SF3928

Purpose

This bill clarifies and expands how Community First Services and Supports (CFSS) work in Minnesota. It adds a formal option for shared services, strengthens documentation and supervision for personal care assistance, and updates how rates and funding for shared services are calculated and used. It also updates definitions and reorganizes related rules to support these changes.

Key Provisions

• Documentation for personal care services

  • Personal care assistants must record their work daily on a time sheet form approved by the commissioner. Documentation can be web-based, electronic, or paper, and must be submitted monthly and kept in the recipient’s health record.
  • Time sheets must match the recipient’s care plan and include:
  • full names (assistant and recipient), provider numbers, recipient’s ID (MA number or date of birth), dates and times, signatures, and any shared care provided.
  • a note that it is a federal crime to submit false information for medical assistance billing.
  • Time sheets must also record hospital stays, travel time, and locations.

• Shared services definition and framework

  • Shared services mean one personal care assistant serving two or three recipients who are all eligible for medical assistance and agree to receive services at the same time and place.
  • The setting can be the home, a family foster care home, or certain child care or school settings.
  • Shared services follow the same service criteria as individual services. Noncovered shared services include: (a) more than three recipients with one assistant, (b) multi-setting care, (c) using more than one agency for the shared care, (d) extra units selected by the recipient, and (e) lack of appropriate coordination.
  • Recipients or their representatives can opt for shared services, one-on-one services, or a mix, and may withdraw at any time.
  • Authorization for shared services must be determined by the commissioner and should ensure health and safety. It is part of the overall CFSS authorization and should not reduce total hours for an individual recipient.
  • A shared service setting requires training for the assistant specific to each recipient, and ongoing monitoring every six months (or sooner if needed). A contingency plan must be created for when a recipient is absent.

• Rates, revenue, and wage considerations for shared services

  • A rate system will be created for shared services. For two recipients sharing services, the rate cannot exceed 1.5 times the single-recipient rate. For three recipients, the rate cannot exceed 2 times the single-recipient rate.
  • Additional revenue for two recipients and for three recipients must be allocated with a portion used for wages and wage-related costs (specific percentages are to be determined).
  • Additional revenue may not be used for mileage, insurance, or other non-wage benefits.
  • Separate provisions cover shared services under both the agency-provider model and the budget model, including passthrough rules (how much of the extra revenue or budget savings goes to wage costs) and rules about not reducing overall participant funding.

• CFSS service delivery and agency-provider responsibilities

  • The personal care assistance choice option requires the agency-provider to employ the assistant and the qualified professional, handle required regulatory obligations (workers’ compensation, unemployment insurance, bonds, liability insurance, etc.), bill the medical assistance program, conduct background studies, and maintain documentation.
  • The provider must ensure arms-length transactions (no close relationships like parent/child or spouse) and manage worker payroll, taxes, and record-keeping.
  • Agencies must enroll as CFSS providers and enter into written agreements with recipients and assistants before services begin.

• Covered CFSS services and expansions

  • CFSS covers a broad range of services, including activities of daily living (ADLs), instrumental activities of daily living (IADLs), health-related procedures, environmental modifications, assistive technology, observations and redirection for behavior or symptoms, and other supports necessary to increase independence.
  • The bill also allows shared services and required training within both the agency-provider and budget models, with guidelines about when and how these services may be used.

• Definitions and coding changes

  • The bill updates and renumbers definitions related to CFSS and shared services, and directs the revisor to reorganize definitions in the statute (including 256B.85 and related sections) to reflect the new structure.

Significant Changes to Existing Law

• Creates an explicit shared services option within CFSS, allowing one personal care assistant to serve two or three recipients at the same time, with rules for authorization, safety, and monitoring.
• Establishes a formal rate framework for shared services, including caps at 1.5x (two recipients) and 2x (three recipients) the single-recipient rate, plus defined uses for any additional revenue or budget savings (primarily for wages and wage-related costs).
• Adds detailed documentation and time-keeping requirements for personal care assistance, including a federally themed warning about falsifying billing information.
• Requires training for shared-service settings, ongoing oversight by a qualified professional, and contingency planning.
• Requires agency-provider models to meet specific employer responsibilities (workers’ compensation, unemployment, licensing, background checks, taxes, etc.) and to provide written agreements and transparent arrangements to avoid conflicts of interest.
• Expands and clarifies CFSS covered services and related administrative processes, including the roles of the commissioner and providers in authorizing and administering shared services.
• Renumbers and reorganizes statutory definitions to accommodate the new structure, ensuring cross-references align with the updated framework.

How It Could Affect Participants and Care Workers

• Participants gain more flexibility by choosing shared services, potentially reducing care gaps and increasing independence, while maintaining safety and oversight.
• Care workers may see wage increases linked to shared services and more formal training and supervision.
• Providers face more rules and documentation requirements but also clearer guidance on how to bill for shared services and how to structure staffing and employment arrangements.

Relevant Terms - CFSS (Community First Services and Supports) - personal care assistant (PCA) - shared services - two recipients sharing services - three recipients sharing services - agency-provider model - budget model - time sheet - documentation (web-based, electronic, paper) - qualified professional - health and safety - care plan - arm's-length transactions - caregiver training - contingency plan - authorized/shared service authorization - wage-related costs - additional revenue - passthrough - wages and wage-related costs - CFSS service delivery plan - health-related procedures - ADLs and IADLs - setting (home, foster care, school-related settings) - eligibility for medical assistance - rates (caps for shared services) - hospital stays and travel time (on time sheets) - federal crime warning for false billing statements