay all applicable federal and state taxes;

(6) verify and keep records of hours worked by the personal care assistant and qualified

professional;

(7) make the arrangements and pay taxes and other benefits, if any, and comply with

any legal requirements for a Minnesota employer;

(8) enroll in the medical assistance program as a personal care assistance choice agency;

and

(9) enter into a written agreement as specified in subdivision 20 before services are

provided.

Sec. 5.

Minnesota Statutes 2025 Supplement, section 256B.85, subdivision 7, is amended

to read:

Subd. 7.

Community first services and supports; covered services.

Services and

supports covered under CFSS include:

(1) assistance to accomplish activities of daily living (ADLs), instrumental activities of

daily living (IADLs), and health-related procedures and tasks through hands-on assistance

to accomplish the task or constant supervision and cueing to accomplish the task;

(2) assistance to acquire, maintain, or enhance the skills necessary for the participant to

accomplish activities of daily living, instrumental activities of daily living, or health-related

tasks;

(3) expenditures for items, services, supports, environmental modifications, or goods,

including assistive technology. These expenditures must:

(i) relate to a need identified in a participant's CFSS service delivery plan; and

(ii) increase independence or substitute for human assistance, to the extent that

expenditures would otherwise be made for human assistance for the participant's assessed

needs;

(4) observation and redirection for behavior or symptoms where there is a need for

assistance;

(5) back-up systems or mechanisms, such as the use of pagers or other electronic devices,

to ensure continuity of the participant's services and supports;

(6) swimming lessons for a participant younger than 12 years of age whose disability

puts the participant at a higher risk of drowning according to the Centers for Disease Control

Vital Statistics System;

(7) services described under subdivision 17 provided by a consultation services provider

meeting the requirements of subdivision 17a;

(8) services provided by an FMS provider as defined under subdivision 13a
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,
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that is an

enrolled provider with the department;

(9) CFSS services provided by a support worker who is a parent, stepparent, or legal

guardian of a participant under age 18, or who is the participant's spouse. Covered services

under this clause are subject to the limitations described in subdivision 7b;
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and
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(10) shared services meeting the shared service requirements of this section; and

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(10)
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(11)
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worker training and development services as described in subdivision 18a.

Sec. 6.

Minnesota Statutes 2024, section 256B.85, is amended by adding a subdivision to

read:

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Subd. 7c.

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Shared services under the agency-provider model.

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(a) The commissioner

shall authorize shared service arrangements if the commissioner determines that a shared

service arrangement is appropriate to meet all the participants' needs and sufficient to

maintain the participants' health and safety. The commissioner must include a decision

regarding authorization of shared services during the process of authorizing CFSS under

subdivision 8. The commissioner must not reduce the total number of authorized units for

a participant who elects to receive shared services.

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(b) An agency-provider must offer a participant or the participant's representative the

option of shared services, one-on-one services, or a combination of both shared services

and one-on-one services when shared services are authorized by the commissioner. The

option of shared services may be elected at the sole discretion of either the participant or

the participant's representative. The participant or the participant's representative may

withdraw from participating in a shared service arrangement at any time.

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Sec. 7.

Minnesota Statutes 2024, section 256B.85, is amended by adding a subdivision to

read:

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Subd. 7d.

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Shared service rates under the agency-provider model.

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The commissioner

shall provide a rate system for shared services. For two participants sharing services, the

rate paid to an agency-provider for the shared services must not exceed one and one-half

times the rate paid for serving a single participant. For three participants sharing services,

the rate paid to an agency-provider for the shared services must not exceed twice the rate

paid for serving a single participant. These rates apply only when all criteria for shared

services are met.

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Sec. 8.

Minnesota Statutes 2024, section 256B.85, is amended by adding a subdivision to

read:

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Subd. 7e.

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Pass-through for shared services under the agency-provider model.

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(a)

Of the additional revenue for shared services provided to two participants, the

agency-provider must use ... percent for the purposes specified in paragraph (b). Of the

additional revenue for shared services provided to three participants, the agency-provider

must use ... percent for the purposes specified in paragraph (b).

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(b) An agency-provider must use the percentages of additional revenue for shared services

specified in paragraph (a) for the wages and wage-related costs of the support worker

providing the shared services. The agency-provider must not use additional revenue for

shared services to pay for mileage reimbursements, uniform allowances, health and dental

insurance, life insurance, disability insurance, long-term care insurance, contributions to

employee retirement accounts when the contribution is not a function of wages, or any other

employee benefits.

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Sec. 9.

Minnesota Statutes 2024, section 256B.85, is amended by adding a subdivision to

read:

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Subd. 7f.

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Shared services under the budget model.

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(a) A participant who intends to

elect shared services under the budget model, or the participant's representative, must include

a statement of this intention in the CFSS service delivery plan, must develop a plan for

shared services when developing or amending the CFSS service delivery plan, and must

follow the CFSS process for approval of the plan as required under subdivision 6.

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(b) The commissioner shall authorize shared service arrangements if the commissioner

determines that a shared service arrangement is appropriate to meet all the participants'

needs and sufficient to maintain the participants' health and safety. The commissioner must

include a decision regarding authorization of shared services during the process of authorizing

CFSS under subdivision 8. The commissioner must not reduce the total authorized dollar

amount available to a participant who elects to receive shared services.

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(c) The participants, or participants' representatives as needed, who elect to share services

under the budget model must jointly develop a shared service agreement with the support

of the participants' representatives as needed. Any participant or any participant's

representative may at any time withdraw from participating in a shared service agreement.

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(d) The commissioner must develop and publish recommendations for negotiating wages

for support workers providing shared services under the budget model.

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Sec. 10.

Minnesota Statutes 2024, section 256B.85, is amended by adding a subdivision

to read:

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Subd. 7g.

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Pass-through for shared services under the budget model.

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(a) Of the budget

savings for shared services provided to two participants, the participant employer must use

... percent for the purposes specified in paragraph (b). Of the budget savings for shared

services provided to three participants, the participant provider must use ... percent for the

purposes specified in paragraph (b).

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(b) A participant employer must use the percentages of budget savings for shared services

specified in paragraph (a) for the wages and wage-related costs of the support worker

providing the shared services. The participant employer must not use budget savings for

shared services to pay for mileage reimbursements, uniform allowances, health and dental

insurance, life insurance, disability insurance, long-term care insurance, contributions to

employee retirement accounts when the contribution is not a function of wages, or any other

employee benefits.

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Sec. 11.

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[256B.8502] COMMUNITY FIRST SERVICES AND SUPPORTS;

DEFINITIONS.

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Subdivision 1.

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Scope.

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For the purposes of this section and sections 256B.85 and

256B.851, the terms in this section have the meanings given.

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Subd. 2.

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Additional revenue for shared services.

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"Additional revenue for shared

services" means the difference between the rate paid to an agency-provider for serving a

single participant and the sum of the rates paid to a personal care assistance provider agency

for shared services provided to more than one recipient.

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Subd. 3.

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Budget savings for shared services.

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"Budget savings for shared services"

means the difference between the wages and wage-related costs paid by a participant

employer to a support worker providing one-on-one service to the participant employer and:

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(1) for two-to-one shared services, three-quarters of the wages and wage-related costs

paid by a participant employer to a support worker providing one-on-one service; or

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(2) for three-to-one shared services, two-thirds of the wages and wage-related costs paid

by a participant employer to a support worker providing one-on-one service.

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Subd. 4.

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Wages and wage-related costs.

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"Wages and wage-related costs" means

increased wages and any corresponding increase in the employer's or participant employer's

share of FICA taxes, Medicare taxes, state and federal unemployment taxes, workers'

compensation premiums, and contributions to employee retirement accounts when the

contribution is a function of wages.

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Sec. 12.
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REVISOR INSTRUCTION.
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(a) The revisor of statutes shall renumber the definitions in Minnesota Statutes, section

256B.85, subdivision 2, and the definitions in Minnesota Statutes, section 256B.851,

subdivision 2, as subdivisions in Minnesota Statutes, section 256B.8502, rearranging the

renumbered and existing definitions in Minnesota Statutes, section 256B.8502, as necessary

to place them in alphabetical order. The revisor of statutes shall revise all statutory

cross-references consistent with this recoding.

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(b) If a provision of Minnesota Statutes, section 256B.85, subdivision 2, or 256B.851,

subdivision 2, are amended or repealed in the 2026 regular legislative session, the revisor

of statutes shall codify the amendment or repealer in Minnesota Statutes, section 256B.8502,

notwithstanding any other law to the contrary.

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