HF 1681

4th Engrossment - 83rd Legislature (2003 - 2004) Posted on 12/15/2009 12:00am

  1.1                          A bill for an act 
  1.2             relating to operation of state government; making 
  1.3             changes to encourage consumer-driven health plans; 
  1.4             encouraging efficiency in providing health care; 
  1.5             requiring disease management initiatives; implementing 
  1.6             health care cost containment, cost-shifting 
  1.7             provisions, and reduction of government mandates; 
  1.8             implementing health plan competition and reform 
  1.9             provisions; changing health maintenance organization 
  1.10            regulatory authority; changing provisions related to 
  1.11            child care, economic supports, health care, long-term 
  1.12            care, continuing care, and program integrity and 
  1.13            administration; making health and human services 
  1.14            forecast adjustments and reductions; appropriating 
  1.15            money; amending Minnesota Statutes 2002, sections 
  1.16            16A.10, by adding a subdivision; 43A.23, by adding a 
  1.17            subdivision; 62A.02, subdivision 2; 62D.02, 
  1.18            subdivision 4, by adding a subdivision; 62D.03, 
  1.19            subdivision 1; 62D.04, subdivision 1; 62D.05, 
  1.20            subdivision 1; 72A.20, by adding a subdivision; 
  1.21            119B.13, by adding a subdivision; 144.148, by adding a 
  1.22            subdivision; 144A.10, subdivision 1a, by adding a 
  1.23            subdivision; 144D.025; 147.03, subdivision 1; 256.01, 
  1.24            by adding subdivisions; 256.9365, subdivision 1; 
  1.25            256.955, subdivisions 2b, 4, 6; 256B.02, subdivision 
  1.26            12; 256B.04, subdivision 14, by adding a subdivision; 
  1.27            256B.056, subdivision 5, by adding subdivisions; 
  1.28            256B.0916, subdivision 2; 256B.431, by adding 
  1.29            subdivisions; 256B.49, by adding a subdivision; 
  1.30            256D.045; 256D.051, subdivisions 1a, 3a, 6c; 256I.04, 
  1.31            subdivision 2a; 256L.01, subdivision 5; 256L.03, 
  1.32            subdivision 5, by adding a subdivision; 256L.04, 
  1.33            subdivision 2, by adding subdivisions; 256L.05, 
  1.34            subdivision 3; 549.02, by adding a subdivision; 
  1.35            549.04; Minnesota Statutes 2003 Supplement, sections 
  1.36            62E.08, subdivision 1; 62E.091; 62J.26, by adding a 
  1.37            subdivision; 119B.09, subdivision 9; 119B.13, 
  1.38            subdivision 1; 144.7063, subdivision 3; 144A.071, 
  1.39            subdivision 4c; 245A.10, subdivision 4; 246B.04, as 
  1.40            amended; 252.27, subdivision 2a; 256.019, subdivision 
  1.41            1; 256.046, subdivision 1; 256.955, subdivisions 2a, 
  1.42            3; 256B.056, subdivision 3c; 256B.057, subdivision 9; 
  1.43            256B.0595, subdivision 2; 256B.06, subdivision 4; 
  1.44            256B.0625, subdivision 9; 256B.0631, subdivision 2; 
  1.45            256B.19, subdivision 1; 256B.434, subdivision 4; 
  1.46            256B.69, subdivision 2; 256D.03, subdivisions 3, 4; 
  2.1             256D.44, subdivision 5; 256J.24, subdivision 6; 
  2.2             256J.37, subdivision 3a; 256J.53, subdivision 1; 
  2.3             256L.03, subdivision 1; 256L.035; 256L.07, 
  2.4             subdivisions 1, 3; 295.50, subdivision 9b; 295.53, 
  2.5             subdivision 1; Laws 2003, First Special Session 
  2.6             chapter 14, article 9, section 34; Laws 2003, First 
  2.7             Special Session chapter 14, article 13C, section 1; 
  2.8             Laws 2003, First Special Session chapter 14, article 
  2.9             13C, section 2, subdivisions 1, 3, 6, 7, 9, 11; Laws 
  2.10            2003, First Special Session chapter 14, article 13C, 
  2.11            section 10, subdivisions 1, 2; proposing coding for 
  2.12            new law in Minnesota Statutes, chapters 62J; 62L; 62Q; 
  2.13            144; 144A; 145; 151; 256B; repealing Minnesota 
  2.14            Statutes 2002, sections 62A.309; 62J.17, subdivisions 
  2.15            1, 3, 4a, 5a, 6a, 7, 8; 256.955, subdivisions 1, 2, 
  2.16            2b, 4, 5, 6, 7, 9; 256L.04, subdivision 11; Minnesota 
  2.17            Statutes 2003 Supplement, sections 62J.17, subdivision 
  2.18            2; 256.955, subdivisions 2a, 3, 4a; 256B.431, 
  2.19            subdivision 36. 
  2.20  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  2.21                             ARTICLE 1 
  2.22         HEALTH CARE COST CONTAINMENT; CONSUMER EMPOWERMENT 
  2.23     Section 1.  Minnesota Statutes 2002, section 43A.23, is 
  2.24  amended by adding a subdivision to read: 
  2.25     Subd. 4.  [HEALTH SAVINGS ACCOUNTS.] During collective 
  2.26  bargaining negotiations with the exclusive representatives of 
  2.27  state employees, the commissioner must propose that state 
  2.28  employee health coverage include at least one plan of hospital 
  2.29  and medical benefits that combines a high deductible health plan 
  2.30  with a health savings account, so as to qualify the health 
  2.31  savings account under section 223 of the Internal Revenue Code, 
  2.32  as amended. 
  2.33     Sec. 2.  [62J.81] [DISCLOSURE OF PAYMENTS FOR HEALTH CARE 
  2.34  SERVICES.] 
  2.35     Subdivision 1.  [REQUIRED DISCLOSURE OF PAYMENT RANGE.] A 
  2.36  health care provider, as defined in section 62J.03, subdivision 
  2.37  8, shall, at the request of a consumer, provide that consumer 
  2.38  with the beginning and end of the range of payments received by 
  2.39  the provider from health plan companies for a specific service 
  2.40  or services that the consumer may reasonably expect to receive 
  2.41  from the provider, based upon the consumer's medical condition.  
  2.42  The beginning of the range of payments received by a provider is 
  2.43  the lowest amount the provider is paid by a health plan company 
  2.44  for a specific service and the end of the range is the highest 
  2.45  amount the provider is paid by a health plan company for the 
  3.1   service, based upon the provider agreements in force at the time 
  3.2   of the request.  A provider is not required to identify the 
  3.3   names of health plan companies. 
  3.4      Subd. 2.  [APPLICABILITY.] For purposes of this section, 
  3.5   "consumer" does not include a medical assistance, MinnesotaCare, 
  3.6   or general assistance medical care enrollee, for services 
  3.7   covered under those programs, and a health care provider shall 
  3.8   not include in the range, payments from the medical assistance, 
  3.9   MinnesotaCare, and general assistance medical care programs. 
  3.10     Sec. 3.  [151.214] [PAYMENT DISCLOSURE.] 
  3.11     Subdivision 1.  [EXPLANATION OF PHARMACY BENEFITS.] A 
  3.12  pharmacist licensed under this chapter must provide to a 
  3.13  patient, for each prescription dispensed where part or all of 
  3.14  the cost of the prescription is being paid or reimbursed by an 
  3.15  employer-sponsored plan or health plan company, or its 
  3.16  contracted pharmacy benefit manager, the patient's co-payment 
  3.17  amount and the usual and customary price of the prescription or 
  3.18  the amount the pharmacy will be paid for the prescription drug 
  3.19  by the patient's employer-sponsored plan or health plan company, 
  3.20  or its contracted pharmacy benefit manager. 
  3.21     Subd. 2.  [NO PROHIBITION ON DISCLOSURE.] No contracting 
  3.22  agreement between an employer-sponsored health plan or health 
  3.23  plan company, or its contracted pharmacy benefit manager, and a 
  3.24  resident or nonresident pharmacy registered under this chapter, 
  3.25  may prohibit the pharmacy from disclosing to patients 
  3.26  information a pharmacy is required or given the option to 
  3.27  provide under subdivision 1. 
  3.28                             ARTICLE 2 
  3.29            HEALTH CARE COST CONTAINMENT; BEST PRACTICES 
  3.30     Section 1.  [62J.43] [BEST PRACTICES AND QUALITY 
  3.31  IMPROVEMENT.] 
  3.32     (a) To improve quality and reduce health care costs, state 
  3.33  agencies shall encourage the adoption of best practice 
  3.34  guidelines and participation in best practices measurement 
  3.35  activities by physicians, other health care providers, 
  3.36  universities and colleges, health care purchasers, and health 
  4.1   plan companies.  The commissioner of health shall facilitate 
  4.2   access to best practice guidelines and quality of care 
  4.3   measurement information for providers, purchasers, and consumers 
  4.4   by: 
  4.5      (1) identifying and promoting local, community-based, 
  4.6   physician-designed best practices care across the Minnesota 
  4.7   health care system; 
  4.8      (2) disseminating information on adherence to best 
  4.9   practices care by physicians and other health care providers in 
  4.10  Minnesota; and 
  4.11     (3) educating consumers and purchasers on how to 
  4.12  effectively use this information in choosing their health care 
  4.13  providers and making purchasing decisions. 
  4.14     (b) The commissioner of health shall collaborate with a 
  4.15  nonprofit Minnesota quality improvement organization 
  4.16  specializing in best practices and quality of care measurements 
  4.17  to provide best practices criteria. 
  4.18     (c) The initial best practices and quality of care 
  4.19  measurement criteria developed shall address diabetes and 
  4.20  congestive heart failure. 
  4.21     (d) The commissioners of human services and employee 
  4.22  relations may use the best practices guidelines to assist them 
  4.23  in developing contracting strategies that are appropriate for 
  4.24  the populations they serve.  The commissioners shall report to 
  4.25  the legislature by January 1, 2006, on agency use of best 
  4.26  practices guidelines. 
  4.27     (e) This section does not apply if the best practices 
  4.28  guidelines authorizes or recommends denial of treatment, food, 
  4.29  or fluids necessary to sustain life on the basis of the 
  4.30  patient's age or expected length of life or the patient's 
  4.31  present or predicted disability, degree of medical dependency, 
  4.32  or quality of life. 
  4.33     Sec. 2.  Minnesota Statutes 2003 Supplement, section 
  4.34  144.7063, subdivision 3, is amended to read: 
  4.35     Subd. 3.  [FACILITY.] "Facility" means a hospital licensed 
  4.36  under sections 144.50 to 144.58 or an outpatient surgical center 
  5.1   licensed under Minnesota Rules, chapter 4675. 
  5.2      Sec. 3.  [256B.075] [DISEASE MANAGEMENT PROGRAMS.] 
  5.3      Subdivision 1.  [GENERAL.] The commissioner shall implement 
  5.4   disease management initiatives that seek to improve patient care 
  5.5   and health outcomes and reduce health care costs by managing the 
  5.6   care provided to recipients with chronic conditions. 
  5.7      Subd. 2.  [FEE-FOR-SERVICE.] (a) The commissioner shall 
  5.8   develop and implement a disease management program for medical 
  5.9   assistance and general assistance medical care recipients who 
  5.10  are not enrolled in the prepaid medical assistance or prepaid 
  5.11  general assistance medical care programs and who are receiving 
  5.12  services on a fee-for-service basis.  The commissioner may 
  5.13  contract with an outside organization to provide these services. 
  5.14     (b) The commissioner shall seek any federal approval 
  5.15  necessary to implement this section and to obtain federal 
  5.16  matching funds. 
  5.17     Subd. 3.  [PREPAID MANAGED CARE PROGRAMS.] For the prepaid 
  5.18  medical assistance, prepaid general assistance medical care, and 
  5.19  MinnesotaCare programs, the commissioner shall ensure that 
  5.20  contracting health plans implement disease management programs 
  5.21  that are appropriate for Minnesota health care program 
  5.22  recipients and have been designed by the health plan to improve 
  5.23  patient care and health outcomes and reduce health care costs by 
  5.24  managing the care provided to recipients with chronic conditions.
  5.25     Subd. 4.  [HEMOPHILIA.] The commissioner shall develop a 
  5.26  disease management initiative for Minnesota health care program 
  5.27  recipients who have been diagnosed with hemophilia.  In 
  5.28  developing the program, the commissioner shall explore the 
  5.29  feasibility of contracting with a section 340B provider to 
  5.30  provide disease management services or coordination of care in 
  5.31  order to maximize the discounted prescription drug prices of the 
  5.32  federal 340B program offered through section 340B of the federal 
  5.33  Public Health Services Act, United States Code, title 42, 
  5.34  section 256b (1999). 
  5.35                             ARTICLE 3 
  5.36            HEALTH CARE COST CONTAINMENT; COST-SHIFTING 
  6.1      Section 1.  Minnesota Statutes 2002, section 16A.10, is 
  6.2   amended by adding a subdivision to read: 
  6.3      Subd. 4.  [LIMIT ON STATE HEALTH CARE PROGRAM 
  6.4   EXPANSION.] No budget proposal shall include any provision that 
  6.5   requests new or increased funding for an expansion of 
  6.6   eligibility or covered services for a state health care program, 
  6.7   unless state health care program reimbursement rates for major 
  6.8   service categories, at the time the expansion is to take effect, 
  6.9   will be sufficient to cover estimated provider costs for each 
  6.10  major service category.  For purposes of this section, "state 
  6.11  health care program" means the medical assistance, 
  6.12  MinnesotaCare, and general assistance medical care programs. 
  6.13     Sec. 2.  [STUDY OF COST-SHIFTING.] 
  6.14     (a) The commissioner of health shall evaluate the extent to 
  6.15  which state health care program reimbursement rates result in 
  6.16  health care provider cost-shifting to private sector payers and 
  6.17  individuals paying for services out-of-pocket.  In conducting 
  6.18  the evaluation, the commissioner shall: 
  6.19     (1) examine the extent to which average state health care 
  6.20  program reimbursement rates for major categories of services 
  6.21  vary from average private sector reimbursement rates; 
  6.22     (2) examine the extent to which average state health care 
  6.23  program reimbursement rates for major categories of services 
  6.24  cover average provider costs; 
  6.25     (3) estimate the amount by which average state health care 
  6.26  program reimbursement rates for major categories of services 
  6.27  would need to be increased to match average private sector 
  6.28  reimbursement rates and to cover average provider costs; and 
  6.29     (4) present recommendations to the legislature on methods 
  6.30  of increasing average state health care program reimbursement 
  6.31  rates for major categories of services, over a six-year period, 
  6.32  to the average private sector reimbursement rate and to a level 
  6.33  that covers average provider costs. 
  6.34     (b) The commissioner shall present results and 
  6.35  recommendations to the legislature by December 15, 2004.  The 
  6.36  commissioner may contract with an actuarial consulting firm to 
  7.1   implement this section.  Payment and reimbursement data 
  7.2   collected by the commissioner in the course of implementing this 
  7.3   section shall be classified as not public data under Minnesota 
  7.4   Statutes, chapter 13, except that data shall be classified as 
  7.5   public data not on individuals if the information collected was 
  7.6   already accessible to the public under the policies of the 
  7.7   private sector entity providing the data.  For purposes of this 
  7.8   section, "state health care program" means the medical 
  7.9   assistance, MinnesotaCare, and general assistance medical care 
  7.10  programs. 
  7.11                             ARTICLE 4 
  7.12     HEALTH CARE COST CONTAINMENT; REDUCING GOVERNMENT MANDATES 
  7.13     Section 1.  Minnesota Statutes 2003 Supplement, section 
  7.14  62J.26, is amended by adding a subdivision to read: 
  7.15     Subd. 6.  [MANDATED BENEFITS MORATORIUM.] (a) No new 
  7.16  mandated health benefit proposal, as defined in subdivision 1, 
  7.17  shall be enacted. 
  7.18     (b) This subdivision expires January 1, 2007. 
  7.19     Sec. 2.  [62L.056] [SMALL EMPLOYER ALTERNATIVE BENEFIT 
  7.20  PLANS.] 
  7.21     (a) Notwithstanding any provision of this chapter, chapter 
  7.22  363A, or any other law to the contrary, the commissioner of 
  7.23  commerce shall by January 1, 2005, permit health carriers to 
  7.24  offer alternative health benefit plans to small employers if the 
  7.25  following requirements are satisfied: 
  7.26     (1) the health carrier is assessed less than ten percent of 
  7.27  the total amount assessed by the Minnesota Comprehensive Health 
  7.28  Association; 
  7.29     (2) the health plans must be offered in compliance with 
  7.30  this chapter, except as otherwise permitted in this section; 
  7.31     (3) the health plans to be offered must be designed to 
  7.32  enable employers and covered persons to better manage costs and 
  7.33  coverage options through the use of co-pays, deductibles, and 
  7.34  other cost-sharing arrangements; 
  7.35     (4) the health plans must be issued and administered in 
  7.36  compliance with sections 62E.141; 62L.03, subdivision 6; and 
  8.1   62L.12, subdivisions 3 and 4, relating to prohibitions against 
  8.2   enrolling in the Minnesota Comprehensive Health Association 
  8.3   persons eligible for employer group coverage; 
  8.4      (5) loss-ratio requirements do not apply to health plans 
  8.5   issued under this section; 
  8.6      (6) the health plans may alter or eliminate coverages that 
  8.7   would otherwise be required by law, except for maternity 
  8.8   coverage as required under federal law; 
  8.9      (7) each health plan must be approved by the commissioner 
  8.10  of commerce; and 
  8.11     (8) the commissioner may limit the types and numbers of 
  8.12  health plan forms permitted under this section, but must permit, 
  8.13  as one option, a health plan form in which a health carrier may 
  8.14  exclude or alter coverage of any or all benefits otherwise 
  8.15  mandated by state law, except for maternity coverage as required 
  8.16  under federal law. 
  8.17     (b) The definitions in section 62L.02 apply to this section 
  8.18  as modified by this section. 
  8.19     (c) An employer may provide health plans permitted under 
  8.20  this section to its employees, the employees' dependents, and 
  8.21  other persons eligible for coverage under the employer's plan, 
  8.22  notwithstanding chapter 363A or any other law to the contrary. 
  8.23     Sec. 3.  [REPEALER; BONE MARROW TRANSPLANT MANDATE.] 
  8.24     Minnesota Statutes 2002, section 62A.309, is repealed. 
  8.25                             ARTICLE 5 
  8.26                   HEALTH CARE COST CONTAINMENT; 
  8.27                 HEALTH PLAN COMPETITION AND REFORM 
  8.28     Section 1.  Minnesota Statutes 2002, section 62A.02, 
  8.29  subdivision 2, is amended to read: 
  8.30     Subd. 2.  [APPROVAL.] (a) The health plan form shall not be 
  8.31  issued, nor shall any application, rider, endorsement, or rate 
  8.32  be used in connection with it, until the expiration of 60 days 
  8.33  after it has been filed unless the commissioner approves it 
  8.34  before that time.  
  8.35     (b) Notwithstanding paragraph (a), a health plan form or a 
  8.36  rate, filed with respect to a policy of accident and sickness 
  9.1   insurance as defined in section 62A.01 by an insurer licensed 
  9.2   under chapter 60A, may be used on or after the date of filing 
  9.3   with the commissioner.  Health plan forms and rates that are not 
  9.4   approved or disapproved within the 60-day time period are deemed 
  9.5   approved.  This paragraph does not apply to Medicare-related 
  9.6   coverage as defined in section 62A.31, subdivision 3, paragraph 
  9.7   (q). 
  9.8      Sec. 2.  Minnesota Statutes 2002, section 62D.02, 
  9.9   subdivision 4, is amended to read: 
  9.10     Subd. 4.  [HEALTH MAINTENANCE ORGANIZATION.] (a) "Health 
  9.11  maintenance organization" means a nonprofit corporation 
  9.12  organized under chapter 317A, or person, including a local 
  9.13  governmental unit as defined in subdivision 11, controlled and 
  9.14  operated as provided in sections 62D.01 to 62D.30, which 
  9.15  provides, either directly or through arrangements with providers 
  9.16  or other persons, comprehensive health maintenance services, or 
  9.17  arranges for the provision of these services, to enrollees on 
  9.18  the basis of a fixed prepaid sum without regard to the frequency 
  9.19  or extent of services furnished to any particular enrollee.  
  9.20     Sec. 3.  Minnesota Statutes 2002, section 62D.02, is 
  9.21  amended by adding a subdivision to read: 
  9.22     Subd. 17.  [PERSON.] "Person" means a natural or artificial 
  9.23  person, including, but not limited to, individuals, 
  9.24  partnerships, limited liability companies, associations, trusts, 
  9.25  corporations, other business entities, or governmental entities. 
  9.26     Sec. 4.  Minnesota Statutes 2002, section 62D.03, 
  9.27  subdivision 1, is amended to read: 
  9.28     Subdivision 1.  [CERTIFICATE OF AUTHORITY REQUIRED.] 
  9.29  Notwithstanding any law of this state to the contrary, any 
  9.30  nonprofit corporation organized to do so or a local governmental 
  9.31  unit person may apply to the commissioner of health for a 
  9.32  certificate of authority to establish and operate a health 
  9.33  maintenance organization in compliance with sections 62D.01 to 
  9.34  62D.30.  No person shall establish or operate a health 
  9.35  maintenance organization in this state, nor sell or offer to 
  9.36  sell, or solicit offers to purchase or receive advance or 
 10.1   periodic consideration in conjunction with a health maintenance 
 10.2   organization or health maintenance contract unless the 
 10.3   organization has a certificate of authority under sections 
 10.4   62D.01 to 62D.30.  An out-of-state corporation may qualify under 
 10.5   this chapter, subject to obtaining a certificate of authority to 
 10.6   do business in this state, as an out-of-state corporation under 
 10.7   chapter 303 and compliance with this chapter and other 
 10.8   applicable state laws. 
 10.9      Sec. 5.  Minnesota Statutes 2002, section 62D.04, 
 10.10  subdivision 1, is amended to read: 
 10.11     Subdivision 1.  [APPLICATION REVIEW.] Upon receipt of an 
 10.12  application for a certificate of authority, the commissioner of 
 10.13  health shall determine whether the applicant for a certificate 
 10.14  of authority has: 
 10.15     (a) demonstrated the willingness and potential ability to 
 10.16  assure that health care services will be provided in such a 
 10.17  manner as to enhance and assure both the availability and 
 10.18  accessibility of adequate personnel and facilities; 
 10.19     (b) arrangements for an ongoing evaluation of the quality 
 10.20  of health care; 
 10.21     (c) a procedure to develop, compile, evaluate, and report 
 10.22  statistics relating to the cost of its operations, the pattern 
 10.23  of utilization of its services, the quality, availability and 
 10.24  accessibility of its services, and such other matters as may be 
 10.25  reasonably required by regulation of the commissioner of health; 
 10.26     (d) reasonable provisions for emergency and out of area 
 10.27  health care services; 
 10.28     (e) demonstrated that it is financially responsible and may 
 10.29  reasonably be expected to meet its obligations to enrollees and 
 10.30  prospective enrollees.  In making this determination, the 
 10.31  commissioner of health shall require the amounts of net worth 
 10.32  and working capital required in section 62D.042, the deposit 
 10.33  required in section 62D.041, and in addition shall consider: 
 10.34     (1) the financial soundness of its arrangements for health 
 10.35  care services and the proposed schedule of charges used in 
 10.36  connection therewith; 
 11.1      (2) arrangements which will guarantee for a reasonable 
 11.2   period of time the continued availability or payment of the cost 
 11.3   of health care services in the event of discontinuance of the 
 11.4   health maintenance organization; and 
 11.5      (3) agreements with providers for the provision of health 
 11.6   care services; 
 11.7      (f) demonstrated that it will assume full financial risk on 
 11.8   a prospective basis for the provision of comprehensive health 
 11.9   maintenance services, including hospital care; provided, 
 11.10  however, that the requirement in this paragraph shall not 
 11.11  prohibit the following: 
 11.12     (1) a health maintenance organization from obtaining 
 11.13  insurance or making other arrangements (i) for the cost of 
 11.14  providing to any enrollee comprehensive health maintenance 
 11.15  services, the aggregate value of which exceeds $5,000 in any 
 11.16  year, (ii) for the cost of providing comprehensive health care 
 11.17  services to its members on a nonelective emergency basis, or 
 11.18  while they are outside the area served by the organization, or 
 11.19  (iii) for not more than 95 percent of the amount by which the 
 11.20  health maintenance organization's costs for any of its fiscal 
 11.21  years exceed 105 percent of its income for such fiscal years; 
 11.22  and 
 11.23     (2) a health maintenance organization from having a 
 11.24  provision in a group health maintenance contract allowing an 
 11.25  adjustment of premiums paid based upon the actual health 
 11.26  services utilization of the enrollees covered under the 
 11.27  contract, except that at no time during the life of the contract 
 11.28  shall the contract holder fully self-insure the financial risk 
 11.29  of health care services delivered under the contract.  Risk 
 11.30  sharing arrangements shall be subject to the requirements of 
 11.31  sections 62D.01 to 62D.30; 
 11.32     (g) demonstrated that it has made provisions for and 
 11.33  adopted a conflict of interest policy applicable to all members 
 11.34  of the board of directors and the principal officers of the 
 11.35  health maintenance organization.  The conflict of interest 
 11.36  policy shall include the procedures described in section 
 12.1   317A.255, subdivisions 1 and 2, or a substantially similar 
 12.2   provision contained in the laws under which the health 
 12.3   maintenance organization is incorporated or otherwise 
 12.4   organized.  However, the commissioner is not precluded from 
 12.5   finding that a particular transaction is an unreasonable expense 
 12.6   as described in section 62D.19 even if the directors follow the 
 12.7   required procedures; and 
 12.8      (h) otherwise met the requirements of sections 62D.01 to 
 12.9   62D.30. 
 12.10     Sec. 6.  Minnesota Statutes 2002, section 62D.05, 
 12.11  subdivision 1, is amended to read: 
 12.12     Subdivision 1.  [AUTHORITY GRANTED.] Any nonprofit 
 12.13  corporation or local governmental unit person may, upon 
 12.14  obtaining a certificate of authority as required in sections 
 12.15  62D.01 to 62D.30, operate as a health maintenance organization. 
 12.16     Sec. 7.  Minnesota Statutes 2003 Supplement, section 
 12.17  62E.08, subdivision 1, is amended to read: 
 12.18     Subdivision 1.  [ESTABLISHMENT.] The association shall 
 12.19  establish the following maximum premiums to be charged for 
 12.20  membership in the comprehensive health insurance plan: 
 12.21     (a) the premium for the number one qualified plan shall 
 12.22  range from a minimum of 101 115 percent to a maximum of 125 135 
 12.23  percent of the weighted average of rates charged by those 
 12.24  insurers and health maintenance organizations with individuals 
 12.25  enrolled in: 
 12.26     (1) $1,000 annual deductible individual plans of insurance 
 12.27  in force in Minnesota; 
 12.28     (2) individual health maintenance organization contracts of 
 12.29  coverage with a $1,000 annual deductible which are in force in 
 12.30  Minnesota; and 
 12.31     (3) other plans of coverage similar to plans offered by the 
 12.32  association based on generally accepted actuarial principles; 
 12.33     (b) the premium for the number two qualified plan shall 
 12.34  range from a minimum of 101 115 percent to a maximum of 125 135 
 12.35  percent of the weighted average of rates charged by those 
 12.36  insurers and health maintenance organizations with individuals 
 13.1   enrolled in: 
 13.2      (1) $500 annual deductible individual plans of insurance in 
 13.3   force in Minnesota; 
 13.4      (2) individual health maintenance organization contracts of 
 13.5   coverage with a $500 annual deductible which are in force in 
 13.6   Minnesota; and 
 13.7      (3) other plans of coverage similar to plans offered by the 
 13.8   association based on generally accepted actuarial principles; 
 13.9      (c) the premiums for the plans with a $2,000, $5,000, or 
 13.10  $10,000 annual deductible shall range from a minimum of 101 115 
 13.11  percent to a maximum of 125 135 percent of the weighted average 
 13.12  of rates charged by those insurers and health maintenance 
 13.13  organizations with individuals enrolled in: 
 13.14     (1) $2,000, $5,000, or $10,000 annual deductible individual 
 13.15  plans, respectively, in force in Minnesota; and 
 13.16     (2) individual health maintenance organization contracts of 
 13.17  coverage with a $2,000, $5,000, or $10,000 annual deductible, 
 13.18  respectively, which are in force in Minnesota; or 
 13.19     (3) other plans of coverage similar to plans offered by the 
 13.20  association based on generally accepted actuarial principles; 
 13.21     (d) the premium for each type of Medicare supplement plan 
 13.22  required to be offered by the association pursuant to section 
 13.23  62E.12 shall range from a minimum of 101 115 percent to a 
 13.24  maximum of 125 135 percent of the weighted average of rates 
 13.25  charged by those insurers and health maintenance organizations 
 13.26  with individuals enrolled in:  
 13.27     (1) Medicare supplement plans in force in Minnesota; 
 13.28     (2) health maintenance organization Medicare supplement 
 13.29  contracts of coverage which are in force in Minnesota; and 
 13.30     (3) other plans of coverage similar to plans offered by the 
 13.31  association based on generally accepted actuarial principles; 
 13.32  and 
 13.33     (e) the charge for health maintenance organization coverage 
 13.34  shall be based on generally accepted actuarial principles. 
 13.35     The list of insurers and health maintenance organizations 
 13.36  whose rates are used to establish the premium for coverage 
 14.1   offered by the association pursuant to paragraphs (a) to (d) 
 14.2   shall be established by the commissioner on the basis of 
 14.3   information which shall be provided to the association by all 
 14.4   insurers and health maintenance organizations annually at the 
 14.5   commissioner's request.  This information shall include the 
 14.6   number of individuals covered by each type of plan or contract 
 14.7   specified in paragraphs (a) to (d) that is sold, issued, and 
 14.8   renewed by the insurers and health maintenance organizations, 
 14.9   including those plans or contracts available only on a renewal 
 14.10  basis.  The information shall also include the rates charged for 
 14.11  each type of plan or contract.  
 14.12     In establishing premiums pursuant to this section, the 
 14.13  association shall utilize generally accepted actuarial 
 14.14  principles, provided that the association shall not discriminate 
 14.15  in charging premiums based upon sex.  In order to compute a 
 14.16  weighted average for each type of plan or contract specified 
 14.17  under paragraphs (a) to (d), the association shall, using the 
 14.18  information collected pursuant to this subdivision, list 
 14.19  insurers and health maintenance organizations in rank order of 
 14.20  the total number of individuals covered by each insurer or 
 14.21  health maintenance organization.  The association shall then 
 14.22  compute a weighted average of the rates charged for coverage by 
 14.23  all the insurers and health maintenance organizations by: 
 14.24     (1) multiplying the numbers of individuals covered by each 
 14.25  insurer or health maintenance organization by the rates charged 
 14.26  for coverage; 
 14.27     (2) separately summing both the number of individuals 
 14.28  covered by all the insurers and health maintenance organizations 
 14.29  and all the products computed under clause (1); and 
 14.30     (3) dividing the total of the products computed under 
 14.31  clause (1) by the total number of individuals covered.  
 14.32     The association may elect to use a sample of information 
 14.33  from the insurers and health maintenance organizations for 
 14.34  purposes of computing a weighted average.  In no case, however, 
 14.35  may a sample used by the association to compute a weighted 
 14.36  average include information from fewer than the two insurers or 
 15.1   health maintenance organizations highest in rank order.  
 15.2      Sec. 8.  Minnesota Statutes 2003 Supplement, section 
 15.3   62E.091, is amended to read: 
 15.4      62E.091 [APPROVAL OF STATE PLAN PREMIUMS.] 
 15.5      The association shall submit to the commissioner any 
 15.6   premiums it proposes to become effective for coverage under the 
 15.7   comprehensive health insurance plan, pursuant to section 62E.08, 
 15.8   subdivision 3.  No later than 45 days before the effective date 
 15.9   for premiums specified in section 62E.08, subdivision 3, the 
 15.10  commissioner shall approve, modify, or reject the proposed 
 15.11  premiums on the basis of the following criteria:  
 15.12     (a) whether the association has complied with the 
 15.13  provisions of section 62E.11, subdivision 11; 
 15.14     (b) whether the association has submitted the proposed 
 15.15  premiums in a manner which provides sufficient time for 
 15.16  individuals covered under the comprehensive insurance plan to 
 15.17  receive notice of any premium increase no less than 30 days 
 15.18  prior to the effective date of the increase; 
 15.19     (c) the degree to which the association's computations and 
 15.20  conclusions are consistent with section 62E.08; 
 15.21     (d) the degree to which any sample used to compute a 
 15.22  weighted average by the association pursuant to section 62E.08 
 15.23  reasonably reflects circumstances existing in the private 
 15.24  marketplace for individual coverage; 
 15.25     (e) the degree to which a weighted average computed 
 15.26  pursuant to section 62E.08 that uses information pertaining to 
 15.27  individual coverage available only on a renewal basis reflects 
 15.28  the circumstances existing in the private marketplace for 
 15.29  individual coverage; 
 15.30     (f) a comparison of the proposed increases with increases 
 15.31  in the cost of medical care and increases experienced in the 
 15.32  private marketplace for individual coverage; 
 15.33     (g) the financial consequences to enrollees of the proposed 
 15.34  increase; 
 15.35     (h) the actuarially projected effect of the proposed 
 15.36  increase upon both total enrollment in, and the nature of the 
 16.1   risks assumed by, the comprehensive health insurance plan; 
 16.2      (i) the relative solvency of the contributing members; and 
 16.3      (j) other factors deemed relevant by the commissioner. 
 16.4      In no case, however, may the commissioner approve premiums 
 16.5   for those plans of coverage described in section 62E.08, 
 16.6   subdivision 1, paragraphs (a) to (d), that are lower than 101 
 16.7   115 percent or greater than 125 135 percent of the weighted 
 16.8   averages computed by the association pursuant to section 
 16.9   62E.08.  The commissioner shall support a decision to approve, 
 16.10  modify, or reject any premium proposed by the association with 
 16.11  written findings and conclusions addressing each criterion 
 16.12  specified in this section.  If the commissioner does not 
 16.13  approve, modify, or reject the premiums proposed by the 
 16.14  association sooner than 45 days before the effective date for 
 16.15  premiums specified in section 62E.08, subdivision 3, the 
 16.16  premiums proposed by the association under this section become 
 16.17  effective.  
 16.18     Sec. 9.  [62Q.37] [AUDITS CONDUCTED BY NATIONALLY 
 16.19  RECOGNIZED INDEPENDENT ORGANIZATION.] 
 16.20     Subdivision 1.  [APPLICABILITY.] This section applies only 
 16.21  to (i) a nonprofit health service plan corporation operating 
 16.22  under chapter 62C; (ii) a health maintenance organization 
 16.23  operating under chapter 62D; (iii) a community integrated 
 16.24  service network operating under chapter 62N; and (iv) managed 
 16.25  care organizations operating under chapter 256B, 256D, or 256L. 
 16.26     Subd. 2.  [DEFINITIONS.] For purposes of this section, the 
 16.27  following terms have the meanings given them. 
 16.28     (a) "Commissioner" means the commissioner of health for 
 16.29  purposes of regulating health maintenance organizations and 
 16.30  community integrated service networks, the commissioner of 
 16.31  commerce for purposes of regulating nonprofit health service 
 16.32  plan corporations, or the commissioner of human services for the 
 16.33  purpose of contracting with managed care organizations serving 
 16.34  persons enrolled in programs under chapter 256B, 256D, or 256L. 
 16.35     (b) "Health plan company" means (i) a nonprofit health 
 16.36  service plan corporation operating under chapter 62C; (ii) a 
 17.1   health maintenance organization operating under chapter 62D; 
 17.2   (iii) a community integrated service network operating under 
 17.3   chapter 62N; or (iv) a managed care organization operating under 
 17.4   chapter 256B, 256D, or 256L. 
 17.5      (c) "Nationally recognized independent organization" means 
 17.6   (i) an organization that sets specific national standards 
 17.7   governing health care quality assurance processes, utilization 
 17.8   review, provider credentialing, marketing, and other topics 
 17.9   covered by this chapter and other chapters and audits and 
 17.10  provides accreditation to those health plan companies that meet 
 17.11  those standards.  The American Accreditation Health Care 
 17.12  Commission (URAC), the National Committee for Quality Assurance 
 17.13  (NCQA), and the Joint Commission on Accreditation of Healthcare 
 17.14  Organizations (JCAHO) are, at a minimum, defined as nationally 
 17.15  recognized independent organizations; and (ii) the Centers for 
 17.16  Medicare and Medicaid Services for purposes of reviews or audits 
 17.17  conducted of health plan companies under Part C of Title XVIII 
 17.18  of the Social Security Act or under section 1876 of the Social 
 17.19  Security Act. 
 17.20     (d) "Performance standard" means those standards relating 
 17.21  to quality management and improvement, access and availability 
 17.22  of service, utilization review, provider selection, provider 
 17.23  credentialing, marketing, member rights and responsibilities, 
 17.24  complaints, appeals, grievance systems, enrollee information and 
 17.25  materials, enrollment and disenrollment, subcontractual 
 17.26  relationships and delegation, confidentiality, continuity and 
 17.27  coordination of care, assurance of adequate capacity and 
 17.28  services, coverage and authorization of services, practice 
 17.29  guidelines, health information systems, and financial solvency. 
 17.30     Subd. 3.  [AUDITS.] (a) The commissioner may conduct 
 17.31  routine audits and investigations as prescribed under the 
 17.32  commissioner's respective state authorizing statutes.  If a 
 17.33  nationally recognized independent organization has conducted an 
 17.34  audit of the health plan company using audit procedures that are 
 17.35  comparable to or more stringent than the commissioner's audit 
 17.36  procedures: 
 18.1      (1) the commissioner may accept the independent audit and 
 18.2   require no further audit if the results of the independent audit 
 18.3   show that the performance standard being audited meets or 
 18.4   exceeds state standards; 
 18.5      (2) the commissioner may accept the independent audit and 
 18.6   limit further auditing if the results of the independent audit 
 18.7   show that the performance standard being audited partially meets 
 18.8   state standards; 
 18.9      (3) the health plan company must demonstrate to the 
 18.10  commissioner that the nationally recognized independent 
 18.11  organization that conducted the audit is qualified and that the 
 18.12  results of the audit demonstrate that the particular performance 
 18.13  standard partially or fully meets state standards; and 
 18.14     (4) if the commissioner has partially or fully accepted an 
 18.15  independent audit of the performance standard, the commissioner 
 18.16  may use the finding of a deficiency with regard to statutes or 
 18.17  rules by an independent audit as the basis for a targeted audit 
 18.18  or enforcement action. 
 18.19     (b) If a health plan company has formally delegated 
 18.20  activities that are required under either state law or contract 
 18.21  to another organization that has undergone an audit by a 
 18.22  nationally recognized independent organization, that health plan 
 18.23  company may use the nationally recognized accrediting body's 
 18.24  determination on its own behalf under this section. 
 18.25     Subd. 4.  [DISCLOSURE OF NATIONAL STANDARDS AND 
 18.26  REPORTS.] The health plan company shall: 
 18.27     (1) request that the nationally recognized independent 
 18.28  organization provide to the commissioner a copy of the current 
 18.29  nationally recognized independent organization's standards upon 
 18.30  which the acceptable accreditation status has been granted; and 
 18.31     (2) provide the commissioner a copy of the most current 
 18.32  final audit report issued by the nationally recognized 
 18.33  independent organization. 
 18.34     Subd. 5.  [ACCREDITATION NOT REQUIRED.] Nothing in this 
 18.35  section requires a health plan company to seek an acceptable 
 18.36  accreditation status from a nationally recognized independent 
 19.1   organization. 
 19.2      Subd. 6.  [CONTINUED AUTHORITY.] Nothing in this section 
 19.3   precludes the commissioner from conducting audits and 
 19.4   investigations or requesting data as granted under the 
 19.5   commissioner's respective state authorizing statutes. 
 19.6      Subd. 7.  [HUMAN SERVICES.] The commissioner of human 
 19.7   services shall implement this section in a manner that is 
 19.8   consistent with applicable federal laws and regulations. 
 19.9      Subd. 8.  [CONFIDENTIALITY.] Any documents provided to the 
 19.10  commissioner related to the audit report that may be accepted 
 19.11  under this section are private data on individuals pursuant to 
 19.12  chapter 13 and may only be released as permitted under section 
 19.13  60A.03, subdivision 9. 
 19.14     Sec. 10.  Minnesota Statutes 2002, section 72A.20, is 
 19.15  amended by adding a subdivision to read: 
 19.16     Subd. 37.  [ELECTRONIC TRANSMISSION OF REQUIRED 
 19.17  INFORMATION.] A health carrier, as defined in section 62A.011, 
 19.18  subdivision 2, is not in violation of this chapter for 
 19.19  electronically transmitting or electronically making available 
 19.20  information otherwise required to be delivered in writing under 
 19.21  chapters 62A to 62Q and 72A to an enrollee as defined in section 
 19.22  62Q.01, subdivision 2a, and with the requirements of those 
 19.23  chapters if the following conditions are met: 
 19.24     (1) the health carrier informs the enrollee that electronic 
 19.25  transmission or access is available and, at the discretion of 
 19.26  the health carrier, the enrollee is given one of the following 
 19.27  options: 
 19.28     (i) electronic transmission or access will occur only if 
 19.29  the enrollee affirmatively requests to the health carrier that 
 19.30  the required information be electronically transmitted or 
 19.31  available and a record of that request is retained by the health 
 19.32  carrier; or 
 19.33     (ii) electronic transmission or access will automatically 
 19.34  occur if the enrollee has not opted out of that manner of 
 19.35  transmission by request to the health carrier and requested that 
 19.36  the information be provided in writing.  If the enrollee opts 
 20.1   out of electronic transmission, a record of that request must be 
 20.2   retained by the health carrier; 
 20.3      (2) the enrollee is allowed to withdraw the request at any 
 20.4   time; 
 20.5      (3) if the information transmitted electronically contains 
 20.6   individually identifiable data, it must be transmitted to a 
 20.7   secured mailbox.  If the information made available 
 20.8   electronically contains individually identifiable data, it must 
 20.9   be made available at a password-protected secured Web site; 
 20.10     (4) the enrollee is provided a customer service number on 
 20.11  the enrollee's member card that may be called to request a 
 20.12  written copy of the document; and 
 20.13     (5) the electronic transmission or electronic availability 
 20.14  meets all other requirements of this chapter including, but not 
 20.15  limited to, size of the typeface and any required time frames 
 20.16  for distribution. 
 20.17     Sec. 11.  [CHANGE OF HEALTH MAINTENANCE ORGANIZATION 
 20.18  REGULATORY AUTHORITY.] 
 20.19     (a) Effective July 1, 2005, regulatory authority for health 
 20.20  maintenance organizations under Minnesota Statutes, chapter 62D; 
 20.21  community health clinics with respect to health care services 
 20.22  prepaid option plans offered under Minnesota Statutes, section 
 20.23  62Q.22; community integrated service networks, as defined in 
 20.24  Minnesota Statutes, section 62N.02, subdivision 4a; health care 
 20.25  cooperatives operating under Minnesota Statutes, chapter 62R; 
 20.26  health care purchasing alliances and accountable provider 
 20.27  networks operating under Minnesota Statutes, chapter 62T; and 
 20.28  county-based purchasing programs operating under Minnesota 
 20.29  Statutes, section 256B.692, subdivision 2, is transferred from 
 20.30  the commissioner of health to the commissioner of commerce. 
 20.31     (b) Minnesota Statutes, section 15.039, applies to this 
 20.32  transfer of authority. 
 20.33     (c) The revisor of statutes shall make changes to conform 
 20.34  to paragraph (a) by changing references to the commissioner of 
 20.35  health, Department of Health, and similar references, to the 
 20.36  commissioner of commerce, Department of Commerce, or similar 
 21.1   references, and by changing references to both commissioners or 
 21.2   both departments or "the appropriate commissioner" or similar 
 21.3   term to the commissioner or Department of Commerce, as 
 21.4   appropriate in Minnesota Statutes, sections 62A.021, subdivision 
 21.5   1, paragraph (h); 62D.02, subdivision 3; 62D.12, subdivision 1; 
 21.6   62D.15, subdivision 1; 62D.24, by also changing the existing 
 21.7   reference to "commissioner of commerce" to read "commissioner of 
 21.8   health"; 62E.05, subdivision 2; 62E.11, subdivision 13; 62J.041, 
 21.9   subdivision 4; 62J.701; 62J.74, subdivisions 1 and 2; 62L.02, 
 21.10  subdivision 8; 62L.05, subdivision 12; 62L.08, subdivisions 10 
 21.11  and 11; 62L.09, subdivision 3; 62L.10, subdivision 4; 62L.11, 
 21.12  subdivision 2; 62M.11; 62M.16; 62N.02, subdivision 4; 62N.26; 
 21.13  62Q.01, subdivision 2; 62Q.106; 62Q.22, subdivisions 2, 6, and 
 21.14  7; 62Q.33, subdivision 2, by specifying that the commissioner 
 21.15  referenced in the last sentence is the commissioner of health; 
 21.16  62Q.49, subdivision 2; 62Q.51, subdivision 3; 62Q.525, 
 21.17  subdivision 3; 62Q.69, subdivisions 2 and 3; 62Q.71; 62Q.72; 
 21.18  62Q.73, subdivisions 3, 4, 5, and 6; 62R.04, subdivision 5; 
 21.19  62R.06, subdivision 1; 62T.01; 256B.692, subdivisions 2 and 7.  
 21.20  The revisor of statutes shall, in preparing Minnesota Statutes 
 21.21  2004, make all conforming changes in Minnesota Statutes, chapter 
 21.22  62D, and other chapters. 
 21.23                             ARTICLE 6 
 21.24    HEALTH CARE COST CONTAINMENT; ADMINISTRATIVE SIMPLIFICATION 
 21.25     Section 1.  Minnesota Statutes 2002, section 147.03, 
 21.26  subdivision 1, is amended to read: 
 21.27     Subdivision 1.  [ENDORSEMENT; RECIPROCITY.] (a) The board 
 21.28  may issue a license to practice medicine to any person who 
 21.29  satisfies the requirements in paragraphs (b) to (f).  
 21.30     (b) The applicant shall satisfy all the requirements 
 21.31  established in section 147.02, subdivision 1, paragraphs (a), 
 21.32  (b), (d), (e), and (f).  
 21.33     (c) The applicant shall: 
 21.34     (1) have passed an examination prepared and graded by the 
 21.35  Federation of State Medical Boards, the National Board of 
 21.36  Medical Examiners, or the United States Medical Licensing 
 22.1   Examination program in accordance with section 147.02, 
 22.2   subdivision 1, paragraph (c), clause (2); the National Board of 
 22.3   Osteopathic Examiners; or the Medical Council of Canada; and 
 22.4      (2) have a current license from the equivalent licensing 
 22.5   agency in another state or Canada and, if the examination in 
 22.6   clause (1) was passed more than ten years ago, either: 
 22.7      (i) pass the Special Purpose Examination of the Federation 
 22.8   of State Medical Boards with a score of 75 or better within 
 22.9   three attempts; or 
 22.10     (ii) have a current certification by a specialty board of 
 22.11  the American Board of Medical Specialties, of the American 
 22.12  Osteopathic Association Bureau of Professional Education, or of 
 22.13  the Royal College of Physicians and Surgeons of Canada. 
 22.14     (d) The applicant shall pay a fee established by the board 
 22.15  by rule.  The fee may not be refunded.  
 22.16     (e) The applicant must not be under license suspension or 
 22.17  revocation by the licensing board of the state or jurisdiction 
 22.18  in which the conduct that caused the suspension or revocation 
 22.19  occurred. 
 22.20     (f) The applicant must not have engaged in conduct 
 22.21  warranting disciplinary action against a licensee, or have been 
 22.22  subject to disciplinary action other than as specified in 
 22.23  paragraph (e).  If an applicant does not satisfy the 
 22.24  requirements stated in this paragraph, the board may issue a 
 22.25  license only on the applicant's showing that the public will be 
 22.26  protected through issuance of a license with conditions or 
 22.27  limitations the board considers appropriate. 
 22.28     (g) Upon the request of an applicant, the board may conduct 
 22.29  the final interview of the applicant by teleconference. 
 22.30     Sec. 2.  Minnesota Statutes 2002, section 256B.04, is 
 22.31  amended by adding a subdivision to read: 
 22.32     Subd. 20.  [INFORMATION WEB SITE FOR INTERPRETER SERVICES.] 
 22.33  The commissioner shall establish an information Web site to 
 22.34  assist health care providers in obtaining oral language 
 22.35  interpreter services when these services are needed to enable a 
 22.36  patient to obtain a health care service from a provider.  The 
 23.1   commissioner must collect and maintain contact and rate 
 23.2   information for providers of oral language interpreter services 
 23.3   and must make this information available to all health care 
 23.4   providers, whether or not the provider is enrolled in a state 
 23.5   health care program.  The Web site list is not an endorsement by 
 23.6   the commissioner of any particular interpreter. 
 23.7      Sec. 3.  [COST OF HEALTH CARE REPORTING.] 
 23.8      The commissioners of human services, health, and commerce 
 23.9   shall meet with representatives of health plan companies as 
 23.10  defined in Minnesota Statutes, section 62Q.01, subdivision 4, 
 23.11  and hospitals to evaluate reporting requirements for these 
 23.12  regulated entities and develop recommendations for reducing 
 23.13  required reports.  The commissioner must meet with the specified 
 23.14  representatives prior to August 30, 2004, and must submit a 
 23.15  consolidated report to the legislature by January 15, 2005.  The 
 23.16  report must: 
 23.17     (1) identify the name and scope of each required report; 
 23.18     (2) evaluate the need for and use of each report, including 
 23.19  the value of the report to consumers; 
 23.20     (3) evaluate the extent to which the report is used to 
 23.21  reduce costs and increase quality of care; 
 23.22     (4) identify reports that are no longer required; and 
 23.23     (5) specify any statutory changes necessary to eliminate 
 23.24  required reports. 
 23.25     Sec. 4.  [REPEALER.] 
 23.26     Minnesota Statutes 2002, section 62J.17, subdivisions 1, 3, 
 23.27  4a, 5a, 6a, 7, and 8; and Minnesota Statutes 2003 Supplement, 
 23.28  section 62J.17, subdivision 2, are repealed effective the day 
 23.29  following final enactment. 
 23.30                             ARTICLE 7 
 23.31                             CHILD CARE 
 23.32     Section 1.  Minnesota Statutes 2003 Supplement, section 
 23.33  119B.09, subdivision 9, is amended to read: 
 23.34     Subd. 9.  [LICENSED AND LEGAL NONLICENSED FAMILY CHILD CARE 
 23.35  PROVIDERS; ASSISTANCE.] Licensed and legal nonlicensed family 
 23.36  child care providers are not eligible to receive child care 
 24.1   assistance subsidies under this chapter for their own children 
 24.2   or children in their custody family during the hours they are 
 24.3   providing child care or being paid to provide child care.  Child 
 24.4   care providers are eligible to receive child care assistance 
 24.5   subsidies for their own children when they are engaged in other 
 24.6   work activities that meet the requirements of this chapter and 
 24.7   for which child care assistance can be paid.  The hours for 
 24.8   which the child care provider receives a child care subsidy for 
 24.9   their own children must not overlap with the hours the provider 
 24.10  provides child care services. 
 24.11     Sec. 2.  Minnesota Statutes 2003 Supplement, section 
 24.12  119B.13, subdivision 1, is amended to read: 
 24.13     Subdivision 1.  [SUBSIDY RESTRICTIONS.] (a) The maximum 
 24.14  rate paid for child care assistance under the child care fund 
 24.15  may not exceed the 75th percentile rate for like-care 
 24.16  arrangements in the county as surveyed by the commissioner.  
 24.17     (b) A rate which includes a provider bonus paid under 
 24.18  subdivision 2 or a special needs rate paid under subdivision 3 
 24.19  may be in excess of the maximum rate allowed under this 
 24.20  subdivision.  
 24.21     (c) The department shall monitor the effect of this 
 24.22  paragraph on provider rates.  The county shall pay the 
 24.23  provider's full charges for every child in care up to the 
 24.24  maximum established.  The commissioner shall determine the 
 24.25  maximum rate for each type of care on an hourly, full-day, and 
 24.26  weekly basis, including special needs and handicapped care.  Not 
 24.27  less than once every two years, the commissioner shall evaluate 
 24.28  market practices for payment of absences and shall establish 
 24.29  policies for payment of absent days that reflect current market 
 24.30  practice. 
 24.31     (d) When the provider charge is greater than the maximum 
 24.32  provider rate allowed, the parent is responsible for payment of 
 24.33  the difference in the rates in addition to any family co-payment 
 24.34  fee. 
 24.35     Sec. 3.  Minnesota Statutes 2002, section 119B.13, is 
 24.36  amended by adding a subdivision to read: 
 25.1      Subd. 7.  [ABSENT DAYS.] Child care providers may not be 
 25.2   reimbursed for more than 25 absent days per child in a 12-month 
 25.3   period, or for more than ten consecutive absent days, unless the 
 25.4   child has a documented medical condition that causes more 
 25.5   frequent absences.  Documentation of medical conditions must be 
 25.6   on the forms and submitted according to the timelines 
 25.7   established by the commissioner. 
 25.8      [EFFECTIVE DATE.] This section is effective July 1, 2004. 
 25.9      Sec. 4.  Minnesota Statutes 2003 Supplement, section 
 25.10  245A.10, subdivision 4, is amended to read: 
 25.11     Subd. 4.  [ANNUAL LICENSE OR CERTIFICATION FEE FOR PROGRAMS 
 25.12  WITH LICENSED CAPACITY.] (a) Child care centers and programs 
 25.13  with a licensed capacity shall pay an annual nonrefundable 
 25.14  license or certification fee based on the following schedule: 
 25.15      Licensed Capacity          Child Care         Other
 25.16                                 Center             Program
 25.17                                 License Fee        License Fee
 25.18       1 to 24 persons               $300 $225          $400
 25.19       25 to 49 persons              $450 $340          $600
 25.20       50 to 74 persons              $600 $450          $800
 25.21       75 to 99 persons              $750 $565        $1,000
 25.22       100 to 124 persons            $900 $675        $1,200
 25.23       125 to 149 persons          $1,200 $900        $1,400
 25.24       150 to 174 persons          $1,400 $1,050      $1,600
 25.25       175 to 199 persons          $1,600 $1,200      $1,800
 25.26       200 to 224 persons          $1,800 $1,350      $2,000
 25.27       225 or more persons         $2,000 $1,500      $2,500
 25.28     (b) A day training and habilitation program serving persons 
 25.29  with developmental disabilities or related conditions shall be 
 25.30  assessed a license fee based on the schedule in paragraph (a) 
 25.31  unless the license holder serves more than 50 percent of the 
 25.32  same persons at two or more locations in the community.  When a 
 25.33  day training and habilitation program serves more than 50 
 25.34  percent of the same persons in two or more locations in a 
 25.35  community, the day training and habilitation program shall pay a 
 25.36  license fee based on the licensed capacity of the largest 
 26.1   facility and the other facility or facilities shall be charged a 
 26.2   license fee based on a licensed capacity of a residential 
 26.3   program serving one to 24 persons. 
 26.4      Sec. 5.  Laws 2003, First Special Session chapter 14, 
 26.5   article 9, section 34, is amended to read: 
 26.6      Sec. 34.  [DIRECTION TO COMMISSIONER; PROVIDER RATES.] 
 26.7      (a) The provider rates determined under Minnesota Statutes, 
 26.8   section 119B.13, for fiscal year 2003 and implemented on July 1, 
 26.9   2002, are to be continued in effect through June 30, 2005 2007.  
 26.10  Beginning on July 1, 2005, counties shall not reduce any child 
 26.11  care center's reimbursement rate below the rate implemented on 
 26.12  July 1, 2003.  
 26.13     (b) The commissioner of human services is directed to 
 26.14  evaluate the costs of child care in Minnesota, to examine the 
 26.15  differences in the cost of child care in rural and metropolitan 
 26.16  areas, and to make recommendations to the legislature for 
 26.17  containing future cost increases in the child care program under 
 26.18  Minnesota Statutes, chapter 119B, in a manner that complies with 
 26.19  federal child care and development block grant requirements for 
 26.20  promoting parental choice and permits the department to track 
 26.21  the effect of rate changes on child care assistance program 
 26.22  costs, the availability of different types of care throughout 
 26.23  the state, the length of waiting lists, and the care options 
 26.24  available to program participants.  The commissioner shall also 
 26.25  examine the allocation formula under Minnesota Statutes, section 
 26.26  119B.03, and make recommendations to the legislature in order to 
 26.27  create a more equitable formula.  The commissioner shall 
 26.28  consider the impact any recommendations might have on work 
 26.29  incentives for low and middle income families and possible 
 26.30  changes to MFIP child care, basic sliding fee child care, and 
 26.31  the dependent care tax credit.  The commissioner shall make 
 26.32  recommendations to the legislature by January 15, 2005. 
 26.33     The commissioner shall also study the relationship between 
 26.34  child care assistance subsidies and tax credits or tax 
 26.35  incentives related to child care expenses, and include this 
 26.36  information in the January 15, 2005, report to the legislature 
 27.1   under this section. 
 27.2      Sec. 6.  [TEMPORARY INELIGIBILITY OF MILITARY PERSONNEL.] 
 27.3      Counties must reserve a family's position under the child 
 27.4   care assistance fund if a family has been receiving child care 
 27.5   assistance but is temporarily ineligible for assistance due to 
 27.6   increased income from active military service.  Activated 
 27.7   military personnel may be temporarily ineligible until 
 27.8   deactivated.  A county must reserve a military family's position 
 27.9   on the basic sliding fee waiting list under the child care 
 27.10  assistance fund if a family is approved to receive child care 
 27.11  assistance and reaches the top of the waiting list but is 
 27.12  temporarily ineligible for assistance. 
 27.13                             ARTICLE 8 
 27.14                         ECONOMIC SUPPORTS 
 27.15     Section 1.  Minnesota Statutes 2002, section 256D.051, 
 27.16  subdivision 1a, is amended to read: 
 27.17     Subd. 1a.  [NOTICES AND SANCTIONS.] (a) At the time the 
 27.18  county agency notifies the household that it is eligible for 
 27.19  food stamps, the county agency must inform all mandatory 
 27.20  employment and training services participants as identified in 
 27.21  subdivision 1 in the household that they must comply with all 
 27.22  food stamp employment and training program requirements each 
 27.23  month, including the requirement to attend an initial 
 27.24  orientation to the food stamp employment and training program 
 27.25  and that food stamp eligibility will end unless the participants 
 27.26  comply with the requirements specified in the notice.  
 27.27     (b) A participant who fails without good cause to comply 
 27.28  with food stamp employment and training program requirements of 
 27.29  this section, including attendance at orientation, will lose 
 27.30  food stamp eligibility for the following periods: 
 27.31     (1) for the first occurrence, for one month or until the 
 27.32  person complies with the requirements not previously complied 
 27.33  with, whichever is longer; 
 27.34     (2) for the second occurrence, for three months or until 
 27.35  the person complies with the requirements not previously 
 27.36  complied with, whichever is longer; or 
 28.1      (3) for the third and any subsequent occurrence, for six 
 28.2   months or until the person complies with the requirements not 
 28.3   previously complied with, whichever is longer. 
 28.4      If the participant is not the food stamp head of household, 
 28.5   the person shall be considered an ineligible household member 
 28.6   for food stamp purposes.  If the participant is the food stamp 
 28.7   head of household, the entire household is ineligible for food 
 28.8   stamps as provided in Code of Federal Regulations, title 7, 
 28.9   section 273.7(g).  "Good cause" means circumstances beyond the 
 28.10  control of the participant, such as illness or injury, illness 
 28.11  or injury of another household member requiring the 
 28.12  participant's presence, a household emergency, or the inability 
 28.13  to obtain child care for children between the ages of six and 12 
 28.14  or to obtain transportation needed in order for the participant 
 28.15  to meet the food stamp employment and training program 
 28.16  participation requirements. 
 28.17     (c) The county agency shall mail or hand deliver a notice 
 28.18  to the participant not later than five days after determining 
 28.19  that the participant has failed without good cause to comply 
 28.20  with food stamp employment and training program requirements 
 28.21  which specifies the requirements that were not complied with, 
 28.22  the factual basis for the determination of noncompliance, and 
 28.23  the right to reinstate eligibility upon a showing of good cause 
 28.24  for failure to meet the requirements.  The notice must ask the 
 28.25  reason for the noncompliance and identify the participant's 
 28.26  appeal rights.  The notice must request that the participant 
 28.27  inform the county agency if the participant believes that good 
 28.28  cause existed for the failure to comply and must state that the 
 28.29  county agency intends to terminate eligibility for food stamp 
 28.30  benefits due to failure to comply with food stamp employment and 
 28.31  training program requirements. 
 28.32     (d) If the county agency determines that the participant 
 28.33  did not comply during the month with all food stamp employment 
 28.34  and training program requirements that were in effect, and if 
 28.35  the county agency determines that good cause was not present, 
 28.36  the county must provide a ten-day notice of termination of food 
 29.1   stamp benefits.  The amount of food stamps that are withheld 
 29.2   from the household and determination of the impact of the 
 29.3   sanction on other household members is governed by Code of 
 29.4   Federal Regulations, title 7, section 273.7. 
 29.5      (e) A participant in the diversionary work program with 
 29.6   children under age six may be required to participate in 
 29.7   employment services under this section, but is not subject to 
 29.8   sanction. 
 29.9      (f) The participant may appeal the termination of food 
 29.10  stamp benefits under the provisions of section 256.045. 
 29.11     Sec. 2.  Minnesota Statutes 2002, section 256D.051, 
 29.12  subdivision 3a, is amended to read: 
 29.13     Subd. 3a.  [PERSONS REQUIRED TO REGISTER FOR AND 
 29.14  PARTICIPATE IN THE FOOD STAMP EMPLOYMENT AND TRAINING PROGRAM.] 
 29.15  (a) To the extent required under Code of Federal Regulations, 
 29.16  title 7, section 273.7(a), each applicant for and recipient of 
 29.17  food stamps is required to register for work as a condition of 
 29.18  eligibility for food stamp benefits.  Applicants and recipients 
 29.19  are registered by signing an application or annual reapplication 
 29.20  for food stamps, and must be informed that they are registering 
 29.21  for work by signing the form.  
 29.22     (b) The commissioner shall determine, within federal 
 29.23  requirements, persons required to participate in the food stamp 
 29.24  employment and training (FSET) program. 
 29.25     (c) The following food stamp recipients are exempt from 
 29.26  mandatory participation in food stamp employment and training 
 29.27  services: 
 29.28     (1) recipients of benefits under the Minnesota family 
 29.29  investment program, Minnesota supplemental aid program, or the 
 29.30  general assistance program; 
 29.31     (2) a child; 
 29.32     (3) a recipient over age 55 49; 
 29.33     (4) a recipient who has a mental or physical illness, 
 29.34  injury, or incapacity which is expected to continue for at least 
 29.35  30 days and which impairs the recipient's ability to obtain or 
 29.36  retain employment as evidenced by professional certification or 
 30.1   the receipt of temporary or permanent disability benefits issued 
 30.2   by a private or government source; 
 30.3      (5) a parent or other household member responsible for the 
 30.4   care of either a dependent child in the household who is under 
 30.5   age six, unless the parent or other household member is a 
 30.6   participant in the diversionary work program, or a person in the 
 30.7   household who is professionally certified as having a physical 
 30.8   or mental illness, injury, or incapacity.  Only one parent or 
 30.9   other household member may claim exemption under this provision; 
 30.10     (6) a recipient receiving unemployment compensation or who 
 30.11  has applied for unemployment compensation and has been required 
 30.12  to register for work with the Department of Economic Security as 
 30.13  part of the unemployment compensation application process; 
 30.14     (7) a recipient participating each week in a drug addiction 
 30.15  or alcohol abuse treatment and rehabilitation program, provided 
 30.16  the operators of the treatment and rehabilitation program, in 
 30.17  consultation with the county agency, recommend that the 
 30.18  recipient not participate in the food stamp employment and 
 30.19  training program; 
 30.20     (8) a recipient employed or self-employed for 30 or more 
 30.21  hours per week at employment paying at least minimum wage, or 
 30.22  who earns wages from employment equal to or exceeding 30 hours 
 30.23  multiplied by the federal minimum wage; or 
 30.24     (9) a student enrolled at least half time in any school, 
 30.25  training program, or institution of higher education.  When 
 30.26  determining if a student meets this criteria, the school's, 
 30.27  program's or institution's criteria for being enrolled half time 
 30.28  shall be used; and 
 30.29     (10) a participant in the diversionary work program who 
 30.30  meets the requirements in section 256J.95, subdivision 11, 
 30.31  paragraph (d). 
 30.32     Sec. 3.  Minnesota Statutes 2002, section 256D.051, 
 30.33  subdivision 6c, is amended to read: 
 30.34     Subd. 6c.  [PROGRAM FUNDING.] Within the limits of 
 30.35  available resources, the commissioner shall reimburse the actual 
 30.36  costs of county agencies and their employment and training 
 31.1   service providers for the provision of food stamp employment and 
 31.2   training services, including participant support services, 
 31.3   direct program services, and program administrative activities.  
 31.4   The cost of services for each county's food stamp employment and 
 31.5   training program shall not exceed an average of $400 per 
 31.6   participant the annual allocated amount.  No more than 15 
 31.7   percent of program funds may be used for administrative 
 31.8   activities.  The county agency may expend county funds in excess 
 31.9   of the limits of this subdivision without state reimbursement. 
 31.10     Program funds shall be allocated based on the county's 
 31.11  average number of food stamp cases as compared to the statewide 
 31.12  total number of such cases.  The average number of cases shall 
 31.13  be based on counts of cases as of March 31, June 30, September 
 31.14  30, and December 31 of the previous calendar year.  The 
 31.15  commissioner may reallocate unexpended money appropriated under 
 31.16  this section to those county agencies that demonstrate a need 
 31.17  for additional funds. 
 31.18     Sec. 4.  Minnesota Statutes 2003 Supplement, section 
 31.19  256J.24, subdivision 6, is amended to read: 
 31.20     Subd. 6.  [FAMILY CAP.] (a) MFIP assistance units shall not 
 31.21  receive an increase in the cash portion of the transitional 
 31.22  standard as a result of the birth of a child, unless one of the 
 31.23  conditions under paragraph (b) is met.  The child shall be 
 31.24  considered a member of the assistance unit according to 
 31.25  subdivisions 1 to 3, but shall be excluded in determining family 
 31.26  size for purposes of determining the amount of the cash portion 
 31.27  of the transitional standard under subdivision 5.  The child 
 31.28  shall be included in determining family size for purposes of 
 31.29  determining the food portion of the transitional standard.  The 
 31.30  transitional standard under this subdivision shall be the total 
 31.31  of the cash and food portions as specified in this paragraph.  
 31.32  The family wage level under this subdivision shall be based on 
 31.33  the family size used to determine the food portion of the 
 31.34  transitional standard. 
 31.35     (b) A child shall be included in determining family size 
 31.36  for purposes of determining the amount of the cash portion of 
 32.1   the MFIP transitional standard when at least one of the 
 32.2   following conditions is met: 
 32.3      (1) for families receiving MFIP assistance on July 1, 2003, 
 32.4   the child is born to the adult parent before May 1, 2004; 
 32.5      (2) for families who apply for the diversionary work 
 32.6   program under section 256J.95 or MFIP assistance on or after 
 32.7   July 1, 2003, the child is born to the adult parent within ten 
 32.8   months of the date the family is eligible for assistance; 
 32.9      (3) the child was conceived as a result of a sexual assault 
 32.10  or incest, provided that the incident has been reported to a law 
 32.11  enforcement agency; 
 32.12     (4) the child's mother is a minor caregiver as defined in 
 32.13  section 256J.08, subdivision 59, and the child, or multiple 
 32.14  children, are the mother's first birth; or 
 32.15     (5) any child previously excluded in determining family 
 32.16  size under paragraph (a) shall be included if the adult parent 
 32.17  or parents have not received benefits from the diversionary work 
 32.18  program under section 256J.95 or MFIP assistance in the previous 
 32.19  ten months.  An adult parent or parents who reapply and have 
 32.20  received benefits from the diversionary work program or MFIP 
 32.21  assistance in the past ten months shall be under the ten-month 
 32.22  grace period of their previous application under clause (2). 
 32.23     (c) Income and resources of a child excluded under this 
 32.24  subdivision, except income of the child support received or 
 32.25  distributed on behalf of this child equal to the change in cash 
 32.26  standard due to the family cap, must be considered using the 
 32.27  same policies as for other children when determining the grant 
 32.28  amount of the assistance unit. 
 32.29     (d) The caregiver must assign support and cooperate with 
 32.30  the child support enforcement agency to establish paternity and 
 32.31  collect child support on behalf of the excluded child.  Failure 
 32.32  to cooperate results in the sanction specified in section 
 32.33  256J.46, subdivisions 2 and 2a.  Current support paid on behalf 
 32.34  of the excluded child shall be distributed according to section 
 32.35  256.741, subdivision 15. 
 32.36     (e) County agencies must inform applicants of the 
 33.1   provisions under this subdivision at the time of each 
 33.2   application and at recertification.  
 33.3      (f) Children excluded under this provision shall be deemed 
 33.4   MFIP recipients for purposes of child care under chapter 119B. 
 33.5      Sec. 5.  Minnesota Statutes 2003 Supplement, section 
 33.6   256J.37, subdivision 3a, is amended to read: 
 33.7      Subd. 3a.  [RENTAL SUBSIDIES; UNEARNED INCOME.] (a) 
 33.8   Effective July 1, 2003, The county agency shall count $50 $200 
 33.9   of the value of public and assisted rental subsidies provided 
 33.10  through the Department of Housing and Urban Development (HUD) as 
 33.11  unearned income to the cash portion of the MFIP grant.  The full 
 33.12  amount of the subsidy must be counted as unearned income when 
 33.13  the subsidy is less than $50 $200.  The income from this subsidy 
 33.14  shall be budgeted according to section 256J.34. 
 33.15     (b) The provisions of this subdivision shall not apply to 
 33.16  an MFIP assistance unit which includes a participant who is: 
 33.17     (1) age 60 or older; 
 33.18     (2) a caregiver who is suffering from an illness, injury, 
 33.19  or incapacity that has been certified by a qualified 
 33.20  professional when the illness, injury, or incapacity is expected 
 33.21  to continue for more than 30 days and prevents the person from 
 33.22  obtaining or retaining employment; or 
 33.23     (3) a caregiver whose presence in the home is required due 
 33.24  to the illness or incapacity of another member in the assistance 
 33.25  unit, a relative in the household, or a foster child in the 
 33.26  household when the illness or incapacity and the need for the 
 33.27  participant's presence in the home has been certified by a 
 33.28  qualified professional and is expected to continue for more than 
 33.29  30 days. 
 33.30     (c) The provisions of this subdivision shall not apply to 
 33.31  an MFIP assistance unit where the parental caregiver is an SSI 
 33.32  recipient. 
 33.33     (d) Prior to implementing this provision, the commissioner 
 33.34  must identify the MFIP participants subject to this provision 
 33.35  and provide written notice to these participants at least 30 
 33.36  days before the first grant reduction.  The notice must inform 
 34.1   the participant of the basis for the potential grant reduction, 
 34.2   the exceptions to the provision, if any, and inform the 
 34.3   participant of the steps necessary to claim an exception.  A 
 34.4   person who is found not to meet one of the exceptions to the 
 34.5   provision must be notified and informed of the right to a fair 
 34.6   hearing under section 256J.40.  The notice must also inform the 
 34.7   participant that the participant may be eligible for a rent 
 34.8   reduction resulting from a reduction in the MFIP grant and 
 34.9   encourage the participant to contact the local housing authority.
 34.10     Sec. 6.  Minnesota Statutes 2003 Supplement, section 
 34.11  256J.53, subdivision 1, is amended to read: 
 34.12     Subdivision 1.  [LENGTH OF PROGRAM.] In order for a 
 34.13  postsecondary education or training program to be an approved 
 34.14  work activity as defined in section 256J.49, subdivision 13, 
 34.15  clause (6), it must be a program lasting 24 12 months or less, 
 34.16  and the participant must meet the requirements of subdivisions 
 34.17  2, 3, and 5.  
 34.18                             ARTICLE 9 
 34.19                            HEALTH CARE 
 34.20     Section 1.  Minnesota Statutes 2003 Supplement, section 
 34.21  256.955, subdivision 2a, is amended to read: 
 34.22     Subd. 2a.  [ELIGIBILITY.] An individual satisfying the 
 34.23  following requirements and the requirements described in 
 34.24  subdivision 2, paragraph (d), is eligible for the prescription 
 34.25  drug program who: 
 34.26     (1) is at least 65 years of age or older; and 
 34.27     (2) is eligible as a qualified Medicare beneficiary 
 34.28  according to section 256B.057, subdivision 3 or 3a, or is 
 34.29  eligible under section 256B.057, subdivision 3 or 3a, and is 
 34.30  also eligible for medical assistance or general assistance 
 34.31  medical care with a spenddown as defined in section 256B.056, 
 34.32  subdivision 5; and 
 34.33     (3) applies for the Medicare drug discount card, if 
 34.34  eligible. 
 34.35     [EFFECTIVE DATE.] Clause (3) is effective July 1, 2004, or 
 34.36  when enrollment for the Medicare drug discount card is 
 35.1   available, whichever is later. 
 35.2      Sec. 2.  Minnesota Statutes 2002, section 256.955, 
 35.3   subdivision 2b, is amended to read: 
 35.4      Subd. 2b.  [ELIGIBILITY.] Effective July 1, 2002, an 
 35.5   individual satisfying the following requirements and the 
 35.6   requirements described in subdivision 2, paragraph (d), is 
 35.7   eligible for the prescription drug program: 
 35.8      (1) is under 65 years of age; and 
 35.9      (2) is eligible as a qualified Medicare beneficiary 
 35.10  according to section 256B.057, subdivision 3 or 3a or is 
 35.11  eligible under section 256B.057, subdivision 3 or 3a and is also 
 35.12  eligible for medical assistance or general assistance medical 
 35.13  care with a spenddown as defined in section 256B.056, 
 35.14  subdivision 5; and 
 35.15     (3) applies for the Medicare drug discount card, if 
 35.16  eligible. 
 35.17     [EFFECTIVE DATE.] Clause (3) is effective July 1, 2004, or 
 35.18  when enrollment for the Medicare drug discount card is 
 35.19  available, whichever is later. 
 35.20     Sec. 3.  Minnesota Statutes 2003 Supplement, section 
 35.21  256.955, subdivision 3, is amended to read: 
 35.22     Subd. 3.  [PRESCRIPTION DRUG COVERAGE.] Coverage under the 
 35.23  program shall be limited to those prescription drugs that: 
 35.24     (1) are covered under the medical assistance program as 
 35.25  described in section 256B.0625, subdivision 13; 
 35.26     (2) are provided by manufacturers that have fully executed 
 35.27  senior prescription drug program rebate agreements with the 
 35.28  commissioner and comply with such agreements; and 
 35.29     (3) for a specific enrollee, are not covered under an 
 35.30  assistance program offered by a pharmaceutical manufacturer, as 
 35.31  determined by the board on aging under section 256.975, 
 35.32  subdivision 9, except that this shall not apply to qualified 
 35.33  individuals under this section who are also eligible for medical 
 35.34  assistance with a spenddown as described in subdivisions 2a, 
 35.35  clause (2), and 2b, clause (2).; and 
 35.36     (4) for a specific enrollee, are not covered under a 
 36.1   Medicare drug discount card plan subsidy unless: 
 36.2      (i) the prescription drug is not included in the Medicare 
 36.3   discount card plan formulary, but is covered under the 
 36.4   prescription drug program; 
 36.5      (ii) the cost of a prescription drug is more than the 
 36.6   remaining Medicare drug discount card subsidy; or 
 36.7      (iii) a prescribed over-the-counter medication is not 
 36.8   included in the Medicare drug discount card plan formulary, but 
 36.9   is covered under the prescription drug program. 
 36.10     Sec. 4.  Minnesota Statutes 2002, section 256.955, 
 36.11  subdivision 4, is amended to read: 
 36.12     Subd. 4.  [APPLICATION PROCEDURES AND COORDINATION WITH 
 36.13  MEDICAL ASSISTANCE AND MEDICARE DRUG DISCOUNT CARD.] 
 36.14  Applications and information on the program must be made 
 36.15  available at county social service agencies, health care 
 36.16  provider offices, and agencies and organizations serving senior 
 36.17  citizens and persons with disabilities.  Individuals shall 
 36.18  submit applications and any information specified by the 
 36.19  commissioner as being necessary to verify eligibility directly 
 36.20  to the county social service agencies:  
 36.21     (1) beginning January 1, 1999, the county social service 
 36.22  agency shall determine medical assistance spenddown eligibility 
 36.23  of individuals who qualify for the prescription drug program; 
 36.24  and 
 36.25     (2) program payments will be used to reduce the spenddown 
 36.26  obligations of individuals who are determined to be eligible for 
 36.27  medical assistance with a spenddown as defined in section 
 36.28  256B.056, subdivision 5. 
 36.29  Qualified individuals who are eligible for medical assistance 
 36.30  with a spenddown shall be financially responsible for the 
 36.31  deductible amount up to the satisfaction of the spenddown.  No 
 36.32  deductible applies once the spenddown has been met.  Payments to 
 36.33  providers for prescription drugs for persons eligible under this 
 36.34  subdivision shall be reduced by the deductible.  
 36.35     County social service agencies shall determine an 
 36.36  applicant's eligibility for the program within 30 days from the 
 37.1   date the application is received.  Eligibility begins the month 
 37.2   after approval. 
 37.3      Enrollees who are also enrolled in the Medicare drug 
 37.4   discount card plan must obtain prescription drugs at a pharmacy 
 37.5   enrolled as a provider for both the Medicare drug discount plan 
 37.6   and the prescription drug program. 
 37.7      Sec. 5.  Minnesota Statutes 2002, section 256.955, 
 37.8   subdivision 6, is amended to read: 
 37.9      Subd. 6.  [PHARMACY REIMBURSEMENT.] The commissioner shall 
 37.10  reimburse participating pharmacies for drug and dispensing costs 
 37.11  at the medical assistance reimbursement level, minus the 
 37.12  deductible required under subdivision 7.  The commissioner shall 
 37.13  not reimburse enrolled pharmacies until the Medicare drug 
 37.14  discount card subsidy has been exhausted, unless the exceptions 
 37.15  in subdivision 3, clause (3), are met. 
 37.16     Sec. 6.  Minnesota Statutes 2003 Supplement, section 
 37.17  256B.056, subdivision 3c, is amended to read: 
 37.18     Subd. 3c.  [ASSET LIMITATIONS FOR FAMILIES AND CHILDREN.] A 
 37.19  household of two or more persons must not own more than $20,000 
 37.20  in total net assets, and a household of one person must not own 
 37.21  more than $10,000 in total net assets.  In addition to these 
 37.22  maximum amounts, an eligible individual or family may accrue 
 37.23  interest on these amounts, but they must be reduced to the 
 37.24  maximum at the time of an eligibility redetermination.  The 
 37.25  value of assets that are not considered in determining 
 37.26  eligibility for medical assistance for families and children is 
 37.27  the value of those assets excluded under the AFDC state plan as 
 37.28  of July 16, 1996, as required by the Personal Responsibility and 
 37.29  Work Opportunity Reconciliation Act of 1996 (PRWORA), Public Law 
 37.30  104-193, with the following exceptions: 
 37.31     (1) household goods and personal effects are not 
 37.32  considered; 
 37.33     (2) capital and operating assets of a trade or business up 
 37.34  to $200,000 are not considered; 
 37.35     (3) one motor vehicle is excluded for each person of legal 
 37.36  driving age who is employed or seeking employment; 
 38.1      (4) one burial plot and all other burial expenses equal to 
 38.2   the supplemental security income program asset limit are not 
 38.3   considered for each individual assets designated as burial 
 38.4   expenses are excluded to the same extent excluded by the 
 38.5   supplemental security income program.  Burial expenses funded by 
 38.6   annuity contracts or life insurance policies must irrevocably 
 38.7   designate the individual's estate as the contingent beneficiary 
 38.8   to the extent proceeds are not used for payment of selected 
 38.9   burial expenses; 
 38.10     (5) court-ordered settlements up to $10,000 are not 
 38.11  considered; 
 38.12     (6) individual retirement accounts and funds are not 
 38.13  considered; and 
 38.14     (7) assets owned by children are not considered.  
 38.15     Sec. 7.  Minnesota Statutes 2003 Supplement, section 
 38.16  256B.057, subdivision 9, is amended to read: 
 38.17     Subd. 9.  [EMPLOYED PERSONS WITH DISABILITIES.] (a) Medical 
 38.18  assistance may be paid for a person who is employed and who: 
 38.19     (1) meets the definition of disabled under the supplemental 
 38.20  security income program; 
 38.21     (2) is at least 16 but less than 65 years of age; 
 38.22     (3) meets the asset limits in paragraph (b); and 
 38.23     (4) effective November 1, 2003, pays a premium and other 
 38.24  obligations under paragraph (d).  
 38.25  Any spousal income or assets shall be disregarded for purposes 
 38.26  of eligibility and premium determinations. 
 38.27     After the month of enrollment, a person enrolled in medical 
 38.28  assistance under this subdivision who: 
 38.29     (1) is temporarily unable to work and without receipt of 
 38.30  earned income due to a medical condition, as verified by a 
 38.31  physician, may retain eligibility for up to four calendar 
 38.32  months; or 
 38.33     (2) effective January 1, 2004, loses employment for reasons 
 38.34  not attributable to the enrollee, may retain eligibility for up 
 38.35  to four consecutive months after the month of job loss.  To 
 38.36  receive a four-month extension, enrollees must verify the 
 39.1   medical condition or provide notification of job loss.  All 
 39.2   other eligibility requirements must be met and the enrollee must 
 39.3   pay all calculated premium costs for continued eligibility. 
 39.4      (b) For purposes of determining eligibility under this 
 39.5   subdivision, a person's assets must not exceed $20,000, 
 39.6   excluding: 
 39.7      (1) all assets excluded under section 256B.056; 
 39.8      (2) retirement accounts, including individual accounts, 
 39.9   401(k) plans, 403(b) plans, Keogh plans, and pension plans; and 
 39.10     (3) medical expense accounts set up through the person's 
 39.11  employer. 
 39.12     (c)(1) Effective January 1, 2004, for purposes of 
 39.13  eligibility, there will be a $65 earned income disregard.  To be 
 39.14  eligible, a person applying for medical assistance under this 
 39.15  subdivision must have earned income above the disregard level. 
 39.16     (2) Effective January 1, 2004, to be considered earned 
 39.17  income, Medicare, Social Security, and applicable state and 
 39.18  federal income taxes must be withheld.  To be eligible, a person 
 39.19  must document earned income tax withholding. 
 39.20     (d)(1) A person whose earned and unearned income is equal 
 39.21  to or greater than 100 percent of federal poverty guidelines for 
 39.22  the applicable family size must pay a premium to be eligible for 
 39.23  medical assistance under this subdivision.  The premium shall be 
 39.24  based on the person's gross earned and unearned income and the 
 39.25  applicable family size using a sliding fee scale established by 
 39.26  the commissioner, which begins at one percent of income at 100 
 39.27  percent of the federal poverty guidelines and increases to 7.5 
 39.28  percent of income for those with incomes at or above 300 percent 
 39.29  of the federal poverty guidelines.  Annual adjustments in the 
 39.30  premium schedule based upon changes in the federal poverty 
 39.31  guidelines shall be effective for premiums due in July of each 
 39.32  year.  
 39.33     (2) Effective January 1, 2004, all enrollees must pay a 
 39.34  premium to be eligible for medical assistance under this 
 39.35  subdivision.  An enrollee shall pay the greater of a $35 premium 
 39.36  or the premium calculated in clause (1). 
 40.1      (3) Effective November 1, 2003, all enrollees who receive 
 40.2   unearned income must pay one-half of one percent of unearned 
 40.3   income in addition to the premium amount. 
 40.4      (4) Effective November 1, 2003, for enrollees whose income 
 40.5   does not exceed 200 percent of the federal poverty guidelines 
 40.6   and who are also enrolled in Medicare, the commissioner must 
 40.7   reimburse the enrollee for Medicare Part B premiums under 
 40.8   section 256B.0625, subdivision 15, paragraph (a). 
 40.9      (5) Increases in benefits under Title II of the Social 
 40.10  Security Act shall not be counted as income for purposes of this 
 40.11  subdivision until July 1 of each year. 
 40.12     (e) A person's eligibility and premium shall be determined 
 40.13  by the local county agency.  Premiums must be paid to the 
 40.14  commissioner.  All premiums are dedicated to the commissioner. 
 40.15     (f) Any required premium shall be determined at application 
 40.16  and redetermined at the enrollee's six-month income review or 
 40.17  when a change in income or household size is reported.  
 40.18  Enrollees must report any change in income or household size 
 40.19  within ten days of when the change occurs.  A decreased premium 
 40.20  resulting from a reported change in income or household size 
 40.21  shall be effective the first day of the next available billing 
 40.22  month after the change is reported.  Except for changes 
 40.23  occurring from annual cost-of-living increases, a change 
 40.24  resulting in an increased premium shall not affect the premium 
 40.25  amount until the next six-month review. 
 40.26     (g) Premium payment is due upon notification from the 
 40.27  commissioner of the premium amount required.  Premiums may be 
 40.28  paid in installments at the discretion of the commissioner. 
 40.29     (h) Nonpayment of the premium shall result in denial or 
 40.30  termination of medical assistance unless the person demonstrates 
 40.31  good cause for nonpayment.  Good cause exists if the 
 40.32  requirements specified in Minnesota Rules, part 9506.0040, 
 40.33  subpart 7, items B to D, are met.  Except when an installment 
 40.34  agreement is accepted by the commissioner, all persons 
 40.35  disenrolled for nonpayment of a premium must pay any past due 
 40.36  premiums as well as current premiums due prior to being 
 41.1   reenrolled.  Nonpayment shall include payment with a returned, 
 41.2   refused, or dishonored instrument.  The commissioner may require 
 41.3   a guaranteed form of payment as the only means to replace a 
 41.4   returned, refused, or dishonored instrument. 
 41.5      [EFFECTIVE DATE.] This section is effective July 1, 2004. 
 41.6      Sec. 8.  Minnesota Statutes 2003 Supplement, section 
 41.7   256B.06, subdivision 4, is amended to read: 
 41.8      Subd. 4.  [CITIZENSHIP REQUIREMENTS.] (a) Eligibility for 
 41.9   medical assistance is limited to citizens of the United States, 
 41.10  qualified noncitizens as defined in this subdivision, and other 
 41.11  persons residing lawfully in the United States. 
 41.12     (b) "Qualified noncitizen" means a person who meets one of 
 41.13  the following immigration criteria: 
 41.14     (1) admitted for lawful permanent residence according to 
 41.15  United States Code, title 8; 
 41.16     (2) admitted to the United States as a refugee according to 
 41.17  United States Code, title 8, section 1157; 
 41.18     (3) granted asylum according to United States Code, title 
 41.19  8, section 1158; 
 41.20     (4) granted withholding of deportation according to United 
 41.21  States Code, title 8, section 1253(h); 
 41.22     (5) paroled for a period of at least one year according to 
 41.23  United States Code, title 8, section 1182(d)(5); 
 41.24     (6) granted conditional entrant status according to United 
 41.25  States Code, title 8, section 1153(a)(7); 
 41.26     (7) determined to be a battered noncitizen by the United 
 41.27  States Attorney General according to the Illegal Immigration 
 41.28  Reform and Immigrant Responsibility Act of 1996, title V of the 
 41.29  Omnibus Consolidated Appropriations Bill, Public Law 104-200; 
 41.30     (8) is a child of a noncitizen determined to be a battered 
 41.31  noncitizen by the United States Attorney General according to 
 41.32  the Illegal Immigration Reform and Immigrant Responsibility Act 
 41.33  of 1996, title V, of the Omnibus Consolidated Appropriations 
 41.34  Bill, Public Law 104-200; or 
 41.35     (9) determined to be a Cuban or Haitian entrant as defined 
 41.36  in section 501(e) of Public Law 96-422, the Refugee Education 
 42.1   Assistance Act of 1980. 
 42.2      (c) All qualified noncitizens who were residing in the 
 42.3   United States before August 22, 1996, who otherwise meet the 
 42.4   eligibility requirements of this chapter, are eligible for 
 42.5   medical assistance with federal financial participation. 
 42.6      (d) All qualified noncitizens who entered the United States 
 42.7   on or after August 22, 1996, and who otherwise meet the 
 42.8   eligibility requirements of this chapter, are eligible for 
 42.9   medical assistance with federal financial participation through 
 42.10  November 30, 1996. 
 42.11     Beginning December 1, 1996, qualified noncitizens who 
 42.12  entered the United States on or after August 22, 1996, and who 
 42.13  otherwise meet the eligibility requirements of this chapter are 
 42.14  eligible for medical assistance with federal participation for 
 42.15  five years if they meet one of the following criteria: 
 42.16     (i) refugees admitted to the United States according to 
 42.17  United States Code, title 8, section 1157; 
 42.18     (ii) persons granted asylum according to United States 
 42.19  Code, title 8, section 1158; 
 42.20     (iii) persons granted withholding of deportation according 
 42.21  to United States Code, title 8, section 1253(h); 
 42.22     (iv) veterans of the United States armed forces with an 
 42.23  honorable discharge for a reason other than noncitizen status, 
 42.24  their spouses and unmarried minor dependent children; or 
 42.25     (v) persons on active duty in the United States armed 
 42.26  forces, other than for training, their spouses and unmarried 
 42.27  minor dependent children. 
 42.28     Beginning December 1, 1996, qualified noncitizens who do 
 42.29  not meet one of the criteria in items (i) to (v) are eligible 
 42.30  for medical assistance without federal financial participation 
 42.31  as described in paragraph (j). 
 42.32     (e) Noncitizens who are not qualified noncitizens as 
 42.33  defined in paragraph (b), who are lawfully residing in the 
 42.34  United States and who otherwise meet the eligibility 
 42.35  requirements of this chapter, are eligible for medical 
 42.36  assistance under clauses (1) to (3).  These individuals must 
 43.1   cooperate with the Immigration and Naturalization Service to 
 43.2   pursue any applicable immigration status, including citizenship, 
 43.3   that would qualify them for medical assistance with federal 
 43.4   financial participation. 
 43.5      (1) Persons who were medical assistance recipients on 
 43.6   August 22, 1996, are eligible for medical assistance with 
 43.7   federal financial participation through December 31, 1996. 
 43.8      (2) Beginning January 1, 1997, persons described in clause 
 43.9   (1) are eligible for medical assistance without federal 
 43.10  financial participation as described in paragraph (j). 
 43.11     (3) Beginning December 1, 1996, persons residing in the 
 43.12  United States prior to August 22, 1996, who were not receiving 
 43.13  medical assistance and persons who arrived on or after August 
 43.14  22, 1996, are eligible for medical assistance without federal 
 43.15  financial participation as described in paragraph (j). 
 43.16     (f) Nonimmigrants who otherwise meet the eligibility 
 43.17  requirements of this chapter are eligible for the benefits as 
 43.18  provided in paragraphs (g) to (i).  For purposes of this 
 43.19  subdivision, a "nonimmigrant" is a person in one of the classes 
 43.20  listed in United States Code, title 8, section 1101(a)(15). 
 43.21     (g) Payment shall also be made for care and services that 
 43.22  are furnished to noncitizens, regardless of immigration status, 
 43.23  who otherwise meet the eligibility requirements of this chapter, 
 43.24  if such care and services are necessary for the treatment of an 
 43.25  emergency medical condition, except for organ transplants and 
 43.26  related care and services and routine prenatal care.  
 43.27     (h) For purposes of this subdivision, the term "emergency 
 43.28  medical condition" means a medical condition that meets the 
 43.29  requirements of United States Code, title 42, section 1396b(v). 
 43.30     (i) Pregnant noncitizens who are undocumented or, 
 43.31  nonimmigrants, or eligible for medical assistance as described 
 43.32  in paragraph (j), and who are not covered by a group health plan 
 43.33  or health insurance coverage according to Code of Federal 
 43.34  Regulations, title 42, section 457.310, and who otherwise meet 
 43.35  the eligibility requirements of this chapter, are eligible for 
 43.36  medical assistance payment without federal financial 
 44.1   participation for care and services through the period of 
 44.2   pregnancy, and including labor and delivery, to the extent 
 44.3   federal funds are available under Title XXI of the Social 
 44.4   Security Act, and the state children's health insurance program, 
 44.5   followed by 60 days postpartum, except for labor and 
 44.6   delivery without federal financial participation.  
 44.7      (j) Qualified noncitizens as described in paragraph (d), 
 44.8   and all other noncitizens lawfully residing in the United States 
 44.9   as described in paragraph (e), who are ineligible for medical 
 44.10  assistance with federal financial participation and who 
 44.11  otherwise meet the eligibility requirements of chapter 256B and 
 44.12  of this paragraph, are eligible for medical assistance without 
 44.13  federal financial participation.  Qualified noncitizens as 
 44.14  described in paragraph (d) are only eligible for medical 
 44.15  assistance without federal financial participation for five 
 44.16  years from their date of entry into the United States.  
 44.17     (k) Beginning October 1, 2003, persons who are receiving 
 44.18  care and rehabilitation services from a nonprofit center 
 44.19  established to serve victims of torture and are otherwise 
 44.20  ineligible for medical assistance under this chapter or general 
 44.21  assistance medical care under section 256D.03 are eligible for 
 44.22  medical assistance without federal financial participation.  
 44.23  These individuals are eligible only for the period during which 
 44.24  they are receiving services from the center.  Individuals 
 44.25  eligible under this paragraph shall not be required to 
 44.26  participate in prepaid medical assistance. 
 44.27     Sec. 9.  Minnesota Statutes 2003 Supplement, section 
 44.28  256B.0625, subdivision 9, is amended to read: 
 44.29     Subd. 9.  [DENTAL SERVICES.] (a) Medical assistance covers 
 44.30  dental services.  Dental services include, with prior 
 44.31  authorization, fixed bridges that are cost-effective for persons 
 44.32  who cannot use removable dentures because of their medical 
 44.33  condition.  
 44.34     (b) Coverage of dental services for adults age 21 and over 
 44.35  who are not pregnant is subject to a $500 annual benefit limit 
 44.36  and covered services are limited to:  
 45.1      (1) diagnostic and preventative services; 
 45.2      (2) basic restorative services; and 
 45.3      (3) emergency services. 
 45.4      Emergency services, dentures, and extractions related to 
 45.5   dentures are not included in the $500 annual benefit limit. 
 45.6      [EFFECTIVE DATE.] This section is effective January 1, 2005.
 45.7      Sec. 10.  Minnesota Statutes 2003 Supplement, section 
 45.8   256B.0631, subdivision 2, is amended to read: 
 45.9      Subd. 2.  [EXCEPTIONS.] Co-payments shall be subject to the 
 45.10  following exceptions: 
 45.11     (1) children under the age of 21; 
 45.12     (2) pregnant women for services that relate to the 
 45.13  pregnancy or any other medical condition that may complicate the 
 45.14  pregnancy; 
 45.15     (3) recipients expected to reside for at least 30 days in a 
 45.16  hospital, nursing home, or intermediate care facility for the 
 45.17  mentally retarded, or group residential housing facility under 
 45.18  chapter 256I, and whose only available income is a personal 
 45.19  needs allowance under section 256B.35 or 256B.36 and whose 
 45.20  exemption from co-payments is approved by the centers for 
 45.21  Medicare and Medicaid services; 
 45.22     (4) recipients receiving hospice care; 
 45.23     (5) 100 percent federally funded services provided by an 
 45.24  Indian health service; 
 45.25     (6) emergency services; 
 45.26     (7) family planning services; 
 45.27     (8) services that are paid by Medicare, resulting in the 
 45.28  medical assistance program paying for the coinsurance and 
 45.29  deductible; and 
 45.30     (9) co-payments that exceed one per day per provider for 
 45.31  nonpreventive visits, eyeglasses, and nonemergency visits to a 
 45.32  hospital-based emergency room. 
 45.33     [EFFECTIVE DATE.] This section is effective 90 days after 
 45.34  federal approval or January 1, 2005, whichever is later. 
 45.35     Sec. 11.  Minnesota Statutes 2003 Supplement, section 
 45.36  256B.69, subdivision 2, is amended to read: 
 46.1      Subd. 2.  [DEFINITIONS.] For the purposes of this section, 
 46.2   the following terms have the meanings given.  
 46.3      (a) "Commissioner" means the commissioner of human services.
 46.4   For the remainder of this section, the commissioner's 
 46.5   responsibilities for methods and policies for implementing the 
 46.6   project will be proposed by the project advisory committees and 
 46.7   approved by the commissioner.  
 46.8      (b) "Demonstration provider" means a health maintenance 
 46.9   organization, community integrated service network, or 
 46.10  accountable provider network authorized and operating under 
 46.11  chapter 62D, 62N, or 62T that participates in the demonstration 
 46.12  project according to criteria, standards, methods, and other 
 46.13  requirements established for the project and approved by the 
 46.14  commissioner.  For purposes of this section, a county board, or 
 46.15  group of county boards operating under a joint powers agreement, 
 46.16  is considered a demonstration provider if the county or group of 
 46.17  county boards meets the requirements of section 256B.692.  
 46.18  Notwithstanding the above, Itasca County may continue to 
 46.19  participate as a demonstration provider until July 1, 2004. 
 46.20     (c) "Eligible individuals" means those persons eligible for 
 46.21  medical assistance benefits as defined in sections 256B.055, 
 46.22  256B.056, and 256B.06. 
 46.23     (d) "Limitation of choice" means suspending freedom of 
 46.24  choice while allowing eligible individuals to choose among the 
 46.25  demonstration providers. 
 46.26     (e) This paragraph supersedes paragraph (c) as long as the 
 46.27  Minnesota health care reform waiver remains in effect.  When the 
 46.28  waiver expires, this paragraph expires and the commissioner of 
 46.29  human services shall publish a notice in the State Register and 
 46.30  notify the revisor of statutes.  "Eligible individuals" means 
 46.31  those persons eligible for medical assistance benefits as 
 46.32  defined in sections 256B.055, 256B.056, and 256B.06.  An 
 46.33  individual enrolled under section 256B.055, subdivision 7, who 
 46.34  becomes ineligible for the program because of failure to submit 
 46.35  income reports or recertification forms in a timely manner, 
 46.36  shall remain enrolled in the prepaid health plan and shall 
 47.1   remain eligible to receive medical assistance coverage through 
 47.2   the last day of the month following the month in which the 
 47.3   enrollee became ineligible for the medical assistance program. 
 47.4      [EFFECTIVE DATE.] This section is effective July 1, 2004, 
 47.5   or upon federal approval, whichever is later. 
 47.6      Sec. 12.  Minnesota Statutes 2003 Supplement, section 
 47.7   256D.03, subdivision 3, is amended to read: 
 47.8      Subd. 3.  [GENERAL ASSISTANCE MEDICAL CARE; ELIGIBILITY.] 
 47.9   (a) General assistance medical care may be paid for any person 
 47.10  who is not eligible for emergency medical assistance, or medical 
 47.11  assistance under chapter 256B, including eligibility for medical 
 47.12  assistance based on a spenddown of excess income according to 
 47.13  section 256B.056, subdivision 5, or MinnesotaCare as defined in 
 47.14  paragraph (b), except as provided in paragraph (c), and: 
 47.15     (1) who is receiving assistance under section 256D.05, 
 47.16  except for families with children who are eligible under 
 47.17  Minnesota family investment program (MFIP), or who is having a 
 47.18  payment made on the person's behalf under sections 256I.01 to 
 47.19  256I.06; or 
 47.20     (2) who is a resident of Minnesota; and 
 47.21     (i) who has gross countable income not in excess of 75 
 47.22  percent of the federal poverty guidelines for the family size, 
 47.23  using a six-month budget period and whose equity in assets is 
 47.24  not in excess of $1,000 per assistance unit.  Exempt assets, the 
 47.25  reduction of excess assets, and the waiver of excess assets must 
 47.26  conform to the medical assistance program in section 256B.056, 
 47.27  subdivision 3, with the following exception:  the maximum amount 
 47.28  of undistributed funds in a trust that could be distributed to 
 47.29  or on behalf of the beneficiary by the trustee, assuming the 
 47.30  full exercise of the trustee's discretion under the terms of the 
 47.31  trust, must be applied toward the asset maximum; or 
 47.32     (ii) who has gross countable income above 75 percent of the 
 47.33  federal poverty guidelines but or assets in excess of the limits 
 47.34  in item (i), but whose income is not in excess of 175 150 
 47.35  percent of the federal poverty guidelines for the family size, 
 47.36  using a six-month budget period, and whose equity in assets is 
 48.1   not in excess of the limits in section 256B.056, subdivision 3c, 
 48.2   and who applies during an inpatient hospitalization.  
 48.3      (b) General assistance medical care may not be paid for 
 48.4   applicants or recipients who meet all eligibility requirements 
 48.5   of MinnesotaCare as defined in sections 256L.01 to 256L.16, and 
 48.6   are adults with dependent children under 21 whose gross family 
 48.7   income is equal to or less than 275 percent of the federal 
 48.8   poverty guidelines. 
 48.9      (c) For applications received on or after October 1, 2003, 
 48.10  eligibility may begin no earlier than the date of application.  
 48.11  For individuals eligible under paragraph (a), clause (2), item 
 48.12  (i), a redetermination of eligibility must occur every 12 
 48.13  months.  Individuals are eligible under paragraph (a), clause 
 48.14  (2), item (ii), only during inpatient hospitalization but may 
 48.15  reapply if there is a subsequent period of inpatient 
 48.16  hospitalization.  Beginning January 1, 2000, Minnesota health 
 48.17  care program applications completed by recipients and applicants 
 48.18  who are persons described in paragraph (b), may be returned to 
 48.19  the county agency to be forwarded to the Department of Human 
 48.20  Services or sent directly to the Department of Human Services 
 48.21  for enrollment in MinnesotaCare.  If all other eligibility 
 48.22  requirements of this subdivision are met, eligibility for 
 48.23  general assistance medical care shall be available in any month 
 48.24  during which a MinnesotaCare eligibility determination and 
 48.25  enrollment are pending.  Upon notification of eligibility for 
 48.26  MinnesotaCare, notice of termination for eligibility for general 
 48.27  assistance medical care shall be sent to an applicant or 
 48.28  recipient.  If all other eligibility requirements of this 
 48.29  subdivision are met, eligibility for general assistance medical 
 48.30  care shall be available until enrollment in MinnesotaCare 
 48.31  subject to the provisions of paragraph (e). 
 48.32     (d) The date of an initial Minnesota health care program 
 48.33  application necessary to begin a determination of eligibility 
 48.34  shall be the date the applicant has provided a name, address, 
 48.35  and Social Security number, signed and dated, to the county 
 48.36  agency or the Department of Human Services.  If the applicant is 
 49.1   unable to provide a name, address, Social Security number, and 
 49.2   signature when health care is delivered due to a medical 
 49.3   condition or disability, a health care provider may act on an 
 49.4   applicant's behalf to establish the date of an initial Minnesota 
 49.5   health care program application by providing the county agency 
 49.6   or Department of Human Services with provider identification and 
 49.7   a temporary unique identifier for the applicant.  The applicant 
 49.8   must complete the remainder of the application and provide 
 49.9   necessary verification before eligibility can be determined.  
 49.10  The county agency must assist the applicant in obtaining 
 49.11  verification if necessary.  
 49.12     (e) County agencies are authorized to use all automated 
 49.13  databases containing information regarding recipients' or 
 49.14  applicants' income in order to determine eligibility for general 
 49.15  assistance medical care or MinnesotaCare.  Such use shall be 
 49.16  considered sufficient in order to determine eligibility and 
 49.17  premium payments by the county agency. 
 49.18     (f) General assistance medical care is not available for a 
 49.19  person in a correctional facility unless the person is detained 
 49.20  by law for less than one year in a county correctional or 
 49.21  detention facility as a person accused or convicted of a crime, 
 49.22  or admitted as an inpatient to a hospital on a criminal hold 
 49.23  order, and the person is a recipient of general assistance 
 49.24  medical care at the time the person is detained by law or 
 49.25  admitted on a criminal hold order and as long as the person 
 49.26  continues to meet other eligibility requirements of this 
 49.27  subdivision.  
 49.28     (g) General assistance medical care is not available for 
 49.29  applicants or recipients who do not cooperate with the county 
 49.30  agency to meet the requirements of medical assistance.  
 49.31     (h) In determining the amount of assets of an individual 
 49.32  eligible under paragraph (a), clause (2), item (i), there shall 
 49.33  be included any asset or interest in an asset, including an 
 49.34  asset excluded under paragraph (a), that was given away, sold, 
 49.35  or disposed of for less than fair market value within the 60 
 49.36  months preceding application for general assistance medical care 
 50.1   or during the period of eligibility.  Any transfer described in 
 50.2   this paragraph shall be presumed to have been for the purpose of 
 50.3   establishing eligibility for general assistance medical care, 
 50.4   unless the individual furnishes convincing evidence to establish 
 50.5   that the transaction was exclusively for another purpose.  For 
 50.6   purposes of this paragraph, the value of the asset or interest 
 50.7   shall be the fair market value at the time it was given away, 
 50.8   sold, or disposed of, less the amount of compensation received.  
 50.9   For any uncompensated transfer, the number of months of 
 50.10  ineligibility, including partial months, shall be calculated by 
 50.11  dividing the uncompensated transfer amount by the average 
 50.12  monthly per person payment made by the medical assistance 
 50.13  program to skilled nursing facilities for the previous calendar 
 50.14  year.  The individual shall remain ineligible until this fixed 
 50.15  period has expired.  The period of ineligibility may exceed 30 
 50.16  months, and a reapplication for benefits after 30 months from 
 50.17  the date of the transfer shall not result in eligibility unless 
 50.18  and until the period of ineligibility has expired.  The period 
 50.19  of ineligibility begins in the month the transfer was reported 
 50.20  to the county agency, or if the transfer was not reported, the 
 50.21  month in which the county agency discovered the transfer, 
 50.22  whichever comes first.  For applicants, the period of 
 50.23  ineligibility begins on the date of the first approved 
 50.24  application. 
 50.25     (i) When determining eligibility for any state benefits 
 50.26  under this subdivision, the income and resources of all 
 50.27  noncitizens shall be deemed to include their sponsor's income 
 50.28  and resources as defined in the Personal Responsibility and Work 
 50.29  Opportunity Reconciliation Act of 1996, title IV, Public Law 
 50.30  104-193, sections 421 and 422, and subsequently set out in 
 50.31  federal rules. 
 50.32     (j) Undocumented noncitizens and nonimmigrants are 
 50.33  ineligible for general assistance medical care, except that an 
 50.34  individual eligible under paragraph (a), clause (4), remains 
 50.35  eligible through September 30, 2003, and an undocumented 
 50.36  noncitizen or nonimmigrant who is diagnosed with active or 
 51.1   latent tuberculosis and meets all other eligibility requirements 
 51.2   of this section is eligible for the duration of the need for 
 51.3   tuberculosis treatment.  For purposes of this subdivision, a 
 51.4   nonimmigrant is an individual in one or more of the classes 
 51.5   listed in United States Code, title 8, section 1101(a)(15), and 
 51.6   an undocumented noncitizen is an individual who resides in the 
 51.7   United States without the approval or acquiescence of the 
 51.8   Immigration and Naturalization Service. 
 51.9      (k) Notwithstanding any other provision of law, a 
 51.10  noncitizen who is ineligible for medical assistance due to the 
 51.11  deeming of a sponsor's income and resources, is ineligible for 
 51.12  general assistance medical care. 
 51.13     (l) Effective July 1, 2003, general assistance medical care 
 51.14  emergency services end.  
 51.15     [EFFECTIVE DATE.] This section is effective July 1, 2004, 
 51.16  except that the change in the income limit for hospital-only 
 51.17  coverage in paragraph (a), clause (2), item (ii) is effective 
 51.18  July 1, 2005. 
 51.19     Sec. 13.  Minnesota Statutes 2003 Supplement, section 
 51.20  256D.03, subdivision 4, is amended to read: 
 51.21     Subd. 4.  [GENERAL ASSISTANCE MEDICAL CARE; SERVICES.] 
 51.22  (a)(i) For a person who is eligible under subdivision 3, 
 51.23  paragraph (a), clause (2), item (i), general assistance medical 
 51.24  care covers, except as provided in paragraph (c): 
 51.25     (1) inpatient hospital services; 
 51.26     (2) outpatient hospital services; 
 51.27     (3) services provided by Medicare certified rehabilitation 
 51.28  agencies; 
 51.29     (4) prescription drugs and other products recommended 
 51.30  through the process established in section 256B.0625, 
 51.31  subdivision 13; 
 51.32     (5) equipment necessary to administer insulin and 
 51.33  diagnostic supplies and equipment for diabetics to monitor blood 
 51.34  sugar level; 
 51.35     (6) eyeglasses and eye examinations provided by a physician 
 51.36  or optometrist; 
 52.1      (7) hearing aids; 
 52.2      (8) prosthetic devices; 
 52.3      (9) laboratory and X-ray services; 
 52.4      (10) physician's services; 
 52.5      (11) medical transportation except special transportation; 
 52.6      (12) chiropractic services as covered under the medical 
 52.7   assistance program; 
 52.8      (13) podiatric services; 
 52.9      (14) dental services and dentures, subject to the 
 52.10  limitations specified in section 256B.0625, subdivision 9 as 
 52.11  covered under the medical assistance program; 
 52.12     (15) outpatient services provided by a mental health center 
 52.13  or clinic that is under contract with the county board and is 
 52.14  established under section 245.62; 
 52.15     (16) day treatment services for mental illness provided 
 52.16  under contract with the county board; 
 52.17     (17) prescribed medications for persons who have been 
 52.18  diagnosed as mentally ill as necessary to prevent more 
 52.19  restrictive institutionalization; 
 52.20     (18) psychological services, medical supplies and 
 52.21  equipment, and Medicare premiums, coinsurance and deductible 
 52.22  payments; 
 52.23     (19) medical equipment not specifically listed in this 
 52.24  paragraph when the use of the equipment will prevent the need 
 52.25  for costlier services that are reimbursable under this 
 52.26  subdivision; 
 52.27     (20) services performed by a certified pediatric nurse 
 52.28  practitioner, a certified family nurse practitioner, a certified 
 52.29  adult nurse practitioner, a certified obstetric/gynecological 
 52.30  nurse practitioner, a certified neonatal nurse practitioner, or 
 52.31  a certified geriatric nurse practitioner in independent 
 52.32  practice, if (1) the service is otherwise covered under this 
 52.33  chapter as a physician service, (2) the service provided on an 
 52.34  inpatient basis is not included as part of the cost for 
 52.35  inpatient services included in the operating payment rate, and 
 52.36  (3) the service is within the scope of practice of the nurse 
 53.1   practitioner's license as a registered nurse, as defined in 
 53.2   section 148.171; 
 53.3      (21) services of a certified public health nurse or a 
 53.4   registered nurse practicing in a public health nursing clinic 
 53.5   that is a department of, or that operates under the direct 
 53.6   authority of, a unit of government, if the service is within the 
 53.7   scope of practice of the public health nurse's license as a 
 53.8   registered nurse, as defined in section 148.171; and 
 53.9      (22) telemedicine consultations, to the extent they are 
 53.10  covered under section 256B.0625, subdivision 3b.  
 53.11     (ii) Effective October 1, 2003, for a person who is 
 53.12  eligible under subdivision 3, paragraph (a), clause (2), item 
 53.13  (ii), general assistance medical care coverage is limited to 
 53.14  inpatient hospital services, including physician services 
 53.15  provided during the inpatient hospital stay.  A $1,000 
 53.16  deductible is required for each inpatient hospitalization.  
 53.17     (b) Gender reassignment surgery and related services are 
 53.18  not covered services under this subdivision unless the 
 53.19  individual began receiving gender reassignment services prior to 
 53.20  July 1, 1995.  
 53.21     (c) In order to contain costs, the commissioner of human 
 53.22  services shall select vendors of medical care who can provide 
 53.23  the most economical care consistent with high medical standards 
 53.24  and shall where possible contract with organizations on a 
 53.25  prepaid capitation basis to provide these services.  The 
 53.26  commissioner shall consider proposals by counties and vendors 
 53.27  for prepaid health plans, competitive bidding programs, block 
 53.28  grants, or other vendor payment mechanisms designed to provide 
 53.29  services in an economical manner or to control utilization, with 
 53.30  safeguards to ensure that necessary services are provided.  
 53.31  Before implementing prepaid programs in counties with a county 
 53.32  operated or affiliated public teaching hospital or a hospital or 
 53.33  clinic operated by the University of Minnesota, the commissioner 
 53.34  shall consider the risks the prepaid program creates for the 
 53.35  hospital and allow the county or hospital the opportunity to 
 53.36  participate in the program in a manner that reflects the risk of 
 54.1   adverse selection and the nature of the patients served by the 
 54.2   hospital, provided the terms of participation in the program are 
 54.3   competitive with the terms of other participants considering the 
 54.4   nature of the population served.  Payment for services provided 
 54.5   pursuant to this subdivision shall be as provided to medical 
 54.6   assistance vendors of these services under sections 256B.02, 
 54.7   subdivision 8, and 256B.0625.  For payments made during fiscal 
 54.8   year 1990 and later years, the commissioner shall consult with 
 54.9   an independent actuary in establishing prepayment rates, but 
 54.10  shall retain final control over the rate methodology.  
 54.11     (d) Recipients eligible under subdivision 3, paragraph (a), 
 54.12  clause (2), item (i), shall pay the following co-payments for 
 54.13  services provided on or after October 1, 2003: 
 54.14     (1) $3 per nonpreventive visit.  For purposes of this 
 54.15  subdivision, a visit means an episode of service which is 
 54.16  required because of a recipient's symptoms, diagnosis, or 
 54.17  established illness, and which is delivered in an ambulatory 
 54.18  setting by a physician or physician ancillary, chiropractor, 
 54.19  podiatrist, nurse midwife, advanced practice nurse, audiologist, 
 54.20  optician, or optometrist; 
 54.21     (2) $25 for eyeglasses; 
 54.22     (3) $25 for nonemergency visits to a hospital-based 
 54.23  emergency room; and 
 54.24     (4) $3 per brand-name drug prescription and $1 per generic 
 54.25  drug prescription, subject to a $20 per month maximum for 
 54.26  prescription drug co-payments.  No co-payments shall apply to 
 54.27  antipsychotic drugs when used for the treatment of mental 
 54.28  illness; and 
 54.29     (5) 50 percent coinsurance on basic restorative dental 
 54.30  services. 
 54.31     (e) Recipients of general assistance medical care are 
 54.32  responsible for all co-payments in this subdivision, except that 
 54.33  this requirement does not apply to recipients receiving group 
 54.34  residential housing payments under chapter 256I whose available 
 54.35  income is limited to a personal needs allowance under section 
 54.36  256B.35.  The general assistance medical care reimbursement to 
 55.1   the provider shall be reduced by the amount of the co-payment, 
 55.2   except that reimbursement for prescription drugs shall not be 
 55.3   reduced once a recipient has reached the $20 per month maximum 
 55.4   for prescription drug co-payments.  The provider collects the 
 55.5   co-payment from the recipient.  Providers may not deny services 
 55.6   to recipients who are unable to pay the co-payment, except as 
 55.7   provided in paragraph (f). 
 55.8      (f) If it is the routine business practice of a provider to 
 55.9   refuse service to an individual with uncollected debt, the 
 55.10  provider may include uncollected co-payments under this 
 55.11  section.  A provider must give advance notice to a recipient 
 55.12  with uncollected debt before services can be denied. 
 55.13     (g) Any county may, from its own resources, provide medical 
 55.14  payments for which state payments are not made. 
 55.15     (h) Chemical dependency services that are reimbursed under 
 55.16  chapter 254B must not be reimbursed under general assistance 
 55.17  medical care. 
 55.18     (i) The maximum payment for new vendors enrolled in the 
 55.19  general assistance medical care program after the base year 
 55.20  shall be determined from the average usual and customary charge 
 55.21  of the same vendor type enrolled in the base year. 
 55.22     (j) The conditions of payment for services under this 
 55.23  subdivision are the same as the conditions specified in rules 
 55.24  adopted under chapter 256B governing the medical assistance 
 55.25  program, unless otherwise provided by statute or rule. 
 55.26     (k) Inpatient and outpatient payments shall be reduced by 
 55.27  five percent, effective July 1, 2003.  This reduction is in 
 55.28  addition to the five percent reduction effective July 1, 2003, 
 55.29  and incorporated by reference in paragraph (i).  
 55.30     (l) Payments for all other health services except 
 55.31  inpatient, outpatient, and pharmacy services shall be reduced by 
 55.32  five percent, effective July 1, 2003.  
 55.33     (m) Payments to managed care plans shall be reduced by five 
 55.34  percent for services provided on or after October 1, 2003. 
 55.35     (n) A hospital receiving a reduced payment as a result of 
 55.36  this section may apply the unpaid balance toward satisfaction of 
 56.1   the hospital's bad debts. 
 56.2      [EFFECTIVE DATE.] This section is effective January 1, 2005.
 56.3      Sec. 14.  Minnesota Statutes 2002, section 256L.01, 
 56.4   subdivision 5, is amended to read: 
 56.5      Subd. 5.  [INCOME.] (a) "Income" has the meaning given for 
 56.6   earned and unearned income for families and children in the 
 56.7   medical assistance program, according to the state's aid to 
 56.8   families with dependent children plan in effect as of July 16, 
 56.9   1996.  The definition does not include medical assistance income 
 56.10  methodologies and deeming requirements.  The earned income of 
 56.11  full-time and part-time students under age 19 is not counted as 
 56.12  income.  Public assistance payments and supplemental security 
 56.13  income are not excluded income. 
 56.14     (b) For purposes of this subdivision, and unless otherwise 
 56.15  specified in this section, the commissioner shall use reasonable 
 56.16  methods to calculate gross earned and unearned income including, 
 56.17  but not limited to, projecting income based on income received 
 56.18  within the last 30 days, the last 90 days, or the last 12 months.
 56.19     [EFFECTIVE DATE.] This section is effective July 1, 2004. 
 56.20     Sec. 15.  Minnesota Statutes 2003 Supplement, section 
 56.21  256L.03, subdivision 1, is amended to read: 
 56.22     Subdivision 1.  [COVERED HEALTH SERVICES.] For individuals 
 56.23  under section 256L.04, subdivision 7, with income no greater 
 56.24  than 75 percent of the federal poverty guidelines or for 
 56.25  families with children under section 256L.04, subdivision 1, all 
 56.26  subdivisions of this section apply.  "Covered health services" 
 56.27  means the health services reimbursed under chapter 256B, with 
 56.28  the exception of inpatient hospital services, special education 
 56.29  services, private duty nursing services, adult dental care 
 56.30  services other than services except as covered under section 
 56.31  256B.0625, subdivision 9, paragraph (b), orthodontic services 
 56.32  3b, nonemergency medical transportation services, personal care 
 56.33  assistant and case management services, nursing home or 
 56.34  intermediate care facilities services, inpatient mental health 
 56.35  services, and chemical dependency services.  Outpatient mental 
 56.36  health services covered under the MinnesotaCare program are 
 57.1   limited to diagnostic assessments, psychological testing, 
 57.2   explanation of findings, medication management by a physician, 
 57.3   day treatment, partial hospitalization, and individual, family, 
 57.4   and group psychotherapy. 
 57.5      No public funds shall be used for coverage of abortion 
 57.6   under MinnesotaCare except where the life of the female would be 
 57.7   endangered or substantial and irreversible impairment of a major 
 57.8   bodily function would result if the fetus were carried to term; 
 57.9   or where the pregnancy is the result of rape or incest. 
 57.10     Covered health services shall be expanded as provided in 
 57.11  this section. 
 57.12     [EFFECTIVE DATE.] This section is effective January 1, 2005.
 57.13     Sec. 16.  Minnesota Statutes 2002, section 256L.03, is 
 57.14  amended by adding a subdivision to read: 
 57.15     Subd. 3b.  [DENTAL SERVICES EFFECTIVE JANUARY 1, 2005.] (a) 
 57.16  Effective January 1, 2005, the provisions in paragraphs (b) to 
 57.17  (c) apply. 
 57.18     (b) For parents, grandparents, foster parents, relative 
 57.19  caretakers, and legal guardians eligible under section 256L.04, 
 57.20  subdivision 1, with incomes not exceeding 75 percent of the 
 57.21  federal poverty guidelines, dental services are covered as 
 57.22  provided under section 256B.0625, subdivision 9, except that no 
 57.23  coverage is provided for orthodontic services. 
 57.24     (c) For pregnant women and children under age 21, dental 
 57.25  services are covered as provided under section 256B.0625, 
 57.26  subdivision 9. 
 57.27     Sec. 17.  Minnesota Statutes 2002, section 256L.03, 
 57.28  subdivision 5, is amended to read: 
 57.29     Subd. 5.  [CO-PAYMENTS AND COINSURANCE.] (a) Except as 
 57.30  provided in paragraphs (b) and (c), the MinnesotaCare benefit 
 57.31  plan shall include the following co-payments and coinsurance 
 57.32  requirements for all enrollees:  
 57.33     (1) ten percent of the paid charges for inpatient hospital 
 57.34  services for adult enrollees, subject to an annual inpatient 
 57.35  out-of-pocket maximum of $1,000 per individual and $3,000 per 
 57.36  family; 
 58.1      (2) $3 per prescription for adult enrollees; 
 58.2      (3) $25 for eyeglasses for adult enrollees; and 
 58.3      (4) $3 per nonpreventive visit.  For purposes of this 
 58.4   subdivision, a visit means an episode of service which is 
 58.5   required because of an enrollee's symptoms, diagnosis, or 
 58.6   established illness, and which is delivered in an ambulatory 
 58.7   setting by a physician or physician ancillary, chiropractor, 
 58.8   podiatrist, advanced practice nurse, audiologist, optician, or 
 58.9   optometrist; 
 58.10     (5) $6 for nonemergency visits to a hospital-based 
 58.11  emergency room; and 
 58.12     (6) 50 percent of the fee-for-service rate for adult dental 
 58.13  care services other than preventive care services for persons 
 58.14  eligible under section 256L.04, subdivisions 1 to 7, with income 
 58.15  equal to or less than 175 percent of the federal poverty 
 58.16  guidelines. 
 58.17     (b) Paragraph (a), clause (1), does not apply to parents 
 58.18  and relative caretakers of children under the age of 21 in 
 58.19  households with family income equal to or less than 175 percent 
 58.20  of the federal poverty guidelines.  Paragraph (a), clause (1), 
 58.21  does not apply to parents and relative caretakers of children 
 58.22  under the age of 21 in households with family income greater 
 58.23  than 175 percent of the federal poverty guidelines for inpatient 
 58.24  hospital admissions occurring on or after January 1, 2001.  
 58.25     (c) Paragraph (a), clauses (1) to (4) (6), do not apply to 
 58.26  pregnant women and children under the age of 21.  
 58.27     (d) Adult enrollees with family gross income that exceeds 
 58.28  175 percent of the federal poverty guidelines and who are not 
 58.29  pregnant shall be financially responsible for the coinsurance 
 58.30  amount, if applicable, and amounts which exceed the $10,000 
 58.31  inpatient hospital benefit limit. 
 58.32     (e) When a MinnesotaCare enrollee becomes a member of a 
 58.33  prepaid health plan, or changes from one prepaid health plan to 
 58.34  another during a calendar year, any charges submitted towards 
 58.35  the $10,000 annual inpatient benefit limit, and any 
 58.36  out-of-pocket expenses incurred by the enrollee for inpatient 
 59.1   services, that were submitted or incurred prior to enrollment, 
 59.2   or prior to the change in health plans, shall be disregarded. 
 59.3      (f) Paragraph (a), clauses (4) and (5), are limited to one 
 59.4   co-payment per day per provider. 
 59.5      [EFFECTIVE DATE.] This section is effective January 1, 2005.
 59.6      Sec. 18.  Minnesota Statutes 2003 Supplement, section 
 59.7   256L.035, is amended to read: 
 59.8      256L.035 [LIMITED BENEFITS COVERAGE FOR CERTAIN SINGLE 
 59.9   ADULTS AND HOUSEHOLDS WITHOUT CHILDREN.] 
 59.10     (a) "Covered health services" for individuals under section 
 59.11  256L.04, subdivision 7, with income above 75 percent, but not 
 59.12  exceeding 175 percent, of the federal poverty guideline means: 
 59.13     (1) inpatient hospitalization benefits with a ten percent 
 59.14  co-payment up to $1,000 and subject to an annual limitation of 
 59.15  $10,000; 
 59.16     (2) physician services provided during an inpatient stay; 
 59.17  and 
 59.18     (3) physician services not provided during an inpatient 
 59.19  stay,; outpatient hospital services,; chiropractic services 
 59.20  ,; lab and diagnostic services,; vision services excluding the 
 59.21  dispensing, fitting, and adjustment of eyeglasses or contacts 
 59.22  and eye examinations to determine refractive state; and 
 59.23  prescription drugs,; and supplies and equipment for diabetic 
 59.24  testing and insulin administration, subject to an aggregate cap 
 59.25  of $2,000 per calendar year and the following co-payments: 
 59.26     (i) $50 co-pay per emergency room visit; 
 59.27     (ii) $3 co-pay per prescription drug; and 
 59.28     (iii) $5 co-pay per nonpreventive physician and optometrist 
 59.29  visit. 
 59.30     For purposes of this subdivision, "a visit" means an 
 59.31  episode of service which is required because of a recipient's 
 59.32  symptoms, diagnosis, or established illness, and which is 
 59.33  delivered in an ambulatory setting by a physician or, physician 
 59.34  ancillary, or optometrist. 
 59.35     Enrollees are responsible for all co-payments in this 
 59.36  subdivision, except that this requirement does not apply to 
 60.1   enrollees receiving group residential housing payments under 
 60.2   chapter 256I whose available income is limited to a personal 
 60.3   needs allowance under section 256B.35. 
 60.4      (b) The November 2006 MinnesotaCare forecast for the 
 60.5   biennium beginning July 1, 2007, shall assume an adjustment in 
 60.6   the aggregate cap on the services identified in paragraph (a), 
 60.7   clause (3), in $1,000 increments up to a maximum of $10,000, but 
 60.8   not less than $2,000, to the extent that the balance in the 
 60.9   health care access fund is sufficient in each year of the 
 60.10  biennium to pay for this benefit level.  The aggregate cap shall 
 60.11  be adjusted according to the forecast. 
 60.12     (c) Reimbursement to the providers shall be reduced by the 
 60.13  amount of the co-payment, except that reimbursement for 
 60.14  prescription drugs shall not be reduced once a recipient has 
 60.15  reached the $20 per month maximum for prescription drug 
 60.16  co-payments.  The provider collects the co-payment from the 
 60.17  recipient.  Providers may not deny services to recipients who 
 60.18  are unable to pay the co-payment, except as provided in 
 60.19  paragraph (d). 
 60.20     (d) If it is the routine business practice of a provider to 
 60.21  refuse service to an individual with uncollected debt, the 
 60.22  provider may include uncollected co-payments under this 
 60.23  section.  A provider must give advance notice to a recipient 
 60.24  with uncollected debt before services can be denied. 
 60.25     [EFFECTIVE DATE.] This section is effective January 1, 2005.
 60.26     Sec. 19.  Minnesota Statutes 2002, section 256L.05, 
 60.27  subdivision 3, is amended to read: 
 60.28     Subd. 3.  [EFFECTIVE DATE OF COVERAGE.] (a) The effective 
 60.29  date of coverage is the first day of the month following the 
 60.30  month in which eligibility is approved and the first premium 
 60.31  payment has been received.  As provided in section 256B.057, 
 60.32  coverage for newborns is automatic from the date of birth and 
 60.33  must be coordinated with other health coverage.  The effective 
 60.34  date of coverage for eligible newly adoptive children added to a 
 60.35  family receiving covered health services is the date of entry 
 60.36  into the family.  The month of placement or the month placement 
 61.1   is reported, whichever is later.  The effective date of coverage 
 61.2   for other new recipients members added to the family receiving 
 61.3   covered health services is the first day of the month following 
 61.4   the month in which eligibility is approved or at renewal, 
 61.5   whichever the family receiving covered health services 
 61.6   prefers the change is reported.  All eligibility criteria must 
 61.7   be met by the family at the time the new family member is 
 61.8   added.  The income of the new family member is included with the 
 61.9   family's gross income and the adjusted premium begins in the 
 61.10  month the new family member is added.  
 61.11     (b) The initial premium must be received by the last 
 61.12  working day of the month for coverage to begin the first day of 
 61.13  the following month.  
 61.14     (c) Benefits are not available until the day following 
 61.15  discharge if an enrollee is hospitalized on the first day of 
 61.16  coverage.  
 61.17     (d) Notwithstanding any other law to the contrary, benefits 
 61.18  under sections 256L.01 to 256L.18 are secondary to a plan of 
 61.19  insurance or benefit program under which an eligible person may 
 61.20  have coverage and the commissioner shall use cost avoidance 
 61.21  techniques to ensure coordination of any other health coverage 
 61.22  for eligible persons.  The commissioner shall identify eligible 
 61.23  persons who may have coverage or benefits under other plans of 
 61.24  insurance or who become eligible for medical assistance. 
 61.25     Sec. 20.  Minnesota Statutes 2003 Supplement, section 
 61.26  256L.07, subdivision 1, is amended to read: 
 61.27     Subdivision 1.  [GENERAL REQUIREMENTS.] (a) Children 
 61.28  enrolled in the original children's health plan as of September 
 61.29  30, 1992, children who enrolled in the MinnesotaCare program 
 61.30  after September 30, 1992, pursuant to Laws 1992, chapter 549, 
 61.31  article 4, section 17, and children who have family gross 
 61.32  incomes that are equal to or less than 150 percent of the 
 61.33  federal poverty guidelines are eligible without meeting the 
 61.34  requirements of subdivision 2 and the four-month requirement in 
 61.35  subdivision 3, as long as they maintain continuous coverage in 
 61.36  the MinnesotaCare program or medical assistance.  Children who 
 62.1   apply for MinnesotaCare on or after the implementation date of 
 62.2   the employer-subsidized health coverage program as described in 
 62.3   Laws 1998, chapter 407, article 5, section 45, who have family 
 62.4   gross incomes that are equal to or less than 150 percent of the 
 62.5   federal poverty guidelines, must meet the requirements of 
 62.6   subdivision 2 to be eligible for MinnesotaCare. 
 62.7      (b) Families enrolled in MinnesotaCare under section 
 62.8   256L.04, subdivision 1, whose income increases above 275 percent 
 62.9   of the federal poverty guidelines, are no longer eligible for 
 62.10  the program and shall be disenrolled by the commissioner.  
 62.11  Individuals enrolled in MinnesotaCare under section 256L.04, 
 62.12  subdivision 7, whose income increases above 175 percent of the 
 62.13  federal poverty guidelines are no longer eligible for the 
 62.14  program and shall be disenrolled by the commissioner.  For 
 62.15  persons disenrolled under this subdivision, MinnesotaCare 
 62.16  coverage terminates the last day of the calendar month following 
 62.17  the month in which the commissioner determines that the income 
 62.18  of a family or individual exceeds program income limits.  
 62.19     (c)(1) Notwithstanding paragraph (b), families enrolled in 
 62.20  MinnesotaCare under section 256L.04, subdivision 1, may remain 
 62.21  enrolled in MinnesotaCare if ten percent of their annual income 
 62.22  is less than the annual premium for a policy with a $500 
 62.23  deductible available through the Minnesota Comprehensive Health 
 62.24  Association.  Families who are no longer eligible for 
 62.25  MinnesotaCare under this subdivision shall be given an 18-month 
 62.26  notice period from the date that ineligibility is determined 
 62.27  before disenrollment.  This clause expires February 1, 2004. 
 62.28     (2) Effective February 1, 2004, notwithstanding paragraph 
 62.29  (b), children may remain enrolled in MinnesotaCare if ten 
 62.30  percent of their annual family income is less than the annual 
 62.31  premium for a policy with a $500 deductible available through 
 62.32  the Minnesota Comprehensive Health Association.  Children who 
 62.33  are no longer eligible for MinnesotaCare under this clause shall 
 62.34  be given a 12-month notice period from the date that 
 62.35  ineligibility is determined before disenrollment.  The premium 
 62.36  for children remaining eligible under this clause shall be the 
 63.1   maximum premium determined under section 256L.15, subdivision 2, 
 63.2   paragraph (b). 
 63.3      (d) Effective July 1, 2003, notwithstanding paragraphs (b) 
 63.4   and (c), parents are no longer eligible for MinnesotaCare if 
 63.5   gross household income exceeds $50,000. 
 63.6      Sec. 21.  Minnesota Statutes 2003 Supplement, section 
 63.7   256L.07, subdivision 3, is amended to read: 
 63.8      Subd. 3.  [OTHER HEALTH COVERAGE.] (a) Families and 
 63.9   individuals enrolled in the MinnesotaCare program must have no 
 63.10  health coverage while enrolled or for at least four months prior 
 63.11  to application and renewal.  Children enrolled in the original 
 63.12  children's health plan and children in families with income 
 63.13  equal to or less than 150 percent of the federal poverty 
 63.14  guidelines, who have other health insurance, are eligible if the 
 63.15  coverage: 
 63.16     (1) lacks two or more of the following: 
 63.17     (i) basic hospital insurance; 
 63.18     (ii) medical-surgical insurance; 
 63.19     (iii) prescription drug coverage; 
 63.20     (iv) dental coverage; or 
 63.21     (v) vision coverage; 
 63.22     (2) requires a deductible of $100 or more per person per 
 63.23  year; or 
 63.24     (3) lacks coverage because the child has exceeded the 
 63.25  maximum coverage for a particular diagnosis or the policy 
 63.26  excludes a particular diagnosis. 
 63.27     The commissioner may change this eligibility criterion for 
 63.28  sliding scale premiums in order to remain within the limits of 
 63.29  available appropriations.  The requirement of no health coverage 
 63.30  does not apply to newborns.  
 63.31     (b) Medical assistance, general assistance medical care, 
 63.32  and the Civilian Health and Medical Program of the Uniformed 
 63.33  Service, CHAMPUS, or other coverage provided under United States 
 63.34  Code, title 10, subtitle A, part II, chapter 55, are not 
 63.35  considered insurance or health coverage for purposes of the 
 63.36  four-month requirement described in this subdivision. 
 64.1      (c) For purposes of this subdivision, Medicare Part A or B 
 64.2   coverage under title XVIII of the Social Security Act, United 
 64.3   States Code, title 42, sections 1395c to 1395w-4, is considered 
 64.4   health coverage.  An applicant or enrollee may not refuse who is 
 64.5   entitled to Medicare but has failed to apply or refused Medicare 
 64.6   coverage to establish eligibility is not eligible for 
 64.7   MinnesotaCare.  
 64.8      (d) Applicants who were recipients of medical assistance or 
 64.9   general assistance medical care within one month of application 
 64.10  must meet the provisions of this subdivision and subdivision 2. 
 64.11     (e) Effective October 1, 2003, applicants who were 
 64.12  recipients of medical assistance and had Cost-effective health 
 64.13  insurance which that was paid for by medical assistance are 
 64.14  exempt from is not considered health coverage for purposes of 
 64.15  the four-month requirement under this section, except if the 
 64.16  insurance continued after medical assistance no longer 
 64.17  considered it cost-effective or after medical assistance closed. 
 64.18     Sec. 22.  [FEDERAL APPROVAL.] 
 64.19     The commissioner of human services shall request federal 
 64.20  approval to exempt from co-payments medical assistance 
 64.21  recipients with personal needs allowances by July 1, 2004, and 
 64.22  provide copies of the request to the chairs of the house Health 
 64.23  and Human Services Finance Committee and senate Health, Human 
 64.24  Services and Corrections Budget Division.  If federal approval 
 64.25  to exempt all recipients with a personal needs allowance is not 
 64.26  obtained, the commissioner shall seek federal approval to exempt 
 64.27  from co-payments all those who can qualify for an exemption 
 64.28  through a state plan amendment or a waiver request. 
 64.29     Sec. 23.  [REPEALER.] 
 64.30     Subdivision 1.  [PRESCRIPTION DRUG PROGRAM.] Minnesota 
 64.31  Statutes 2002, section 256.955, subdivisions 1, 2, 2b, 4, 5, 6, 
 64.32  7, and 9; and Minnesota Statutes 2003 Supplement, section 
 64.33  256.955, subdivisions 2a, 3, and 4a, are repealed effective 
 64.34  January 1, 2006.  
 64.35     Subd. 2.  [MINNESOTACARE OUTREACH GRANTS.] Minnesota 
 64.36  Statutes 2002, section 256L.04, subdivision 11, is repealed 
 65.1   effective July 1, 2004. 
 65.2                              ARTICLE 10 
 65.3                            LONG-TERM CARE 
 65.4      Section 1.  Minnesota Statutes 2003 Supplement, section 
 65.5   144A.071, subdivision 4c, is amended to read: 
 65.6      Subd. 4c.  [EXCEPTIONS FOR REPLACEMENT BEDS AFTER JUNE 30, 
 65.7   2003.] (a) The commissioner of health, in coordination with the 
 65.8   commissioner of human services, may approve the renovation, 
 65.9   replacement, upgrading, or relocation of a nursing home or 
 65.10  boarding care home, under the following conditions: 
 65.11     (1) to license and certify an 80-bed city-owned facility in 
 65.12  Nicollet County to be constructed on the site of a new 
 65.13  city-owned hospital to replace an existing 85-bed facility 
 65.14  attached to a hospital that is also being replaced.  The 
 65.15  threshold allowed for this project under section 144A.073 shall 
 65.16  be the maximum amount available to pay the additional medical 
 65.17  assistance costs of the new facility; and 
 65.18     (2) to license and certify 29 beds to be added to an 
 65.19  existing 69-bed facility in St. Louis County, provided that the 
 65.20  29 beds must be transferred from active or layaway status at an 
 65.21  existing facility in St. Louis County that had 235 beds on April 
 65.22  1, 2003. 
 65.23  The licensed capacity at the 235-bed facility must be reduced to 
 65.24  206 beds, but the payment rate at that facility shall not be 
 65.25  adjusted as a result of this transfer.  The operating payment 
 65.26  rate of the facility adding beds after completion of this 
 65.27  project shall be the same as it was on the day prior to the day 
 65.28  the beds are licensed and certified.  This project shall not 
 65.29  proceed unless it is approved and financed under the provisions 
 65.30  of section 144A.073; and 
 65.31     (3) to license and certify a new 60-bed facility in Austin, 
 65.32  provided that: 
 65.33     (i) 45 of the new beds are transferred from a 45-bed 
 65.34  facility in Austin under common ownership that is closed, and 15 
 65.35  of the new beds are transferred from a 182-bed facility in 
 65.36  Albert Lea under common ownership; 
 66.1      (ii) the commissioner of human services is authorized by 
 66.2   the 2004 legislature to negotiate budget-neutral planned nursing 
 66.3   facility closures; and 
 66.4      (iii) money is available from planned closures of 
 66.5   facilities under common ownership to make implementation of this 
 66.6   clause budget-neutral to the state.  
 66.7      The bed capacity of the Albert Lea facility shall be 
 66.8   reduced to 167 beds following the transfer.  Of the 60 beds at 
 66.9   the new facility, 20 beds shall be used for a special care unit 
 66.10  for persons with Alzheimer's disease or related dementias. 
 66.11     (b) Projects approved under this subdivision shall be 
 66.12  treated in a manner equivalent to projects approved under 
 66.13  subdivision 4a. 
 66.14     Sec. 2.  Minnesota Statutes 2002, section 144A.10, 
 66.15  subdivision 1a, is amended to read: 
 66.16     Subd. 1a.  [TRAINING AND EDUCATION FOR NURSING FACILITY 
 66.17  PROVIDERS.] The commissioner of health must establish and 
 66.18  implement a prescribed process and program for providing 
 66.19  training and education to providers licensed by the Department 
 66.20  of Health, either by itself or in conjunction with the industry 
 66.21  trade associations, before using any new regulatory guideline, 
 66.22  regulation, interpretation, program letter or memorandum, or any 
 66.23  other materials used in surveyor training to survey licensed 
 66.24  providers.  The process should include, but is not limited to, 
 66.25  the following key components: 
 66.26     (1) facilitate the implementation of immediate revisions to 
 66.27  any course curriculum for nursing assistants which reflect any 
 66.28  new standard of care practice that has been adopted or 
 66.29  referenced by the Health Department concerning the issue in 
 66.30  question; 
 66.31     (2) conduct training of long-term care providers and health 
 66.32  department survey inspectors either jointly or during the same 
 66.33  time frame on the department's new expectations; and 
 66.34     (3) within available resources the commissioner shall 
 66.35  cooperate in the development of clinical standards, work with 
 66.36  vendors of supplies and services regarding hazards, and identify 
 67.1   research of interest to the long-term care community consult 
 67.2   with experts in the field to develop or make available training 
 67.3   resources on current standards of practice and the use of 
 67.4   technology.  
 67.5      Sec. 3.  Minnesota Statutes 2002, section 144A.10, is 
 67.6   amended by adding a subdivision to read: 
 67.7      Subd. 17.  [AGENCY QUALITY IMPROVEMENT PROGRAM; ANNUAL 
 67.8   REPORT ON SURVEY PROCESS.] (a) The commissioner shall establish 
 67.9   a quality improvement program for the nursing facility survey 
 67.10  and complaint processes.  The commissioner must regularly 
 67.11  consult with consumers, consumer advocates, and representatives 
 67.12  of the nursing home industry and representatives of nursing home 
 67.13  employees in implementing the program.  The commissioner, 
 67.14  through the quality improvement program, shall submit to the 
 67.15  legislature an annual survey and certification quality 
 67.16  improvement report, beginning December 15, 2004, and each 
 67.17  December 15 thereafter.  
 67.18     (b) The report must include, but is not limited to, an 
 67.19  analysis of: 
 67.20     (1) the number, scope, and severity of citations by region 
 67.21  within the state; 
 67.22     (2) cross-referencing of citations by region within the 
 67.23  state and between states within the Centers for Medicare and 
 67.24  Medicaid Services region in which Minnesota is located; 
 67.25     (3) the number and outcomes of independent dispute 
 67.26  resolutions; 
 67.27     (4) the number and outcomes of appeals; 
 67.28     (5) compliance with timelines for survey revisits and 
 67.29  complaint investigations; 
 67.30     (6) techniques of surveyors in investigations, 
 67.31  communication, and documentation to identify and support 
 67.32  citations; 
 67.33     (7) compliance with timelines for providing facilities with 
 67.34  completed statements of deficiencies; and 
 67.35     (8) other survey statistics relevant to improving the 
 67.36  survey process. 
 68.1      (c) The report must also identify and explain 
 68.2   inconsistencies and patterns across regions of the state, 
 68.3   include analyses and recommendations for quality improvement 
 68.4   areas identified by the commissioner, consumers, consumer 
 68.5   advocates, and representatives of the nursing home industry and 
 68.6   nursing home employees, and provide action plans to address 
 68.7   problems that are identified. 
 68.8      Sec. 4.  [144A.101] [PROCEDURES FOR FEDERALLY REQUIRED 
 68.9   SURVEY PROCESS.] 
 68.10     Subdivision 1.  [APPLICABILITY.] This section applies to 
 68.11  survey certification and enforcement activities by the 
 68.12  commissioner related to regular, expanded, or extended surveys 
 68.13  under Code of Federal Regulations, title 42, part 488. 
 68.14     Subd. 2.  [STATEMENT OF DEFICIENCIES.] The commissioner 
 68.15  shall provide nursing facilities with draft statements of 
 68.16  deficiencies at the time of the survey exit process and shall 
 68.17  provide facilities with completed statements of deficiencies 
 68.18  within 15 working days of the exit process. 
 68.19     Subd. 3.  [SURVEYOR NOTES.] The commissioner, upon the 
 68.20  request of a nursing facility, shall provide the facility with 
 68.21  copies of formal surveyor notes taken during the survey, with 
 68.22  the exception of the resident, family, and staff interviews, at 
 68.23  the time the completed statement of deficiency is provided to 
 68.24  the facility.  The survey notes shall be redacted to protect the 
 68.25  confidentiality of individuals providing information to the 
 68.26  surveyors.  A facility requesting formal surveyor notes must 
 68.27  agree to pay the commissioner for the cost of copying and 
 68.28  redacting. 
 68.29     Subd. 4.  [POSTING OF STATEMENTS OF DEFICIENCIES.] The 
 68.30  commissioner, when posting statements of a nursing facility's 
 68.31  deficiencies on the agency Web site, must include in the posting 
 68.32  the facility's response to the citations.  The Web site must 
 68.33  also include the dates upon which deficiencies are corrected and 
 68.34  the date upon which a facility is considered to be in compliance 
 68.35  with survey requirements.  If deficiencies are under dispute, 
 68.36  the commissioner must note this on the Web site using a method 
 69.1   that clearly identifies for consumers which citations are under 
 69.2   dispute. 
 69.3      Subd. 5.  [SURVEY REVISITS.] The commissioner shall conduct 
 69.4   survey revisits within 15 calendar days of the date by which 
 69.5   corrections will be completed, as specified by the provider in 
 69.6   its plan of correction, in cases where category 2 or category 3 
 69.7   remedies are in place.  The commissioner may conduct survey 
 69.8   revisits by telephone or written communications for facilities 
 69.9   at which the highest scope and severity score for a violation 
 69.10  was level E or lower. 
 69.11     Subd. 6.  [FAMILY COUNCILS.] Nursing facility family 
 69.12  councils shall be interviewed as part of the survey process and 
 69.13  invited to participate in the exit conference. 
 69.14     Sec. 5.  Minnesota Statutes 2002, section 256.01, is 
 69.15  amended by adding a subdivision to read: 
 69.16     Subd. 21.  [INTERAGENCY AGREEMENT WITH DEPARTMENT OF 
 69.17  HEALTH.] The commissioner of human services shall amend the 
 69.18  interagency agreement with the commissioner of health to certify 
 69.19  nursing facilities for participation in the medical assistance 
 69.20  program, to require the commissioner of health, as a condition 
 69.21  of the agreement, to comply beginning July 1, 2005, with action 
 69.22  plans included in the annual survey and certification quality 
 69.23  improvement report required under section 144A.10, subdivision 
 69.24  17. 
 69.25     Sec. 6.  Minnesota Statutes 2002, section 256B.431, is 
 69.26  amended by adding a subdivision to read: 
 69.27     Subd. 40.  [DESIGNATION OF AREAS TO RECEIVE METROPOLITAN 
 69.28  RATES.] (a) For rate years beginning on or after July 1, 2004, 
 69.29  and subject to paragraph (b), nursing facilities located in 
 69.30  areas designated as metropolitan areas by the federal Office of 
 69.31  Management and Budget using census bureau data shall be 
 69.32  considered metro, in order to: 
 69.33     (1) determine rate increases under this section, section 
 69.34  256B.434, or any other section; and 
 69.35     (2) establish nursing facility reimbursement rates for the 
 69.36  new nursing facility reimbursement system developed under Laws 
 70.1   2001, First Special Session chapter 9, article 5, section 35, as 
 70.2   amended by Laws 2002, chapter 220, article 14, section 19. 
 70.3      (b) Paragraph (a) applies only if designation as a metro 
 70.4   facility results in a level of reimbursement that is higher than 
 70.5   the level the facility would have received without application 
 70.6   of that paragraph. 
 70.7      [EFFECTIVE DATE.] This section is effective July 1, 2004. 
 70.8      Sec. 7.  Minnesota Statutes 2002, section 256B.431, is 
 70.9   amended by adding a subdivision to read: 
 70.10     Subd. 41.  [PROFESSIONAL LIABILITY COSTS.] (a) The 
 70.11  commissioner shall make available to eligible nursing facilities 
 70.12  reimbursed under this section whose rates are not determined 
 70.13  under Minnesota Rules, part 9549.0057, and to eligible nursing 
 70.14  facilities reimbursed under section 256B.434, an adjustment to 
 70.15  the nursing facility's operating cost per diems for the rate 
 70.16  year beginning July 1, 2004, to assist facilities in paying 
 70.17  increased professional liability insurance premiums where the 
 70.18  increase, on a per bed basis, is greater than five percent.  The 
 70.19  per diem adjustment shall be computed by the commissioner using 
 70.20  the information described in paragraph (b) and the method 
 70.21  described in paragraph (c).  This adjustment is onetime and must 
 70.22  not be included in a facility's base when calculating operating 
 70.23  cost per diems for rate years beginning on or after July 1, 2005.
 70.24     (b) A facility is eligible for an adjustment if the 
 70.25  facility experienced a rate of increase in premiums for 
 70.26  professional liability insurance of more than five percent 
 70.27  between calendar years 2002 and 2003, and provides to the 
 70.28  commissioner, in the form and manner specified by the 
 70.29  commissioner, information on the amount of premiums paid for 
 70.30  professional liability insurance for calendar years 2002 and 
 70.31  2003.  The information must be delivered to the commissioner by 
 70.32  October 1, 2004, or postmarked by September 30, 2004.  
 70.33  Facilities that do not meet this deadline are ineligible for the 
 70.34  rate adjustment. 
 70.35     (c) The commissioner shall review the information timely 
 70.36  submitted under paragraph (b) to determine each facility's 
 71.1   allowable increased costs.  For purposes of this requirement, 
 71.2   "allowable increased costs" is the dollar amount of the portion 
 71.3   of the percentage increase in a facility's professional 
 71.4   liability insurance between calendar years 2002 and 2003 that 
 71.5   exceeds five percent, on a per bed basis.  Subject to the 
 71.6   limitation in paragraph (d), the commissioner shall compute a 
 71.7   facility's rate adjustment by dividing the allowable increased 
 71.8   costs for that facility by actual resident days from the most 
 71.9   recent reporting year. 
 71.10     (d) If the rate increases are projected to increase the 
 71.11  state share of medical assistance costs by $1,550,000 or less, 
 71.12  the rate adjustments shall be implemented.  If the rate 
 71.13  increases are projected to increase the state share of medical 
 71.14  assistance costs by more than $1,550,000, the commissioner shall 
 71.15  proportionally decrease each facility's rate adjustment to 
 71.16  levels that project to spending no more than $1,550,000. 
 71.17     Sec. 8.  Minnesota Statutes 2003 Supplement, section 
 71.18  256B.434, subdivision 4, is amended to read: 
 71.19     Subd. 4.  [ALTERNATE RATES FOR NURSING FACILITIES.] (a) For 
 71.20  nursing facilities which have their payment rates determined 
 71.21  under this section rather than section 256B.431, the 
 71.22  commissioner shall establish a rate under this subdivision.  The 
 71.23  nursing facility must enter into a written contract with the 
 71.24  commissioner. 
 71.25     (b) A nursing facility's case mix payment rate for the 
 71.26  first rate year of a facility's contract under this section is 
 71.27  the payment rate the facility would have received under section 
 71.28  256B.431. 
 71.29     (c) A nursing facility's case mix payment rates for the 
 71.30  second and subsequent years of a facility's contract under this 
 71.31  section are the previous rate year's contract payment rates plus 
 71.32  an inflation adjustment and, for facilities reimbursed under 
 71.33  this section or section 256B.431, an adjustment to include the 
 71.34  cost of any increase in Health Department licensing fees for the 
 71.35  facility taking effect on or after July 1, 2001.  The index for 
 71.36  the inflation adjustment must be based on the change in the 
 72.1   Consumer Price Index-All Items (United States City average) 
 72.2   (CPI-U) forecasted by the commissioner of finance's national 
 72.3   economic consultant, as forecasted in the fourth quarter of the 
 72.4   calendar year preceding the rate year.  The inflation adjustment 
 72.5   must be based on the 12-month period from the midpoint of the 
 72.6   previous rate year to the midpoint of the rate year for which 
 72.7   the rate is being determined.  For the rate years beginning on 
 72.8   July 1, 1999, July 1, 2000, July 1, 2001, July 1, 2002, July 1, 
 72.9   2003, and July 1, 2004, July 1, 2005, and July 1, 2006, this 
 72.10  paragraph shall apply only to the property-related payment rate, 
 72.11  except that adjustments to include the cost of any increase in 
 72.12  Health Department licensing fees taking effect on or after July 
 72.13  1, 2001, shall be provided.  In determining the amount of the 
 72.14  property-related payment rate adjustment under this paragraph, 
 72.15  the commissioner shall determine the proportion of the 
 72.16  facility's rates that are property-related based on the 
 72.17  facility's most recent cost report. 
 72.18     (d) The commissioner shall develop additional 
 72.19  incentive-based payments of up to five percent above the 
 72.20  standard contract rate for achieving outcomes specified in each 
 72.21  contract.  The specified facility-specific outcomes must be 
 72.22  measurable and approved by the commissioner.  The commissioner 
 72.23  may establish, for each contract, various levels of achievement 
 72.24  within an outcome.  After the outcomes have been specified the 
 72.25  commissioner shall assign various levels of payment associated 
 72.26  with achieving the outcome.  Any incentive-based payment cancels 
 72.27  if there is a termination of the contract.  In establishing the 
 72.28  specified outcomes and related criteria the commissioner shall 
 72.29  consider the following state policy objectives: 
 72.30     (1) improved cost effectiveness and quality of life as 
 72.31  measured by improved clinical outcomes; 
 72.32     (2) successful diversion or discharge to community 
 72.33  alternatives; 
 72.34     (3) decreased acute care costs; 
 72.35     (4) improved consumer satisfaction; 
 72.36     (5) the achievement of quality; or 
 73.1      (6) any additional outcomes proposed by a nursing facility 
 73.2   that the commissioner finds desirable. 
 73.3      Sec. 9.  [GRANTS TO MEDICARE CERTIFIED HOME CARE AGENCIES.] 
 73.4      Subdivision 1.  [GRANT AVAILABILITY.] The commissioner of 
 73.5   human services shall make available to eligible Medicare 
 73.6   certified home care agencies reimbursed under Minnesota 
 73.7   Statutes, chapter 256B, grants to assist agencies in paying 
 73.8   professional liability insurance premiums greater than five 
 73.9   percent from the previous year.  These grants are one-time and 
 73.10  shall not be included in an agency's payment rate. 
 73.11     Subd. 2.  [ELIGIBILITY FOR GRANTS.] An agency is eligible 
 73.12  for a grant if the agency experienced a rate increase in 
 73.13  premiums for professional liability insurance of more than five 
 73.14  percent between calendar years 2002 and 2003, and provides to 
 73.15  the commissioner, in the form and manner specified by the 
 73.16  commissioner, information on the amount of premiums paid for 
 73.17  professional liability insurance for calendar years 2002 and 
 73.18  2003, and any increases in the number of client visits and the 
 73.19  number of employees for that time period.  The information must 
 73.20  be delivered to the commissioner by October 1, 2004, or 
 73.21  postmarked by September 30, 2004. Agencies that do not meet this 
 73.22  deadline are ineligible for a grant. 
 73.23     Subd. 3.  [GRANT BASED ON ALLOWABLE INCREASED COSTS.] The 
 73.24  commissioner shall review the information timely submitted to 
 73.25  determine each agency's allowable increased costs, and subject 
 73.26  to the limitations in subdivision 4, shall provide a grant to 
 73.27  the agency equal to the agency's allowable increased costs.  For 
 73.28  purposes of this requirement, "allowable increased costs" is the 
 73.29  dollar amount of the portion of the percentage increase in an 
 73.30  agency's professional liability insurance premiums between 
 73.31  calendar years 2002 and 2003 that exceeds five percent, minus 
 73.32  any dollar amount due to an increase in the number of client 
 73.33  visits or the number of employees. 
 73.34     Subd. 4.  [STATE SHARE; FEDERAL MATCH.] If the grants 
 73.35  provided to agencies are projected to increase state spending by 
 73.36  more than $150,000, the commissioner shall proportionally 
 74.1   decrease agency grant amounts to levels that limit state 
 74.2   spending to $150,000.  If the commissioner is able to obtain a 
 74.3   federal match of medical assistance for this purpose, the 
 74.4   federal match shall be added to the state allocation, and used 
 74.5   to provide grants under this section. 
 74.6      Sec. 10.  [NURSING FACILITY SCHOLARSHIP PROGRAM.] 
 74.7      For the rate year beginning July 1, 2004, the amount 
 74.8   determined under Minnesota Statutes, section 256B.431, 
 74.9   subdivision 36, shall be removed from each nursing facility's 
 74.10  rate. 
 74.11     Sec. 11.  [PROGRESS REPORT.] 
 74.12     The commissioner of health shall include in the December 
 74.13  15, 2004, quality improvement report required under section 2 a 
 74.14  progress report and implementation plan for the following 
 74.15  legislatively directed activities: 
 74.16     (1) an analysis of the frequency of defensive documentation 
 74.17  and a plan, developed in consultation with the nursing home 
 74.18  industry, consumers, unions representing nursing home employees, 
 74.19  and advocates, to minimize defensive documentation; 
 74.20     (2) the nursing home providers workgroup established under 
 74.21  Laws 2003, First Special Session chapter 14, article 13C, 
 74.22  section 3; and 
 74.23     (3) progress in implementing the independent informal 
 74.24  dispute resolution process required under Minnesota Statutes, 
 74.25  section 144A.10, subdivision 16. 
 74.26     Sec. 12.  [RESUBMITTAL OF REQUESTS FOR FEDERAL WAIVERS AND 
 74.27  APPROVALS.] 
 74.28     (a) The commissioner of health shall seek federal waivers, 
 74.29  approvals, and law changes necessary to implement the 
 74.30  alternative nursing home survey process established under 
 74.31  Minnesota Statutes, section 144A.37. 
 74.32     (b) The commissioner of health shall seek changes in the 
 74.33  federal policy that mandates the imposition of federal sanctions 
 74.34  without providing an opportunity for a nursing facility to 
 74.35  correct deficiencies, solely as the result of previous 
 74.36  deficiencies issued to the nursing facility. 
 75.1      Sec. 13.  [REPEALER; NURSING FACILITY SCHOLARSHIPS.] 
 75.2      Minnesota Statutes 2003 Supplement, section 256B.431, 
 75.3   subdivision 36, is repealed effective July 1, 2004. 
 75.4                              ARTICLE 11 
 75.5                           CONTINUING CARE 
 75.6      Section 1.  Minnesota Statutes 2003 Supplement, section 
 75.7   252.27, subdivision 2a, is amended to read: 
 75.8      Subd. 2a.  [CONTRIBUTION AMOUNT.] (a) The natural or 
 75.9   adoptive parents of a minor child, including a child determined 
 75.10  eligible for medical assistance without consideration of 
 75.11  parental income, must contribute monthly to the cost of 
 75.12  services, unless the child is married or has been married, 
 75.13  parental rights have been terminated, or the child's adoption is 
 75.14  subsidized according to section 259.67 or through title IV-E of 
 75.15  the Social Security Act. 
 75.16     (b) For households with adjusted gross income equal to or 
 75.17  greater than 100 percent of federal poverty guidelines, the 
 75.18  parental contribution shall be computed by applying the 
 75.19  following schedule of rates to the adjusted gross income of the 
 75.20  natural or adoptive parents: 
 75.21     (1) if the adjusted gross income is equal to or greater 
 75.22  than 100 percent of federal poverty guidelines and less than 175 
 75.23  percent of federal poverty guidelines, the parental contribution 
 75.24  is $4 per month; 
 75.25     (2) if the adjusted gross income is equal to or greater 
 75.26  than 175 percent of federal poverty guidelines and less than or 
 75.27  equal to 375 545 percent of federal poverty guidelines, the 
 75.28  parental contribution shall be determined using a sliding fee 
 75.29  scale established by the commissioner of human services which 
 75.30  begins at one percent of adjusted gross income at 175 percent of 
 75.31  federal poverty guidelines and increases to 7.5 percent of 
 75.32  adjusted gross income for those with adjusted gross income up to 
 75.33  375 545 percent of federal poverty guidelines; 
 75.34     (3) if the adjusted gross income is greater than 375 545 
 75.35  percent of federal poverty guidelines and less than 675 percent 
 75.36  of federal poverty guidelines, the parental contribution shall 
 76.1   be 7.5 percent of adjusted gross income; 
 76.2      (4) if the adjusted gross income is equal to or greater 
 76.3   than 675 percent of federal poverty guidelines and less than 975 
 76.4   percent of federal poverty guidelines, the parental contribution 
 76.5   shall be determined using a sliding fee scale established by the 
 76.6   commissioner of human services which begins at 7.5 percent of 
 76.7   adjusted gross income at 675 percent of federal poverty 
 76.8   guidelines and increases to ten percent of adjusted gross income 
 76.9   for those with adjusted gross income up to 975 percent of 
 76.10  federal poverty guidelines; and 
 76.11     (5) if the adjusted gross income is equal to or greater 
 76.12  than 975 percent of federal poverty guidelines, the parental 
 76.13  contribution shall be 12.5 percent of adjusted gross income. 
 76.14     If the child lives with the parent, the annual adjusted 
 76.15  gross income is reduced by $2,400 prior to calculating the 
 76.16  parental contribution.  If the child resides in an institution 
 76.17  specified in section 256B.35, the parent is responsible for the 
 76.18  personal needs allowance specified under that section in 
 76.19  addition to the parental contribution determined under this 
 76.20  section.  The parental contribution is reduced by any amount 
 76.21  required to be paid directly to the child pursuant to a court 
 76.22  order, but only if actually paid. 
 76.23     (c) The household size to be used in determining the amount 
 76.24  of contribution under paragraph (b) includes natural and 
 76.25  adoptive parents and their dependents under age 21, including 
 76.26  the child receiving services.  Adjustments in the contribution 
 76.27  amount due to annual changes in the federal poverty guidelines 
 76.28  shall be implemented on the first day of July following 
 76.29  publication of the changes. 
 76.30     (d) For purposes of paragraph (b), "income" means the 
 76.31  adjusted gross income of the natural or adoptive parents 
 76.32  determined according to the previous year's federal tax form, 
 76.33  except, effective retroactive to July 1, 2003, taxable capital 
 76.34  gains to the extent the funds have been used to purchase a home 
 76.35  shall not be counted as income. 
 76.36     (e) The contribution shall be explained in writing to the 
 77.1   parents at the time eligibility for services is being 
 77.2   determined.  The contribution shall be made on a monthly basis 
 77.3   effective with the first month in which the child receives 
 77.4   services.  Annually upon redetermination or at termination of 
 77.5   eligibility, if the contribution exceeded the cost of services 
 77.6   provided, the local agency or the state shall reimburse that 
 77.7   excess amount to the parents, either by direct reimbursement if 
 77.8   the parent is no longer required to pay a contribution, or by a 
 77.9   reduction in or waiver of parental fees until the excess amount 
 77.10  is exhausted. 
 77.11     (f) The monthly contribution amount must be reviewed at 
 77.12  least every 12 months; when there is a change in household size; 
 77.13  and when there is a loss of or gain in income from one month to 
 77.14  another in excess of ten percent.  The local agency shall mail a 
 77.15  written notice 30 days in advance of the effective date of a 
 77.16  change in the contribution amount.  A decrease in the 
 77.17  contribution amount is effective in the month that the parent 
 77.18  verifies a reduction in income or change in household size. 
 77.19     (g) Parents of a minor child who do not live with each 
 77.20  other shall each pay the contribution required under paragraph 
 77.21  (a).  An amount equal to the annual court-ordered child support 
 77.22  payment actually paid on behalf of the child receiving services 
 77.23  shall be deducted from the adjusted gross income of the parent 
 77.24  making the payment prior to calculating the parental 
 77.25  contribution under paragraph (b). 
 77.26     (h) The contribution under paragraph (b) shall be increased 
 77.27  by an additional five percent if the local agency determines 
 77.28  that insurance coverage is available but not obtained for the 
 77.29  child.  For purposes of this section, "available" means the 
 77.30  insurance is a benefit of employment for a family member at an 
 77.31  annual cost of no more than five percent of the family's annual 
 77.32  income.  For purposes of this section, "insurance" means health 
 77.33  and accident insurance coverage, enrollment in a nonprofit 
 77.34  health service plan, health maintenance organization, 
 77.35  self-insured plan, or preferred provider organization. 
 77.36     Parents who have more than one child receiving services 
 78.1   shall not be required to pay more than the amount for the child 
 78.2   with the highest expenditures.  There shall be no resource 
 78.3   contribution from the parents.  The parent shall not be required 
 78.4   to pay a contribution in excess of the cost of the services 
 78.5   provided to the child, not counting payments made to school 
 78.6   districts for education-related services.  Notice of an increase 
 78.7   in fee payment must be given at least 30 days before the 
 78.8   increased fee is due.  
 78.9      (i) The contribution under paragraph (b) shall be reduced 
 78.10  by $300 per fiscal year if, in the 12 months prior to July 1: 
 78.11     (1) the parent applied for insurance for the child; 
 78.12     (2) the insurer denied insurance; 
 78.13     (3) the parents submitted a complaint or appeal, in writing 
 78.14  to the insurer, submitted a complaint or appeal, in writing, to 
 78.15  the commissioner of health or the commissioner of commerce, or 
 78.16  litigated the complaint or appeal; and 
 78.17     (4) as a result of the dispute, the insurer reversed its 
 78.18  decision and granted insurance. 
 78.19     For purposes of this section, "insurance" has the meaning 
 78.20  given in paragraph (h). 
 78.21     A parent who has requested a reduction in the contribution 
 78.22  amount under this paragraph shall submit proof in the form and 
 78.23  manner prescribed by the commissioner or county agency, 
 78.24  including, but not limited to, the insurer's denial of 
 78.25  insurance, the written letter or complaint of the parents, court 
 78.26  documents, and the written response of the insurer approving 
 78.27  insurance.  The determinations of the commissioner or county 
 78.28  agency under this paragraph are not rules subject to chapter 14. 
 78.29     Sec. 2.  Minnesota Statutes 2002, section 256.9365, 
 78.30  subdivision 1, is amended to read: 
 78.31     Subdivision 1.  [PROGRAM ESTABLISHED.] The commissioner of 
 78.32  human services shall establish a program to pay private health 
 78.33  plan premiums for persons who have contracted human 
 78.34  immunodeficiency virus (HIV) to enable them to continue coverage 
 78.35  under a group or individual health plan.  If a person is 
 78.36  determined to be eligible under subdivision 2, the commissioner 
 79.1   shall pay the portion of the group plan premium for which the 
 79.2   individual is responsible, if the individual is responsible for 
 79.3   at least 50 percent of the cost of the premium, or pay the 
 79.4   individual plan premium.  The commissioner shall not pay for 
 79.5   that portion of a premium that is attributable to other family 
 79.6   members or dependents.  The commissioner shall establish 
 79.7   cost-sharing provisions for individuals participating in this 
 79.8   program that are consistent with provisions in section 256B.057, 
 79.9   subdivision 9, for employed persons with disabilities. 
 79.10     [EFFECTIVE DATE.] This section is effective July 1, 2004. 
 79.11     Sec. 3.  Minnesota Statutes 2002, section 256B.0916, 
 79.12  subdivision 2, is amended to read: 
 79.13     Subd. 2.  [DISTRIBUTION OF FUNDS; PARTNERSHIPS.] (a) 
 79.14  Beginning with fiscal year 2000, the commissioner shall 
 79.15  distribute all funding available for home and community-based 
 79.16  waiver services for persons with mental retardation or related 
 79.17  conditions to individual counties or to groups of counties that 
 79.18  form partnerships to jointly plan, administer, and authorize 
 79.19  funding for eligible individuals.  The commissioner shall 
 79.20  encourage counties to form partnerships that have a sufficient 
 79.21  number of recipients and funding to adequately manage the risk 
 79.22  and maximize use of available resources.  
 79.23     (b) Counties must submit a request for funds and a plan for 
 79.24  administering the program as required by the commissioner.  The 
 79.25  plan must identify the number of clients to be served, their 
 79.26  ages, and their priority listing based on: 
 79.27     (1) requirements in Minnesota Rules, part 9525.1880; 
 79.28     (2) unstable living situations due to the age or incapacity 
 79.29  of the primary caregiver; 
 79.30     (3) the need for services to avoid out-of-home placement of 
 79.31  children; and 
 79.32     (4) the need to serve persons affected by private sector 
 79.33  ICF/MR closures; and 
 79.34     (5) the need to serve persons whose consumer support grant 
 79.35  exception amount was eliminated in 2004. 
 79.36  The plan must also identify changes made to improve services to 
 80.1   eligible persons and to improve program management. 
 80.2      (c) In allocating resources to counties, priority must be 
 80.3   given to groups of counties that form partnerships to jointly 
 80.4   plan, administer, and authorize funding for eligible individuals 
 80.5   and to counties determined by the commissioner to have 
 80.6   sufficient waiver capacity to maximize resource use. 
 80.7      (d) Within 30 days after receiving the county request for 
 80.8   funds and plans, the commissioner shall provide a written 
 80.9   response to the plan that includes the level of resources 
 80.10  available to serve additional persons. 
 80.11     (e) Counties are eligible to receive medical assistance 
 80.12  administrative reimbursement for administrative costs under 
 80.13  criteria established by the commissioner.  
 80.14     Sec. 4.  Minnesota Statutes 2003 Supplement, section 
 80.15  256B.19, subdivision 1, is amended to read: 
 80.16     Subdivision 1.  [DIVISION OF COST.] The state and county 
 80.17  share of medical assistance costs not paid by federal funds 
 80.18  shall be as follows:  
 80.19     (1) beginning January 1, 1992, 50 percent state funds and 
 80.20  50 percent county funds for the cost of placement of severely 
 80.21  emotionally disturbed children in regional treatment centers; 
 80.22     (2) beginning January 1, 2003, 80 percent state funds and 
 80.23  20 percent county funds for the costs of nursing facility 
 80.24  placements of persons with disabilities under the age of 65 that 
 80.25  have exceeded 90 days.  This clause shall be subject to chapter 
 80.26  256G and shall not apply to placements in facilities not 
 80.27  certified to participate in medical assistance; and 
 80.28     (3) beginning July 1, 2004, 80 percent state funds and 20 
 80.29  percent county funds for the costs of placements that have 
 80.30  exceeded 90 days in intermediate care facilities for persons 
 80.31  with mental retardation or a related condition that have seven 
 80.32  or more beds.  This provision includes pass-through payments 
 80.33  made under section 256B.5015; and 
 80.34     (4) beginning July 1, 2004, when state funds are used to 
 80.35  pay for a nursing facility placement due to the facility's 
 80.36  status as an institution for mental diseases (IMD), the county 
 81.1   shall pay 20 percent of the nonfederal share of costs that have 
 81.2   exceeded 90 days.  This clause is subject to chapter 256G. 
 81.3      For counties that participate in a Medicaid demonstration 
 81.4   project under sections 256B.69 and 256B.71, the division of the 
 81.5   nonfederal share of medical assistance expenses for payments 
 81.6   made to prepaid health plans or for payments made to health 
 81.7   maintenance organizations in the form of prepaid capitation 
 81.8   payments, this division of medical assistance expenses shall be 
 81.9   95 percent by the state and five percent by the county of 
 81.10  financial responsibility.  
 81.11     In counties where prepaid health plans are under contract 
 81.12  to the commissioner to provide services to medical assistance 
 81.13  recipients, the cost of court ordered treatment ordered without 
 81.14  consulting the prepaid health plan that does not include 
 81.15  diagnostic evaluation, recommendation, and referral for 
 81.16  treatment by the prepaid health plan is the responsibility of 
 81.17  the county of financial responsibility. 
 81.18     [EFFECTIVE DATE.] This section is effective the day 
 81.19  following final enactment.  
 81.20     Sec. 5.  Minnesota Statutes 2002, section 256B.49, is 
 81.21  amended by adding a subdivision to read: 
 81.22     Subd. 21.  [REPORT.] The commissioner shall expand on the 
 81.23  annual report required under section 256B.0916, subdivision 7, 
 81.24  to include information on the county of residence and financial 
 81.25  responsibility, age, and major diagnoses for persons eligible 
 81.26  for the home and community-based waivers authorized under 
 81.27  subdivision 11 who are: 
 81.28     (1) receiving those services; 
 81.29     (2) screened and waiting for waiver services; and 
 81.30     (3) residing in nursing facilities and are under age 65. 
 81.31     Sec. 6.  [ICF/MR PLAN.] 
 81.32     The commissioner of human services shall consult with 
 81.33  ICF/MR providers, advocates, counties, and consumer families to 
 81.34  develop recommendations and legislation concerning the future 
 81.35  services provided to people now served in ICFs/MR.  The 
 81.36  recommendations shall be reported to the house and senate 
 82.1   committees with jurisdiction over health and human services 
 82.2   policy and finance issues by December 15, 2004.  In preparing 
 82.3   the recommendations, the commissioner shall consider: 
 82.4      (1) consumer choice of services; 
 82.5      (2) consumers' service needs, including, but not limited 
 82.6   to, active treatment; 
 82.7      (3) the total cost of providing services in ICFs/MR and 
 82.8   alternative delivery systems; 
 82.9      (4) whether it is the policy of the state to maintain an 
 82.10  ICF/MR system and, if so, the recommendations shall define the 
 82.11  ICF/MR payment system to ensure adequate resources to meet 
 82.12  changing consumer needs, provide crisis and respite services, 
 82.13  and ensure stability when occupancy changes; and 
 82.14     (5) if alternative services are recommended to support 
 82.15  people now receiving services in an ICF/MR, the recommendations 
 82.16  shall ensure adequate financial resources are available to meet 
 82.17  the needs of ICF/MR recipients. 
 82.18     [EFFECTIVE DATE.] This section is effective the day 
 82.19  following final enactment. 
 82.20     Sec. 7.  [CONSUMER DIRECTED COMMUNITY SUPPORT; INDEPENDENT 
 82.21  EVALUATION AND STAKEHOLDER PARTICIPATION.] 
 82.22     The commissioner shall consult with a group of interested 
 82.23  stakeholders including representatives of persons affected, 
 82.24  families, guardians, advocacy groups, counties, and providers in 
 82.25  conducting an independent evaluation of the new consumer 
 82.26  directed community support option under the home and 
 82.27  community-based waiver programs required by the federal Center 
 82.28  for Medicare and Medicaid Services.  The independent evaluation 
 82.29  shall include, but not be limited to, an examination of whether 
 82.30  any current consumer directed option participants will have 
 82.31  their funding reduced so significantly that their health, 
 82.32  safety, and welfare at home will be jeopardized and whether 
 82.33  replacement services will cost more or be of lower quality than 
 82.34  their current consumer directed services.  The preliminary 
 82.35  findings of the independent evaluation shall be provided to the 
 82.36  house and senate committees with jurisdiction over human 
 83.1   services policy and finance by February 15, 2005. 
 83.2                              ARTICLE 12 
 83.3               DHS PROGRAM INTEGRITY AND ADMINISTRATION 
 83.4      Section 1.  Minnesota Statutes 2002, section 256.01, is 
 83.5   amended by adding a subdivision to read: 
 83.6      Subd. 2a.  [AUTHORIZATION FOR TEST SITES FOR HEALTH CARE 
 83.7   PROGRAMS.] In coordination with the development and 
 83.8   implementation of HealthMatch, an automated eligibility system 
 83.9   for medical assistance, general assistance medical care, and 
 83.10  MinnesotaCare, the commissioner, in cooperation with county 
 83.11  agencies, is authorized to test and compare a variety of 
 83.12  administrative models to demonstrate and evaluate outcomes of 
 83.13  integrating health care program business processes and points of 
 83.14  access.  The models will be evaluated for ease of enrollment for 
 83.15  health care program applicants and recipients and administrative 
 83.16  efficiencies.  Test sites will combine the administration of all 
 83.17  three programs and will include both local county and 
 83.18  centralized statewide customer assistance.  The duration of each 
 83.19  approved test site shall be no more than one year.  Based on the 
 83.20  evaluation, the commissioner shall recommend the most efficient 
 83.21  and effective administrative model for statewide implementation. 
 83.22     Sec. 2.  Minnesota Statutes 2003 Supplement, section 
 83.23  256.019, subdivision 1, is amended to read: 
 83.24     Subdivision 1.  [RETENTION RATES.] When an assistance 
 83.25  recovery amount is collected and posted by a county agency under 
 83.26  the provisions governing public assistance programs including 
 83.27  general assistance medical care, general assistance, and 
 83.28  Minnesota supplemental aid, the county may keep one-half of the 
 83.29  recovery made by the county agency using any method other than 
 83.30  recoupment.  For medical assistance, if the recovery is made by 
 83.31  a county agency using any method other than recoupment, the 
 83.32  county may keep one-half of the nonfederal share of the 
 83.33  recovery.  County agencies may retain 25 percent of a 
 83.34  MinnesotaCare assistance recovery collection when the recovery 
 83.35  is collected and posted by the county. 
 83.36     This does not apply to recoveries from medical providers or 
 84.1   to recoveries begun by the Department of Human Services' 
 84.2   Surveillance and Utilization Review Division, State Hospital 
 84.3   Collections Unit, and the Benefit Recoveries Division or, by the 
 84.4   attorney general's office, or child support collections.  In the 
 84.5   food stamp or food support program, the nonfederal share of 
 84.6   recoveries in the federal tax offset program only will be 
 84.7   divided equally between the state agency and the involved county 
 84.8   agency. 
 84.9      Sec. 3.  Minnesota Statutes 2003 Supplement, section 
 84.10  256.046, subdivision 1, is amended to read: 
 84.11     Subdivision 1.  [HEARING AUTHORITY.] A local agency must 
 84.12  initiate an administrative fraud disqualification hearing for 
 84.13  individuals, including child care providers caring for children 
 84.14  receiving child care assistance, accused of wrongfully obtaining 
 84.15  assistance or intentional program violations, in lieu of a 
 84.16  criminal action when it has not been pursued, in the aid to 
 84.17  families with dependent children program formerly codified in 
 84.18  sections 256.72 to 256.87, MFIP, child care assistance programs, 
 84.19  general assistance, family general assistance program formerly 
 84.20  codified in section 256D.05, subdivision 1, clause (15), 
 84.21  Minnesota supplemental aid, food stamp programs, general 
 84.22  assistance medical care, MinnesotaCare for adults without 
 84.23  children, and upon federal approval, all categories of medical 
 84.24  assistance and remaining categories of MinnesotaCare except for 
 84.25  children through age 18.  The Department of Human Services, in 
 84.26  lieu of a local agency, may initiate an administrative fraud 
 84.27  disqualification hearing for individuals accused of wrongfully 
 84.28  obtaining assistance or intentional program violations, in lieu 
 84.29  of a criminal action when a criminal action has not been pursued 
 84.30  in the MinnesotaCare program for adults without children, and 
 84.31  upon federal approval, all remaining categories of 
 84.32  MinnesotaCare, except for children through age 18.  The hearing 
 84.33  is subject to the requirements of section 256.045 and the 
 84.34  requirements in Code of Federal Regulations, title 7, section 
 84.35  273.16, for the food stamp program and title 45, section 
 84.36  235.112, as of September 30, 1995, for the cash grant, medical 
 85.1   care programs, and child care assistance under chapter 119B. 
 85.2      Sec. 4.  Minnesota Statutes 2002, section 256B.02, 
 85.3   subdivision 12, is amended to read: 
 85.4      Subd. 12.  "Third-party payer" means a person, entity, or 
 85.5   agency or government program that has a probable obligation to 
 85.6   pay all or part of the costs of a medical assistance recipient's 
 85.7   health services.  Third-party payer includes an entity under 
 85.8   contract with the recipient to cover all or part of the 
 85.9   recipient's medical costs. 
 85.10     Sec. 5.  Minnesota Statutes 2002, section 256B.04, 
 85.11  subdivision 14, is amended to read: 
 85.12     Subd. 14.  [COMPETITIVE BIDDING.] When determined to be 
 85.13  effective, economical, and feasible, the commissioner may 
 85.14  utilize volume purchase through competitive bidding and 
 85.15  negotiation under the provisions of chapter 16C, to provide 
 85.16  items under the medical assistance program including but not 
 85.17  limited to the following: 
 85.18     (1) eyeglasses; 
 85.19     (2) oxygen.  The commissioner shall provide for oxygen 
 85.20  needed in an emergency situation on a short-term basis, until 
 85.21  the vendor can obtain the necessary supply from the contract 
 85.22  dealer; 
 85.23     (3) hearing aids and supplies; and 
 85.24     (4) durable medical equipment, including but not limited to:
 85.25     (a) hospital beds; 
 85.26     (b) commodes; 
 85.27     (c) glide-about chairs; 
 85.28     (d) patient lift apparatus; 
 85.29     (e) wheelchairs and accessories; 
 85.30     (f) oxygen administration equipment; 
 85.31     (g) respiratory therapy equipment; 
 85.32     (h) electronic diagnostic, therapeutic and life support 
 85.33  systems; 
 85.34     (5) special transportation services; and 
 85.35     (6) drugs. 
 85.36     Rate changes under chapters 256B, 256D, and 256L, do not 
 86.1   effect contract payments under this subdivision unless 
 86.2   specifically identified. 
 86.3      Sec. 6.  Minnesota Statutes 2002, section 256B.056, 
 86.4   subdivision 5, is amended to read: 
 86.5      Subd. 5.  [EXCESS INCOME.] (a) A person who has excess 
 86.6   income is eligible for medical assistance if the person has 
 86.7   expenses for medical care that are more than the amount of the 
 86.8   person's excess income, computed by deducting incurred medical 
 86.9   expenses from the excess income to reduce the excess to the 
 86.10  income standard specified in subdivision 5c.  If a person is 
 86.11  ineligible for payment of long-term care services due to an 
 86.12  uncompensated transfer under section 256B.0595, only the current 
 86.13  month's long-term care expenses that are greater than the 
 86.14  average medical assistance rate for nursing facility services in 
 86.15  the state, along with other incurred medical expenses, may be 
 86.16  deducted from excess income.  The person shall elect to have the 
 86.17  medical expenses deducted at the beginning of a one-month budget 
 86.18  period or at the beginning of a six-month budget period.  
 86.19     (b) The commissioner shall allow persons eligible for 
 86.20  assistance on a one-month spenddown basis under this subdivision 
 86.21  to elect to pay the monthly spenddown amount in advance of the 
 86.22  month of eligibility to the state agency in order to maintain 
 86.23  eligibility on a continuous basis.  If the recipient does not 
 86.24  pay the spenddown amount on or before the 20th last business day 
 86.25  of the month, the recipient is ineligible for this option for 
 86.26  the following month.  The local agency shall code the Medicaid 
 86.27  Management Information System (MMIS) to indicate that the 
 86.28  recipient has elected this option.  The state agency shall 
 86.29  convey recipient eligibility information relative to the 
 86.30  collection of the spenddown to providers through the Electronic 
 86.31  Verification System (EVS).  A recipient electing advance payment 
 86.32  must pay the state agency the monthly spenddown amount on or 
 86.33  before noon on the 20th last business day of the month in order 
 86.34  to be eligible for this option in the following month.  
 86.35     [EFFECTIVE DATE.] The amendment to paragraph (b) is 
 86.36  effective upon implementation of HealthMatch. 
 87.1      Sec. 7.  Minnesota Statutes 2002, section 256B.056, is 
 87.2   amended by adding a subdivision to read: 
 87.3      Subd. 8a.  [NOTICE.] The state agency must be given notice 
 87.4   of monetary claims against a person, entity, or corporation that 
 87.5   may be liable to pay all or part of all of the cost of medical 
 87.6   care when the state agency has paid or becomes liable for the 
 87.7   cost of that care.  Notice must be given as follows: 
 87.8      (a) An applicant for medical assistance shall notify the 
 87.9   state or local agency of any possible claims when the applicant 
 87.10  submits the application.  A recipient of medical assistance 
 87.11  shall notify the state or local agency of any possible claims 
 87.12  when those claims arise. 
 87.13     (b) A person providing medical care services to a recipient 
 87.14  of medical assistance shall notify the state agency when the 
 87.15  person has reason to believe that a third party may be liable 
 87.16  for payment of the cost of medical care. 
 87.17     (c) A party to a claim that may be assigned to the state 
 87.18  agency under this section shall notify the state agency of its 
 87.19  potential assignment claim in writing at each of the following 
 87.20  stages of a claim: 
 87.21     (1) when a claim is filed; 
 87.22     (2) when an action is commenced; and 
 87.23     (3) when a claim is concluded by payment, award, judgment, 
 87.24  settlement, or otherwise. 
 87.25     Every party involved in any stage of a claim under this 
 87.26  subdivision is required to provide notice to the state agency at 
 87.27  that stage of the claim.  However, when one of the parties to 
 87.28  the claim provides notice at that stage, every other party to 
 87.29  the claim is deemed to have provided the required notice for 
 87.30  that stage of the claim.  If the required notice under this 
 87.31  paragraph is not provided to the state agency, all parties to 
 87.32  the claim are deemed to have failed to provide the required 
 87.33  notice.  A party to the claim includes the injured person or the 
 87.34  person's legal representative, the plaintiff, the defendants, or 
 87.35  persons alleged to be responsible for compensating the injured 
 87.36  person or plaintiff, and any other party to the cause of action 
 88.1   or claim, regardless of whether the party knows the state agency 
 88.2   has a potential or actual assignment claim. 
 88.3      Sec. 8.  Minnesota Statutes 2002, section 256B.056, is 
 88.4   amended by adding a subdivision to read: 
 88.5      Subd. 8b.  [JOINDER OF STATE IN ACTIONS AGAINST THIRD 
 88.6   PARTIES.] Any medical assistance recipient or the recipient's 
 88.7   legal representative asserting a claim against a third party 
 88.8   potentially liable for all or part of the recipient's medical 
 88.9   costs shall join the state agency as a party to the claim. 
 88.10     Sec. 9.  Minnesota Statutes 2002, section 256B.056, is 
 88.11  amended by adding a subdivision to read: 
 88.12     Subd. 8c.  [SETTLEMENT.] Pursuant to United States Code, 
 88.13  title 42, section 1396k(b), no judgment, award, or settlement of 
 88.14  any action or claim by or on behalf of a medical assistance 
 88.15  recipient to recover damages from a third party potentially 
 88.16  liable for all or part of the recipient's medical costs shall be 
 88.17  acceded to or satisfied by the recipient or the recipient's 
 88.18  legal representative or approved by the court without granting 
 88.19  the state agency first recovery from the liable third party to 
 88.20  the full extent of its medical expenditures, minus pro rata 
 88.21  costs and attorney fees, regardless of whether the recipient has 
 88.22  been fully compensated. 
 88.23     Sec. 10.  Minnesota Statutes 2003 Supplement, section 
 88.24  256B.0595, subdivision 2, is amended to read: 
 88.25     Subd. 2.  [PERIOD OF INELIGIBILITY.] (a) For any 
 88.26  uncompensated transfer occurring on or before August 10, 1993, 
 88.27  the number of months of ineligibility for long-term care 
 88.28  services shall be the lesser of 30 months, or the uncompensated 
 88.29  transfer amount divided by the average medical assistance rate 
 88.30  for nursing facility services in the state in effect on the date 
 88.31  of application.  The amount used to calculate the average 
 88.32  medical assistance payment rate shall be adjusted each July 1 to 
 88.33  reflect payment rates for the previous calendar year.  The 
 88.34  period of ineligibility begins with the month in which the 
 88.35  assets were transferred.  If the transfer was not reported to 
 88.36  the local agency at the time of application, and the applicant 
 89.1   received long-term care services during what would have been the 
 89.2   period of ineligibility if the transfer had been reported, a 
 89.3   cause of action exists against the transferee for the cost of 
 89.4   long-term care services provided during the period of 
 89.5   ineligibility, or for the uncompensated amount of the transfer, 
 89.6   whichever is less.  The action may be brought by the state or 
 89.7   the local agency responsible for providing medical assistance 
 89.8   under chapter 256G.  The uncompensated transfer amount is the 
 89.9   fair market value of the asset at the time it was given away, 
 89.10  sold, or disposed of, less the amount of compensation received.  
 89.11     (b) For uncompensated transfers made after August 10, 1993, 
 89.12  the number of months of ineligibility for long-term care 
 89.13  services shall be the total uncompensated value of the resources 
 89.14  transferred divided by the average medical assistance rate for 
 89.15  nursing facility services in the state in effect on the date of 
 89.16  application.  The amount used to calculate the average medical 
 89.17  assistance payment rate shall be adjusted each July 1 to reflect 
 89.18  payment rates for the previous calendar year.  The period of 
 89.19  ineligibility begins with the first day of the month after the 
 89.20  month in which the assets were transferred except that if one or 
 89.21  more uncompensated transfers are made during a period of 
 89.22  ineligibility, the total assets transferred during the 
 89.23  ineligibility period shall be combined and a penalty period 
 89.24  calculated to begin on the first day of the month after the 
 89.25  month in which the first uncompensated transfer was made.  If 
 89.26  the transfer was reported to the local agency after the date 
 89.27  advance notice of a period of ineligibility that affects the 
 89.28  next month could be provided to the recipient and the recipient 
 89.29  received medical assistance services, or the transfer was not 
 89.30  reported to the local agency, and the applicant or recipient 
 89.31  received medical assistance services during what would have been 
 89.32  the period of ineligibility if the transfer had been reported, a 
 89.33  cause of action exists against the transferee for the cost of 
 89.34  medical assistance services provided during the period of 
 89.35  ineligibility, or for the uncompensated amount of the transfer, 
 89.36  whichever is less.  The action may be brought by the state or 
 90.1   the local agency responsible for providing medical assistance 
 90.2   under chapter 256G.  The uncompensated transfer amount is the 
 90.3   fair market value of the asset at the time it was given away, 
 90.4   sold, or disposed of, less the amount of compensation received.  
 90.5   Effective for transfers made on or after March 1, 1996, 
 90.6   involving persons who apply for medical assistance on or after 
 90.7   April 13, 1996, no cause of action exists for a transfer unless: 
 90.8      (1) the transferee knew or should have known that the 
 90.9   transfer was being made by a person who was a resident of a 
 90.10  long-term care facility or was receiving that level of care in 
 90.11  the community at the time of the transfer; 
 90.12     (2) the transferee knew or should have known that the 
 90.13  transfer was being made to assist the person to qualify for or 
 90.14  retain medical assistance eligibility; or 
 90.15     (3) the transferee actively solicited the transfer with 
 90.16  intent to assist the person to qualify for or retain eligibility 
 90.17  for medical assistance.  
 90.18     (c) If a calculation of a penalty period results in a 
 90.19  partial month, payments for long-term care services shall be 
 90.20  reduced in an amount equal to the fraction, except that in 
 90.21  calculating the value of uncompensated transfers, if the total 
 90.22  value of all uncompensated transfers made in a month not 
 90.23  included in an existing penalty period does not exceed $200, 
 90.24  then such transfers shall be disregarded for each month prior to 
 90.25  the month of application for or during receipt of medical 
 90.26  assistance. 
 90.27     [EFFECTIVE DATE.] This section is effective for transfers 
 90.28  occurring on or after July 1, 2004. 
 90.29     Sec. 11.  Minnesota Statutes 2003 Supplement, section 
 90.30  256D.03, subdivision 3, is amended to read: 
 90.31     Subd. 3.  [GENERAL ASSISTANCE MEDICAL CARE; ELIGIBILITY.] 
 90.32  (a) General assistance medical care may be paid for any person 
 90.33  who is not eligible for medical assistance under chapter 256B, 
 90.34  including eligibility for medical assistance based on a 
 90.35  spenddown of excess income according to section 256B.056, 
 90.36  subdivision 5, or MinnesotaCare as defined in paragraph (b), 
 91.1   except as provided in paragraph (c), and: 
 91.2      (1) who is receiving assistance under section 256D.05, 
 91.3   except for families with children who are eligible under 
 91.4   Minnesota family investment program (MFIP), or who is having a 
 91.5   payment made on the person's behalf under sections 256I.01 to 
 91.6   256I.06; or 
 91.7      (2) who is a resident of Minnesota; and 
 91.8      (i) who has gross countable income not in excess of 75 
 91.9   percent of the federal poverty guidelines for the family size, 
 91.10  using a six-month budget period and whose equity in assets is 
 91.11  not in excess of $1,000 per assistance unit.  Exempt assets, the 
 91.12  reduction of excess assets, and the waiver of excess assets must 
 91.13  conform to the medical assistance program in section 256B.056, 
 91.14  subdivision 3, with the following exception:  the maximum amount 
 91.15  of undistributed funds in a trust that could be distributed to 
 91.16  or on behalf of the beneficiary by the trustee, assuming the 
 91.17  full exercise of the trustee's discretion under the terms of the 
 91.18  trust, must be applied toward the asset maximum; or 
 91.19     (ii) who has gross countable income above 75 percent of the 
 91.20  federal poverty guidelines but not in excess of 175 percent of 
 91.21  the federal poverty guidelines for the family size, using a 
 91.22  six-month budget period, whose equity in assets is not in excess 
 91.23  of the limits in section 256B.056, subdivision 3c, and who 
 91.24  applies during an inpatient hospitalization.  
 91.25     (b) General assistance medical care may not be paid for 
 91.26  applicants or recipients who meet all eligibility requirements 
 91.27  of MinnesotaCare as defined in sections 256L.01 to 256L.16, and 
 91.28  are adults with dependent children under 21 whose gross family 
 91.29  income is equal to or less than 275 percent of the federal 
 91.30  poverty guidelines. 
 91.31     (c) For applications received on or after October 1, 2003, 
 91.32  eligibility may begin no earlier than the date of application.  
 91.33  For individuals eligible under paragraph (a), clause (2), item 
 91.34  (i), a redetermination of eligibility must occur every 12 
 91.35  months.  Individuals are eligible under paragraph (a), clause 
 91.36  (2), item (ii), only during inpatient hospitalization but may 
 92.1   reapply if there is a subsequent period of inpatient 
 92.2   hospitalization.  Beginning January 1, 2000, Minnesota health 
 92.3   care program applications completed by recipients and applicants 
 92.4   who are persons described in paragraph (b), may be returned to 
 92.5   the county agency to be forwarded to the Department of Human 
 92.6   Services or sent directly to the Department of Human Services 
 92.7   for enrollment in MinnesotaCare.  If all other eligibility 
 92.8   requirements of this subdivision are met, eligibility for 
 92.9   general assistance medical care shall be available in any month 
 92.10  during which a MinnesotaCare eligibility determination and 
 92.11  enrollment are pending.  Upon notification of eligibility for 
 92.12  MinnesotaCare, notice of termination for eligibility for general 
 92.13  assistance medical care shall be sent to an applicant or 
 92.14  recipient.  If all other eligibility requirements of this 
 92.15  subdivision are met, eligibility for general assistance medical 
 92.16  care shall be available until enrollment in MinnesotaCare 
 92.17  subject to the provisions of paragraph (e). 
 92.18     (d) The date of an initial Minnesota health care program 
 92.19  application necessary to begin a determination of eligibility 
 92.20  shall be the date the applicant has provided a name, address, 
 92.21  and Social Security number, signed and dated, to the county 
 92.22  agency or the Department of Human Services.  If the applicant is 
 92.23  unable to provide a name, address, Social Security number, and 
 92.24  signature when health care is delivered due to a medical 
 92.25  condition or disability, a health care provider may act on an 
 92.26  applicant's behalf to establish the date of an initial Minnesota 
 92.27  health care program application by providing the county agency 
 92.28  or Department of Human Services with provider identification and 
 92.29  a temporary unique identifier for the applicant.  The applicant 
 92.30  must complete the remainder of the application and provide 
 92.31  necessary verification before eligibility can be determined.  
 92.32  The county agency must assist the applicant in obtaining 
 92.33  verification if necessary.  
 92.34     (e) County agencies are authorized to use all automated 
 92.35  databases containing information regarding recipients' or 
 92.36  applicants' income in order to determine eligibility for general 
 93.1   assistance medical care or MinnesotaCare.  Such use shall be 
 93.2   considered sufficient in order to determine eligibility and 
 93.3   premium payments by the county agency. 
 93.4      (f) General assistance medical care is not available for a 
 93.5   person in a correctional facility unless the person is detained 
 93.6   by law for less than one year in a county correctional or 
 93.7   detention facility as a person accused or convicted of a crime, 
 93.8   or admitted as an inpatient to a hospital on a criminal hold 
 93.9   order, and the person is a recipient of general assistance 
 93.10  medical care at the time the person is detained by law or 
 93.11  admitted on a criminal hold order and as long as the person 
 93.12  continues to meet other eligibility requirements of this 
 93.13  subdivision.  
 93.14     (g) General assistance medical care is not available for 
 93.15  applicants or recipients who do not cooperate with the county 
 93.16  agency to meet the requirements of medical assistance.  
 93.17     (h) In determining the amount of assets of an individual 
 93.18  eligible under paragraph (a), clause (2), item (i), there shall 
 93.19  be included any asset or interest in an asset, including an 
 93.20  asset excluded under paragraph (a), that was given away, sold, 
 93.21  or disposed of for less than fair market value within the 60 
 93.22  months preceding application for general assistance medical care 
 93.23  or during the period of eligibility.  Any transfer described in 
 93.24  this paragraph shall be presumed to have been for the purpose of 
 93.25  establishing eligibility for general assistance medical care, 
 93.26  unless the individual furnishes convincing evidence to establish 
 93.27  that the transaction was exclusively for another purpose.  For 
 93.28  purposes of this paragraph, the value of the asset or interest 
 93.29  shall be the fair market value at the time it was given away, 
 93.30  sold, or disposed of, less the amount of compensation received.  
 93.31  For any uncompensated transfer, the number of months of 
 93.32  ineligibility, including partial months, shall be calculated by 
 93.33  dividing the uncompensated transfer amount by the average 
 93.34  monthly per person payment made by the medical assistance 
 93.35  program to skilled nursing facilities for the previous calendar 
 93.36  year.  The individual shall remain ineligible until this fixed 
 94.1   period has expired.  The period of ineligibility may exceed 30 
 94.2   months, and a reapplication for benefits after 30 months from 
 94.3   the date of the transfer shall not result in eligibility unless 
 94.4   and until the period of ineligibility has expired.  The period 
 94.5   of ineligibility begins in the month the transfer was reported 
 94.6   to the county agency, or if the transfer was not reported, the 
 94.7   month in which the county agency discovered the transfer, 
 94.8   whichever comes first.  For applicants, the period of 
 94.9   ineligibility begins on the date of the first approved 
 94.10  application. 
 94.11     (i) When determining eligibility for any state benefits 
 94.12  under this subdivision, the income and resources of all 
 94.13  noncitizens shall be deemed to include their sponsor's income 
 94.14  and resources as defined in the Personal Responsibility and Work 
 94.15  Opportunity Reconciliation Act of 1996, title IV, Public Law 
 94.16  104-193, sections 421 and 422, and subsequently set out in 
 94.17  federal rules. 
 94.18     (j) Undocumented noncitizens and nonimmigrants are 
 94.19  ineligible for general assistance medical care, except an 
 94.20  individual eligible under paragraph (a), clause (4), remains 
 94.21  eligible through September 30, 2003.  For purposes of this 
 94.22  subdivision, a nonimmigrant is an individual in one or more of 
 94.23  the classes listed in United States Code, title 8, section 
 94.24  1101(a)(15), and an undocumented noncitizen is an individual who 
 94.25  resides in the United States without the approval or 
 94.26  acquiescence of the Immigration and Naturalization Service. 
 94.27     (k) Notwithstanding any other provision of law, a 
 94.28  noncitizen who is ineligible for medical assistance due to the 
 94.29  deeming of a sponsor's income and resources, is ineligible for 
 94.30  general assistance medical care. 
 94.31     (l) Effective July 1, 2003, general assistance medical care 
 94.32  emergency services end.  
 94.33     Sec. 12.  Minnesota Statutes 2002, section 256D.045, is 
 94.34  amended to read: 
 94.35     256D.045 [SOCIAL SECURITY NUMBER REQUIRED.] 
 94.36     To be eligible for general assistance under sections 
 95.1   256D.01 to 256D.21, an individual must provide the individual's 
 95.2   Social Security number to the county agency or submit proof that 
 95.3   an application has been made.  An individual who refuses to 
 95.4   provide a Social Security number because of a well-established 
 95.5   religious objection as described in Code of Federal Regulations, 
 95.6   title 42, section 435.910, may be eligible for general 
 95.7   assistance medical care under section 256D.03.  The provisions 
 95.8   of this section do not apply to the determination of eligibility 
 95.9   for emergency general assistance under section 256D.06, 
 95.10  subdivision 2.  This provision applies to eligible children 
 95.11  under the age of 18 effective July 1, 1997.  
 95.12     Sec. 13.  Minnesota Statutes 2002, section 256L.04, is 
 95.13  amended by adding a subdivision to read: 
 95.14     Subd. 1a.  [SOCIAL SECURITY NUMBER REQUIRED.] (a) 
 95.15  Individuals and families applying for MinnesotaCare coverage 
 95.16  must provide a Social Security number. 
 95.17     (b) The commissioner shall not deny eligibility to an 
 95.18  otherwise eligible applicant who has applied for a Social 
 95.19  Security number and is awaiting issuance of that Social Security 
 95.20  number. 
 95.21     (c) Newborns enrolled under section 256L.05, subdivision 3, 
 95.22  are exempt from the requirements of this subdivision. 
 95.23     (d) Individuals who refuse to provide a Social Security 
 95.24  number because of well-established religious objections are 
 95.25  exempt from this subdivision.  The term "well-established 
 95.26  religious objections" has the meaning given in Code of Federal 
 95.27  Regulations, title 42, section 435.910. 
 95.28     Sec. 14.  Minnesota Statutes 2002, section 256L.04, 
 95.29  subdivision 2, is amended to read: 
 95.30     Subd. 2.  [COOPERATION IN ESTABLISHING THIRD-PARTY 
 95.31  LIABILITY, PATERNITY, AND OTHER MEDICAL SUPPORT.] (a) To be 
 95.32  eligible for MinnesotaCare, individuals and families must 
 95.33  cooperate with the state agency to identify potentially liable 
 95.34  third-party payers and assist the state in obtaining third-party 
 95.35  payments.  "Cooperation" includes, but is not limited to, 
 95.36  complying with the notice and settlement requirements in section 
 96.1   256B.056, subdivisions 8a and 8c, identifying any third party 
 96.2   who may be liable for care and services provided under 
 96.3   MinnesotaCare to the enrollee, providing relevant information to 
 96.4   assist the state in pursuing a potentially liable third party, 
 96.5   and completing forms necessary to recover third-party payments. 
 96.6      (b) A parent, guardian, relative caretaker, or child 
 96.7   enrolled in the MinnesotaCare program must cooperate with the 
 96.8   Department of Human Services and the local agency in 
 96.9   establishing the paternity of an enrolled child and in obtaining 
 96.10  medical care support and payments for the child and any other 
 96.11  person for whom the person can legally assign rights, in 
 96.12  accordance with applicable laws and rules governing the medical 
 96.13  assistance program.  A child shall not be ineligible for or 
 96.14  disenrolled from the MinnesotaCare program solely because the 
 96.15  child's parent, relative caretaker, or guardian fails to 
 96.16  cooperate in establishing paternity or obtaining medical support.
 96.17     Sec. 15.  Minnesota Statutes 2002, section 256L.04, is 
 96.18  amended by adding a subdivision to read: 
 96.19     Subd. 2a.  [APPLICATIONS FOR OTHER BENEFITS.] To be 
 96.20  eligible for MinnesotaCare, individuals and families must take 
 96.21  all necessary steps to obtain other benefits as described in 
 96.22  Code of Federal Regulations, title 42, section 435.608.  
 96.23  Applicants and enrollees must apply for other benefits within 30 
 96.24  days.  
 96.25     Sec. 16.  Minnesota Statutes 2002, section 549.02, is 
 96.26  amended by adding a subdivision to read: 
 96.27     Subd. 3.  [LIMITATION.] Notwithstanding subdivisions 1 and 
 96.28  2, where the state agency is joined as a party according to 
 96.29  section 256B.056, subdivision 8b, or brings an independent 
 96.30  action to enforce the agency's rights under section 256B.056, 
 96.31  the state agency shall not be liable for costs to any prevailing 
 96.32  defendant. 
 96.33     Sec. 17.  Minnesota Statutes 2002, section 549.04, is 
 96.34  amended to read: 
 96.35     549.04 [DISBURSEMENTS; TAXATION AND ALLOWANCE.] 
 96.36     Subdivision 1.  [GENERALLY.] In every action in a district 
 97.1   court, the prevailing party, including any public employee who 
 97.2   prevails in an action for wrongfully denied or withheld 
 97.3   employment benefits or rights, shall be allowed reasonable 
 97.4   disbursements paid or incurred, including fees and mileage paid 
 97.5   for service of process by the sheriff or by a private person.  
 97.6      Subd. 2.  [LIMITATION.] Notwithstanding subdivision 1, 
 97.7   where the state agency is joined as a party according to section 
 97.8   256B.056, subdivision 8b, or brings an independent action to 
 97.9   enforce its rights under section 256B.056, the state agency 
 97.10  shall not be liable for disbursements to any prevailing 
 97.11  defendant. 
 97.12     Sec. 18.  [CONTINUATION OF LIFE ESTATES AND JOINT TENANCY 
 97.13  INTERESTS IN REAL ESTATE.] 
 97.14     Subdivision 1.  [EXEMPTION FOR CERTAIN NURSING FACILITY 
 97.15  RESIDENTS.] The provisions of Minnesota Statutes, section 
 97.16  256B.15, subdivisions 1, 1d, 1f, 1g, 1h, 1i, and 1j, and section 
 97.17  514.981, subdivision 6, related to the continuation of a 
 97.18  recipient's life estate or joint tenancy interests in real 
 97.19  estate property after the recipient's death for the purpose of 
 97.20  recovering medical assistance, do not apply to life estates and 
 97.21  joint tenancy interests of recipients who were permanent 
 97.22  residents of a nursing facility on August 1, 2003, and who had 
 97.23  established a life estate or joint tenancy interest in real 
 97.24  estate prior to August 1, 2003. 
 97.25     Subd. 2.  [TEMPORARY PROHIBITION ON RECOVERY.] The 
 97.26  commissioner of human services is prohibited from making medical 
 97.27  assistance recoveries related to the continuation of a 
 97.28  recipient's life estate or joint tenancy interests in real 
 97.29  estate after the recipient's death for decedents who die between 
 97.30  August 1, 2003, and July 31, 2005, and who had established a 
 97.31  life estate or joint tenancy interest in real estate prior to 
 97.32  August 1, 2003. 
 97.33     Subd. 3.  [REFUND OF AMOUNTS RECOVERED.] The commissioner 
 97.34  of human services and any county agency which has collected any 
 97.35  sum attributable to a life estate or joint tenancy interest in 
 97.36  real estate which was continued for recipients described in 
 98.1   subdivisions 1 or 2, shall promptly refund the amount collected 
 98.2   to the person or persons who paid the amount collected, in 
 98.3   proportion to each person's contribution to the amount. 
 98.4      Subd. 4.  [LIEN NOTICES.] Lien notices of record against 
 98.5   life estate or joint tenancy interests described in subdivisions 
 98.6   1 and 2 shall have no effect beyond the death of the recipient 
 98.7   unless continued after that time by the terms of the instrument 
 98.8   creating the interest, shall be disregarded by examiners of 
 98.9   title, and shall not be carried forward to subsequent 
 98.10  certificates of title. 
 98.11     Subd. 5.  [DEFINITIONS.] (a) For purposes of this section, 
 98.12  the following definitions apply. 
 98.13     (b) A life estate or joint tenancy interest is established 
 98.14  on the date the instrument creating the interest is recorded or 
 98.15  filed in the office of the county recorder or registrar of 
 98.16  titles where the real estate interest it describes is located. 
 98.17     (c) A recipient is a permanent resident of a nursing 
 98.18  facility if the recipient had resided in the nursing facility 
 98.19  for 30 days or longer and could not be reasonably expected to be 
 98.20  discharged and return home. 
 98.21     [EFFECTIVE DATE.] This section is effective retroactive to 
 98.22  August 1, 2003. 
 98.23                             ARTICLE 13 
 98.24                           MISCELLANEOUS 
 98.25     Section 1.  Minnesota Statutes 2002, section 144.148, is 
 98.26  amended by adding a subdivision to read: 
 98.27     Subd. 9.  [STATUS OF PREVIOUS AWARDS.] The commissioner 
 98.28  must regard grants or loans awarded to eligible rural hospitals 
 98.29  before August 1, 1999, as grants subject to the conditions of 
 98.30  this section and not subject to repayment as loans under 
 98.31  Minnesota Statutes 1998, section 144.148. 
 98.32     Sec. 2.  [144.552] [PUBLIC INTEREST REVIEW.] 
 98.33     (a) A hospital seeking to increase its number of licensed 
 98.34  beds or an organization seeking to obtain a hospital license 
 98.35  must submit a plan to the commissioner of health.  The plan must 
 98.36  include information that includes an explanation of how the 
 99.1   expansion will meet the public's interest.  When submitting a 
 99.2   plan to the commissioner, an applicant shall pay the 
 99.3   commissioner for the commissioner's cost of reviewing the plan, 
 99.4   as determined by the commissioner and notwithstanding section 
 99.5   16A.1283.  Money received by the commissioner under this section 
 99.6   is appropriated to the commissioner for the purpose of 
 99.7   administering this section. 
 99.8      (b) Plans submitted under this section shall include 
 99.9   detailed information necessary for the commissioner to review 
 99.10  the plan and reach a finding.  The commissioner may request 
 99.11  additional information from the hospital submitting a plan under 
 99.12  this section and from others affected by the plan that the 
 99.13  commissioner deems necessary to review the plan and make a 
 99.14  finding. 
 99.15     (c) The commissioner shall review the plan and, within 90 
 99.16  days, but no more than six months if extenuating circumstances 
 99.17  apply, issue a finding on whether the plan is in the public 
 99.18  interest.  In making the recommendation, the commissioner shall 
 99.19  consider issues including but not limited to: 
 99.20     (1) whether the new hospital or hospital beds are needed to 
 99.21  provide timely access to care or access to new or improved 
 99.22  services; 
 99.23     (2) the financial impact of the new hospital or hospital 
 99.24  beds on existing acute-care hospitals that have emergency 
 99.25  departments in the region; 
 99.26     (3) how the new hospital or hospital beds will affect the 
 99.27  ability of existing hospitals in the region to maintain existing 
 99.28  staff; 
 99.29     (4) the extent to which the new hospital or hospital beds 
 99.30  will provide services to nonpaying or low-income patients 
 99.31  relative to the level of services provided to these groups by 
 99.32  existing hospitals in the region; and 
 99.33     (5) the views of affected parties. 
 99.34     (d) Upon making a recommendation under paragraph (c), the 
 99.35  commissioner shall provide a copy of the recommendation to the 
 99.36  chairs of the house and senate committees having jurisdiction 
100.1   over health and human services policy and finance. 
100.2      Sec. 3.  Minnesota Statutes 2002, section 144D.025, is 
100.3   amended to read: 
100.4      144D.025 [OPTIONAL REGISTRATION.] 
100.5      An establishment that meets all the requirements of this 
100.6   chapter except that fewer than 80 percent of the adult residents 
100.7   are age 55 or older, or a supportive housing establishment 
100.8   developed and funded in whole or in part with funds provided 
100.9   specifically as part of the plan to end long-term homelessness 
100.10  required under Laws 2003, chapter 128, article 15, section 9, 
100.11  may, at its option, register as a housing with services 
100.12  establishment. 
100.13     Sec. 4.  [145.417] [FAMILY PLANNING GRANT FUNDS NOT USED TO 
100.14  SUBSIDIZE ABORTION SERVICES.] 
100.15     Subdivision 1.  [DEFINITIONS.] (a) For purposes of this 
100.16  section, the following definitions apply. 
100.17     (b) "Abortion" means the use or prescription of any 
100.18  instrument, medicine, drug, or any other substance or device to 
100.19  intentionally terminate the pregnancy of a female known to be 
100.20  pregnant, with an intention other than to prevent the death of 
100.21  the female, increase the probability of a live birth, preserve 
100.22  the life or health of the child after live birth, or remove a 
100.23  dead fetus. 
100.24     (c) "Family planning grant funds" means funds distributed 
100.25  through the maternal and child health block grant program under 
100.26  sections 145.881 to 145.889, the family planning special 
100.27  projects grant program under section 145.925, the program to 
100.28  eliminate health disparities under section 145.928, or any other 
100.29  state grant program whose funds are or may be used to fund 
100.30  family planning services. 
100.31     (d) "Family planning services" means preconception services 
100.32  that limit or enhance fertility, including methods of 
100.33  contraception, the management of infertility, preconception 
100.34  counseling, education, and general reproductive health care. 
100.35     (e) "Nondirective counseling" means providing patients with:
100.36     (1) a list of health care providers and social service 
101.1   providers that provide prenatal care, childbirth care, infant 
101.2   care, foster care, adoption services, alternatives to abortion, 
101.3   or abortion services; and 
101.4      (2) nondirective, nonmarketing information regarding such 
101.5   providers. 
101.6      (f) "Public advocacy" means engaging in one or more of the 
101.7   following: 
101.8      (1) regularly engaging in efforts to encourage the passage 
101.9   or defeat of legislation pertaining to the continued or expanded 
101.10  availability of abortion; 
101.11     (2) publicly endorsing or recommending the election or 
101.12  defeat of a candidate for public office based on the candidate's 
101.13  position on the legality of abortion; or 
101.14     (3) engaging in civil litigation against a unit of 
101.15  government as a plaintiff seeking to enjoin or otherwise 
101.16  prohibit enforcement of a statute, ordinance, rule, or 
101.17  regulation pertaining to abortion. 
101.18     Subd. 2.  [USES OF FAMILY PLANNING GRANT FUNDS.] No family 
101.19  planning grant funds may be: 
101.20     (1) expended to directly or indirectly subsidize abortion 
101.21  services or administrative expenses; or 
101.22     (2) paid or granted to an organization or an affiliate of 
101.23  an organization that provides abortion services, unless the 
101.24  affiliate is independent as provided in subdivision 4. 
101.25     Subd. 3.  [ORGANIZATIONS RECEIVING FAMILY PLANNING GRANT 
101.26  FUNDS.] An organization that receives family planning grant 
101.27  funds:  
101.28     (1) may provide nondirective counseling relating to 
101.29  pregnancy, but may not directly refer patients who seek abortion 
101.30  services to any organization that provides abortion services, 
101.31  including an independent affiliate of the organization receiving 
101.32  family planning grant funds.  For purposes of this clause, an 
101.33  affiliate is independent if it satisfies the criteria in 
101.34  subdivision 4, paragraph (a); 
101.35     (2) may not display or distribute marketing materials about 
101.36  abortion services to patients; 
102.1      (3) may not engage in public advocacy promoting the 
102.2   legality or accessibility of abortion; and 
102.3      (4) must be separately incorporated from any affiliated 
102.4   organization that provides abortion services. 
102.5      Subd. 4.  [INDEPENDENT AFFILIATES THAT PROVIDE ABORTION 
102.6   SERVICES.] (a) To ensure that the state does not lend its 
102.7   imprimatur to abortion services and to ensure that an 
102.8   organization that provides abortion services does not receive a 
102.9   direct or indirect economic or marketing benefit from family 
102.10  planning grant funds, an organization that receives family 
102.11  planning grant funds may not be affiliated with an organization 
102.12  that provides abortion services unless the organizations are 
102.13  independent from each other.  To be independent, the 
102.14  organizations may not share any of the following: 
102.15     (1) the same or a similar name; 
102.16     (2) medical facilities or nonmedical facilities, including, 
102.17  but not limited to, business offices, treatment rooms, 
102.18  consultation rooms, examination rooms, and waiting rooms; 
102.19     (3) expenses; 
102.20     (4) employee wages or salaries; or 
102.21     (5) equipment or supplies, including, but not limited to, 
102.22  computers, telephone systems, telecommunications equipment, and 
102.23  office supplies. 
102.24     (b) An organization that receives family planning grant 
102.25  funds and that is affiliated with an organization that provides 
102.26  abortion services must maintain financial records that 
102.27  demonstrate strict compliance with this subdivision and that 
102.28  demonstrate that its independent affiliate that provides 
102.29  abortion services receives no direct or indirect economic or 
102.30  marketing benefit from the family planning grant funds. 
102.31     Subd. 5.  [INDEPENDENT AUDIT.] When an organization applies 
102.32  for family planning grant funds, the organization must submit 
102.33  with the grant application a copy of the organization's most 
102.34  recent independent audit to ensure the organization is in 
102.35  compliance with this section.  The independent audit must have 
102.36  been conducted no more than two years before the organization 
103.1   submits its grant application. 
103.2      Subd. 6.  [ORGANIZATIONS RECEIVING TITLE X FUNDS.] Nothing 
103.3   in this section requires an organization that receives federal 
103.4   funds under Title X of the Public Health Service Act to refrain 
103.5   from performing any service that is required to be provided as a 
103.6   condition of receiving Title X funds, as specified by the 
103.7   provisions of Title X or the Title X program guidelines for 
103.8   project grants for family planning services published by the 
103.9   United States Department of Health and Human Services. 
103.10     Subd. 7.  [SEVERABILITY.] If any one or more provision, 
103.11  word, phrase, clause, sentence, or subdivision of this section, 
103.12  or the application to any person or circumstance, is found to be 
103.13  unconstitutional, it is declared to be severable and the balance 
103.14  of this section shall remain effective notwithstanding such 
103.15  unconstitutionality.  The legislature hereby declares that it 
103.16  would have passed this section, and each provision, word, 
103.17  phrase, clause, sentence, or subdivision of it, regardless of 
103.18  the fact that any one or more provision, word, phrase, clause, 
103.19  sentence, or subdivision be declared unconstitutional. 
103.20     Sec. 5.  Minnesota Statutes 2003 Supplement, section 
103.21  246B.04, as amended by Laws 2004, chapter 134, section 2, is 
103.22  amended to read: 
103.23     246B.04 [RULES; EVALUATION.] 
103.24     Subdivision 1.  [PROGRAM RULES AND EVALUATION.] The 
103.25  commissioner of human services shall adopt rules to govern the 
103.26  operation, maintenance, and licensure of secure treatment 
103.27  facilities operated by the Minnesota sex offender program or at 
103.28  any other facility operated by the commissioner, for a person 
103.29  committed as a sexual psychopathic personality or a sexually 
103.30  dangerous person.  The commissioner shall establish an 
103.31  evaluation process to measure outcomes and behavioral changes as 
103.32  a result of treatment compared with incarceration without 
103.33  treatment, to determine the value, if any, of treatment in 
103.34  protecting the public. 
103.35     Subd. 2.  [BAN ON OBSCENE MATERIAL OR PORNOGRAPHIC WORK.] 
103.36  The commissioner shall prohibit persons civilly committed as 
104.1   sexual psychopathic personalities or sexually dangerous persons 
104.2   under sections Minnesota Statutes 1978, section 246.43 and 
104.3   section 253B.185 from having or receiving material that is 
104.4   obscene as defined under section 617.241, subdivision 1, 
104.5   material that depicts sexual conduct as defined under section 
104.6   617.241, subdivision 1, or pornographic work as defined under 
104.7   section 617.246, subdivision 1, while receiving services in any 
104.8   secure treatment facilities operated by the Minnesota sex 
104.9   offender program or any other facilities operated by the 
104.10  commissioner. 
104.11     Sec. 6.  Minnesota Statutes 2002, section 256.01, is 
104.12  amended by adding a subdivision to read: 
104.13     Subd. 14a.  [SINGLE BENEFIT DEMONSTRATION.] The 
104.14  commissioner may conduct a demonstration program under a federal 
104.15  Title IV-E waiver to demonstrate the impact of a single benefit 
104.16  level on the rate of permanency for children in long-term foster 
104.17  care through transfer of permanent legal custody or adoption.  
104.18  The commissioner of human services is authorized to waive 
104.19  enforcement of related statutory program requirements, rules, 
104.20  and standards in one or more counties for the purpose of this 
104.21  demonstration.  The demonstration must comply with the 
104.22  requirements of the secretary of health and human services under 
104.23  federal waiver and be cost neutral to the state. 
104.24     The commissioner may measure cost neutrality to the state 
104.25  by the same mechanism approved by the secretary of health and 
104.26  human services to measure federal cost neutrality.  The 
104.27  commissioner is authorized to accept and administer county funds 
104.28  and to transfer state and federal funds among the affected 
104.29  programs as necessary for the conduct of the demonstration. 
104.30     Sec. 7.  Minnesota Statutes 2003 Supplement, section 
104.31  256D.44, subdivision 5, is amended to read: 
104.32     Subd. 5.  [SPECIAL NEEDS.] In addition to the state 
104.33  standards of assistance established in subdivisions 1 to 4, 
104.34  payments are allowed for the following special needs of 
104.35  recipients of Minnesota supplemental aid who are not residents 
104.36  of a nursing home, a regional treatment center, or a group 
105.1   residential housing facility. 
105.2      (a) The county agency shall pay a monthly allowance for 
105.3   medically prescribed diets if the cost of those additional 
105.4   dietary needs cannot be met through some other maintenance 
105.5   benefit.  The need for special diets or dietary items must be 
105.6   prescribed by a licensed physician.  Costs for special diets 
105.7   shall be determined as percentages of the allotment for a 
105.8   one-person household under the thrifty food plan as defined by 
105.9   the United States Department of Agriculture.  The types of diets 
105.10  and the percentages of the thrifty food plan that are covered 
105.11  are as follows: 
105.12     (1) high protein diet, at least 80 grams daily, 25 percent 
105.13  of thrifty food plan; 
105.14     (2) controlled protein diet, 40 to 60 grams and requires 
105.15  special products, 100 percent of thrifty food plan; 
105.16     (3) controlled protein diet, less than 40 grams and 
105.17  requires special products, 125 percent of thrifty food plan; 
105.18     (4) low cholesterol diet, 25 percent of thrifty food plan; 
105.19     (5) high residue diet, 20 percent of thrifty food plan; 
105.20     (6) pregnancy and lactation diet, 35 percent of thrifty 
105.21  food plan; 
105.22     (7) gluten-free diet, 25 percent of thrifty food plan; 
105.23     (8) lactose-free diet, 25 percent of thrifty food plan; 
105.24     (9) antidumping diet, 15 percent of thrifty food plan; 
105.25     (10) hypoglycemic diet, 15 percent of thrifty food plan; or 
105.26     (11) ketogenic diet, 25 percent of thrifty food plan. 
105.27     (b) Payment for nonrecurring special needs must be allowed 
105.28  for necessary home repairs or necessary repairs or replacement 
105.29  of household furniture and appliances using the payment standard 
105.30  of the AFDC program in effect on July 16, 1996, for these 
105.31  expenses, as long as other funding sources are not available.  
105.32     (c) A fee for guardian or conservator service is allowed at 
105.33  a reasonable rate negotiated by the county or approved by the 
105.34  court.  This rate shall not exceed five percent of the 
105.35  assistance unit's gross monthly income up to a maximum of $100 
105.36  per month.  If the guardian or conservator is a member of the 
106.1   county agency staff, no fee is allowed. 
106.2      (d) The county agency shall continue to pay a monthly 
106.3   allowance of $68 for restaurant meals for a person who was 
106.4   receiving a restaurant meal allowance on June 1, 1990, and who 
106.5   eats two or more meals in a restaurant daily.  The allowance 
106.6   must continue until the person has not received Minnesota 
106.7   supplemental aid for one full calendar month or until the 
106.8   person's living arrangement changes and the person no longer 
106.9   meets the criteria for the restaurant meal allowance, whichever 
106.10  occurs first. 
106.11     (e) A fee of ten percent of the recipient's gross income or 
106.12  $25, whichever is less, is allowed for representative payee 
106.13  services provided by an agency that meets the requirements under 
106.14  SSI regulations to charge a fee for representative payee 
106.15  services.  This special need is available to all recipients of 
106.16  Minnesota supplemental aid regardless of their living 
106.17  arrangement.  
106.18     (f) Notwithstanding the language in this subdivision, an 
106.19  amount equal to the maximum allotment authorized by the federal 
106.20  Food Stamp Program for a single individual which is in effect on 
106.21  the first day of January of the previous year will be added to 
106.22  the standards of assistance established in subdivisions 1 to 4 
106.23  for individuals under the age of 65 who are relocating from an 
106.24  institution or a Department of Human Services Rule 36 facility, 
106.25  and who are shelter needy.  An eligible individual who receives 
106.26  this benefit prior to age 65 may continue to receive the benefit 
106.27  after the age of 65. 
106.28     "Shelter needy" means that the assistance unit incurs 
106.29  monthly shelter costs that exceed 40 percent of the assistance 
106.30  unit's gross income before the application of this special needs 
106.31  standard.  "Gross income" for the purposes of this section is 
106.32  the applicant's or recipient's income as defined in section 
106.33  256D.35, subdivision 10, or the standard specified in 
106.34  subdivision 3, whichever is greater.  A recipient of a federal 
106.35  or state housing subsidy, that limits shelter costs to a 
106.36  percentage of gross income, shall not be considered shelter 
107.1   needy for purposes of this paragraph. 
107.2      Sec. 8.  Minnesota Statutes 2002, section 256I.04, 
107.3   subdivision 2a, is amended to read: 
107.4      Subd. 2a.  [LICENSE REQUIRED.] A county agency may not 
107.5   enter into an agreement with an establishment to provide group 
107.6   residential housing unless:  
107.7      (1) the establishment is licensed by the Department of 
107.8   Health as a hotel and restaurant; a board and lodging 
107.9   establishment; a residential care home; a boarding care home 
107.10  before March 1, 1985; or a supervised living facility, and the 
107.11  service provider for residents of the facility is licensed under 
107.12  chapter 245A.  However, an establishment licensed by the 
107.13  Department of Health to provide lodging need not also be 
107.14  licensed to provide board if meals are being supplied to 
107.15  residents under a contract with a food vendor who is licensed by 
107.16  the Department of Health; 
107.17     (2) the residence is licensed by the commissioner of human 
107.18  services under Minnesota Rules, parts 9555.5050 to 9555.6265, or 
107.19  certified by a county human services agency prior to July 1, 
107.20  1992, using the standards under Minnesota Rules, parts 9555.5050 
107.21  to 9555.6265; or 
107.22     (3) the establishment is registered under chapter 144D and 
107.23  provides three meals a day, except that or is an establishment 
107.24  voluntarily registered under section 144D.025 as a supportive 
107.25  housing establishment.  An establishment voluntarily registered 
107.26  under section 144D.025, other than a supportive housing 
107.27  establishment under this subdivision, is not eligible for an 
107.28  agreement to provide group residential housing. 
107.29     The requirements under clauses (1), (2), and (3) this 
107.30  subdivision do not apply to establishments exempt from state 
107.31  licensure because they are located on Indian reservations and 
107.32  subject to tribal health and safety requirements. 
107.33     Sec. 9.  Minnesota Statutes 2003 Supplement, section 
107.34  295.50, subdivision 9b, is amended to read: 
107.35     Subd. 9b.  [PATIENT SERVICES.] (a) "Patient services" means 
107.36  inpatient and outpatient services and other goods and services 
108.1   provided by hospitals, surgical centers, or health care 
108.2   providers.  They include the following health care goods and 
108.3   services provided to a patient or consumer: 
108.4      (1) bed and board; 
108.5      (2) nursing services and other related services; 
108.6      (3) use of hospitals, surgical centers, or health care 
108.7   provider facilities; 
108.8      (4) medical social services; 
108.9      (5) drugs, biologicals, supplies, appliances, and 
108.10  equipment; 
108.11     (6) other diagnostic or therapeutic items or services; 
108.12     (7) medical or surgical services; 
108.13     (8) items and services furnished to ambulatory patients not 
108.14  requiring emergency care; and 
108.15     (9) emergency services; and 
108.16     (10) covered services listed in section 256B.0625 and in 
108.17  Minnesota Rules, parts 9505.0170 to 9505.0475. 
108.18     (b) "Patient services" does not include:  
108.19     (1) services provided to nursing homes licensed under 
108.20  chapter 144A; 
108.21     (2) examinations for purposes of utilization reviews, 
108.22  insurance claims or eligibility, litigation, and employment, 
108.23  including reviews of medical records for those purposes; 
108.24     (3) services provided to and by community residential 
108.25  mental health facilities licensed under Minnesota Rules, parts 
108.26  9520.0500 to 9520.0690, and to and by children's residential 
108.27  treatment programs licensed under Minnesota Rules, parts 
108.28  9545.0905 to 9545.1125, or its successor; 
108.29     (4) services provided to and by community support programs 
108.30  and family community support programs approved under Minnesota 
108.31  Rules, parts 9535.1700 to 9535.1760 or certified as mental 
108.32  health rehabilitative services under chapter 256B; 
108.33     (5) services provided to and by community mental health 
108.34  centers as defined in section 245.62, subdivision 2; 
108.35     (6) services provided to and by assisted living programs 
108.36  and congregate housing programs; and 
109.1      (7) hospice care services.; 
109.2      (8) home and community-based waivered services under 
109.3   sections 256B.0915, 256B.49, 256B.491, and 256B.501; 
109.4      (9) targeted case management services under sections 
109.5   256B.0621; 256B.0625, subdivisions 20, 20a, 33, and 44; and 
109.6   256B.094; and 
109.7      (10) services provided to the following:  supervised living 
109.8   facilities for persons with mental retardation or related 
109.9   conditions licensed under Minnesota Rules, parts 4665.0100 to 
109.10  4665.9900; housing with services establishments required to be 
109.11  registered under chapter 144D; board and lodging establishments 
109.12  providing only custodial services that are licensed under 
109.13  chapter 157 and registered under section 157.17 to provide 
109.14  supportive services or health supervision services; adult foster 
109.15  homes as defined in Minnesota Rules, part 9555.5105; day 
109.16  training and habilitation services for adults with mental 
109.17  retardation and related conditions as defined in section 252.41, 
109.18  subdivision 3; boarding care homes as defined in Minnesota 
109.19  Rules, part 4655.0100; adult day care centers as defined in 
109.20  Minnesota Rules, part 9555.9600; and home health agencies as 
109.21  defined in Minnesota Rules, part 9505.0175, subpart 15. 
109.22     [EFFECTIVE DATE.] This section is effective retroactively 
109.23  from January 1, 2004. 
109.24     Sec. 10.  Minnesota Statutes 2003 Supplement, section 
109.25  295.53, subdivision 1, is amended to read: 
109.26     Subdivision 1.  [EXEMPTIONS.] (a) The following payments 
109.27  are excluded from the gross revenues subject to the hospital, 
109.28  surgical center, or health care provider taxes under sections 
109.29  295.50 to 295.59: 
109.30     (1) payments received for services provided under the 
109.31  Medicare program, including payments received from the 
109.32  government, and organizations governed by sections 1833 and 1876 
109.33  of title XVIII of the federal Social Security Act, United States 
109.34  Code, title 42, section 1395, and enrollee deductibles, 
109.35  coinsurance, and co-payments, whether paid by the Medicare 
109.36  enrollee or by a Medicare supplemental coverage as defined in 
110.1   section 62A.011, subdivision 3, clause (10), or by Medicaid 
110.2   payments under title XIX of the federal Social Security Act.  
110.3   Payments for services not covered by Medicare are taxable; 
110.4      (2) payments received for home health care services; 
110.5      (3) payments received from hospitals or surgical centers 
110.6   for goods and services on which liability for tax is imposed 
110.7   under section 295.52 or the source of funds for the payment is 
110.8   exempt under clause (1), (7), (10), or (14); 
110.9      (4) payments received from health care providers for goods 
110.10  and services on which liability for tax is imposed under this 
110.11  chapter or the source of funds for the payment is exempt under 
110.12  clause (1), (7), (10), or (14); 
110.13     (5) amounts paid for legend drugs, other than nutritional 
110.14  products, to a wholesale drug distributor who is subject to tax 
110.15  under section 295.52, subdivision 3, reduced by reimbursements 
110.16  received for legend drugs otherwise exempt under this chapter; 
110.17     (6) payments received by a health care provider or the 
110.18  wholly owned subsidiary of a health care provider for care 
110.19  provided outside Minnesota; 
110.20     (7) payments received from the chemical dependency fund 
110.21  under chapter 254B; 
110.22     (8) payments received in the nature of charitable donations 
110.23  that are not designated for providing patient services to a 
110.24  specific individual or group; 
110.25     (9) payments received for providing patient services 
110.26  incurred through a formal program of health care research 
110.27  conducted in conformity with federal regulations governing 
110.28  research on human subjects.  Payments received from patients or 
110.29  from other persons paying on behalf of the patients are subject 
110.30  to tax; 
110.31     (10) payments received from any governmental agency for 
110.32  services benefiting the public, not including payments made by 
110.33  the government in its capacity as an employer or insurer or 
110.34  payments made by the government for services provided under 
110.35  medical assistance, general assistance medical care, or the 
110.36  MinnesotaCare program, or the medical assistance program 
111.1   governed by title XIX of the federal Social Security Act, United 
111.2   States Code, title 42, sections 1396 to 1396v; 
111.3      (11) government payments received by a regional treatment 
111.4   center the commissioner of human services for state-operated 
111.5   services; 
111.6      (12) payments received by a health care provider for 
111.7   hearing aids and related equipment or prescription eyewear 
111.8   delivered outside of Minnesota; 
111.9      (13) payments received by an educational institution from 
111.10  student tuition, student activity fees, health care service 
111.11  fees, government appropriations, donations, or grants, and for 
111.12  services identified in and provided under an individualized 
111.13  education plan as defined in section 256B.0625 or Code of 
111.14  Federal Regulations, chapter 34, section 300340(a).  Fee for 
111.15  service payments and payments for extended coverage are taxable; 
111.16  and 
111.17     (14) payments received under the federal Employees Health 
111.18  Benefits Act, United States Code, title 5, section 8909(f), as 
111.19  amended by the Omnibus Reconciliation Act of 1990. 
111.20     (b) Payments received by wholesale drug distributors for 
111.21  legend drugs sold directly to veterinarians or veterinary bulk 
111.22  purchasing organizations are excluded from the gross revenues 
111.23  subject to the wholesale drug distributor tax under sections 
111.24  295.50 to 295.59. 
111.25     [EFFECTIVE DATE.] This section is effective retroactively 
111.26  from January 1, 2004. 
111.27                             ARTICLE 14 
111.28           HEALTH AND HUMAN SERVICES FORECAST ADJUSTMENTS
111.29     Section 1.  Laws 2003, First Special Session chapter 14, 
111.30  article 13C, section 1, is amended to read: 
111.31  Section 1.  [HEALTH AND HUMAN SERVICES APPROPRIATIONS FORECAST 
111.32  ADJUSTMENTS.] 
111.33     The sums shown in the columns marked "APPROPRIATIONS" are 
111.34  appropriated from the general fund, or any other fund named, to 
111.35  the agencies and for the purposes specified in the sections of 
111.36  this article, to be available for the fiscal years indicated for 
112.1   each purpose.  The figures "2004" and "2005" where used in this 
112.2   article, mean that the appropriation or appropriations listed 
112.3   under them are available for the fiscal year ending June 30, 
112.4   2004, or June 30, 2005, respectively.  Where a dollar amount 
112.5   appears in parentheses, it means a reduction of an appropriation.
112.6                           SUMMARY BY FUND
112.7                                                        BIENNIAL
112.8                              2004          2005           TOTAL
112.9   General            $3,765,212,000 $3,727,319,000 $7,492,531,000
112.10                     $3,500,860,000 $3,746,520,000 $7,247,380,000
112.11  State Government
112.12  Special Revenue        45,337,000     45,104,000     90,441,000
112.13  Health Care 
112.14  Access                294,090,000    308,525,000    602,615,000
112.15                        280,060,000    308,609,000    588,669,000
112.16  Federal TANF          261,552,000    270,364,000    531,916,000
112.17                        276,425,000    276,363,000    552,788,000
112.18  Lottery Prize 
112.19  Fund                    1,556,000      1,556,000      3,112,000
112.20  Special Revenue         3,340,000      3,340,000      6,680,000
112.21  TOTAL              $4,371,087,000 $4,356,208,000 $8,727,295,000
112.22                     $4,107,578,000 $4,381,492,000 $8,489,070,000
112.23                                             APPROPRIATIONS 
112.24                                         Available for the Year 
112.25                                             Ending June 30 
112.26                                            2004         2005 
112.27     Sec. 2.  Laws 2003, First Special Session chapter 14, 
112.28  article 13C, section 2, subdivision 1, is amended to read: 
112.29  Subdivision 1.  Total
112.30  Appropriation                     $4,111,558,000 $4,110,496,000
112.31                                    $3,848,049,000 $4,135,780,000
112.32                Summary by Fund
112.33  General           3,566,163,000 3,541,854,000
112.34                    3,301,811,000 3,561,055,000
112.35  State Government 
112.36  Special Revenue         534,000       534,000
112.37  Health Care
112.38  Access              287,753,000   302,188,000
112.39                      273,723,000   302,272,000
112.40  Federal TANF        255,552,000   264,364,000
112.41                      270,425,000   270,363,000
113.1   Lottery Cash
113.2   Flow                  1,556,000     1,556,000
113.3   [FEDERAL CONTINGENCY APPROPRIATION.] 
113.4   (a) Any additional Federal Medicaid 
113.5   funds made available under title IV of 
113.6   the federal Jobs and Growth Tax Relief 
113.7   Reconciliation Act of 2003 are 
113.8   appropriated to the commissioner of 
113.9   human services for use in the state's 
113.10  medical assistance and MinnesotaCare 
113.11  programs.  The commissioners of human 
113.12  services and finance shall report to 
113.13  the legislative advisory committee on 
113.14  the additional federal Medicaid 
113.15  matching funds that will be available 
113.16  to the state. 
113.17  (b) Contingent upon Because of the 
113.18  availability of these funds, the 
113.19  following policies shall become 
113.20  effective and necessary funds are 
113.21  appropriated for those purposes: 
113.22  (1) medical assistance and 
113.23  MinnesotaCare eligibility and local 
113.24  financial participation changes 
113.25  provided for in this act may be 
113.26  implemented prior to September 2, 2003, 
113.27  or may be delayed as necessary to 
113.28  maximize the use of federal funds 
113.29  received under title IV of the Jobs and 
113.30  Growth Tax Relief Reconciliation Act of 
113.31  2003; 
113.32  (2) the aggregate cap on the services 
113.33  identified in Minnesota Statutes, 
113.34  section 256L.035, paragraph (a), clause 
113.35  (3), shall be increased from $2,000 to 
113.36  $5,000.  This increase shall expire at 
113.37  the end of fiscal year 2007.  Funds may 
113.38  be transferred from the general fund to 
113.39  the health care access fund as 
113.40  necessary to implement this provision; 
113.41  and 
113.42  (3) the following payment shifts shall 
113.43  not be implemented: 
113.44  (i) MFIP payment shift found in 
113.45  subdivision 11; 
113.46  (ii) the county payment shift found in 
113.47  subdivision 1; and 
113.48  (iii) the delay in medical assistance 
113.49  and general assistance medical care 
113.50  fee-for-service payments found in 
113.51  subdivision 6. 
113.52  (c) Notwithstanding section 14, 
113.53  paragraphs (a) and (b) shall expire 
113.54  June 30, 2007. 
113.55  [RECEIPTS FOR SYSTEMS PROJECTS.] 
113.56  Appropriations and federal receipts for 
113.57  information system projects for MAXIS, 
113.58  PRISM, MMIS, and SSIS must be deposited 
113.59  in the state system account authorized 
113.60  in Minnesota Statutes, section 
113.61  256.014.  Money appropriated for 
114.1   computer projects approved by the 
114.2   Minnesota office of technology, funded 
114.3   by the legislature, and approved by the 
114.4   commissioner of finance may be 
114.5   transferred from one project to another 
114.6   and from development to operations as 
114.7   the commissioner of human services 
114.8   considers necessary.  Any unexpended 
114.9   balance in the appropriation for these 
114.10  projects does not cancel but is 
114.11  available for ongoing development and 
114.12  operations. 
114.13  [GIFTS.] Notwithstanding Minnesota 
114.14  Statutes, chapter 7, the commissioner 
114.15  may accept on behalf of the state 
114.16  additional funding from sources other 
114.17  than state funds for the purpose of 
114.18  financing the cost of assistance 
114.19  program grants or nongrant 
114.20  administration.  All additional funding 
114.21  is appropriated to the commissioner for 
114.22  use as designated by the grantor of 
114.23  funding. 
114.24  [SYSTEMS CONTINUITY.] In the event of 
114.25  disruption of technical systems or 
114.26  computer operations, the commissioner 
114.27  may use available grant appropriations 
114.28  to ensure continuity of payments for 
114.29  maintaining the health, safety, and 
114.30  well-being of clients served by 
114.31  programs administered by the department 
114.32  of human services.  Grant funds must be 
114.33  used in a manner consistent with the 
114.34  original intent of the appropriation. 
114.35  [NONFEDERAL SHARE TRANSFERS.] The 
114.36  nonfederal share of activities for 
114.37  which federal administrative 
114.38  reimbursement is appropriated to the 
114.39  commissioner may be transferred to the 
114.40  special revenue fund. 
114.41  [TANF FUNDS APPROPRIATED TO OTHER 
114.42  ENTITIES.] Any expenditures from the 
114.43  TANF block grant shall be expended in 
114.44  accordance with the requirements and 
114.45  limitations of part A of title IV of 
114.46  the Social Security Act, as amended, 
114.47  and any other applicable federal 
114.48  requirement or limitation.  Prior to 
114.49  any expenditure of these funds, the 
114.50  commissioner shall assure that funds 
114.51  are expended in compliance with the 
114.52  requirements and limitations of federal 
114.53  law and that any reporting requirements 
114.54  of federal law are met.  It shall be 
114.55  the responsibility of any entity to 
114.56  which these funds are appropriated to 
114.57  implement a memorandum of understanding 
114.58  with the commissioner that provides the 
114.59  necessary assurance of compliance prior 
114.60  to any expenditure of funds.  The 
114.61  commissioner shall receipt TANF funds 
114.62  appropriated to other state agencies 
114.63  and coordinate all related interagency 
114.64  accounting transactions necessary to 
114.65  implement these appropriations.  
114.66  Unexpended TANF funds appropriated to 
114.67  any state, local, or nonprofit entity 
115.1   cancel at the end of the state fiscal 
115.2   year unless appropriating language 
115.3   permits otherwise. 
115.4   [TANF FUNDS TRANSFERRED TO OTHER 
115.5   FEDERAL GRANTS.] The commissioner must 
115.6   authorize transfers from TANF to other 
115.7   federal block grants so that funds are 
115.8   available to meet the annual 
115.9   expenditure needs as appropriated.  
115.10  Transfers may be authorized prior to 
115.11  the expenditure year with the agreement 
115.12  of the receiving entity.  Transferred 
115.13  funds must be expended in the year for 
115.14  which the funds were appropriated 
115.15  unless appropriation language permits 
115.16  otherwise.  In accelerating transfer 
115.17  authorizations, the commissioner must 
115.18  aim to preserve the future potential 
115.19  transfer capacity from TANF to other 
115.20  block grants. 
115.21  [TANF MAINTENANCE OF EFFORT.] (a) In 
115.22  order to meet the basic maintenance of 
115.23  effort (MOE) requirements of the TANF 
115.24  block grant specified under Code of 
115.25  Federal Regulations, title 45, section 
115.26  263.1, the commissioner may only report 
115.27  nonfederal money expended for allowable 
115.28  activities listed in the following 
115.29  clauses as TANF/MOE expenditures: 
115.30  (1) MFIP cash, diversionary work 
115.31  program, and food assistance benefits 
115.32  under Minnesota Statutes, chapter 256J; 
115.33  (2) the child care assistance programs 
115.34  under Minnesota Statutes, sections 
115.35  119B.03 and 119B.05, and county child 
115.36  care administrative costs under 
115.37  Minnesota Statutes, section 119B.15; 
115.38  (3) state and county MFIP 
115.39  administrative costs under Minnesota 
115.40  Statutes, chapters 256J and 256K; 
115.41  (4) state, county, and tribal MFIP 
115.42  employment services under Minnesota 
115.43  Statutes, chapters 256J and 256K; 
115.44  (5) expenditures made on behalf of 
115.45  noncitizen MFIP recipients who qualify 
115.46  for the medical assistance without 
115.47  federal financial participation program 
115.48  under Minnesota Statutes, section 
115.49  256B.06, subdivision 4, paragraphs (d), 
115.50  (e), and (j); and 
115.51  (6) qualifying working family credit 
115.52  expenditures under Minnesota Statutes, 
115.53  section 290.0671. 
115.54  (b) The commissioner shall ensure that 
115.55  sufficient qualified nonfederal 
115.56  expenditures are made each year to meet 
115.57  the state's TANF/MOE requirements.  For 
115.58  the activities listed in paragraph (a), 
115.59  clauses (2) to (6), the commissioner 
115.60  may only report expenditures that are 
115.61  excluded from the definition of 
115.62  assistance under Code of Federal 
116.1   Regulations, title 45, section 260.31. 
116.2   (c) By August 31 of each year, the 
116.3   commissioner shall make a preliminary 
116.4   calculation to determine the likelihood 
116.5   that the state will meet its annual 
116.6   federal work participation requirement 
116.7   under Code of Federal Regulations, 
116.8   title 45, sections 261.21 and 261.23, 
116.9   after adjustment for any caseload 
116.10  reduction credit under Code of Federal 
116.11  Regulations, title 45, section 261.41.  
116.12  If the commissioner determines that the 
116.13  state will meet its federal work 
116.14  participation rate for the federal 
116.15  fiscal year ending that September, the 
116.16  commissioner may reduce the expenditure 
116.17  under paragraph (a), clause (1), to the 
116.18  extent allowed under Code of Federal 
116.19  Regulations, title 45, section 
116.20  263.1(a)(2). 
116.21  (d) For fiscal years beginning with 
116.22  state fiscal year 2003, the 
116.23  commissioner shall assure that the 
116.24  maintenance of effort used by the 
116.25  commissioner of finance for the 
116.26  February and November forecasts 
116.27  required under Minnesota Statutes, 
116.28  section 16A.103, contains expenditures 
116.29  under paragraph (a), clause (1), equal 
116.30  to at least 25 percent of the total 
116.31  required under Code of Federal 
116.32  Regulations, title 45, section 263.1. 
116.33  (e) If nonfederal expenditures for the 
116.34  programs and purposes listed in 
116.35  paragraph (a) are insufficient to meet 
116.36  the state's TANF/MOE requirements, the 
116.37  commissioner shall recommend additional 
116.38  allowable sources of nonfederal 
116.39  expenditures to the legislature, if the 
116.40  legislature is or will be in session to 
116.41  take action to specify additional 
116.42  sources of nonfederal expenditures for 
116.43  TANF/MOE before a federal penalty is 
116.44  imposed.  The commissioner shall 
116.45  otherwise provide notice to the 
116.46  legislative commission on planning and 
116.47  fiscal policy under paragraph (g). 
116.48  (f) If the commissioner uses authority 
116.49  granted under section 11, or similar 
116.50  authority granted by a subsequent 
116.51  legislature, to meet the state's 
116.52  TANF/MOE requirement in a reporting 
116.53  period, the commissioner shall inform 
116.54  the chairs of the appropriate 
116.55  legislative committees about all 
116.56  transfers made under that authority for 
116.57  this purpose. 
116.58  (g) If the commissioner determines that 
116.59  nonfederal expenditures under paragraph 
116.60  (a) are insufficient to meet TANF/MOE 
116.61  expenditure requirements, and if the 
116.62  legislature is not or will not be in 
116.63  session to take timely action to avoid 
116.64  a federal penalty, the commissioner may 
116.65  report nonfederal expenditures from 
116.66  other allowable sources as TANF/MOE 
117.1   expenditures after the requirements of 
117.2   this paragraph are met.  The 
117.3   commissioner may report nonfederal 
117.4   expenditures in addition to those 
117.5   specified under paragraph (a) as 
117.6   nonfederal TANF/MOE expenditures, but 
117.7   only ten days after the commissioner of 
117.8   finance has first submitted the 
117.9   commissioner's recommendations for 
117.10  additional allowable sources of 
117.11  nonfederal TANF/MOE expenditures to the 
117.12  members of the legislative commission 
117.13  on planning and fiscal policy for their 
117.14  review. 
117.15  (h) The commissioner of finance shall 
117.16  not incorporate any changes in federal 
117.17  TANF expenditures or nonfederal 
117.18  expenditures for TANF/MOE that may 
117.19  result from reporting additional 
117.20  allowable sources of nonfederal 
117.21  TANF/MOE expenditures under the interim 
117.22  procedures in paragraph (g) into the 
117.23  February or November forecasts required 
117.24  under Minnesota Statutes, section 
117.25  16A.103, unless the commissioner of 
117.26  finance has approved the additional 
117.27  sources of expenditures under paragraph 
117.28  (g). 
117.29  (i) Minnesota Statutes, section 
117.30  256.011, subdivision 3, which requires 
117.31  that federal grants or aids secured or 
117.32  obtained under that subdivision be used 
117.33  to reduce any direct appropriations 
117.34  provided by law, do not apply if the 
117.35  grants or aids are federal TANF funds. 
117.36  (j) Notwithstanding section 14, 
117.37  paragraph (a), clauses (1) to (6), and 
117.38  paragraphs (b) to (j) expire June 30, 
117.39  2007. 
117.40  [WORKING FAMILY CREDIT EXPENDITURES AS 
117.41  TANF MOE.] The commissioner may claim 
117.42  as TANF maintenance of effort up to the 
117.43  following amounts of working family 
117.44  credit expenditures for the following 
117.45  fiscal years: 
117.46  (1) fiscal year 2004, $7,013,000; 
117.47  (2) fiscal year 2005, $25,133,000; 
117.48  (3) fiscal year 2006, $6,942,000; and 
117.49  (4) fiscal year 2007, $6,707,000. 
117.50  [FISCAL YEAR 2003 APPROPRIATIONS 
117.51  CARRYFORWARD.] Effective the day 
117.52  following final enactment, 
117.53  notwithstanding Minnesota Statutes, 
117.54  section 16A.28, or any other law to the 
117.55  contrary, state agencies and 
117.56  constitutional offices may carry 
117.57  forward unexpended and unencumbered 
117.58  nongrant operating balances from fiscal 
117.59  year 2003 general fund appropriations 
117.60  into fiscal year 2004 to offset general 
117.61  budget reductions. 
118.1   [TRANSFER OF GRANT BALANCES.] Effective 
118.2   the day following final enactment, the 
118.3   commissioner of human services, with 
118.4   the approval of the commissioner of 
118.5   finance and after notification of the 
118.6   chair of the senate health, human 
118.7   services and corrections budget 
118.8   division and the chair of the house of 
118.9   representatives health and human 
118.10  services finance committee, may 
118.11  transfer unencumbered appropriation 
118.12  balances for the biennium ending June 
118.13  30, 2003, in fiscal year 2003 among the 
118.14  MFIP, MFIP child care assistance under 
118.15  Minnesota Statutes, section 119B.05, 
118.16  general assistance, general assistance 
118.17  medical care, medical assistance, 
118.18  Minnesota supplemental aid, and group 
118.19  residential housing programs, and the 
118.20  entitlement portion of the chemical 
118.21  dependency consolidated treatment fund, 
118.22  and between fiscal years of the 
118.23  biennium. 
118.24  [TANF APPROPRIATION CANCELLATION.] 
118.25  Notwithstanding the provisions of Laws 
118.26  2000, chapter 488, article 1, section 
118.27  16, any prior appropriations of TANF 
118.28  funds to the department of trade and 
118.29  economic development or to the job 
118.30  skills partnership board or any 
118.31  transfers of TANF funds from another 
118.32  agency to the department of trade and 
118.33  economic development or to the job 
118.34  skills partnership board are not 
118.35  available until expended, and if 
118.36  unobligated as of June 30, 2003, these 
118.37  appropriations or transfers shall 
118.38  cancel to the TANF fund. 
118.39  [SHIFT COUNTY PAYMENT.] The 
118.40  commissioner shall make up to 100 
118.41  percent of the calendar year 2005 
118.42  payments to counties for developmental 
118.43  disabilities semi-independent living 
118.44  services grants, developmental 
118.45  disabilities family support grants, and 
118.46  adult mental health grants from fiscal 
118.47  year 2006 appropriations.  This is a 
118.48  onetime payment shift.  Calendar year 
118.49  2006 and future payments for these 
118.50  grants are not affected by this shift.  
118.51  This provision expires June 30, 2006. 
118.52  [CAPITATION RATE INCREASE.] Of the 
118.53  health care access fund appropriations 
118.54  to the University of Minnesota in the 
118.55  higher education omnibus appropriation 
118.56  bill, $2,157,000 in fiscal year 2004 
118.57  and $2,157,000 in fiscal year 2005 are 
118.58  to be used to increase the capitation 
118.59  payments under Minnesota Statutes, 
118.60  section 256B.69.  Notwithstanding the 
118.61  provisions of section 14, this 
118.62  provision shall not expire. 
118.63     Sec. 3.  Laws 2003, First Special Session chapter 14, 
118.64  article 13C, section 2, subdivision 3, is amended to read: 
118.65  Subd. 3.  Revenue and Pass-Through 
119.1   Federal TANF         55,855,000    53,315,000
119.2                        56,643,000    57,275,000
119.3   [TANF TRANSFER TO SOCIAL SERVICES BLOCK 
119.4   GRANT.] $3,137,000 in fiscal year 2005 
119.5   is appropriated to the commissioner for 
119.6   the purposes of providing services for 
119.7   families with children whose incomes 
119.8   are at or below 200 percent of the 
119.9   federal poverty guidelines.  The 
119.10  commissioner shall authorize a 
119.11  sufficient transfer of funds from the 
119.12  state's federal TANF block grant to the 
119.13  state's federal social services block 
119.14  grant to meet this appropriation.  The 
119.15  funds shall be distributed to counties 
119.16  for the children and community services 
119.17  grant according to the formula for the 
119.18  state appropriations in Minnesota 
119.19  Statutes, chapter 256M. 
119.20  [TANF FUNDS FOR FISCAL YEAR 2006 AND 
119.21  FISCAL YEAR 2007 REFINANCING.] 
119.22  $12,692,000 $6,692,000 in fiscal year 
119.23  2006 and $9,192,000 $3,192,000 in 
119.24  fiscal year 2007 in TANF funds are 
119.25  available to the commissioner to 
119.26  replace general funds in the amount 
119.27  of $12,692,000 $6,692,000 in fiscal 
119.28  year 2006 and $9,192,000 $3,192,000 in 
119.29  fiscal year 2007 in expenditures that 
119.30  may be counted toward TANF maintenance 
119.31  of effort requirements or as an 
119.32  allowable TANF expenditure. 
119.33  [ADJUSTMENTS IN TANF TRANSFER TO CHILD 
119.34  CARE AND DEVELOPMENT FUND.] Transfers 
119.35  of TANF to the child care development 
119.36  fund for the purposes of MFIP child 
119.37  care assistance shall be reduced by 
119.38  $116,000 in fiscal year 2004 and shall 
119.39  be increased by $1,976,000 in fiscal 
119.40  year 2005. 
119.41     Sec. 4.  Laws 2003, First Special Session chapter 14, 
119.42  article 13C, section 2, subdivision 6, is amended to read: 
119.43  Subd. 6.  Basic Health Care Grants 
119.44                Summary by Fund
119.45  General           1,499,941,000 1,533,016,000
119.46                    1,290,454,000 1,475,996,000
119.47  Health Care Access  268,151,000   282,605,000
119.48                      254,121,000   282,689,000
119.49  [UPDATING FEDERAL POVERTY GUIDELINES.] 
119.50  Annual updates to the federal poverty 
119.51  guidelines are effective each July 1, 
119.52  following publication by the United 
119.53  States Department of Health and Human 
119.54  Services for health care programs under 
119.55  Minnesota Statutes, chapters 256, 256B, 
119.56  256D, and 256L. 
119.57  The amounts that may be spent from this 
120.1   appropriation for each purpose are as 
120.2   follows: 
120.3   (a) MinnesotaCare Grants 
120.4   Health Care Access 267,401,000   281,855,000
120.5                      253,371,000   281,939,000
120.6   [MINNESOTACARE FEDERAL RECEIPTS.] 
120.7   Receipts received as a result of 
120.8   federal participation pertaining to 
120.9   administrative costs of the Minnesota 
120.10  health care reform waiver shall be 
120.11  deposited as nondedicated revenue in 
120.12  the health care access fund.  Receipts 
120.13  received as a result of federal 
120.14  participation pertaining to grants 
120.15  shall be deposited in the federal fund 
120.16  and shall offset health care access 
120.17  funds for payments to providers. 
120.18  [MINNESOTACARE FUNDING.] The 
120.19  commissioner may expend money 
120.20  appropriated from the health care 
120.21  access fund for MinnesotaCare in either 
120.22  fiscal year of the biennium. 
120.23  (b) MA Basic Health Care Grants - 
120.24  Families and Children 
120.25  General             568,254,000   582,161,000
120.26                      427,769,000   489,545,000
120.27  [SERVICES TO PREGNANT WOMEN.] The 
120.28  commissioner shall use available 
120.29  federal money for the State-Children's 
120.30  Health Insurance Program for medical 
120.31  assistance services provided to 
120.32  pregnant women who are not otherwise 
120.33  eligible for federal financial 
120.34  participation beginning in fiscal year 
120.35  2003.  This federal money shall be 
120.36  deposited in the federal fund and shall 
120.37  offset general funds for payments to 
120.38  providers.  Notwithstanding section 14, 
120.39  this paragraph shall not expire. 
120.40  [MANAGED CARE RATE INCREASE.] (a) 
120.41  Effective January 1, 2004, the 
120.42  commissioner of human services shall 
120.43  increase the total payments to managed 
120.44  care plans under Minnesota Statutes, 
120.45  section 256B.69, by an amount equal to 
120.46  the cost increases to the managed care 
120.47  plans from by the elimination of: (1) 
120.48  the exemption from the taxes imposed 
120.49  under Minnesota Statutes, section 
120.50  297I.05, subdivision 5, for premiums 
120.51  paid by the state for medical 
120.52  assistance, general assistance medical 
120.53  care, and the MinnesotaCare program; 
120.54  and (2) the exemption of gross revenues 
120.55  subject to the taxes imposed under 
120.56  Minnesota Statutes, sections 295.50 to 
120.57  295.57, for payments paid by the state 
120.58  for services provided under medical 
120.59  assistance, general assistance medical 
120.60  care, and the MinnesotaCare program.  
120.61  Any increase based on clause (2) must 
121.1   be reflected in provider rates paid by 
121.2   the managed care plan unless the 
121.3   managed care plan is a staff model 
121.4   health plan company. 
121.5   (b) The commissioner of human services 
121.6   shall increase by two percent the 
121.7   fee-for-service payments under medical 
121.8   assistance, general assistance medical 
121.9   care, and the MinnesotaCare program for 
121.10  services subject to the hospital, 
121.11  surgical center, or health care 
121.12  provider taxes under Minnesota 
121.13  Statutes, sections 295.50 to 295.57, 
121.14  effective for services rendered on or 
121.15  after January 1, 2004.  
121.16  (c) The commissioner of finance shall 
121.17  transfer from the health care access 
121.18  fund to the general fund the following 
121.19  amounts in the fiscal years indicated:  
121.20  2004, $16,587,000; 2005, $46,322,000; 
121.21  2006, $49,413,000; and 2007, 
121.22  $52,659,000. 
121.23  (d) For fiscal years after 2007, the 
121.24  commissioner of finance shall transfer 
121.25  from the health care access fund to the 
121.26  general fund an amount equal to the 
121.27  revenue collected by the commissioner 
121.28  of revenue on the following:  
121.29  (1) gross revenues received by 
121.30  hospitals, surgical centers, and health 
121.31  care providers as payments for services 
121.32  provided under medical assistance, 
121.33  general assistance medical care, and 
121.34  the MinnesotaCare program, including 
121.35  payments received directly from the 
121.36  state or from a prepaid plan, under 
121.37  Minnesota Statutes, sections 295.50 to 
121.38  295.57; and 
121.39  (2) premiums paid by the state under 
121.40  medical assistance, general assistance 
121.41  medical care, and the MinnesotaCare 
121.42  program under Minnesota Statutes, 
121.43  section 297I.05, subdivision 5.  
121.44  The commissioner of finance shall 
121.45  monitor and adjust if necessary the 
121.46  amount transferred each fiscal year 
121.47  from the health care access fund to the 
121.48  general fund to ensure that the amount 
121.49  transferred equals the tax revenue 
121.50  collected for the items described in 
121.51  clauses (1) and (2) for that fiscal 
121.52  year. 
121.53  (e) Notwithstanding section 14, these 
121.54  provisions shall not expire. 
121.55  (c) MA Basic Health Care Grants - Elderly 
121.56  and Disabled 
121.57  General             695,421,000   741,605,000
121.58                      610,518,000   743,858,000
121.59  [DELAY MEDICAL ASSISTANCE 
121.60  FEE-FOR-SERVICE - ACUTE CARE.] The 
122.1   following payments in fiscal year 2005 
122.2   from the Medicaid Management 
122.3   Information System that would otherwise 
122.4   have been made to providers for medical 
122.5   assistance and general assistance 
122.6   medical care services shall be delayed 
122.7   and included in the first payment in 
122.8   fiscal year 2006: 
122.9   (1) for hospitals, the last two 
122.10  payments; and 
122.11  (2) for nonhospital providers, the last 
122.12  payment. 
122.13  This payment delay shall not include 
122.14  payments to skilled nursing facilities, 
122.15  intermediate care facilities for mental 
122.16  retardation, prepaid health plans, home 
122.17  health agencies, personal care nursing 
122.18  providers, and providers of only waiver 
122.19  services.  The provisions of Minnesota 
122.20  Statutes, section 16A.124, shall not 
122.21  apply to these delayed payments.  
122.22  Notwithstanding section 14, this 
122.23  provision shall not expire. 
122.24  [DEAF AND HARD-OF-HEARING SERVICES.] 
122.25  If, after making reasonable efforts, 
122.26  the service provider for mental health 
122.27  services to persons who are deaf or 
122.28  hearing impaired is not able to earn 
122.29  $227,000 through participation in 
122.30  medical assistance intensive 
122.31  rehabilitation services in fiscal year 
122.32  2005, the commissioner shall transfer 
122.33  $227,000 minus medical assistance 
122.34  earnings achieved by the grantee to 
122.35  deaf and hard-of-hearing grants to 
122.36  enable the provider to continue 
122.37  providing services to eligible persons. 
122.38  (d) General Assistance Medical Care 
122.39  Grants 
122.40  General             223,960,000   196,617,000
122.41                      239,861,000   229,960,000
122.42  (e) Health Care Grants - Other 
122.43  Assistance 
122.44  General               3,067,000     3,407,000
122.45  Health Care Access      750,000       750,000
122.46  [MINNESOTA PRESCRIPTION DRUG DEDICATED 
122.47  FUND.] Of the general fund 
122.48  appropriation, $284,000 in fiscal year 
122.49  2005 is appropriated to the 
122.50  commissioner for the prescription drug 
122.51  dedicated fund established under the 
122.52  prescription drug discount program. 
122.53  [DENTAL ACCESS GRANTS CARRYOVER 
122.54  AUTHORITY.] Any unspent portion of the 
122.55  appropriation from the health care 
122.56  access fund in fiscal years 2002 and 
122.57  2003 for dental access grants under 
122.58  Minnesota Statutes, section 256B.53, 
122.59  shall not cancel but shall be allowed 
123.1   to carry forward to be spent in the 
123.2   biennium beginning July 1, 2003, for 
123.3   these purposes. 
123.4   [STOP-LOSS FUND ACCOUNT.] The 
123.5   appropriation to the purchasing 
123.6   alliance stop-loss fund account 
123.7   established under Minnesota Statutes, 
123.8   section 256.956, subdivision 2, for 
123.9   fiscal years 2004 and 2005 shall only 
123.10  be available for claim reimbursements 
123.11  for qualifying enrollees who are 
123.12  members of purchasing alliances that 
123.13  meet the requirements described under 
123.14  Minnesota Statutes, section 256.956, 
123.15  subdivision 1, paragraph (f), clauses 
123.16  (1), (2), and (3). 
123.17  (f) Prescription Drug Program 
123.18  General               9,239,000     9,226,000
123.19  [PRESCRIPTION DRUG ASSISTANCE PROGRAM.] 
123.20  Of the general fund appropriation, 
123.21  $702,000 in fiscal year 2004 and 
123.22  $887,000 in fiscal year 2005 are for 
123.23  the commissioner to establish and 
123.24  administer the prescription drug 
123.25  assistance program through the 
123.26  Minnesota board on aging. 
123.27  [REBATE REVENUE RECAPTURE.] Any funds 
123.28  received by the state from a drug 
123.29  manufacturer due to errors in the 
123.30  pharmaceutical pricing used by the 
123.31  manufacturer in determining the 
123.32  prescription drug rebate are 
123.33  appropriated to the commissioner to 
123.34  augment funding of the prescription 
123.35  drug program established in Minnesota 
123.36  Statutes, section 256.955. 
123.37     Sec. 5.  Laws 2003, First Special Session chapter 14, 
123.38  article 13C, section 2, subdivision 7, is amended to read: 
123.39  Subd. 7.  Health Care Management 
123.40                Summary by Fund
123.41  General              24,845,000    26,199,000
123.42                       24,834,000
123.43  Health Care Access   14,522,000    14,533,000
123.44  The amounts that may be spent from this 
123.45  appropriation for each purpose are as 
123.46  follows: 
123.47  (a) Health Care Policy Administration 
123.48  General               5,523,000     7,223,000
123.49  Health Care Access    1,066,000     1,200,000
123.50  [PAYMENT CODE STUDY.] Of this 
123.51  appropriation, $345,000 each year is 
123.52  for a study to determine the 
123.53  appropriateness of eliminating 
123.54  reimbursement for certain payment codes 
124.1   under medical assistance, general 
124.2   assistance medical care, or 
124.3   MinnesotaCare.  As part of the study, 
124.4   the commissioner shall also examine 
124.5   covered services under the Minnesota 
124.6   health care programs and make 
124.7   recommendations on possible 
124.8   modification of the services covered 
124.9   under the program.  The commissioner 
124.10  shall report to the legislature by 
124.11  January 15, 2005, with an analysis of 
124.12  the feasibility of this approach, a 
124.13  list of codes, if any, to be eliminated 
124.14  from the payment system, and estimates 
124.15  of savings to be obtained from this 
124.16  approach. 
124.17  [TRANSFERS FROM HEALTH CARE ACCESS 
124.18  FUND.] (a) Notwithstanding Minnesota 
124.19  Statutes, section 295.581, to the 
124.20  extent available resources in the 
124.21  health care access fund exceed 
124.22  expenditures in that fund during fiscal 
124.23  years 2005 to 2007, the excess annual 
124.24  funds shall be transferred from the 
124.25  health care access fund to the general 
124.26  fund on June 30 of fiscal years 2005, 
124.27  2006, and 2007.  These transfers shall 
124.28  not be reduced to accommodate 
124.29  MinnesotaCare expansions.  The 
124.30  estimated amounts to be transferred are:
124.31  (1) in fiscal year 2005, $192,442,000; 
124.32  (2) in fiscal year 2006, $52,943,000; 
124.33  and 
124.34  (3) in fiscal year 2007, $59,105,000. 
124.35  These estimates shall be updated with 
124.36  each forecast, but in no case shall the 
124.37  transfers exceed the amounts listed in 
124.38  clauses (1) to (3). 
124.39  (b) The commissioner shall limit 
124.40  transfers under paragraph (a) in order 
124.41  to avoid implementation of Minnesota 
124.42  Statutes, section 256L.02, subdivision 
124.43  3, paragraph (b). 
124.44  (c) For fiscal years 2004 to 2007, 
124.45  MinnesotaCare shall be a forecasted 
124.46  program and, if necessary, the 
124.47  commissioner shall reduce transfers 
124.48  under paragraph (a) to meet forecasted 
124.49  expenditures. 
124.50  (d) The department of human services in 
124.51  recommending its 2007-2008 budget shall 
124.52  consider the repayment of the amount 
124.53  transferred in fiscal years 2006 and 
124.54  2007 from the health care access fund 
124.55  to the general fund to the health care 
124.56  access fund. 
124.57  (e) Notwithstanding section 14, this 
124.58  section is in effect until June 30, 
124.59  2007. 
124.60  [MINNESOTACARE OUTREACH REIMBURSEMENT.] 
124.61  Federal administrative reimbursement 
125.1   resulting from MinnesotaCare outreach 
125.2   is appropriated to the commissioner for 
125.3   this activity. 
125.4   [MINNESOTA SENIOR HEALTH OPTIONS 
125.5   REIMBURSEMENT.] Federal administrative 
125.6   reimbursement resulting from the 
125.7   Minnesota senior health options project 
125.8   is appropriated to the commissioner for 
125.9   this activity. 
125.10  [UTILIZATION REVIEW.] Federal 
125.11  administrative reimbursement resulting 
125.12  from prior authorization and inpatient 
125.13  admission certification by a 
125.14  professional review organization shall 
125.15  be dedicated to the commissioner for 
125.16  these purposes.  A portion of these 
125.17  funds must be used for activities to 
125.18  decrease unnecessary pharmaceutical 
125.19  costs in medical assistance. 
125.20  (b) Health Care Operations 
125.21  General              19,322,000    18,976,000
125.22                       19,311,000
125.23  Health Care Access   13,456,000    13,333,000
125.24  [PREPAID MEDICAL PROGRAMS.] For all 
125.25  counties in which the PMAP program has 
125.26  been operating for 12 or more months, 
125.27  state funding for the nonfederal share 
125.28  of prepaid medical assistance program 
125.29  administration costs for county managed 
125.30  care advocacy and enrollment operations 
125.31  is eliminated.  State funding will 
125.32  continue for these activities for 
125.33  counties and tribes establishing new 
125.34  PMAP programs for a maximum of 16 
125.35  months (four months prior to beginning 
125.36  PMAP enrollment and through the first 
125.37  12 months of their PMAP program 
125.38  operation).  Those counties operating 
125.39  PMAP programs for less than 12 months 
125.40  can continue to receive state funding 
125.41  for advocacy and enrollment activities 
125.42  through their first year of operation. 
125.43     Sec. 6.  Laws 2003, First Special Session chapter 14, 
125.44  article 13C, section 2, subdivision 9, is amended to read: 
125.45  Subd. 9.  Continuing Care Grants 
125.46                Summary by Fund
125.47  General           1,504,933,000 1,490,958,000
125.48                    1,448,029,000 1,567,392,000
125.49  Lottery Prize Fund    1,408,000     1,408,000
125.50  The amounts that may be spent from this 
125.51  appropriation for each purpose are as 
125.52  follows: 
125.53  (a) Community Social Services
125.54  General                 496,000       371,000
126.1   (b) Aging and Adult Service Grant 
126.2   General              12,998,000    13,951,000
126.3   [LONG-TERM CARE PROGRAM REDUCTIONS.] 
126.4   For the biennium ending June 30, 2005, 
126.5   state funding for the following state 
126.6   long-term care programs is reduced by 
126.7   15 percent from the level of state 
126.8   funding provided on June 30, 2003:  
126.9   SAIL project grants under Minnesota 
126.10  Statutes, section 256B.0917; senior 
126.11  nutrition programs under Minnesota 
126.12  Statutes, section 256.9752; foster 
126.13  grandparents program under Minnesota 
126.14  Statutes, section 256.976; retired 
126.15  senior volunteer program under 
126.16  Minnesota Statutes, section 256.9753; 
126.17  and the senior companion program under 
126.18  Minnesota Statutes, section 256.977. 
126.19  (c) Deaf and Hard-of-hearing 
126.20  Service Grants 
126.21  General               1,719,000     1,490,000
126.22  (d) Mental Health Grants 
126.23  General              53,479,000    34,690,000
126.24                                     46,551,000
126.25  Lottery Prize Fund    1,408,000     1,408,000
126.26  [RESTRUCTURING OF ADULT MENTAL HEALTH 
126.27  SERVICES.] The commissioner may make 
126.28  transfers that do not increase the 
126.29  state share of costs to effectively 
126.30  implement the restructuring of adult 
126.31  mental health services.  
126.32  [COMPULSIVE GAMBLING.] Of the 
126.33  appropriation from the lottery prize 
126.34  fund, $250,000 each year is for the 
126.35  following purposes: 
126.36  (1) $100,000 each year is for a grant 
126.37  to the Southeast Asian Problem Gambling 
126.38  Consortium.  The consortium must 
126.39  provide statewide compulsive gambling 
126.40  prevention and treatment services for 
126.41  Lao, Hmong, Vietnamese, and Cambodian 
126.42  families, adults, and adolescents.  The 
126.43  appropriation in this clause shall not 
126.44  become part of base level funding for 
126.45  the biennium beginning July 1, 2005.  
126.46  Any unencumbered balance of the 
126.47  appropriation in the first year does 
126.48  not cancel but is available for the 
126.49  second year; and 
126.50  (2) $150,000 each year is for a grant 
126.51  to a compulsive gambling council 
126.52  located in St. Louis county.  The 
126.53  gambling council must provide a 
126.54  statewide compulsive gambling 
126.55  prevention and education project for 
126.56  adolescents.  Any unencumbered balance 
126.57  of the appropriation in the first year 
126.58  of the biennium does not cancel but is 
126.59  available for the second year. 
127.1   (e) Community Support Grants 
127.2                         12,523,000   9,093,000
127.3                                     12,024,000
127.4   [CENTERS FOR INDEPENDENT LIVING STUDY.] 
127.5   The commissioner of human services, in 
127.6   consultation with the commissioner of 
127.7   economic security, the centers for 
127.8   independent living, and consumer 
127.9   representatives, shall study the 
127.10  financing of the centers for 
127.11  independent living authorized under 
127.12  Minnesota Statutes, section 268A.11, 
127.13  and make recommendations on options to 
127.14  maximize federal financial 
127.15  participation.  Study components shall 
127.16  include: 
127.17  (1) the demographics of individuals 
127.18  served by the centers for independent 
127.19  living; 
127.20  (2) the range of services the centers 
127.21  for independent living provide to these 
127.22  individuals; 
127.23  (3) other publicly funded services 
127.24  received by individuals supported by 
127.25  the centers; and 
127.26  (4) strategies for maximizing federal 
127.27  financial participation for eligible 
127.28  activities carried out by centers for 
127.29  independent living. 
127.30  The commissioner shall report with 
127.31  fiscal and programmatic recommendations 
127.32  to the chairs of the appropriate house 
127.33  of representatives and senate finance 
127.34  and policy committees by January 15, 
127.35  2004. 
127.36  (f) Medical Assistance Long-Term 
127.37  Care Waivers and Home Care Grants 
127.38  General              659,211,000  718,665,000
127.39                       624,631,000  748,189,000
127.40  [RATE AND ALLOCATION DECREASES FOR 
127.41  CONTINUING CARE PROGRAMS.] 
127.42  Notwithstanding any law or rule to the 
127.43  contrary, the commissioner of human 
127.44  services shall decrease reimbursement 
127.45  rates or reduce allocations to assure 
127.46  the necessary reductions in state 
127.47  spending for the providers or programs 
127.48  listed in paragraphs (a) to (d).  The 
127.49  decreases are effective for services 
127.50  rendered on or after July 1, 2003. 
127.51  (a) Effective July 1, 2003, the 
127.52  commissioner shall reduce payment rates 
127.53  for services and individual or service 
127.54  limits by one percent.  The rate 
127.55  decreases described in this section 
127.56  must be applied to: 
127.57  (1) home and community-based waivered 
128.1   services for the elderly under 
128.2   Minnesota Statutes, section 256B.0915; 
128.3   (2) day training and habilitation 
128.4   services for adults with mental 
128.5   retardation or related conditions under 
128.6   Minnesota Statutes, sections 252.40 to 
128.7   252.46; 
128.8   (3) the group residential housing 
128.9   supplementary service rate under 
128.10  Minnesota Statutes, section 256I.05, 
128.11  subdivision 1a; 
128.12  (4) chemical dependency residential and 
128.13  nonresidential service rates under 
128.14  Minnesota Statutes, section 245B.03; 
128.15  (5) consumer support grants under 
128.16  Minnesota Statutes, section 256.476; 
128.17  and 
128.18  (6) home and community-based services 
128.19  for alternative care services under 
128.20  Minnesota Statutes, section 256B.0913. 
128.21  (b) The commissioner shall reduce 
128.22  allocations made available to county 
128.23  agencies for home and community-based 
128.24  waivered services to assure a 
128.25  one-percent reduction in state spending 
128.26  for services rendered on or after July 
128.27  1, 2003.  The commissioner shall apply 
128.28  the allocation decreases described in 
128.29  this section to: 
128.30  (1) persons with mental retardation or 
128.31  related conditions under Minnesota 
128.32  Statutes, section 256B.501; 
128.33  (2) waivered services under community 
128.34  alternatives for disabled individuals 
128.35  under Minnesota Statutes, section 
128.36  256B.49; 
128.37  (3) community alternative care waivered 
128.38  services under Minnesota Statutes, 
128.39  section 256B.49; and 
128.40  (4) traumatic brain injury waivered 
128.41  services under Minnesota Statutes, 
128.42  section 256B.49. 
128.43  County agencies will be responsible for 
128.44  100 percent of any spending in excess 
128.45  of the allocation made by the 
128.46  commissioner.  Nothing in this section 
128.47  shall be construed as reducing the 
128.48  county's responsibility to offer and 
128.49  make available feasible home and 
128.50  community-based options to eligible 
128.51  waiver recipients within the resources 
128.52  allocated to them for that purpose. 
128.53  (c) The commissioner shall reduce deaf 
128.54  and hard-of-hearing grants by one 
128.55  percent on July 1, 2003. 
128.56  (d) Effective July 1, 2003, the 
128.57  commissioner shall reduce payment rates 
128.58  for each facility reimbursed under 
129.1   Minnesota Statutes, section 256B.5012, 
129.2   by decreasing the total operating 
129.3   payment rate for intermediate care 
129.4   facilities for the mentally retarded by 
129.5   one percent.  For each facility, the 
129.6   commissioner shall multiply the 
129.7   adjustment by the total payment rate, 
129.8   excluding the property-related payment 
129.9   rate, in effect on June 30, 2003.  A 
129.10  facility whose payment rates are 
129.11  governed by closure agreements, 
129.12  receivership agreements, or Minnesota 
129.13  Rules, part 9553.0075, is not subject 
129.14  to an adjustment otherwise taken under 
129.15  this subdivision. 
129.16  Notwithstanding section 14, these 
129.17  adjustments shall not expire. 
129.18  [REDUCE GROWTH IN MR/RC WAIVER.] The 
129.19  commissioner shall reduce the growth in 
129.20  the MR/RC waiver by not allocating the 
129.21  300 additional diversion allocations 
129.22  that are included in the February 2003 
129.23  forecast for the fiscal years that 
129.24  begin on July 1, 2003, and July 1, 2004.
129.25  [MANAGE THE GROWTH IN THE TBI WAIVER.] 
129.26  During the fiscal years beginning on 
129.27  July 1, 2003, and July 1, 2004, the 
129.28  commissioner shall allocate money for 
129.29  home and community-based programs 
129.30  covered under Minnesota Statutes, 
129.31  section 256B.49, to assure a reduction 
129.32  in state spending that is equivalent to 
129.33  limiting the caseload growth of the TBI 
129.34  waiver to 150 in each year of the 
129.35  biennium.  Priorities for the 
129.36  allocation of funds shall be for 
129.37  individuals anticipated to be 
129.38  discharged from institutional settings 
129.39  or who are at imminent risk of a 
129.40  placement in an institutional setting. 
129.41  [TARGETED CASE MANAGEMENT FOR HOME CARE 
129.42  RECIPIENTS.] Implementation of the 
129.43  targeted case management benefit for 
129.44  home care recipients, according to 
129.45  Minnesota Statutes, section 256B.0621, 
129.46  subdivisions 2, 3, 5, 6, 7, 9, and 10, 
129.47  will be delayed until July 1, 2005. 
129.48  [COMMON SERVICE MENU.] Implementation 
129.49  of the common service menu option 
129.50  within the home and community-based 
129.51  waivers, according to Minnesota 
129.52  Statutes, section 256B.49, subdivision 
129.53  16, will be delayed until July 1, 2005. 
129.54  [LIMITATION ON COMMUNITY ALTERNATIVES 
129.55  FOR DISABLED INDIVIDUALS CASELOAD 
129.56  GROWTH.] For the biennium ending June 
129.57  30, 2005, the commissioner shall limit 
129.58  the allocations made available in the 
129.59  community alternatives for disabled 
129.60  individuals waiver program in order not 
129.61  to exceed average caseload growth of 95 
129.62  per month from June 2003 program 
129.63  levels, plus any additional 
129.64  legislatively authorized program 
129.65  growth.  The commissioner shall 
130.1   allocate available resources to achieve 
130.2   the following outcomes: 
130.3   (1) the establishment of feasible and 
130.4   viable alternatives for persons in 
130.5   institutional or hospital settings to 
130.6   relocate to home and community-based 
130.7   settings; 
130.8   (2) the availability of timely 
130.9   assistance to persons at imminent risk 
130.10  of institutional or hospital placement 
130.11  or whose health and safety is at 
130.12  immediate risk; and 
130.13  (3) the maximum provision of essential 
130.14  community supports to eligible persons 
130.15  in need of and waiting for home and 
130.16  community-based service alternatives.  
130.17  The commissioner may reallocate 
130.18  resources from one county or region to 
130.19  another if available funding in that 
130.20  county or region is not likely to be 
130.21  spent and the reallocation is necessary 
130.22  to achieve the outcomes specified in 
130.23  this paragraph. 
130.24  (g) Medical Assistance Long-term 
130.25  Care Facilities Grants 
130.26  General             543,999,000   514,483,000
130.27                      513,763,000   536,321,000
130.28  (h) Alternative Care Grants 
130.29  General              75,206,000    66,351,000
130.30  [ALTERNATIVE CARE TRANSFER.] Any money 
130.31  allocated to the alternative care 
130.32  program that is not spent for the 
130.33  purposes indicated does not cancel but 
130.34  shall be transferred to the medical 
130.35  assistance account. 
130.36  [ALTERNATIVE CARE APPROPRIATION.] The 
130.37  commissioner may expend the money 
130.38  appropriated for the alternative care 
130.39  program for that purpose in either year 
130.40  of the biennium. 
130.41  [ALTERNATIVE CARE IMPLEMENTATION OF 
130.42  CHANGES TO FEES AND ELIGIBILITY.] 
130.43  Changes to Minnesota Statutes, section 
130.44  256B.0913, subdivision 4, paragraph 
130.45  (d), and subdivision 12, are effective 
130.46  July 1, 2003, for all persons found 
130.47  eligible for the alternative care 
130.48  program on or after July 1, 2003.  All 
130.49  recipients of alternative care funding 
130.50  as of June 30, 2003, shall be subject 
130.51  to Minnesota Statutes, section 
130.52  256B.0913, subdivision 4, paragraph 
130.53  (d), and subdivision 12, on the annual 
130.54  reassessment and review of their 
130.55  eligibility after July 1, 2003, but no 
130.56  later than January 1, 2004. 
130.57  (i) Group Residential Housing Grants 
130.58  General              94,996,000    80,472,000
131.1                        94,547,000    81,055,000
131.2   [GROUP RESIDENTIAL HOUSING COSTS 
131.3   REFINANCED.] (1) Effective July 1, 
131.4   2004, the commissioner shall increase 
131.5   the home and community-based service 
131.6   rates and county allocations provided 
131.7   to programs for persons with 
131.8   disabilities established under section 
131.9   1915(c) of the Social Security Act to 
131.10  the extent that these programs will be 
131.11  paying for the costs above the rate 
131.12  established in Minnesota Statutes, 
131.13  section 256I.05, subdivision 1. 
131.14  (2) For persons in receipt of services 
131.15  under Minnesota Statutes, section 
131.16  256B.0915, who reside in licensed adult 
131.17  foster care beds for which a 
131.18  supplemental room and board payment was 
131.19  being made under Minnesota Statutes, 
131.20  section 256I.05, subdivision 1, 
131.21  counties may request an exception to 
131.22  the individual caps specified in 
131.23  Minnesota Statutes, section 256B.0915, 
131.24  subdivision 3, paragraph (b), not to 
131.25  exceed the difference between the 
131.26  individual cap and the client's monthly 
131.27  service expenditures plus the amount of 
131.28  the supplemental room and board rate.  
131.29  The county must submit a request to 
131.30  exceed the individual cap to the 
131.31  commissioner for approval. 
131.32  (j) Chemical Dependency
131.33  Entitlement Grants 
131.34  General              49,251,000    50,337,000
131.35                       57,612,000    60,034,000
131.36  (k) Chemical Dependency Nonentitlement 
131.37  Grants 
131.38  General               1,055,000     1,055,000
131.39     Sec. 7.  Laws 2003, First Special Session chapter 14, 
131.40  article 13C, section 2, subdivision 11, is amended to read: 
131.41  Subd. 11.  Economic Support Grants 
131.42                Summary by Fund
131.43  General             122,647,000   117,198,000
131.44                      124,697,000   116,985,000
131.45  Federal TANF        199,009,000   207,224,000
131.46                      212,844,000   209,264,000
131.47  The amounts that may be spent from this 
131.48  appropriation for each purpose are as 
131.49  follows: 
131.50  (a) Minnesota Family Investment Program 
131.51  General              59,922,000   39,375,000
131.52                       53,818,000   43,942,000
132.1   Federal TANF        106,535,000   110,543,000
132.2                       114,370,000   106,583,000
132.3   (b) Work Grants 
132.4   General                 666,000    14,678,000
132.5                         8,666,000     8,678,000
132.6   Federal TANF         92,474,000    96,681,000
132.7                        98,474,000   102,681,000
132.8   [MFIP SUPPORT SERVICES COUNTY AND 
132.9   TRIBAL ALLOCATION.] When determining 
132.10  the funds available for the 
132.11  consolidated MFIP support services 
132.12  grant in the 18-month period ending 
132.13  December 31, 2004, the commissioner 
132.14  shall apportion the funds appropriated 
132.15  for fiscal year 2005 in such manner as 
132.16  necessary to provide $14,000,000 more 
132.17  to counties and tribes for the period 
132.18  ending December 31, 2004, than would 
132.19  have been available had the funds been 
132.20  evenly divided within the fiscal year 
132.21  between the period before December 31, 
132.22  2004, and the period after December 31, 
132.23  2004. 
132.24  For allocations for the calendar years 
132.25  starting January 1, 2005, the 
132.26  commissioner shall apportion the funds 
132.27  appropriated for each fiscal year in 
132.28  such manner as necessary to provide 
132.29  $14,000,000 more to counties and tribes 
132.30  for the period ending December 31 of 
132.31  that year than would have been 
132.32  available had the funds been evenly 
132.33  divided within the fiscal year between 
132.34  the period before December 31 and the 
132.35  period after December 31. 
132.36  (c) Economic Support Grants - Other 
132.37  Assistance 
132.38  General               3,358,000     3,463,000
132.39  [SUPPORTIVE HOUSING.] Of the general 
132.40  fund appropriation, $500,000 each year 
132.41  is to provide services to families who 
132.42  are participating in the supportive 
132.43  housing and managed care pilot project 
132.44  under Minnesota Statutes, section 
132.45  256K.25.  This appropriation shall not 
132.46  become part of base level funding for 
132.47  the biennium beginning July 1, 2007. 
132.48  (d) Child Support Enforcement Grants 
132.49  General               3,571,000     3,503,000
132.50  (e) General Assistance Grants
132.51  General              24,901,000    24,732,000
132.52                       26,329,000    26,909,000
132.53  [GENERAL ASSISTANCE STANDARD.] The 
132.54  commissioner shall set the monthly 
133.1   standard of assistance for general 
133.2   assistance units consisting of an adult 
133.3   recipient who is childless and 
133.4   unmarried or living apart from parents 
133.5   or a legal guardian at $203.  The 
133.6   commissioner may reduce this amount 
133.7   according to Laws 1997, chapter 85, 
133.8   article 3, section 54. 
133.9   [EMERGENCY GENERAL ASSISTANCE.] The 
133.10  amount appropriated for emergency 
133.11  general assistance funds is limited to 
133.12  no more than $7,889,812 in each fiscal 
133.13  year of 2004 and 2005.  Funds to 
133.14  counties shall be allocated by the 
133.15  commissioner using the allocation 
133.16  method specified in Minnesota Statutes, 
133.17  section 256D.06. 
133.18  (f) Minnesota Supplemental Aid Grants 
133.19  General              30,229,000    31,447,000
133.20                       28,955,000    30,490,000
133.21  [EMERGENCY MINNESOTA SUPPLEMENTAL AID 
133.22  FUNDS.] The amount appropriated for 
133.23  emergency Minnesota supplemental aid 
133.24  funds is limited to no more than 
133.25  $1,138,707 in fiscal year 2004 and 
133.26  $1,017,000 in fiscal year 2005.  Funds 
133.27  to counties shall be allocated by the 
133.28  commissioner using the allocation 
133.29  method specified in Minnesota Statutes, 
133.30  section 256D.46. 
133.31     Sec. 8.  Laws 2003, First Special Session chapter 14, 
133.32  article 13C, section 10, subdivision 1, is amended to read: 
133.33  Subdivision 1.  Total 
133.34  Appropriation                     $  107,829,000 $   92,649,000
133.35                                    $  106,221,000 $   97,564,000
133.36                Summary by Fund
133.37  General             104,489,000    89,309,000
133.38                      102,881,000    94,224,000
133.39  State Special 
133.40  Revenue               3,340,000     3,340,000 
133.41     Sec. 9.  Laws 2003, First Special Session chapter 14, 
133.42  article 13C, section 10, subdivision 2, is amended to read: 
133.43  Subd. 2.  Child Care 
133.44  [BASIC SLIDING FEE CHILD CARE.] Of this 
133.45  appropriation, $27,628,000 in fiscal 
133.46  year 2004 and $18,771,000 in fiscal 
133.47  year 2005 are for child care assistance 
133.48  according to Minnesota Statutes, 
133.49  section 119B.03.  These appropriations 
133.50  are available to be spent either year.  
133.51  The fiscal years 2006 and 2007 general 
133.52  fund base for basic sliding fee child 
133.53  care is $30,312,000 each year. 
133.54  [MFIP CHILD CARE.] Of this 
134.1   appropriation, $69,543,000 $67,935,000 
134.2   in fiscal year 2004 
134.3   and $63,720,000 $68,635,000 in fiscal 
134.4   year 2005 are for MFIP child care. 
134.5   [CHILD CARE PROGRAM INTEGRITY.] Of this 
134.6   appropriation, $425,000 in fiscal year 
134.7   2004, and $376,000 in fiscal year 2005 
134.8   are for the administrative costs of 
134.9   program integrity and fraud prevention 
134.10  for child care assistance under 
134.11  Minnesota Statutes, chapter 119B. 
134.12  [CHILD CARE DEVELOPMENT.] Of this 
134.13  appropriation, $1,115,000 in fiscal 
134.14  year 2004, and $1,164,000 in fiscal 
134.15  year 2005 are for child care 
134.16  development grants according to 
134.17  Minnesota Statutes, section 119B.21. 
134.18     Sec. 10.  [EFFECTIVE DATE.] 
134.19     Sections 1 to 9 are effective the day following final 
134.20  enactment, unless a different effective date is specified. 
134.21                             ARTICLE 15
134.22                           APPROPRIATIONS 
134.23  Section 1.  [HEALTH AND HUMAN SERVICES APPROPRIATIONS.] 
134.24     The sums shown in the columns marked "APPROPRIATIONS" are 
134.25  added to or, if shown in parentheses, are subtracted from the 
134.26  appropriations in Laws 2003, First Special Session chapter 14, 
134.27  article 13C, or other law, and are appropriated from the general 
134.28  fund, or any other fund named, to the agencies and for the 
134.29  purposes specified in the sections of this article, to be 
134.30  available for the fiscal years indicated for each purpose.  The 
134.31  figures "2004" and "2005" where used in this article, mean that 
134.32  the appropriation or appropriations listed under them are 
134.33  available for the fiscal year ending June 30, 2004, or June 30, 
134.34  2005, respectively.  
134.35                          SUMMARY BY FUND 
134.36                            2004          2005           TOTAL
134.37  General               $136,924,000  $(201,661,000) $(64,737,000)
134.38  Health Care
134.39  Access                  41,994,000    (46,406,000)   (4,412,000)
134.40  Federal TANF             -0-             -0-            -0-     
134.41  Lottery Prize Fund       -0-               75,000        75,000
134.42  TOTAL                 $178,918,000  $(247,992,000) $(69,149,000)
134.43                                             APPROPRIATIONS 
134.44                                         Available for the Year 
135.1                                              Ending June 30 
135.2                                             2004         2005 
135.3   Sec. 2.  COMMISSIONER OF
135.4   HUMAN SERVICES
135.5   Subdivision 1.  Total
135.6   Appropriation                     $  178,918,000 $(247,154,000)
135.7                 Summary by Fund
135.8   General             136,924,000  (200,979,000)
135.9   Health Care
135.10  Access               41,994,000   (46,400,000)
135.11  Federal TANF             -0-           -0-    
135.12  Lottery Prize Fund       -0-           75,000
135.13  Other Funds              -0-          150,000
135.14  Subd. 2.  Agency Management 
135.15                Summary by Fund
135.16  General                  -0-       (2,300,000)
135.17  The amounts that may be spent from the 
135.18  appropriation for each purpose are as 
135.19  follows: 
135.20  (a) Financial Operations
135.21  General                  -0-       (2,300,000)
135.22  (b) Legal and Regulatory Operations
135.23  General                  -0-          250,000
135.24  (c) Management Operations
135.25  (d) Information Technology
135.26  Subd. 3.  Revenue and Pass-Through
135.27  Federal TANF             -0-       10,579,000
135.28  [TANF REFINANCING.] In addition to the 
135.29  amount of TANF funds available for use 
135.30  with the Minnesota working family tax 
135.31  credit program under current law 
135.32  appropriations, there is further 
135.33  appropriated the following amounts: 
135.34       FY 2005        .....     $10,579,000
135.35       FY 2006        .....     $15,028,000
135.36       FY 2007        .....     $15,254,000
135.37  [ADJUSTMENTS IN WORKING FAMILY CREDIT 
135.38  EXPENDITURES COUNTED AS TANF MOE.] In 
135.39  addition to the amounts identified in 
135.40  Laws 2003, First Special Session 
135.41  chapter 14, article 13C, section 2, the 
135.42  commissioner may claim up to the 
135.43  following amounts of Working Family 
135.44  Credit expenditures for the following 
135.45  fiscal years: 
136.1        FY 2006        .....     $27,656,000 
136.2        FY 2007        .....     $17,883,000
136.3   Subd. 4.  Children's Services Grants
136.4   [PRIVATIZED ADOPTION GRANT.] For the 
136.5   biennium ending June 30, 2005, federal 
136.6   reimbursement for privatized adoption 
136.7   grant and foster care recruitment grant 
136.8   expenditures is appropriated to the 
136.9   commissioner for adoption grants and 
136.10  foster care and adoption administrative 
136.11  purposes. 
136.12  [ADJUSTMENTS IN TANF TRANSFERS TO CHILD 
136.13  CARE DEVELOPMENT FUND.] Transfers of 
136.14  TANF to the federal Child Care 
136.15  Development Fund for child care 
136.16  assistance shall be reduced by these 
136.17  amounts in fiscal year 2005: 
136.18  Basic sliding fee child care     $370,000 
136.19  MFIP child care                $1,152,000
136.20  Subd. 5.  Children's Services Management
136.21  Subd. 6.  Basic Health Care Grants
136.22                Summary by Fund
136.23  General             133,114,000 (138,463,000)
136.24  Health Care Access   41,994,000  (46,580,000)
136.25  The amounts that may be spent from this 
136.26  appropriation for each purpose are as 
136.27  follows: 
136.28  (a) MinnesotaCare Grants
136.29  Health Care Access   41,994,000  (45,830,000)
136.30  [HEALTH CARE ACCESS FUND TRANSFER.] 
136.31  Notwithstanding Laws 2003, First 
136.32  Special Session chapter 14, article 
136.33  13C, section 2, subdivision 7, the 
136.34  commissioner of finance shall transfer 
136.35  $70,000,000 from the health care access 
136.36  fund to the general fund on July 1, 
136.37  2004.  This transfer is in addition to 
136.38  all other transfers from the health 
136.39  care access fund to the general fund. 
136.40  (b) MA Basic Health Care
136.41  Grants - Families and Children
136.42  General              76,265,000 (80,589,000)
136.43  [CAPITATION PAYMENTS.] Capitation 
136.44  payments and performance withhold 
136.45  payments under Minnesota Statutes, 
136.46  chapters 256B, 256D, and 256L, for the 
136.47  months of June 2004 and July 2004 shall 
136.48  be made prior to June 30, 2004.  This 
136.49  rider is effective the day following 
136.50  final enactment. 
136.51  [HEALTH CARE GRANTS FORECAST.] The 
136.52  commissioner of finance, as part of the 
137.1   November 2004 forecast, shall determine 
137.2   the extent to which projected state 
137.3   spending for the portion of medical 
137.4   assistance that serves MFIP and 
137.5   Families basic health care grants for 
137.6   the FY 2006-2007 biennium exceeds the 
137.7   level of spending projected for those 
137.8   programs in the FY 2004-2005 biennium.  
137.9   If the level of state spending 
137.10  projected for the FY 2006-2007 biennium 
137.11  exceeds the level of state spending for 
137.12  those programs in the FY 2004-2005 
137.13  biennium by more than $100,000,000, the 
137.14  commissioner of human services must 
137.15  prepare a plan to reduce expenditures 
137.16  for the portion of medical assistance 
137.17  that serves MFIP and Families basic 
137.18  health care grants for the FY 2006-2007 
137.19  biennium by an amount so that 
137.20  expenditures in those programs do not 
137.21  exceed the expenditures for those 
137.22  programs in the FY 2004-2005 biennium 
137.23  by more than $100,000,000.  The 
137.24  reductions in the plan presented by the 
137.25  commissioner of human services shall 
137.26  not reduce medical assistance 
137.27  reimbursement rates to providers.  The 
137.28  commissioner must present this plan to 
137.29  the chairs of the House Health and 
137.30  Human Services Finance Committee and 
137.31  the Senate Finance Health, Human 
137.32  Services and Corrections Budget 
137.33  Division by December 15, 2004. 
137.34  (c) MA Basic Health Care 
137.35  Grants - Elderly and Disabled
137.36  General              28,821,000 (31,301,000)
137.37  (d) General Assistance
137.38  Medical Care Grants
137.39  General              28,028,000 (26,863,000)
137.40  (e) Health Care Grants -
137.41  Other Assistance
137.42  General                  -0-           290,000 
137.43  Health Care Access       -0-          (750,000)
137.44  (f) Prescription Drug Program
137.45  General                  -0-             -0-
137.46  [PRESCRIPTION DRUG PROGRAM.] The 
137.47  commissioner may expend the money 
137.48  appropriated for the prescription drug 
137.49  program in either year of the 
137.50  biennium.  Unexpended funds do not 
137.51  cancel and are available to the 
137.52  commissioner for fiscal year 2006 
137.53  prescription drug program expenditures. 
137.54  Subd. 7.  Health Care Management
137.55                Summary by Fund
137.56  General                  -0-         2,085,000
137.57  Health Care Access       -0-           300,000
138.1   Other Funds              -0-           150,000
138.2   The amounts that may be spent from this 
138.3   appropriation for each purpose are as 
138.4   follows: 
138.5   (a) Health Care Policy
138.6   Administration
138.7   General                  -0-         1,965,000
138.8   Health Care Access       -0-           300,000
138.9   Other Funds              -0-           150,000
138.10  (b) Health Care
138.11  Operations
138.12  General                  -0-           120,000 
138.13  Subd. 8.  State-Operated Services
138.14                Summary by Fund
138.15  General               4,262,000      5,520,000 
138.16  [TEMPORARY CONFINEMENT COST OF CARE.] 
138.17  The cost of care shall be ten percent 
138.18  as specified in Minnesota Statutes, 
138.19  section 246.54, subdivision 2, for any 
138.20  individual for whom a county obtained 
138.21  an order from a court authorizing 
138.22  temporary confinement, as defined in 
138.23  Minnesota Statutes, section 253B.045, 
138.24  between January 1, 2004, and June 30, 
138.25  2004, to the Minnesota sex offender 
138.26  program as defined in Minnesota 
138.27  Statutes, section 253B.02, subdivision 
138.28  18a, not 100 percent as required under 
138.29  Minnesota Statutes, section 253B.045, 
138.30  subdivision 3. 
138.31  Subd. 9.  Continuing Care Grants
138.32                Summary by Fund
138.33  General                  -0-       15,409,000
138.34  Lottery Prize Fund       -0-           75,000
138.35  The amounts that may be spent from this 
138.36  appropriation for each purpose are as 
138.37  follows: 
138.38  (a) Community Social Services
138.39  (b) Aging Adult Service Grant
138.40   General                 -0-            1,000 
138.41  (c) Deaf and Hard-of-Hearing
138.42  Service Grants
138.43  General                  -0-            4,000 
138.44  (d) Mental Health Grants
138.45  Lottery Prize Fund       -0-           75,000
138.46  $75,000 in fiscal year 2005 is 
138.47  appropriated from the lottery prize 
139.1   fund to the commissioner of human 
139.2   services for a grant to the Northstar 
139.3   Problem Gambling Alliance, located in 
139.4   Arlington, Minnesota.  The Northstar 
139.5   Problem Gambling Alliance must provide 
139.6   services to increase public awareness 
139.7   of problem gambling, education and 
139.8   training for individuals and 
139.9   organizations providing services to 
139.10  problem gamblers and their families, 
139.11  and research relating to problem 
139.12  gambling.  This appropriation is 
139.13  contingent on the demonstration of an 
139.14  equal amount in nonstate matching funds 
139.15  to the commissioner of finance but may 
139.16  be disbursed in two payments of $37,500 
139.17  upon receipt of a commitment for an 
139.18  equal amount of matching nonstate funds.
139.19  (e) Community Support Grants
139.20  General                  -0-          111,000 
139.21  (f) Medical Assistance
139.22  Long-Term Waivers and Home
139.23  Care Grants
139.24  General                  -0-        2,222,000
139.25  [MANAGE THE GROWTH IN THE TBI WAIVER.] 
139.26  The commissioner shall allocate funding 
139.27  for home and community-based services 
139.28  covered under Minnesota Statutes, 
139.29  section 256B.49, so that new TBI waiver 
139.30  caseload growth is limited to 300 each 
139.31  year of the biennium ending June 30, 
139.32  2007.  State fiscal year 2005 caseload 
139.33  levels, as determined in the February 
139.34  2004 forecast, will serve as the base 
139.35  against which these limits will be 
139.36  established.  Priority for new 
139.37  allocations shall be given to 
139.38  individuals seeking to be discharged 
139.39  from institutional settings or who are 
139.40  at imminent risk of placement in an 
139.41  institutional setting.  Notwithstanding 
139.42  any provision to the contrary, this 
139.43  paragraph remains in effect for the 
139.44  biennium ending June 30, 2007. 
139.45  [MANAGE THE GROWTH IN THE COMMUNITY 
139.46  ALTERNATIVES FOR DISABLED INDIVIDUALS 
139.47  WAIVER.] The commissioner shall 
139.48  allocate funding for home and 
139.49  community-based services covered under 
139.50  Minnesota Statutes, section 256B.49, so 
139.51  that new CADI caseload growth is 
139.52  limited to an average of 160 per month 
139.53  in each year of the biennium ending 
139.54  June 30, 2007.  State fiscal year 2005 
139.55  caseload levels, as determined in the 
139.56  February 2004 forecast, will serve as 
139.57  the base against which these limits 
139.58  will be established.  Priority for new 
139.59  allocations shall be given to 
139.60  individuals seeking to be discharged 
139.61  from institutional settings or who are 
139.62  at imminent risk of a placement in an 
139.63  institutional setting.  Notwithstanding 
139.64  any provision to the contrary, this 
139.65  paragraph remains in effect for the 
140.1   biennium ending June 30, 2007. 
140.2   (g) Medical Assistance
140.3   Long-term Care Facilities Grants
140.4   General                 -0-      12,591,000
140.5   [NURSING FACILITY SCHOLARSHIP PROGRAM.] 
140.6   From the effective date of this act 
140.7   through June 30, 2005, nursing 
140.8   facilities shall receive as a per diem 
140.9   adjustment to their total payment 
140.10  rates, the per diem amount determined 
140.11  in Minnesota Statutes 2003 Supplement, 
140.12  section 256B.431, subdivision 36, 
140.13  paragraph (b), minus $0.25.  If this 
140.14  amount is less than zero, then the 
140.15  facility shall receive no rate 
140.16  adjustment.  
140.17  For the rate year beginning July 1, 
140.18  2005, the amount determined under 
140.19  Minnesota Statutes 2003 Supplement, 
140.20  section 256B.431, subdivision 36, 
140.21  paragraph (b), shall be removed from 
140.22  each nursing facility's rate. 
140.23  [RATE AND ALLOCATION INCREASES FOR 
140.24  CONTINUING CARE PROGRAMS.] 
140.25  Notwithstanding any law or rule to the 
140.26  contrary, including Laws 2003, First 
140.27  Special Session chapter 14, article 
140.28  13C, section 2, subdivision 9, the 
140.29  commissioner of human services shall 
140.30  increase reimbursement rates or 
140.31  increase allocations to assure the 
140.32  necessary increases in state spending 
140.33  for the providers or programs listed in 
140.34  clauses (1) to (4).  The increases are 
140.35  added to base-level funding and are 
140.36  effective for services rendered on or 
140.37  after July 1, 2004. 
140.38  (1) Effective July 1, 2004, the 
140.39  commissioner shall increase payment 
140.40  rates for services and individual or 
140.41  service limits by up to one-half 
140.42  percent.  The rate increases described 
140.43  in this section must be applied to: 
140.44  (i) home and community-based waivered 
140.45  services for the elderly under 
140.46  Minnesota Statutes, section 256B.0915; 
140.47  (ii) day training and habilitation 
140.48  services for adults with mental 
140.49  retardation or related conditions under 
140.50  Minnesota Statutes, sections 252.40 to 
140.51  252.46; 
140.52  (iii) the group residential housing 
140.53  supplementary service rate under 
140.54  Minnesota Statutes, section 256I.05, 
140.55  subdivision 1a; 
140.56  (iv) chemical dependency residential 
140.57  and nonresidential service rates under 
140.58  Minnesota Statutes, section 245B.03; 
140.59  (v) consumer support grants under 
140.60  Minnesota Statutes, section 256.476; 
141.1   and 
141.2   (vi) home and community-based services 
141.3   for alternative care services under 
141.4   Minnesota Statutes, section 256B.0913. 
141.5   (2) The commissioner shall increase 
141.6   allocations made available to county 
141.7   agencies for home and community-based 
141.8   waivered services to assure up to a 
141.9   one-half percent increase in state 
141.10  spending for services rendered on or 
141.11  after July 1, 2004.  The commissioner 
141.12  shall apply the allocation increases 
141.13  described in this section to: 
141.14  (i) persons with mental retardation or 
141.15  related conditions under Minnesota 
141.16  Statutes, section 256B.501; 
141.17  (ii) waivered services under community 
141.18  alternatives for disabled individuals 
141.19  under Minnesota Statutes, section 
141.20  256B.49; 
141.21  (iii) community alternative care 
141.22  waivered services under Minnesota 
141.23  Statutes, section 256B.49; and 
141.24  (iv) traumatic brain injury waivered 
141.25  services under Minnesota Statutes, 
141.26  section 256B.49. 
141.27  County agencies will be responsible for 
141.28  100 percent of any spending in excess 
141.29  of the allocation made by the 
141.30  commissioner.  Nothing in this section 
141.31  shall be construed as changing the 
141.32  county's responsibility to offer and 
141.33  make available feasible home and 
141.34  community-based options to eligible 
141.35  waiver recipients within the resources 
141.36  allocated to them for that purpose. 
141.37  (3) The commissioner shall increase 
141.38  deaf and hard-of-hearing grants by up 
141.39  to one-half percent on July 1, 2004. 
141.40  (4) Effective July 1, 2004, the 
141.41  commissioner shall increase payment 
141.42  rates for each facility reimbursed 
141.43  under Minnesota Statutes, section 
141.44  256B.5012, by increasing the total 
141.45  operating payment rate for intermediate 
141.46  care facilities for the mentally 
141.47  retarded by up to one-half percent.  
141.48  For each facility, the commissioner 
141.49  shall multiply the adjustment by the 
141.50  total payment rate, excluding the 
141.51  property-related payment rate, in 
141.52  effect on June 30, 2004.  A facility 
141.53  whose payment rates are governed by 
141.54  closure agreements, receivership 
141.55  agreements, or Minnesota Rules, part 
141.56  9553.0075, is not subject to an 
141.57  adjustment otherwise taken under this 
141.58  subdivision. 
141.59  Notwithstanding any contrary provision, 
141.60  these adjustments shall not expire. 
142.1   (h) Alternative Care Grants
142.2   General                 -0-           252,000 
142.3   (i) Group Residential
142.4   Housing Grants
142.5   General                 -0-           (25,000)
142.6   (j) Chemical Dependency
142.7   Entitlement Grants
142.8   General                 -0-           253,000 
142.9   (k) Chemical Dependency
142.10  Nonentitlement Grants
142.11  Subd. 10.  Continuing Care Management
142.12  Subd. 11.  Economic Support Grants
142.13                Summary by Fund
142.14  General                 -0-           118,000
142.15  Federal TANF            -0-       (10,152,000)
142.16  The amounts that may be spent from this 
142.17  appropriation for each purpose are as 
142.18  follows: 
142.19  (a) Minnesota Family
142.20  Investment Program
142.21  Federal TANF            -0-       (10,152,000)
142.22  (b) Work Grants
142.23  [FOOD STAMPS EMPLOYMENT AND TRAINING 
142.24  FUNDS.] Notwithstanding Minnesota 
142.25  Statutes, section 256D.051, subdivision 
142.26  6d, for fiscal years 2005, 2006, and 
142.27  2007 only, Federal food stamps 
142.28  employment and training funds received 
142.29  as reimbursement of Minnesota family 
142.30  investment program consolidated fund 
142.31  grant expenditures must be deposited in 
142.32  the general fund.  Consistent with the 
142.33  receipt of these federal funds, the 
142.34  commissioner may adjust the level of 
142.35  working family credit expenditures 
142.36  claimed as TANF maintenance of effort. 
142.37  (c) Economic Support Grants - 
142.38  Other Assistance
142.39  [MEC
2
 IMPLEMENTATION.] The commissioner 
142.40  may make up to five percent of a 
142.41  county's subsequent calendar year basic 
142.42  sliding fee child care assistance 
142.43  allocation available to the county in 
142.44  the current calendar year to offset the 
142.45  cash flow effect of MEC
2
 implementation.
142.46  This adjustment shall not be considered 
142.47  when calculating future allocation 
142.48  amounts under Minnesota Statutes, 
142.49  section 119B.03. 
142.50  [BASIC SLIDING FEE CHILD CARE.] The 
142.51  fiscal year 2006 and 2007 general fund 
142.52  base for basic sliding fee child care 
142.53  is reduced by $11,045,000. 
143.1   (d) Child Support Enforcement Grants
143.2   (e) General Assistance Grants
143.3   (f) Minnesota Supplemental Aid Grants
143.4   General                                  -0-            118,000 
143.5   Sec. 3.  COMMISSIONER OF HEALTH
143.6   Subdivision 1.  Total       
143.7   Appropriation                            -0-            598,000 
143.8                           Summary by Fund
143.9   General Fund                             -0-           (592,000)
143.10  Health Care Access Fund                  -0-             (6,000)
143.11  Subd. 2.  Health Quality and Access 
143.12  Health Care Access Fund                  -0-             83,000 
143.13  Of the Health Care Access Fund 
143.14  appropriation, $48,000 is for the 
143.15  evaluation of health care providers 
143.16  cost-shifting.  This is a onetime 
143.17  appropriation. 
143.18  Subd. 3.  Management and    
143.19  Support Services                         -0-           (692,000)
143.20  Health Care Access Fund                  -0-            (89,000)
143.21  Subd. 4.  Health Protection 
143.22  General Fund                             -0-            100,000 
143.23  [TRANSFER OF LEAD ABATEMENT.] The lead 
143.24  abatement program is transferred from 
143.25  the Department of Education to the 
143.26  Department of Health.  The program 
143.27  shall be administered according to 
143.28  Minnesota Statutes, section 119A.46. 
143.29  Sec. 4.  BOARD OF CHIROPRACTIC EXAMINERS 
143.30  In fiscal year 2004, $200,000 in state 
143.31  government special revenue funds is 
143.32  transferred from Laws 2003, First 
143.33  Special Session chapter 1, article 1, 
143.34  section 28, to the Board of 
143.35  Chiropractic Examiners to pay for 
143.36  contested case activity.  These funds 
143.37  are available until June 30, 2005. 
143.38  Sec. 5.  VETERANS HOMES BOARD 
143.39  General Fund                             -0-         (90,000)