SF4698

Purpose

Clarify and strengthen the Community First Services and Supports (CFSS) program. The bill aims to make CFSS more person-centered, increase accountability for providers, expand monitoring and training requirements, and align financial and administrative practices with state standards. It also adds protections to ensure services are appropriate, properly funded, and delivered by qualified providers.

Main Provisions

• CFSS service delivery plan updates

  • Plans must be created and reviewed through a person-centered planning process led by the participant or their representative.
  • Must reflect what the participant needs and wants, the setting they live in, strengths, goals, and the supports (paid and unpaid) that will help them meet those goals.
  • Must specify how much in services is available (units or dollars), how often supports will occur (face-to-face and remote/technology), and include budget details and a plan for worker training per subdivision 18a.
  • Must identify risk factors and backup plans, be understandable, finalized in writing, and distributed to the participant and others involved.
  • Requires annual review or review when there is significant change in the participant’s condition or needs.
  • Requires approval by the lead agency (or case manager/care coordinator for waiver participants) and coordination with the consultation services provider and other parties involved.

• Provider qualifications and duties (Agency providers and FMS providers)

  • Must enroll as Minnesota Health Care Programs (MA) providers, meet all standards, complete required training, and comply with applicable laws and policies.
  • Must pass background checks, maintain service and expenditure records, and document hours worked.
  • Prohibited from agency-initiated in-person or electronic marketing to potential participants or their families.
  • Must provide direct services (no subcontracting for those services) and meet financial solvency requirements.
  • Must have a Minnesota-based office and meet other financial and integrity standards (no fraud history with lead agencies, etc.).
  • Must bill based on actual hours, cover training costs, handle payroll taxes, unemployment, workers’ compensation, liability insurance, and other benefits.
  • Must enter written agreements with participants or their representatives detailing roles and responsibilities before services begin.
  • Must report maltreatment, comply with labor market reporting, and respond to data requests.
  • Must maintain documentation to qualify for enhanced rates and request reassessments 60 days before current authorization ends.
  • Must notify the commissioner of changes in worker employment status and do so within specified time frames (e.g., six months after a worker leaves; 30 days for workers in training roles).

• Enrollment and compliance requirements for CFSS providers

  • Enrolling providers must share contact information, proof of surety bonds, fidelity bonds, workers’ compensation, liability insurance, and other financial safeguards.
  • Bond requirements scale with current or prior MA revenue (lower revenue → smaller bond; higher revenue → larger bond).
  • Must provide an organizational chart and documentation on policies (hiring, training, fraud prevention, billing, safety, grievances, incident response, disease prevention, etc.).
  • Must show how 72.5% of CFSS revenue (from those services) will go toward support worker wages and benefits; special treatment for revenue increases due to collective bargaining agreements.
  • Must disclose ownership and affiliations, marketing practices, and ensure no participant is coerced into non-competitive agreements.
  • Requires self-auditing policies and yearly or periodic reporting to the commissioner; training for leadership and management staff; and compliance with documentation deadlines.

• Worker training and development (CFSS staff and consultants)

  • Establishes the scope, standards, and limits for worker training and development.
  • Costs are added to the participant’s service budget and may be provided by the agency or purchased by the participant’s employer.
  • Training must be delivered by qualified personnel and tied to the participant’s assessed needs and CFSS plan.
  • Includes tuition for related classes, direct observation and coaching, and documentation of staff skills beyond what the participant or participant’s representative provides.
  • Training is generally required at the start of a worker’s service for a participant; general agency training or CFSS self-directed-model training is not included.
  • Requires documentation of all training, including the trainer, participant, and staff identifiers, and limits on training expenses.

• Consultation services and exemptions

  • Consultation services providers must meet specific qualifications and be under contract with the department (not the lead agency or FMS provider).
  • Bond requirements and other qualifications apply to consultation services providers as well.
  • There is a formal exemption: a participant may be exempt from mandatory consultation services if the same provider is used and there has been no significant change in condition since the last assessment or CFSS plan review. Lead agencies must document when exemption does or does not apply.

• Uniformity with state requirements

  • Managed care plans and county purchasing plans must not add more restrictive requirements for CFSS than those imposed by the commissioner (e.g., on authorization amounts, provider identifiers, claims, or daily time and activities documentation).

Significant Changes from Current Law

• Increased financial oversight and safeguards

  • New bonding requirements (surety, fidelity) tied to MA revenue, with annual renewals and debt recovery timelines.
  • Clear capital requirements for new CFSS agency providers to demonstrate operating capital.
  • Detailed organizational structure, policies, and internal controls required for providers.

• Enhanced wage and use of funds rules

  • A defined portion (72.5%) of CFSS revenue must be used for support worker wages and benefits (with exceptions for wage increases tied to collective bargaining agreements).

• Expanded training and workforce requirements

  • Mandatory training for management and supervisory staff, with cross-organization transfer provisions for existing staff.
  • Formalized worker training and development processes, including direct observation and documentation of skills.

• Expanded duties and reporting

  • Increased administrative duties for providers, including more frequent reassessments, monitoring of service delivery plans, and stricter reporting to the commissioner.

• Participant protections and flexibility

  • Maintains option for consultation services exemption under defined conditions to avoid unnecessary service requirements when there is no significant change.

Implementation and Oversight

• The Department and lead agencies will set formats and criteria for CFSS plans and monitoring.
• Lead agencies or case managers will approve CFSS plans for waiver participants; others require lead agency approval.
• The commissioner will oversee provider enrollment, bonding, financial solvency, and data reporting requirements.
• There are defined timelines for notifying changes in worker employment and for submitting required documentation.

Potential Impacts and Considerations

• For participants: stronger protections around service planning, budget transparency, and worker qualifications; potential for more stable service delivery and clearer budgeting.
• For agencies/providers: higher upfront costs to meet bonding, insurance, documentation, and training requirements; greater ongoing administrative workload; need to manage fund allocation toward wages as specified.
• For the system: improved consistency across plans and providers, with stronger safeguards against fraud and mismanagement; possible adjustments in how CFSS services are budgeted and delivered.

Relevant Terms - CFSS (Community First Services and Supports) - service delivery plan - person-centered planning - lead agency - case manager - care coordinator - agency provider - FMS provider - Minnesota Health Care Programs (MA) - medical assistance - service budget - units - face-to-face supports - remote supports - technology - risk factors - backup plans - natural supports - paid and unpaid supports - consultation services provider - lead professional staff - bond (surety bond) - fidelity bond - workers’ compensation - liability insurance - organizational chart - self-auditing - training requirements - data practices - CFSS plan documentation - vendor fiscal-employer agent (FMS) model - self-directed program - uniformity with state requirements - MA revenue - revenue use (wages and benefits) - collective bargaining agreement (CBA) - reassessment - support worker - wages and benefits allocation - exemption from consultation services