SF 760

2nd Unofficial Engrossment - 87th Legislature (2011 - 2012) Posted on 04/07/2011 12:44pm

1.1A bill for an act

1.2relating to state government; establishing the health and human services
1.3budget; making changes to children and family services, Department of Health,
1.4miscellaneous provisions, health licensing fees, health care, and continuing
1.5care; redesigning service delivery; making changes to chemical and mental
1.6health; modifying fee schedules; modifying program eligibility requirements;
1.7authorizing rulemaking; imposing criminal penalties; requiring reports;
1.8appropriating money for the Departments of Health and Human Services and
1.9other health-related boards and councils; making forecast adjustments;amending
1.10Minnesota Statutes 2010, sections 3.98, by adding a subdivision; 62D.08,
1.11subdivision 7; 62E.08, subdivision 1; 62E.14, by adding a subdivision; 62J.04,
1.12subdivisions 3, 9; 62J.17, subdivision 4a; 62J.495, by adding a subdivision;
1.1362J.497, by adding a subdivision; 62J.692; 62Q.32; 62U.04, subdivisions 3, 9;
1.1462U.06, subdivision 2; 119B.011, subdivision 13; 119B.035, subdivisions 1,
1.154; 119B.09, subdivision 10, by adding subdivisions; 119B.13, subdivisions 1,
1.161a, 7; 144.05, by adding a subdivision; 144.1499; 144.1501, subdivisions 1,
1.174; 144.98, subdivisions 2a, 7, by adding subdivisions; 144A.071, by adding a
1.18subdivision; 144A.102; 144A.61, by adding a subdivision; 144E.123; 145.928,
1.19subdivision 2; 145.986, by adding subdivisions; 145A.17, subdivision 3; 148.07,
1.20subdivision 1; 148.108, by adding a subdivision; 148.191, subdivision 2;
1.21148.212, subdivision 1; 148.231; 148B.17; 148B.33, subdivision 2; 148B.52;
1.22150A.091, subdivisions 2, 3, 4, 5, 8, by adding a subdivision; 151.07; 151.101;
1.23151.102, by adding a subdivision; 151.12; 151.13, subdivision 1; 151.19; 151.25;
1.24151.47, subdivision 1; 151.48; 152.027, by adding a subdivision; 152.12,
1.25subdivision 3; 157.15, by adding a subdivision; 157.20, by adding a subdivision;
1.26169A.20, subdivisions 1, 1a, 1b, 1c; 245.50; 245A.14, subdivision 4; 246B.10;
1.27252.025, subdivision 7; 252.27, subdivision 2a; 253B.212; 254B.03, subdivisions
1.281, 4; 254B.04, subdivision 1, by adding a subdivision; 254B.06, subdivision
1.292; 256.01, subdivisions 2b, 14b, 24, 29, by adding subdivisions; 256.045,
1.30subdivision 4a; 256.9657, subdivision 1; 256.969, subdivision 2b, by adding a
1.31subdivision; 256B.04, subdivisions 14a, 18; 256B.05, by adding a subdivision;
1.32256B.055, subdivision 15; 256B.056, subdivisions 3, 4, by adding a subdivision;
1.33256B.057, subdivision 9; 256B.06, subdivision 4; 256B.0625, subdivisions
1.348e, 13e, 13h, 17, 17a, 18, 31a, 41, by adding subdivisions; 256B.0631,
1.35subdivisions 1, 2, 3; 256B.0644; 256B.0657; 256B.0659, subdivisions 11,
1.3628; 256B.0751, subdivisions 1, 2, 3, 4, by adding subdivisions; 256B.0753,
1.37by adding a subdivision; 256B.0754, by adding a subdivision; 256B.0755,
1.38subdivision 4, by adding subdivisions; 256B.0756; 256B.0911, subdivisions 1a,
1.393a, 4a, 6; 256B.0913, subdivision 4; 256B.0915, subdivisions 3a, 3b, 3e, 3h, 5,
2.110; 256B.0916, subdivision 6a; 256B.092, subdivisions 1a, 1b, 1e, 1g, 3, 8;
2.2256B.0945, subdivision 4; 256B.14, by adding a subdivision; 256B.19, by adding
2.3a subdivision; 256B.37, subdivision 5; 256B.431, subdivision 2r, by adding
2.4a subdivision; 256B.434, subdivision 4; 256B.437, subdivision 6; 256B.441,
2.5by adding a subdivision; 256B.48, subdivision 1; 256B.49, subdivisions 12,
2.613, 14, 15; 256B.5012, by adding subdivisions; 256B.69, subdivisions 3a, 4,
2.75a, 5c, 6, by adding subdivisions; 256B.692, subdivisions 2, 5, 7, by adding
2.8a subdivision; 256B.694; 256B.76, subdivision 4; 256D.03, subdivision 3;
2.9256D.031, subdivisions 6, 7, 10; 256D.05, subdivision 1; 256D.06, subdivisions
2.101, 1b, 2; 256D.09, subdivision 6; 256D.44, subdivision 5; 256D.46, subdivision
2.111; 256D.49, subdivision 3; 256G.02, subdivision 6; 256I.03, by adding a
2.12subdivision; 256I.04, subdivision 2b; 256I.05, subdivisions 1a, 1e, by adding a
2.13subdivision; 256J.20, subdivision 3; 256J.38, subdivision 1; 256J.49, subdivision
2.1413; 256J.53, subdivision 2; 256L.01, subdivision 4a; 256L.02, subdivision 3;
2.15256L.03, subdivisions 3, 5; 256L.04, subdivisions 1, 7; 256L.05, subdivisions
2.162, 3a, 5, by adding a subdivision; 256L.07, subdivision 1; 256L.09, subdivision
2.174; 256L.11, subdivision 7; 256L.12, subdivision 9; 256L.15, subdivision 1a;
2.18260C.157, subdivision 3; 260D.01; 297F.10, subdivision 1; 326B.175; 393.07,
2.19subdivisions 10, 10a; 402A.10, subdivisions 4, 5; 402A.15; 402A.18; 402A.20;
2.20518A.51; Laws 2008, chapter 363, article 18, section 3, subdivision 5; Laws
2.212009, chapter 79, article 8, sections 4, as amended; 51, as amended; article 13,
2.22section 3, subdivision 8, as amended; Laws 2010, First Special Session chapter 1,
2.23article 15, section 3, subdivision 6; article 25, section 3, subdivision 6; proposing
2.24coding for new law in Minnesota Statutes, chapters 1; 62E; 62J; 62Q; 62U; 137;
2.25144; 145; 148; 151; 256; 256B; 256L; 326B; 402A; repealing Minnesota Statutes
2.262010, sections 62J.07, subdivisions 1, 2, 3; 62J.17, subdivisions 1, 3, 5a, 6a, 8;
2.2762J.321, subdivision 5a; 62J.381; 62J.41, subdivisions 1, 2; 144.1464; 145A.14,
2.28subdivisions 1, 2; 256.979, subdivisions 5, 6, 7, 10; 256.9791; 256.9862,
2.29subdivision 2; 256B.055, subdivision 15; 256B.057, subdivision 2c; 256D.46,
2.30subdivisions 2, 3; 256L.07, subdivision 7; 402A.30; 402A.45; Laws 2008,
2.31chapter 358, article 3, sections 8; 9; Laws 2009, chapter 79, article 3, section
2.3218, as amended; article 5, sections 55, as amended; 56; 57; 60; 61; 62; 63; 64;
2.3365; 66; 68; 69; 79; Minnesota Rules, parts 3400.0130, subpart 8; 4651.0100,
2.34subparts 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 14, 15, 16, 16a, 18, 19, 20, 20a, 21,
2.3522, 23; 4651.0110, subparts 2, 2a, 3, 4, 5; 4651.0120; 4651.0130; 4651.0140;
2.364651.0150; 9500.1243, subpart 3; 9500.1261, subparts 3, items D, E, 4, 5.
2.37BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

2.38ARTICLE 1

2.39CHILDREN AND FAMILY SERVICES

2.40    Section 1. Minnesota Statutes 2010, section 119B.011, subdivision 13, is amended to
2.41read:
2.42    Subd. 13. Family. "Family" means parents, stepparents, guardians and their spouses,
2.43or other eligible relative caregivers and their spouses, and their blood related dependent
2.44children and adoptive siblings under the age of 18 years living in the same home including
2.45children temporarily absent from the household in settings such as schools, foster care, and
2.46residential treatment facilities or parents, stepparents, guardians and their spouses, or other
2.47relative caregivers and their spouses temporarily absent from the household in settings
2.48such as schools, military service, or rehabilitation programs. An adult family member who
3.1is not in an authorized activity under this chapter may be temporarily absent for up to 60
3.2days. When a minor parent or parents and his, her, or their child or children are living with
3.3other relatives, and the minor parent or parents apply for a child care subsidy, "family"
3.4means only the minor parent or parents and their child or children. An adult age 18 or
3.5older who meets this definition of family and is a full-time high school or postsecondary
3.6student may be considered a dependent member of the family unit if 50 percent or more of
3.7the adult's support is provided by the parents, stepparents, guardians, and their spouses or
3.8eligible relative caregivers and their spouses residing in the same household.
3.9EFFECTIVE DATE.This section is effective April 16, 2012.

3.10    Sec. 2. Minnesota Statutes 2010, section 119B.035, subdivision 1, is amended to read:
3.11    Subdivision 1. Establishment. A family in which a parent provides care for the
3.12family's infant child may receive a subsidy in lieu of assistance if the family is eligible for
3.13or is receiving assistance under the basic sliding fee program. An eligible family must
3.14meet the eligibility factors under section 119B.09, except as provided in subdivision 4,
3.15and the requirements of this section. Subject to federal match and maintenance of effort
3.16requirements for the child care and development fund, and up to available appropriations,
3.17the commissioner shall provide assistance under the at-home infant child care program and
3.18for administrative costs associated with the program. The commissioner shall set aside
3.19two percent of the basic sliding fee child care appropriation under section 119B.03, for
3.20purposes of this section. At the end of a fiscal year, the commissioner may carry forward
3.21any unspent funds under this section to the next fiscal year within the same biennium for
3.22assistance under the basic sliding fee program.

3.23    Sec. 3. Minnesota Statutes 2010, section 119B.035, subdivision 4, is amended to read:
3.24    Subd. 4. Assistance. (a) A family is limited to a lifetime total of 12 months of
3.25assistance under subdivision 2. The maximum rate of assistance is equal to 90 64 percent
3.26of the rate established under section 119B.13 for care of infants in licensed family child
3.27care in the applicant's county of residence.
3.28(b) A participating family must report income and other family changes as specified
3.29in the county's plan under section 119B.08, subdivision 3.
3.30(c) Persons who are admitted to the at-home infant child care program retain their
3.31position in any basic sliding fee program. Persons leaving the at-home infant child care
3.32program reenter the basic sliding fee program at the position they would have occupied.
3.33(d) Assistance under this section does not establish an employer-employee
3.34relationship between any member of the assisted family and the county or state.

4.1    Sec. 4. Minnesota Statutes 2010, section 119B.09, is amended by adding a subdivision
4.2to read:
4.3    Subd. 9a. Child care centers; assistance. (a) For the purposes of this subdivision,
4.4"qualifying child" means a child who satisfies both of the following:
4.5(1) is not a child or dependent of an employee of the child care provider; and
4.6(2) does not reside with an employee of the child care provider.
4.7(b) Funds distributed under this chapter must not be paid for child care services
4.8that are provided for a child by a child care provider who employs either the parent of
4.9the child or a person who resides with the child, unless at all times at least 50 percent of
4.10the children for whom the child care provider is providing care are qualifying children
4.11under paragraph (a).
4.12(c) If a child care provider satisfies the requirements for payment under paragraph
4.13(b), but the percentage of qualifying children under paragraph (a) for whom the provider
4.14is providing care falls below 50 percent, the provider shall have four weeks to raise the
4.15percentage of qualifying children for whom the provider is providing care to at least 50
4.16percent before payments to the provider are discontinued for child care services provided
4.17for a child who is not a qualifying child.
4.18EFFECTIVE DATE.This section is effective January 1, 2013.

4.19    Sec. 5. Minnesota Statutes 2010, section 119B.09, subdivision 10, is amended to read:
4.20    Subd. 10. Payment of funds. All federal, state, and local child care funds must
4.21be paid directly to the parent when a provider cares for children in the children's own
4.22home. In all other cases, all federal, state, and local child care funds must be paid directly
4.23to the child care provider, either licensed or legal nonlicensed, on behalf of the eligible
4.24family. Funds distributed under this chapter must not be used for child care services that
4.25are provided for a child by a child care provider who resides in the same household or
4.26occupies the same residence as the child.
4.27EFFECTIVE DATE.This section is effective March 5, 2012.

4.28    Sec. 6. Minnesota Statutes 2010, section 119B.09, is amended by adding a subdivision
4.29to read:
4.30    Subd. 13. Child care in the child's home. Child care assistance must only be
4.31authorized in the child's home if the child's parents have authorized activities outside of
4.32the home and if one or more of the following circumstances are met:
5.1(1) the parents' qualifying activity occurs during times when out-of-home care is
5.2not available. If child care is needed during any period when out-of-home care is not
5.3available, in-home care can be approved for the entire time care is needed;
5.4(2) the family lives in an area where out-of-home care is not available; or
5.5(3) a child has a verified illness or disability that would place the child or other
5.6children in an out-of-home facility at risk or creates a hardship for the child and the family
5.7to take the child out of the home to a child care home or center.
5.8EFFECTIVE DATE.This section is effective March 5, 2012.

5.9    Sec. 7. Minnesota Statutes 2010, section 119B.13, subdivision 1, is amended to read:
5.10    Subdivision 1. Subsidy restrictions. (a) Beginning July 1, 2006, the maximum rate
5.11paid for child care assistance in any county or multicounty region under the child care
5.12fund shall be the rate for like-care arrangements in the county effective January 1, 2006,
5.13increased by six percent.
5.14    (b) Rate changes shall be implemented for services provided in September 2006
5.15unless a participant eligibility redetermination or a new provider agreement is completed
5.16between July 1, 2006, and August 31, 2006.
5.17    As necessary, appropriate notice of adverse action must be made according to
5.18Minnesota Rules, part 3400.0185, subparts 3 and 4.
5.19    New cases approved on or after July 1, 2006, shall have the maximum rates under
5.20paragraph (a), implemented immediately.
5.21    (c) Every year, the commissioner shall survey rates charged by child care providers in
5.22Minnesota to determine the 75th percentile for like-care arrangements in counties. When
5.23the commissioner determines that, using the commissioner's established protocol, the
5.24number of providers responding to the survey is too small to determine the 75th percentile
5.25rate for like-care arrangements in a county or multicounty region, the commissioner may
5.26establish the 75th percentile maximum rate based on like-care arrangements in a county,
5.27region, or category that the commissioner deems to be similar.
5.28    (d) A rate which includes a special needs rate paid under subdivision 3 or under a
5.29school readiness service agreement paid under section 119B.231, may be in excess of the
5.30maximum rate allowed under this subdivision.
5.31    (e) The department shall monitor the effect of this paragraph on provider rates. The
5.32county shall pay the provider's full charges for every child in care up to the maximum
5.33established. The commissioner shall determine the maximum rate for each type of care
5.34on an hourly, full-day, and weekly basis, including special needs and disability care. The
6.1maximum payment to a provider for one day of care must not exceed the daily rate. The
6.2maximum payment to a provider for one week of care must not exceed the weekly rate.
6.3(f) Child care providers receiving reimbursement under this chapter must not be paid
6.4activity fees or an additional amount above the maximum rates for care provided during
6.5nonstandard hours for families receiving assistance.
6.6    (f) (g) When the provider charge is greater than the maximum provider rate allowed,
6.7the parent is responsible for payment of the difference in the rates in addition to any
6.8family co-payment fee.
6.9    (g) (h) All maximum provider rates changes shall be implemented on the Monday
6.10following the effective date of the maximum provider rate.
6.11EFFECTIVE DATE.This section is effective September 3, 2012, except the
6.12amendments to paragraph (e) are effective April 16, 2012.

6.13    Sec. 8. Minnesota Statutes 2010, section 119B.13, subdivision 1a, is amended to read:
6.14    Subd. 1a. Legal nonlicensed family child care provider rates. (a) Legal
6.15nonlicensed family child care providers receiving reimbursement under this chapter must
6.16be paid on an hourly basis for care provided to families receiving assistance.
6.17(b) The maximum rate paid to legal nonlicensed family child care providers must be
6.1880 64 percent of the county maximum hourly rate for licensed family child care providers.
6.19In counties where the maximum hourly rate for licensed family child care providers is
6.20higher than the maximum weekly rate for those providers divided by 50, the maximum
6.21hourly rate that may be paid to legal nonlicensed family child care providers is the rate
6.22equal to the maximum weekly rate for licensed family child care providers divided by 50
6.23and then multiplied by 0.80 0.64. The maximum payment to a provider for one day of care
6.24must not exceed the maximum hourly rate times ten. The maximum payment to a provider
6.25for one week of care must not exceed the maximum hourly rate times 50.
6.26(c) A rate which includes a special needs rate paid under subdivision 3 may be in
6.27excess of the maximum rate allowed under this subdivision.
6.28(d) Legal nonlicensed family child care providers receiving reimbursement under
6.29this chapter may not be paid registration fees for families receiving assistance.
6.30EFFECTIVE DATE.This section is effective April 16, 2012, except the
6.31amendment changing 80 to 64 and 0.80 to 0.64 is effective July 1, 2011.

6.32    Sec. 9. Minnesota Statutes 2010, section 119B.13, subdivision 7, is amended to read:
7.1    Subd. 7. Absent days. (a) Licensed child care providers may and license-exempt
7.2centers must not be reimbursed for more than 25 ten full-day absent days per child,
7.3excluding holidays, in a fiscal year, or for more than ten consecutive full-day absent days,
7.4unless the child has a documented medical condition that causes more frequent absences.
7.5Absences due to a documented medical condition of a parent or sibling who lives in the
7.6same residence as the child receiving child care assistance do not count against the 25-day
7.7absent day limit in a fiscal year. Documentation of medical conditions must be on the
7.8forms and submitted according to the timelines established by the commissioner. A public
7.9health nurse or school nurse may verify the illness in lieu of a medical practitioner. If a
7.10provider sends a child home early due to a medical reason, including, but not limited to,
7.11fever or contagious illness, the child care center director or lead teacher may verify the
7.12illness in lieu of a medical practitioner. Legal nonlicensed family child care providers
7.13must not be reimbursed for absent days. If a child attends for part of the time authorized to
7.14be in care in a day, but is absent for part of the time authorized to be in care in that same
7.15day, the absent time will must be reimbursed but the time will must not count toward the
7.16ten consecutive or 25 cumulative absent day limits limit. Children in families where at
7.17least one parent is under the age of 21, does not have a high school or general equivalency
7.18diploma, and is a student in a school district or another similar program that provides or
7.19arranges for child care, as well as parenting, social services, career and employment
7.20supports, and academic support to achieve high school graduation, may be exempt from
7.21the absent day limits upon request of the program and approval of the county. If a child
7.22attends part of an authorized day, payment to the provider must be for the full amount
7.23of care authorized for that day. Child care providers may must only be reimbursed for
7.24absent days if the provider has a written policy for child absences and charges all other
7.25families in care for similar absences.
7.26    (b) Child care providers must be reimbursed for up to ten federal or state holidays
7.27or designated holidays per year when the provider charges all families for these days
7.28and the holiday or designated holiday falls on a day when the child is authorized to be
7.29in attendance. Parents may substitute other cultural or religious holidays for the ten
7.30recognized state and federal holidays. Holidays do not count toward the ten consecutive
7.31or 25 cumulative absent day limits limit.
7.32    (c) A family or child care provider may must not be assessed an overpayment for an
7.33absent day payment unless (1) there was an error in the amount of care authorized for the
7.34family, (2) all of the allowed full-day absent payments for the child have been paid, or (3)
7.35the family or provider did not timely report a change as required under law.
8.1    (d) The provider and family must receive notification of the number of absent days
8.2used upon initial provider authorization for a family and when the family has used 15
8.3cumulative absent days. Upon statewide implementation of the Minnesota Electronic
8.4Child Care System, the provider and family shall receive notification of the number of
8.5absent days used upon initial provider authorization for a family and ongoing notification
8.6of the number of absent days used as of the date of the notification.
8.7    (e) A county may pay for more absent days than the statewide absent day policy
8.8established under this subdivision if current market practice in the county justifies payment
8.9for those additional days. County policies for payment of absent days in excess of the
8.10statewide absent day policy and justification for these county policies must be included in
8.11the county's child care fund plan under section 119B.08, subdivision 3.
8.12EFFECTIVE DATE.This section is effective January 1, 2013.

8.13    Sec. 10. [256.987] ELECTRONIC BENEFIT TRANSFER CARD.
8.14    Subdivision 1. Electronic benefit transfer (EBT) card. Beginning July 1, 2011,
8.15cash benefits for the general assistance and Minnesota supplemental aid programs under
8.16chapter 256D and programs under chapter 256J must be issued on a separate EBT card
8.17with the name of the head of household printed on the card. The card must include the
8.18following statement: "It is unlawful to use this card to purchase tobacco products or
8.19alcoholic beverages." This card must be issued within 30 calendar days of an eligibility
8.20determination. During the initial 30 calendar days of eligibility, a recipient may have
8.21cash benefits issued on an EBT card without a name printed on the card. This card may
8.22be the same card on which food support benefits are issued and does not need to meet
8.23the requirements of this section.
8.24    Subd. 2. EBT card use restricted to Minnesota vendors. EBT cardholders
8.25receiving cash benefits under the general assistance and Minnesota supplemental aid
8.26programs under chapter 256D or programs under chapter 256J are prohibited from using
8.27their EBT cards at vendors located outside of Minnesota. This subdivision does not apply
8.28to food support benefits.
8.29    Subd. 3. Prohibited purchases. EBT debit cardholders in programs listed under
8.30subdivision 1 are prohibited from using the EBT debit card to purchase tobacco products
8.31and alcoholic beverages, as defined in section 340A.101, subdivision 2. It is unlawful for
8.32an EBT cardholder to purchase or attempt to purchase tobacco products or alcoholic
8.33beverages with the cardholder's EBT card. Violation of this subdivision is a petty
8.34misdemeanor.

9.1    Sec. 11. Minnesota Statutes 2010, section 256D.05, subdivision 1, is amended to read:
9.2    Subdivision 1. Eligibility. (a) Each assistance unit with income and resources
9.3less than the standard of assistance established by the commissioner and with a member
9.4who is a resident of the state shall be eligible for and entitled to general assistance if
9.5the assistance unit is:
9.6(1) a person who is suffering from a professionally certified permanent or temporary
9.7illness, injury, or incapacity which is expected to continue for more than 30 90 days and
9.8which prevents the person from obtaining or retaining employment;
9.9(2) a person whose presence in the home on a substantially continuous basis is
9.10required because of the professionally certified illness, injury, incapacity, or the age of
9.11another member of the household;
9.12(3) (2) a person who has been placed in, and is residing in, a licensed or certified
9.13facility for purposes of physical or mental health or rehabilitation, or in an approved
9.14chemical dependency domiciliary facility, if the placement is based on illness or incapacity
9.15and is according to a plan developed or approved by the county agency through its
9.16director or designated representative;
9.17(4) (3) a person who resides in a shelter facility described in subdivision 3;
9.18(5) (4) a person not described in clause (1) or (3) (2) who is diagnosed by a licensed
9.19physician, psychological practitioner, or other qualified professional, as developmentally
9.20disabled or mentally ill, and that condition prevents the person from obtaining or retaining
9.21employment;
9.22(6) a person who has an application pending for, or is appealing termination of
9.23benefits from, the Social Security disability program or the program of supplemental
9.24security income for the aged, blind, and disabled, provided the person has a professionally
9.25certified permanent or temporary illness, injury, or incapacity which is expected to
9.26continue for more than 30 days and which prevents the person from obtaining or retaining
9.27employment;
9.28(7) a person who is unable to obtain or retain employment because advanced age
9.29significantly affects the person's ability to seek or engage in substantial work;
9.30(8) (5) a person who has been assessed by a vocational specialist and, in consultation
9.31with the county agency, has been determined to be unemployable for purposes of this
9.32clause; a person is considered employable if there exist positions of employment in the
9.33local labor market, regardless of the current availability of openings for those positions,
9.34that the person is capable of performing. The person's eligibility under this category must
9.35be reassessed at least annually. The county agency must provide notice to the person not
9.36later than 30 days before annual eligibility under this item ends, informing the person of the
10.1date annual eligibility will end and the need for vocational assessment if the person wishes
10.2to continue eligibility under this clause. For purposes of establishing eligibility under this
10.3clause, it is the applicant's or recipient's duty to obtain any needed vocational assessment;
10.4(9) (6) a person who is determined by the county agency, according to permanent
10.5rules adopted by the commissioner, to be learning disabled have a condition that qualifies
10.6under Minnesota's special education rules as a specific learning disability, provided that if
10.7a rehabilitation plan for the person is developed or approved by the county agency, and
10.8the person is following the plan;
10.9(10) a child under the age of 18 who is not living with a parent, stepparent, or legal
10.10custodian, and only if: the child is legally emancipated or living with an adult with the
10.11consent of an agency acting as a legal custodian; the child is at least 16 years of age
10.12and the general assistance grant is approved by the director of the county agency or a
10.13designated representative as a component of a social services case plan for the child; or the
10.14child is living with an adult with the consent of the child's legal custodian and the county
10.15agency. For purposes of this clause, "legally emancipated" means a person under the age
10.16of 18 years who: (i) has been married; (ii) is on active duty in the uniformed services of
10.17the United States; (iii) has been emancipated by a court of competent jurisdiction; or (iv)
10.18is otherwise considered emancipated under Minnesota law, and for whom county social
10.19services has not determined that a social services case plan is necessary, for reasons other
10.20than the child has failed or refuses to cooperate with the county agency in developing
10.21the plan;
10.22(11) (7) a person who is eligible for displaced homemaker services, programs, or
10.23assistance under section 116L.96, but only if that person is enrolled as a full-time student;
10.24(12) a person who lives more than four hours round-trip traveling time from any
10.25potential suitable employment;
10.26(13) (8) a person who is involved with protective or court-ordered services that
10.27prevent the applicant or recipient from working at least four hours per day; or
10.28(14) a person over age 18 whose primary language is not English and who is
10.29attending high school at least half time; or
10.30(15) (9) a person whose alcohol and drug addiction is a material factor that
10.31contributes to the person's disability; applicants who assert this clause as a basis for
10.32eligibility must be assessed by the county agency to determine if they are amenable
10.33to treatment; if the applicant is determined to be not amenable to treatment, but is
10.34otherwise eligible for benefits, then general assistance must be paid in vendor form, for
10.35the individual's shelter costs up to the limit of the grant amount, with the residual, if
10.36any, paid according to section 256D.09, subdivision 2a; if the applicant is determined
11.1to be amenable to treatment, then in order to receive benefits, the applicant must be in
11.2a treatment program or on a waiting list and the benefits must be paid in vendor form,
11.3for the individual's shelter costs, up to the limit of the grant amount, with the residual, if
11.4any, paid according to section 256D.09, subdivision 2a.
11.5(b) As a condition of eligibility under paragraph (a), clauses (1), (3) (2), (5) (4),
11.6(8) (5), and (9) (6), the recipient must complete an interim assistance agreement and
11.7must apply for other maintenance benefits as specified in section 256D.06, subdivision
11.85 , and must comply with efforts to determine the recipient's eligibility for those other
11.9maintenance benefits.
11.10(c) As a condition of eligibility under this section, the recipient must complete
11.11at least 20 hours per month of volunteer or paid work. The county of residence shall
11.12determine what may be included as volunteer work. Recipients must provide monthly
11.13proof of volunteer work on the forms established by the county. A person who is unable
11.14to obtain or retain 20 hours per month of volunteer or paid work due to a professionally
11.15certified illness, injury, disability, or incapacity must not be made ineligible for general
11.16assistance under this section.
11.17(c) (d) The burden of providing documentation for a county agency to use to verify
11.18eligibility for general assistance or for exemption from the food stamp employment
11.19and training program is upon the applicant or recipient. The county agency shall use
11.20documents already in its possession to verify eligibility, and shall help the applicant or
11.21recipient obtain other existing verification necessary to determine eligibility which the
11.22applicant or recipient does not have and is unable to obtain.

11.23    Sec. 12. Minnesota Statutes 2010, section 256D.06, subdivision 1, is amended to read:
11.24    Subdivision 1. Eligibility; amount of assistance. General assistance shall be
11.25granted in an amount that when added to the nonexempt income actually available to the
11.26assistance unit, the total amount equals the applicable standard of assistance for general
11.27assistance. In determining eligibility for and the amount of assistance for an individual or
11.28married couple, the county agency shall disregard the first $50 $150 of earned income
11.29per month.

11.30    Sec. 13. Minnesota Statutes 2010, section 256D.06, subdivision 1b, is amended to read:
11.31    Subd. 1b. Earned income savings account. In addition to the $50 $150 disregard
11.32required under subdivision 1, the county agency shall disregard an additional earned
11.33income up to a maximum of $150 $500 per month for: (1) persons residing in facilities
11.34licensed under Minnesota Rules, parts 9520.0500 to 9520.0690 and 9530.2500 to
12.19530.4000, and for whom discharge and work are part of a treatment plan; and (2)
12.2persons living in supervised apartments with services funded under Minnesota Rules,
12.3parts 9535.0100 to 9535.1600, and for whom discharge and work are part of a treatment
12.4plan; and (3) persons residing in group residential housing, as that term is defined in
12.5section 256I.03, subdivision 3, for whom the county agency has approved a discharge plan
12.6which includes work. The additional amount disregarded must be placed in a separate
12.7savings account by the eligible individual, to be used upon discharge from the residential
12.8facility into the community. For individuals residing in a chemical dependency program
12.9licensed under Minnesota Rules, part 9530.4100, subpart 22, item D, withdrawals from
12.10the savings account require the signature of the individual and for those individuals with
12.11an authorized representative payee, the signature of the payee. A maximum of $1,000
12.12$2,000, including interest, of the money in the savings account must be excluded from
12.13the resource limits established by section 256D.08, subdivision 1, clause (1). Amounts in
12.14that account in excess of $1,000 $2,000 must be applied to the resident's cost of care. If
12.15excluded money is removed from the savings account by the eligible individual at any
12.16time before the individual is discharged from the facility into the community, the money is
12.17income to the individual in the month of receipt and a resource in subsequent months. If
12.18an eligible individual moves from a community facility to an inpatient hospital setting,
12.19the separate savings account is an excluded asset for up to 18 months. During that time,
12.20amounts that accumulate in excess of the $1,000 $2,000 savings limit must be applied to
12.21the patient's cost of care. If the patient continues to be hospitalized at the conclusion of the
12.2218-month period, the entire account must be applied to the patient's cost of care.

12.23    Sec. 14. Minnesota Statutes 2010, section 256D.06, subdivision 2, is amended to read:
12.24    Subd. 2. Emergency need. (a) Notwithstanding the provisions of subdivision 1, a
12.25grant of emergency general assistance shall, to the extent funds are available, be made to
12.26an eligible single adult, married couple, or family for an emergency need, as defined in
12.27rules promulgated by the commissioner, where the recipient requests temporary assistance
12.28not exceeding 30 days if an emergency situation appears to exist and the individual or
12.29family is ineligible for MFIP or DWP or is not a participant of MFIP or DWP under
12.30written criteria adopted by the county agency. If an applicant or recipient relates facts
12.31to the county agency which may be sufficient to constitute an emergency situation, the
12.32county agency shall, to the extent funds are available, advise the person of the procedure
12.33for applying for assistance according to this subdivision.
12.34    (b) The applicant must be ineligible for assistance under chapter 256J, must have
12.35annual net income no greater than 200 percent of the federal poverty guidelines for the
13.1previous calendar year, and may receive an emergency general assistance grant is available
13.2to a recipient not more than once in any 12-month period.
13.3    (c) Funding for an emergency general assistance program is limited to the
13.4appropriation. Each fiscal year, the commissioner shall allocate to counties the money
13.5appropriated for emergency general assistance grants based on each county agency's
13.6average share of state's emergency general expenditures for the immediate past three fiscal
13.7years as determined by the commissioner, and may reallocate any unspent amounts to
13.8other counties. No county shall be allocated less than $1,000 for a fiscal year.
13.9    (d) Any emergency general assistance expenditures by a county above the amount of
13.10the commissioner's allocation to the county must be made from county funds.

13.11    Sec. 15. Minnesota Statutes 2010, section 256D.44, subdivision 5, is amended to read:
13.12    Subd. 5. Special needs. In addition to the state standards of assistance established in
13.13subdivisions 1 to 4, payments are allowed for the following special needs of recipients of
13.14Minnesota supplemental aid who are not residents of a nursing home, a regional treatment
13.15center, or a group residential housing facility.
13.16    (a) The county agency shall pay a monthly allowance for medically prescribed
13.17diets if the cost of those additional dietary needs cannot be met through some other
13.18maintenance benefit. The need for special diets or dietary items must be prescribed by
13.19a licensed physician. Costs for special diets shall be determined as percentages of the
13.20allotment for a one-person household under the thrifty food plan as defined by the United
13.21States Department of Agriculture. The types of diets and the percentages of the thrifty
13.22food plan that are covered are as follows:
13.23    (1) high protein diet, at least 80 grams daily, 25 percent of thrifty food plan;
13.24    (2) controlled protein diet, 40 to 60 grams and requires special products, 100 percent
13.25of thrifty food plan;
13.26    (3) controlled protein diet, less than 40 grams and requires special products, 125
13.27percent of thrifty food plan;
13.28    (4) low cholesterol diet, 25 percent of thrifty food plan;
13.29    (5) high residue diet, 20 percent of thrifty food plan;
13.30    (6) pregnancy and lactation diet, 35 percent of thrifty food plan;
13.31    (7) gluten-free diet, 25 percent of thrifty food plan;
13.32    (8) lactose-free diet, 25 percent of thrifty food plan;
13.33    (9) antidumping diet, 15 percent of thrifty food plan;
13.34    (10) hypoglycemic diet, 15 percent of thrifty food plan; or
13.35    (11) ketogenic diet, 25 percent of thrifty food plan.
14.1    (b) Payment for nonrecurring special needs must be allowed for necessary home
14.2repairs or necessary repairs or replacement of household furniture and appliances using
14.3the payment standard of the AFDC program in effect on July 16, 1996, for these expenses,
14.4as long as other funding sources are not available.
14.5    (c) A fee for guardian or conservator service is allowed at a reasonable rate
14.6negotiated by the county or approved by the court. This rate shall not exceed five percent
14.7of the assistance unit's gross monthly income up to a maximum of $100 per month. If the
14.8guardian or conservator is a member of the county agency staff, no fee is allowed.
14.9    (d) The county agency shall continue to pay a monthly allowance of $68 for
14.10restaurant meals for a person who was receiving a restaurant meal allowance on June 1,
14.111990, and who eats two or more meals in a restaurant daily. The allowance must continue
14.12until the person has not received Minnesota supplemental aid for one full calendar month
14.13or until the person's living arrangement changes and the person no longer meets the criteria
14.14for the restaurant meal allowance, whichever occurs first.
14.15    (e) A fee of ten percent of the recipient's gross income or $25, whichever is less,
14.16is allowed for representative payee services provided by an agency that meets the
14.17requirements under SSI regulations to charge a fee for representative payee services. This
14.18special need is available to all recipients of Minnesota supplemental aid regardless of
14.19their living arrangement.
14.20    (f)(1) Notwithstanding the language in this subdivision, an amount equal to the
14.21maximum allotment authorized by the federal Food Stamp Program for a single individual
14.22which is in effect on the first day of July of each year will be added to the standards of
14.23assistance established in subdivisions 1 to 4 for adults under the age of 65 who qualify
14.24as shelter needy and are: (i) relocating from an institution, or an adult mental health
14.25residential treatment program under section 256B.0622; (ii) eligible for the self-directed
14.26supports option as defined under section 256B.0657, subdivision 2; or (iii) home and
14.27community-based waiver recipients living in their own home or rented or leased apartment
14.28which is not owned, operated, or controlled by a provider of service not related by blood
14.29or marriage, unless allowed under paragraph (g).
14.30    (2) Notwithstanding subdivision 3, paragraph (c), an individual eligible for the
14.31shelter needy benefit under this paragraph is considered a household of one. An eligible
14.32individual who receives this benefit prior to age 65 may continue to receive the benefit
14.33after the age of 65.
14.34    (3) "Shelter needy" means that the assistance unit incurs monthly shelter costs that
14.35exceed 40 percent of the assistance unit's gross income before the application of this
14.36special needs standard. "Gross income" for the purposes of this section is the applicant's or
15.1recipient's income as defined in section 256D.35, subdivision 10, or the standard specified
15.2in subdivision 3, paragraph (a) or (b), whichever is greater. A recipient of a federal or
15.3state housing subsidy, that limits shelter costs to a percentage of gross income, shall not be
15.4considered shelter needy for purposes of this paragraph.
15.5(g) Notwithstanding this subdivision, to access housing and services as provided
15.6in paragraph (f), the recipient may choose housing that may be owned, operated, or
15.7controlled by the recipient's service provider. In a multifamily building of more than four
15.8or more units, the maximum number of apartments at one address that may be used by
15.9recipients of this program shall be 50 percent of the units in a building. This paragraph
15.10expires on June 30, 2012 2014.

15.11    Sec. 16. Minnesota Statutes 2010, section 256D.46, subdivision 1, is amended to read:
15.12    Subdivision 1. Eligibility. A county agency must grant emergency Minnesota
15.13supplemental aid, to the extent funds are available, if the recipient is without adequate
15.14resources to resolve an emergency that, if unresolved, will threaten the health or safety of
15.15the recipient. For the purposes of this section, the term "recipient" includes persons for
15.16whom a group residential housing benefit is being paid under sections 256I.01 to 256I.06.
15.17Applicants for or recipients of SSI or Minnesota supplemental aid who have emergency
15.18need may apply for emergency general assistance under section 256D.06, subdivision 2.

15.19    Sec. 17. Minnesota Statutes 2010, section 256I.03, is amended by adding a subdivision
15.20to read:
15.21    Subd. 8. Supplementary services. "Supplementary services" means services
15.22provided to residents of group residential housing providers in addition to room and
15.23board including, but not limited to, oversight and up to 24-hour supervision, medication
15.24reminders, assistance with transportation, arranging for meetings and appointments, and
15.25arranging for medical and social services.

15.26    Sec. 18. Minnesota Statutes 2010, section 256I.04, subdivision 2b, is amended to read:
15.27    Subd. 2b. Group residential housing agreements. (a) Agreements between county
15.28agencies and providers of group residential housing must be in writing and must specify
15.29the name and address under which the establishment subject to the agreement does
15.30business and under which the establishment, or service provider, if different from the
15.31group residential housing establishment, is licensed by the Department of Health or the
15.32Department of Human Services; the specific license or registration from the Department
15.33of Health or the Department of Human Services held by the provider and the number
16.1of beds subject to that license; the address of the location or locations at which group
16.2residential housing is provided under this agreement; the per diem and monthly rates that
16.3are to be paid from group residential housing funds for each eligible resident at each
16.4location; the number of beds at each location which are subject to the group residential
16.5housing agreement; whether the license holder is a not-for-profit corporation under section
16.6501(c)(3) of the Internal Revenue Code; and a statement that the agreement is subject to
16.7the provisions of sections 256I.01 to 256I.06 and subject to any changes to those sections.
16.8Group residential housing agreements may be terminated with or without cause by either
16.9the county or the provider with two calendar months prior notice.
16.10(b) Beginning July 1, 2011, counties must not enter into agreements with providers
16.11of group residential housing that are licensed as board and lodging with special services
16.12and that do not include a residency requirement of at least 20 hours per month of volunteer
16.13or paid work. A person who is unable to obtain or retain 20 hours per month of volunteer
16.14or paid work due to a professionally certified illness, injury, disability, or incapacity must
16.15not be made ineligible for group residential housing under this section.

16.16    Sec. 19. Minnesota Statutes 2010, section 256I.05, subdivision 1a, is amended to read:
16.17    Subd. 1a. Supplementary service rates. (a) Subject to the provisions of section
16.18256I.04, subdivision 3 , the county agency may negotiate a payment not to exceed $426.37
16.19for other services necessary to provide room and board provided by the group residence
16.20if the residence is licensed by or registered by the Department of Health, or licensed by
16.21the Department of Human Services to provide services in addition to room and board,
16.22and if the provider of services is not also concurrently receiving funding for services for
16.23a recipient under a home and community-based waiver under title XIX of the Social
16.24Security Act; or funding from the medical assistance program under section 256B.0659,
16.25for personal care services for residents in the setting; or residing in a setting which
16.26receives funding under Minnesota Rules, parts 9535.2000 to 9535.3000. If funding is
16.27available for other necessary services through a home and community-based waiver, or
16.28personal care services under section 256B.0659, then the GRH rate is limited to the rate
16.29set in subdivision 1. Unless otherwise provided in law, in no case may the supplementary
16.30service rate exceed $426.37. The registration and licensure requirement does not apply to
16.31establishments which are exempt from state licensure because they are located on Indian
16.32reservations and for which the tribe has prescribed health and safety requirements. Service
16.33payments under this section may be prohibited under rules to prevent the supplanting of
16.34federal funds with state funds. The commissioner shall pursue the feasibility of obtaining
16.35the approval of the Secretary of Health and Human Services to provide home and
17.1community-based waiver services under title XIX of the Social Security Act for residents
17.2who are not eligible for an existing home and community-based waiver due to a primary
17.3diagnosis of mental illness or chemical dependency and shall apply for a waiver if it is
17.4determined to be cost-effective.
17.5(b) The commissioner is authorized to make cost-neutral transfers from the GRH
17.6fund for beds under this section to other funding programs administered by the department
17.7after consultation with the county or counties in which the affected beds are located.
17.8The commissioner may also make cost-neutral transfers from the GRH fund to county
17.9human service agencies for beds permanently removed from the GRH census under a plan
17.10submitted by the county agency and approved by the commissioner. The commissioner
17.11shall report the amount of any transfers under this provision annually to the legislature.
17.12(c) The provisions of paragraph (b) do not apply to a facility that has its
17.13reimbursement rate established under section 256B.431, subdivision 4, paragraph (c).
17.14    (d) Beginning July 1, 2011, counties must not negotiate supplementary service rates
17.15with providers of group residential housing that are licensed as board and lodging with
17.16special services and that do not enforce a policy of sobriety on their premises.

17.17    Sec. 20. Minnesota Statutes 2010, section 256I.05, subdivision 1e, is amended to read:
17.18    Subd. 1e. Supplementary rate for certain facilities. (a) Notwithstanding the
17.19provisions of subdivisions 1a and 1c, beginning July 1, 2005, a county agency shall
17.20negotiate a supplementary rate in addition to the rate specified in subdivision 1, not to
17.21exceed $700 per month, including any legislatively authorized inflationary adjustments,
17.22for a group residential housing provider that:
17.23(1) is located in Hennepin County and has had a group residential housing contract
17.24with the county since June 1996;
17.25(2) operates in three separate locations a 75-bed facility, a 50-bed facility, and a
17.2626-bed facility; and
17.27(3) serves a chemically dependent clientele, providing 24 hours per day supervision
17.28and limiting a resident's maximum length of stay to 13 months out of a consecutive
17.2924-month period.
17.30(b) Notwithstanding the provisions of subdivisions 1a and 1c, beginning July 1,
17.312011, a county agency shall negotiate a supplementary rate in addition to the rate specified
17.32in subdivision 1, not to exceed $700 per month, including any legislatively authorized
17.33inflationary adjustments, for the group residential provider described under paragraph
17.34(a), not to exceed an additional 175 beds.

18.1    Sec. 21. Minnesota Statutes 2010, section 256I.05, is amended by adding a subdivision
18.2to read:
18.3    Subd. 1o. Supplemental rate adjustment. Notwithstanding any other provision to
18.4the contrary, board and lodging with services providers that receive a supplemental service
18.5rate in excess of the supplemental service rate established under subdivision 1, shall be
18.6reduced no more than $10.42 per bed per month.

18.7    Sec. 22. Minnesota Statutes 2010, section 256J.20, subdivision 3, is amended to read:
18.8    Subd. 3. Other property limitations. To be eligible for MFIP, the equity value of
18.9all nonexcluded real and personal property of the assistance unit must not exceed $2,000
18.10for applicants and $5,000 for ongoing participants. The value of assets in clauses (1) to
18.11(19) must be excluded when determining the equity value of real and personal property:
18.12    (1) a licensed vehicle up to a loan value of less than or equal to $15,000 $10,000. If
18.13the assistance unit owns more than one licensed vehicle, the county agency shall determine
18.14the loan value of all additional vehicles and exclude the combined loan value of less than
18.15or equal to $7,500. The county agency shall apply any excess loan value as if it were
18.16equity value to the asset limit described in this section, excluding: (i) the value of one
18.17vehicle per physically disabled person when the vehicle is needed to transport the disabled
18.18unit member; this exclusion does not apply to mentally disabled people; (ii) the value of
18.19special equipment for a disabled member of the assistance unit; and (iii) any vehicle used
18.20for long-distance travel, other than daily commuting, for the employment of a unit member.
18.21    To establish the loan value of vehicles, a county agency must use the N.A.D.A.
18.22Official Used Car Guide, Midwest Edition, for newer model cars. When a vehicle is not
18.23listed in the guidebook, or when the applicant or participant disputes the loan value listed
18.24in the guidebook as unreasonable given the condition of the particular vehicle, the county
18.25agency may require the applicant or participant document the loan value by securing a
18.26written statement from a motor vehicle dealer licensed under section 168.27, stating
18.27the amount that the dealer would pay to purchase the vehicle. The county agency shall
18.28reimburse the applicant or participant for the cost of a written statement that documents
18.29a lower loan value;
18.30    (2) the value of life insurance policies for members of the assistance unit;
18.31    (3) one burial plot per member of an assistance unit;
18.32    (4) the value of personal property needed to produce earned income, including
18.33tools, implements, farm animals, inventory, business loans, business checking and
18.34savings accounts used at least annually and used exclusively for the operation of a
19.1self-employment business, and any motor vehicles if at least 50 percent of the vehicle's use
19.2is to produce income and if the vehicles are essential for the self-employment business;
19.3    (5) the value of personal property not otherwise specified which is commonly
19.4used by household members in day-to-day living such as clothing, necessary household
19.5furniture, equipment, and other basic maintenance items essential for daily living;
19.6    (6) the value of real and personal property owned by a recipient of Supplemental
19.7Security Income or Minnesota supplemental aid;
19.8    (7) the value of corrective payments, but only for the month in which the payment
19.9is received and for the following month;
19.10    (8) a mobile home or other vehicle used by an applicant or participant as the
19.11applicant's or participant's home;
19.12    (9) money in a separate escrow account that is needed to pay real estate taxes or
19.13insurance and that is used for this purpose;
19.14    (10) money held in escrow to cover employee FICA, employee tax withholding,
19.15sales tax withholding, employee worker compensation, business insurance, property rental,
19.16property taxes, and other costs that are paid at least annually, but less often than monthly;
19.17    (11) monthly assistance payments for the current month's or short-term emergency
19.18needs under section 256J.626, subdivision 2;
19.19    (12) the value of school loans, grants, or scholarships for the period they are
19.20intended to cover;
19.21    (13) payments listed in section 256J.21, subdivision 2, clause (9), which are held
19.22in escrow for a period not to exceed three months to replace or repair personal or real
19.23property;
19.24    (14) income received in a budget month through the end of the payment month;
19.25    (15) savings from earned income of a minor child or a minor parent that are set aside
19.26in a separate account designated specifically for future education or employment costs;
19.27    (16) the federal earned income credit, Minnesota working family credit, state and
19.28federal income tax refunds, state homeowners and renters credits under chapter 290A,
19.29property tax rebates and other federal or state tax rebates in the month received and the
19.30following month;
19.31    (17) payments excluded under federal law as long as those payments are held in a
19.32separate account from any nonexcluded funds;
19.33    (18) the assets of children ineligible to receive MFIP benefits because foster care or
19.34adoption assistance payments are made on their behalf; and
19.35    (19) the assets of persons whose income is excluded under section 256J.21,
19.36subdivision 2 , clause (43).

20.1    Sec. 23. Minnesota Statutes 2010, section 256J.49, subdivision 13, is amended to read:
20.2    Subd. 13. Work activity. (a) "Work activity" means any activity in a participant's
20.3approved employment plan that leads to employment. For purposes of the MFIP program,
20.4this includes activities that meet the definition of work activity under the participation
20.5requirements of TANF. Work activity includes:
20.6    (1) unsubsidized employment, including work study and paid apprenticeships or
20.7internships;
20.8    (2) subsidized private sector or public sector employment, including grant diversion
20.9as specified in section 256J.69, on-the-job training as specified in section 256J.66, paid
20.10work experience, and supported work when a wage subsidy is provided;
20.11    (3) unpaid work experience, including community service, volunteer work,
20.12the community work experience program as specified in section 256J.67, unpaid
20.13apprenticeships or internships, and supported work when a wage subsidy is not provided.
20.14Unpaid work experience is only an option if the participant has been unable to obtain or
20.15maintain paid employment in the competitive labor market, and no paid work experience
20.16programs are available to the participant. Prior to placing a participant in unpaid work,
20.17the county must inform the participant that the participant will be notified if a paid work
20.18experience or supported work position becomes available. Unless a participant consents in
20.19writing to participate in unpaid work experience, the participant's employment plan may
20.20only include unpaid work experience if including the unpaid work experience in the plan
20.21will meet the following criteria:
20.22    (i) the unpaid work experience will provide the participant specific skills or
20.23experience that cannot be obtained through other work activity options where the
20.24participant resides or is willing to reside; and
20.25    (ii) the skills or experience gained through the unpaid work experience will result
20.26in higher wages for the participant than the participant could earn without the unpaid
20.27work experience;
20.28    (4) job search including job readiness assistance, job clubs, job placement,
20.29job-related counseling, and job retention services;
20.30    (5) job readiness education, including English as a second language (ESL) or
20.31functional work literacy classes as limited by the provisions of section 256J.531,
20.32subdivision 2 , general educational development (GED) course work, high school
20.33completion, and adult basic education as limited by the provisions of section 256J.531,
20.34subdivision 1 ;
21.1    (6) job skills training directly related to employment, including education and
21.2training that can reasonably be expected to lead to employment, as limited by the
21.3provisions of section 256J.53;
21.4    (7) providing child care services to a participant who is working in a community
21.5service program;
21.6    (8) activities included in the employment plan that is developed under section
21.7256J.521, subdivision 3 ; and
21.8    (9) preemployment activities including chemical and mental health assessments,
21.9treatment, and services; learning disabilities services; child protective services; family
21.10stabilization services; or other programs designed to enhance employability.
21.11(b) "Work activity" does not include activities done for political purposes as defined
21.12in section 211B.01, subdivision 6.

21.13    Sec. 24. Minnesota Statutes 2010, section 256J.53, subdivision 2, is amended to read:
21.14    Subd. 2. Approval of postsecondary education or training. (a) In order for a
21.15postsecondary education or training program to be an approved activity in an employment
21.16plan, the plan must include additional work activities if the education and training
21.17activities do not meet the minimum hours required to meet the federal work participation
21.18rate under Code of Federal Regulations, title 45, sections 261.31 and 261.35 participant
21.19must be working in unsubsidized employment at least 20 hours per week.
21.20    (b) Participants seeking approval of a postsecondary education or training plan
21.21must provide documentation that:
21.22    (1) the employment goal can only be met with the additional education or training;
21.23    (2) there are suitable employment opportunities that require the specific education or
21.24training in the area in which the participant resides or is willing to reside;
21.25    (3) the education or training will result in significantly higher wages for the
21.26participant than the participant could earn without the education or training;
21.27    (4) the participant can meet the requirements for admission into the program; and
21.28    (5) there is a reasonable expectation that the participant will complete the training
21.29program based on such factors as the participant's MFIP assessment, previous education,
21.30training, and work history; current motivation; and changes in previous circumstances.
21.31(c) The hourly unsubsidized employment requirement does not apply for intensive
21.32education or training programs lasting 12 weeks or less when full-time attendance is
21.33required.

21.34    Sec. 25. Minnesota Statutes 2010, section 260C.157, subdivision 3, is amended to read:
22.1    Subd. 3. Juvenile treatment screening team. (a) The responsible social services
22.2agency shall establish a juvenile treatment screening team to conduct screenings and
22.3prepare case plans under this subdivision section 245.487, subdivision 3, and chapters
22.4260C and 260D. Screenings shall be conducted within 15 days of a request for a screening.
22.5The team, which may be the team constituted under section 245.4885 or 256B.092 or
22.6Minnesota Rules, parts 9530.6600 to 9530.6655, shall consist of social workers, juvenile
22.7justice professionals, and persons with expertise in the treatment of juveniles who are
22.8emotionally disabled, chemically dependent, or have a developmental disability. The team
22.9shall involve parents or guardians in the screening process as appropriate, and the child's
22.10parent, guardian, or permanent legal custodian under section 260C.201, subdivision 11.
22.11The team may be the same team as defined in section 260B.157, subdivision 3.
22.12(b) The social services agency shall determine whether a child brought to its
22.13attention for the purposes described in this section is an Indian child, as defined in section
22.14260C.007, subdivision 21 , and shall determine the identity of the Indian child's tribe, as
22.15defined in section 260.755, subdivision 9. When a child to be evaluated is an Indian child,
22.16the team provided in paragraph (a) shall include a designated representative of the Indian
22.17child's tribe, unless the child's tribal authority declines to appoint a representative. The
22.18Indian child's tribe may delegate its authority to represent the child to any other federally
22.19recognized Indian tribe, as defined in section 260.755, subdivision 12.
22.20(c) If the court, prior to, or as part of, a final disposition, proposes to place a child:
22.21(1) for the primary purpose of treatment for an emotional disturbance, a
22.22developmental disability, or chemical dependency in a residential treatment facility out
22.23of state or in one which is within the state and licensed by the commissioner of human
22.24services under chapter 245A; or
22.25(2) in any out-of-home setting potentially exceeding 30 days in duration, including a
22.26postdispositional placement in a facility licensed by the commissioner of corrections or
22.27human services, the court shall ascertain whether the child is an Indian child and shall
22.28notify the county welfare agency and, if the child is an Indian child, shall notify the Indian
22.29child's tribe. The county's juvenile treatment screening team must either: (i) screen and
22.30evaluate the child and file its recommendations with the court within 14 days of receipt
22.31of the notice; or (ii) elect not to screen a given case and notify the court of that decision
22.32within three working days.
22.33(d) If the screening team has elected to screen and evaluate the child, The child
22.34may not be placed for the primary purpose of treatment for an emotional disturbance, a
22.35developmental disability, or chemical dependency, in a residential treatment facility out of
23.1state nor in a residential treatment facility within the state that is licensed under chapter
23.2245A, unless one of the following conditions applies:
23.3(1) a treatment professional certifies that an emergency requires the placement
23.4of the child in a facility within the state;
23.5(2) the screening team has evaluated the child and recommended that a residential
23.6placement is necessary to meet the child's treatment needs and the safety needs of the
23.7community, that it is a cost-effective means of meeting the treatment needs, and that it
23.8will be of therapeutic value to the child; or
23.9(3) the court, having reviewed a screening team recommendation against placement,
23.10determines to the contrary that a residential placement is necessary. The court shall state
23.11the reasons for its determination in writing, on the record, and shall respond specifically
23.12to the findings and recommendation of the screening team in explaining why the
23.13recommendation was rejected. The attorney representing the child and the prosecuting
23.14attorney shall be afforded an opportunity to be heard on the matter.
23.15(e) When the county's juvenile treatment screening team has elected to screen and
23.16evaluate a child determined to be an Indian child, the team shall provide notice to the
23.17tribe or tribes that accept jurisdiction for the Indian child or that recognize the child as a
23.18member of the tribe or as a person eligible for membership in the tribe, and permit the
23.19tribe's representative to participate in the screening team.
23.20(f) When the Indian child's tribe or tribal health care services provider or Indian
23.21Health Services provider proposes to place a child for the primary purpose of treatment
23.22for an emotional disturbance, a developmental disability, or co-occurring emotional
23.23disturbance and chemical dependency, the Indian child's tribe or the tribe delegated by
23.24the child's tribe shall submit necessary documentation to the county juvenile treatment
23.25screening team, which must invite the Indian child's tribe to designate a representative to
23.26the screening team.

23.27    Sec. 26. Minnesota Statutes 2010, section 260D.01, is amended to read:
23.28260D.01 CHILD IN VOLUNTARY FOSTER CARE FOR TREATMENT.
23.29    (a) Sections 260D.01 to 260D.10, may be cited as the "child in voluntary foster care
23.30for treatment" provisions of the Juvenile Court Act.
23.31    (b) The juvenile court has original and exclusive jurisdiction over a child in
23.32voluntary foster care for treatment upon the filing of a report or petition required under
23.33this chapter. All obligations of the agency to a child and family in foster care contained in
23.34chapter 260C not inconsistent with this chapter are also obligations of the agency with
23.35regard to a child in foster care for treatment under this chapter.
24.1    (c) This chapter shall be construed consistently with the mission of the children's
24.2mental health service system as set out in section 245.487, subdivision 3, and the duties
24.3of an agency under section 256B.092, 260C.157, and Minnesota Rules, parts 9525.0004
24.4to 9525.0016, to meet the needs of a child with a developmental disability or related
24.5condition. This chapter:
24.6    (1) establishes voluntary foster care through a voluntary foster care agreement as the
24.7means for an agency and a parent to provide needed treatment when the child must be in
24.8foster care to receive necessary treatment for an emotional disturbance or developmental
24.9disability or related condition;
24.10    (2) establishes court review requirements for a child in voluntary foster care for
24.11treatment due to emotional disturbance or developmental disability or a related condition;
24.12    (3) establishes the ongoing responsibility of the parent as legal custodian to visit the
24.13child, to plan together with the agency for the child's treatment needs, to be available and
24.14accessible to the agency to make treatment decisions, and to obtain necessary medical,
24.15dental, and other care for the child; and
24.16    (4) applies to voluntary foster care when the child's parent and the agency agree that
24.17the child's treatment needs require foster care either:
24.18    (i) due to a level of care determination by the agency's screening team informed by
24.19the diagnostic and functional assessment under section 245.4885; or
24.20    (ii) due to a determination regarding the level of services needed by the responsible
24.21social services' screening team under section 256B.092, and Minnesota Rules, parts
24.229525.0004 to 9525.0016.
24.23    (d) This chapter does not apply when there is a current determination under section
24.24626.556 that the child requires child protective services or when the child is in foster care
24.25for any reason other than treatment for the child's emotional disturbance or developmental
24.26disability or related condition. When there is a determination under section 626.556 that
24.27the child requires child protective services based on an assessment that there are safety
24.28and risk issues for the child that have not been mitigated through the parent's engagement
24.29in services or otherwise, or when the child is in foster care for any reason other than
24.30the child's emotional disturbance or developmental disability or related condition, the
24.31provisions of chapter 260C apply.
24.32    (e) The paramount consideration in all proceedings concerning a child in voluntary
24.33foster care for treatment is the safety, health, and the best interests of the child. The
24.34purpose of this chapter is:
24.35    (1) to ensure a child with a disability is provided the services necessary to treat or
24.36ameliorate the symptoms of the child's disability;
25.1    (2) to preserve and strengthen the child's family ties whenever possible and in the
25.2child's best interests, approving the child's placement away from the child's parents only
25.3when the child's need for care or treatment requires it and the child cannot be maintained
25.4in the home of the parent; and
25.5    (3) to ensure the child's parent retains legal custody of the child and associated
25.6decision-making authority unless the child's parent willfully fails or is unable to make
25.7decisions that meet the child's safety, health, and best interests. The court may not find
25.8that the parent willfully fails or is unable to make decisions that meet the child's needs
25.9solely because the parent disagrees with the agency's choice of foster care facility, unless
25.10the agency files a petition under chapter 260C, and establishes by clear and convincing
25.11evidence that the child is in need of protection or services.
25.12    (f) The legal parent-child relationship shall be supported under this chapter by
25.13maintaining the parent's legal authority and responsibility for ongoing planning for the
25.14child and by the agency's assisting the parent, where necessary, to exercise the parent's
25.15ongoing right and obligation to visit or to have reasonable contact with the child. Ongoing
25.16planning means:
25.17    (1) actively participating in the planning and provision of educational services,
25.18medical, and dental care for the child;
25.19    (2) actively planning and participating with the agency and the foster care facility
25.20for the child's treatment needs; and
25.21    (3) planning to meet the child's need for safety, stability, and permanency, and the
25.22child's need to stay connected to the child's family and community.
25.23    (g) The provisions of section 260.012 to ensure placement prevention, family
25.24reunification, and all active and reasonable effort requirements of that section apply. This
25.25chapter shall be construed consistently with the requirements of the Indian Child Welfare
25.26Act of 1978, United States Code, title 25, section 1901, et al., and the provisions of the
25.27Minnesota Indian Family Preservation Act, sections 260.751 to 260.835.

25.28    Sec. 27. Minnesota Statutes 2010, section 393.07, subdivision 10a, is amended to read:
25.29    Subd. 10a. Expedited issuance of food stamps. The commissioner of human
25.30services shall continually monitor the expedited issuance of food stamp benefits to ensure
25.31that each county complies with federal regulations and that households eligible for
25.32expedited issuance of food stamps are identified, processed, and certified within the time
25.33frames prescribed in federal regulations.
26.1County food stamp offices shall screen and issue food stamps to applicants on the
26.2day of application. Applicants who meet the federal criteria for expedited issuance and
26.3have an immediate need for food assistance shall receive within two working days either:
26.4(1) a manual Authorization to Participate (ATP) card; or
26.5(2) the immediate issuance of food stamp coupons benefits.
26.6The local food stamp agency shall conspicuously post in each food stamp office a
26.7notice of the availability of and the procedure for applying for expedited issuance and
26.8verbally advise each applicant of the availability of the expedited process.

26.9    Sec. 28. Minnesota Statutes 2010, section 518A.51, is amended to read:
26.10518A.51 FEES FOR IV-D SERVICES.
26.11    (a) When a recipient of IV-D services is no longer receiving assistance under the
26.12state's title IV-A, IV-E foster care, medical assistance, or MinnesotaCare programs, the
26.13public authority responsible for child support enforcement must notify the recipient,
26.14within five working days of the notification of ineligibility, that IV-D services will be
26.15continued unless the public authority is notified to the contrary by the recipient. The
26.16notice must include the implications of continuing to receive IV-D services, including the
26.17available services and fees, cost recovery fees, and distribution policies relating to fees.
26.18    (b) An application fee of $25 shall be paid by the person who applies for child
26.19support and maintenance collection services, except persons who are receiving public
26.20assistance as defined in section 256.741 and the diversionary work program under section
26.21256J.95 , persons who transfer from public assistance to nonpublic assistance status, and
26.22minor parents and parents enrolled in a public secondary school, area learning center, or
26.23alternative learning program approved by the commissioner of education.
26.24    (c) In the case of an individual who has never received assistance under a state
26.25program funded under Title IV-A of the Social Security Act and for whom the public
26.26authority has collected at least $500 of support, the public authority must impose an
26.27annual federal collections fee of $25 for each case in which services are furnished. This
26.28fee must be retained by the public authority from support collected on behalf of the
26.29individual, but not from the first $500 collected.
26.30    (d) When the public authority provides full IV-D services to an obligee who has
26.31applied for those services, upon written notice to the obligee, the public authority must
26.32charge a cost recovery fee of one percent of the amount collected. This fee must be
26.33deducted from the amount of the child support and maintenance collected and not assigned
26.34under section 256.741 before disbursement to the obligee. This fee does not apply to an
26.35obligee who:
27.1    (1) is currently receiving assistance under the state's title IV-A, IV-E foster care,
27.2medical assistance, or MinnesotaCare programs; or
27.3    (2) has received assistance under the state's title IV-A or IV-E foster care programs,
27.4until the person has not received this assistance for 24 consecutive months.
27.5     (e) When the public authority provides full IV-D services to an obligor who has
27.6applied for such services, upon written notice to the obligor, the public authority must
27.7charge a cost recovery fee of one percent of the monthly court-ordered child support and
27.8maintenance obligation. The fee may be collected through income withholding, as well
27.9as by any other enforcement remedy available to the public authority responsible for
27.10child support enforcement.
27.11     (f) Fees assessed by state and federal tax agencies for collection of overdue support
27.12owed to or on behalf of a person not receiving public assistance must be imposed on the
27.13person for whom these services are provided. The public authority upon written notice to
27.14the obligee shall assess a fee of $25 to the person not receiving public assistance for each
27.15successful federal tax interception. The fee must be withheld prior to the release of the
27.16funds received from each interception and deposited in the general fund.
27.17     (g) Federal collections fees collected under paragraph (c) and cost recovery
27.18fees collected under paragraphs (d) and (e), retained by the commissioner of human
27.19services, shall be considered child support program income according to Code of Federal
27.20Regulations, title 45, section 304.50, and shall be deposited in the special revenue fund
27.21account established under paragraph (i). The commissioner of human services must elect
27.22to recover costs based on either actual or standardized costs.
27.23     (h) The limitations of this section on the assessment of fees shall not apply to
27.24the extent inconsistent with the requirements of federal law for receiving funds for the
27.25programs under Title IV-A and Title IV-D of the Social Security Act, United States Code,
27.26title 42, sections 601 to 613 and United States Code, title 42, sections 651 to 662.
27.27     (i) The commissioner of human services is authorized to establish a special revenue
27.28fund account to receive the federal collections fees collected under paragraph (c) and cost
27.29recovery fees collected under paragraphs (d) and (e). A portion of the nonfederal share of
27.30these fees may be retained for expenditures necessary to administer the fees and must be
27.31transferred to the child support system special revenue account. The remaining nonfederal
27.32share of the federal collections fees and cost recovery fees must be retained by the
27.33commissioner and dedicated to the child support general fund county performance-based
27.34grant account authorized under sections 256.979 and 256.9791. The commissioner shall
27.35distribute the remaining nonfederal share of these fees to the counties quarterly using the
27.36methodology specified in section 256.979, subdivision 11. The funds received by the
28.1counties must be reinvested in the child support enforcement program, and the counties
28.2shall not reduce the funding of their child support programs by the amount of funding
28.3distributed.

28.4    Sec. 29. GRANT PROGRAM TO PROMOTE HEALTHY COMMUNITY
28.5INITIATIVES.
28.6    (a) The commissioner of human services must contract with the Search Institute to
28.7help local communities develop, expand, and maintain the tools, training, and resources
28.8needed to foster positive community development and effectively engage people in their
28.9community. The Search Institute must: (1) provide training in community mobilization,
28.10youth development, and assets getting to outcomes; (2) provide ongoing technical
28.11assistance to communities receiving grants under this section; (3) use best practices to
28.12promote community development; (4) share best program practices with other interested
28.13communities; (5) create electronic and other opportunities for communities to share
28.14experiences in and resources for promoting healthy community development; and (6)
28.15provide an annual report of the strong communities project.
28.16    (b) Specifically, the Search Institute must use a competitive grant process to select
28.17four interested communities throughout Minnesota to undertake strong community
28.18mobilization initiatives to support communities wishing to catalyze multiple sectors to
28.19create or strengthen a community collaboration to address issues of poverty in their
28.20communities. The Search Institute must provide the selected communities with the
28.21tools, training, and resources they need for successfully implementing initiatives focused
28.22on strengthening the community. The Search Institute also must use a competitive
28.23grant process to provide four strong community innovation grants to encourage current
28.24community initiatives to bring new innovation approaches to their work to reduce poverty.
28.25Finally, the Search Institute must work to strengthen networking and information sharing
28.26activities among all healthy community initiatives throughout Minnesota, including
28.27sharing best program practices and providing personal and electronic opportunities for
28.28peer learning and ongoing program support.
28.29(c) In order to receive a grant under paragraph (b), a community must show
28.30involvement of at least three sectors of their community and the active leadership of both
28.31youth and adults. Sectors may include, but are not limited to, local government, schools,
28.32community action agencies, faith communities, businesses, higher education institutions,
28.33and the medical community. In addition, communities must agree to: (1) attend training
28.34on community mobilization processes and strength-based approaches; (2) apply the assets
28.35getting to outcomes process in their initiative; (3) meet at least two times during the
29.1grant period to share successes and challenges with other grantees; (4) participate on an
29.2electronic listserv to share information throughout the period on their work; and (5) all
29.3communication requirements and reporting processes.
29.4    (d) The commissioner of human services must evaluate the effectiveness of this
29.5program and must recommend to the committees of the legislature with jurisdiction over
29.6health and human services reform and finance by February 15, 2013, whether or not
29.7to make the program available statewide. The Search Institute annually must report to
29.8the commissioner of human services on the services it provided and the grant money
29.9it expended under this section.
29.10EFFECTIVE DATE.This section is effective the day following final enactment.

29.11    Sec. 30. CIRCLES OF SUPPORT GRANTS.
29.12The commissioner of human services must provide grants to community action
29.13agencies to help local communities develop, expand, and maintain the tools, training, and
29.14resources needed to foster social assets to assist people out of poverty through circles of
29.15support. The circles of support model must provide a framework for a community to build
29.16relationships across class and race lines so that people can work together to advocate for
29.17change in their communities and move individuals toward self-sufficiency.
29.18Specifically, circles of support initiatives must focus on increasing social capital,
29.19income, educational attainment, and individual accountability, while reducing debt,
29.20service dependency, and addressing systemic disparities that hold poverty in place. The
29.21effort must support the development of local guiding coalitions as the link between the
29.22community and circles of support for resource development and funding leverage.
29.23EFFECTIVE DATE.This section is effective July 1, 2011.

29.24    Sec. 31. HOMELESS SHELTERS; SCHOOL DISTRICTS.
29.25School districts may coordinate with local units of government and homeless
29.26services providers to use empty school buildings as homeless shelters.

29.27    Sec. 32. REQUIREMENT FOR LIQUOR STORES, TOBACCO STORES,
29.28GAMBLING ESTABLISHMENTS, AND TATTOO PARLORS.
29.29Liquor stores, tobacco stores, gambling establishments, and tattoo parlors must
29.30negotiate with their third-party processors to block EBT card cash transactions at their
29.31places of business and withdrawals of cash at automatic teller machines located in their
29.32places of business.

30.1    Sec. 33. MINNESOTA EBT BUSINESS TASK FORCE.
30.2    Subdivision 1. Members. The Minnesota EBT Business Task Force includes seven
30.3members, appointed as follows:
30.4(1) two members of the Minnesota house of representatives, one appointed by the
30.5speaker of the house and one appointed by the minority leader;
30.6(2) two members of the Minnesota senate, one appointed by the senate majority
30.7leader and one appointed by the senate minority leader;
30.8(3) the commissioner of human services, or designee;
30.9(4) an appointee of the Minnesota Grocers Association; and
30.10(5) a credit card processor, appointed by the commissioner of human services.
30.11    Subd. 2. Duties. The Minnesota EBT Business Task Force shall create a workable
30.12strategy to eliminate the purchase of tobacco and alcoholic beverages by recipients of the
30.13general assistance program and Minnesota supplemental aid program under Minnesota
30.14Statutes, chapter 256D, and programs under Minnesota Statutes, chapter 256J, using EBT
30.15cards. The task force will consider cost to the state, feasibility of execution at retail, and
30.16ease of use and privacy for EBT cardholders.
30.17    Subd. 3. Report. The task force will report back to the legislative committees with
30.18jurisdiction over health and human services policy and finance by April 1, 2012, with
30.19recommendations related to the task force duties under subdivision 2.
30.20    Subd. 4. Expiration. The task force expires on June 30, 2012.

30.21    Sec. 34. STREAMLINING CHILDREN AND COMMUNITY SERVICES ACT
30.22REPORTING REQUIREMENTS.
30.23    The commissioner of human services and county human services representatives, in
30.24consultation with other interested parties, shall develop a streamlined alternative to current
30.25reporting requirements related to the Children and Community Services Act service plan.
30.26The commissioner shall submit recommendations and draft legislation to the chairs and
30.27ranking minority members of the committees having jurisdiction over human services no
30.28later than November 15, 2012.

30.29    Sec. 35. REPEALER.
30.30(a) Minnesota Statutes 2010, sections 256.979, subdivisions 5, 6, 7, and 10;
30.31256.9791; 256.9862, subdivision 2; and 256D.46, subdivisions 2 and 3, are repealed.
30.32(b) Minnesota Rules, parts 3400.0130, subpart 8; and 9500.1261, subparts 3, items D
30.33and E, 4, and 5, are repealed effective September 3, 2012.

31.1ARTICLE 2

31.2DEPARTMENT OF HEALTH

31.3    Section 1. Minnesota Statutes 2010, section 62D.08, subdivision 7, is amended to read:
31.4    Subd. 7. Consistent administrative expenses and investment income reporting.
31.5(a) Every health maintenance organization must directly allocate administrative expenses
31.6to specific lines of business or products when such information is available. The definition
31.7of administrative expenses must be consistent with that of the National Association of
31.8Insurance Commissioners (NAIC) as provided in the most current NAIC blank. Remaining
31.9expenses that cannot be directly allocated must be allocated based on other methods, as
31.10recommended by the Advisory Group on Administrative Expenses. Health maintenance
31.11organizations must submit this information, including administrative expenses for dental
31.12services, using the reporting template provided by the commissioner of health.
31.13(b) Every health maintenance organization must allocate investment income based
31.14on cumulative net income over time by business line or product and must submit this
31.15information, including investment income for dental services, using the reporting template
31.16provided by the commissioner of health.

31.17    Sec. 2. Minnesota Statutes 2010, section 62J.04, subdivision 3, is amended to read:
31.18    Subd. 3. Cost containment duties. The commissioner shall:
31.19(1) establish statewide and regional cost containment goals for total health care
31.20spending under this section and collect data as described in sections 62J.38 to 62J.41 and
31.2162J.40 to monitor statewide achievement of the cost containment goals;
31.22(2) divide the state into no fewer than four regions, with one of those regions being
31.23the Minneapolis/St. Paul metropolitan statistical area but excluding Chisago, Isanti,
31.24Wright, and Sherburne Counties, for purposes of fostering the development of regional
31.25health planning and coordination of health care delivery among regional health care
31.26systems and working to achieve the cost containment goals;
31.27(3) monitor the quality of health care throughout the state and take action as
31.28necessary to ensure an appropriate level of quality;
31.29(4) issue recommendations regarding uniform billing forms, uniform electronic
31.30billing procedures and data interchanges, patient identification cards, and other uniform
31.31claims and administrative procedures for health care providers and private and public
31.32sector payers. In developing the recommendations, the commissioner shall review the
31.33work of the work group on electronic data interchange (WEDI) and the American National
31.34Standards Institute (ANSI) at the national level, and the work being done at the state and
32.1local level. The commissioner may adopt rules requiring the use of the Uniform Bill
32.282/92 form, the National Council of Prescription Drug Providers (NCPDP) 3.2 electronic
32.3version, the Centers for Medicare and Medicaid Services 1500 form, or other standardized
32.4forms or procedures;
32.5(5) undertake health planning responsibilities;
32.6(6) authorize, fund, or promote research and experimentation on new technologies
32.7and health care procedures;
32.8(7) within the limits of appropriations for these purposes, administer or contract for
32.9statewide consumer education and wellness programs that will improve the health of
32.10Minnesotans and increase individual responsibility relating to personal health and the
32.11delivery of health care services, undertake prevention programs including initiatives to
32.12improve birth outcomes, expand childhood immunization efforts, and provide start-up
32.13grants for worksite wellness programs;
32.14(8) undertake other activities to monitor and oversee the delivery of health care
32.15services in Minnesota with the goal of improving affordability, quality, and accessibility of
32.16health care for all Minnesotans; and
32.17(9) make the cost containment goal data available to the public in a
32.18consumer-oriented manner.
32.19EFFECTIVE DATE.This section is effective July 1, 2011.

32.20    Sec. 3. Minnesota Statutes 2010, section 62J.17, subdivision 4a, is amended to read:
32.21    Subd. 4a. Expenditure reporting. Each hospital, outpatient surgical center,
32.22diagnostic imaging center, and physician clinic shall report annually to the commissioner
32.23on all major spending commitments, in the form and manner specified by the
32.24commissioner. The report shall include the following information:
32.25    (a) a description of major spending commitments made during the previous year,
32.26including the total dollar amount of major spending commitments and purpose of the
32.27expenditures;
32.28    (b) the cost of land acquisition, construction of new facilities, and renovation of
32.29existing facilities;
32.30    (c) the cost of purchased or leased medical equipment, by type of equipment;
32.31    (d) expenditures by type for specialty care and new specialized services;
32.32    (e) information on the amount and types of added capacity for diagnostic imaging
32.33services, outpatient surgical services, and new specialized services; and
32.34    (f) information on investments in electronic medical records systems.
33.1For hospitals and outpatient surgical centers, this information shall be included in reports
33.2to the commissioner that are required under section 144.698. For diagnostic imaging
33.3centers, this information shall be included in reports to the commissioner that are required
33.4under section 144.565. For physician clinics, this information shall be included in reports
33.5to the commissioner that are required under section 62J.41. For all other health care
33.6providers that are subject to this reporting requirement, reports must be submitted to the
33.7commissioner by March 1 each year for the preceding calendar year.
33.8EFFECTIVE DATE.This section is effective July 1, 2011.

33.9    Sec. 4. Minnesota Statutes 2010, section 62J.495, is amended by adding a subdivision
33.10to read:
33.11    Subd. 7. Exemption. Any clinical practice with a total annual net revenue of less
33.12than $500,000, and that has not received a state or federal grant for implementation
33.13of electronic health records, is exempt from the requirements of subdivision 1. This
33.14subdivision expires December 31, 2020.

33.15    Sec. 5. Minnesota Statutes 2010, section 62J.497, is amended by adding a subdivision
33.16to read:
33.17    Subd. 6. Additional standards for electronic prescribing. By January 1, 2012,
33.18the commissioner of health, in consultation with the Minnesota e-Health Advisory
33.19Committee, must develop a method for incorporation of the following transactions into the
33.20requirements and standards for electronic prescribing provided in subdivisions 2 and 3:
33.21(1) submission of requests for a formulary exception based on information required
33.22on the form developed according to subdivision 4; and
33.23(2) submission of prior authorization requests based on information required on the
33.24form developed according to subdivision 5.

33.25    Sec. 6. Minnesota Statutes 2010, section 62J.692, is amended to read:
33.2662J.692 MEDICAL EDUCATION.
33.27    Subdivision 1. Definitions. For purposes of this section, the following definitions
33.28apply:
33.29    (a) "Accredited clinical training" means the clinical training provided by a
33.30medical education program that is accredited through an organization recognized by the
33.31Department of Education, the Centers for Medicare and Medicaid Services, or another
33.32national body who reviews the accrediting organizations for multiple disciplines and
34.1whose standards for recognizing accrediting organizations are reviewed and approved by
34.2the commissioner of health in consultation with the Medical Education and Research
34.3Advisory Committee.
34.4    (b) "Commissioner" means the commissioner of health.
34.5    (c) "Clinical medical education program" means the accredited clinical training of
34.6physicians (medical students and residents), doctor of pharmacy practitioners, doctors
34.7of chiropractic, dentists, advanced practice nurses (clinical nurse specialists, certified
34.8registered nurse anesthetists, nurse practitioners, and certified nurse midwives), and
34.9physician assistants.
34.10    (d) "Sponsoring institution" means a hospital, school, or consortium located in
34.11Minnesota that sponsors and maintains primary organizational and financial responsibility
34.12for a clinical medical education program in Minnesota and which is accountable to the
34.13accrediting body.
34.14    (e) "Teaching institution" means a hospital, medical center, clinic, or other
34.15organization that conducts a clinical medical education program in Minnesota.
34.16    (f) "Trainee" means a student or resident involved in a clinical medical education
34.17program.
34.18    (g) "Eligible trainee FTE's" means the number of trainees, as measured by full-time
34.19equivalent counts, that are at training sites located in Minnesota with currently active
34.20medical assistance enrollment status and a National Provider Identification (NPI) number
34.21where training occurs in either an inpatient or ambulatory patient care setting and where
34.22the training is funded, in part, by patient care revenues. Training that occurs in nursing
34.23facility settings is not eligible for funding under this section.
34.24    Subd. 3. Application process. (a) A clinical medical education program conducted
34.25in Minnesota by a teaching institution to train physicians, doctor of pharmacy practitioners,
34.26dentists, advanced dental therapists, chiropractors, or physician assistants is eligible for
34.27funds under subdivision 4 or 11, as appropriate, if the program:
34.28(1) is funded, in part, by patient care revenues;
34.29(2) occurs in patient care settings that face increased financial pressure as a result of
34.30competition with nonteaching patient care entities training activities; and
34.31(3) emphasizes primary care or specialties that are in undersupply in Minnesota in
34.32rural areas or for racial, ethnic, or cultural populations in the state experiencing health
34.33disparities.
34.34A clinical medical education program that trains pediatricians is requested to include
34.35in its program curriculum training in case management and medication management for
34.36children suffering from mental illness to be eligible for funds under subdivision 4.
35.1(b) A clinical medical education program for advanced practice nursing, registered
35.2nurses, or licensed practical nurses is eligible for funds under subdivision 4 or 11, as
35.3appropriate, if the program meets the eligibility requirements in paragraph (a), clauses
35.4(1) to (3), and is sponsored by the University of Minnesota Academic Health Center,
35.5the Mayo Foundation, or institutions that are part of the Minnesota State Colleges and
35.6Universities system or members of the Minnesota Private College Council.
35.7(c) Applications must be submitted to the commissioner by a sponsoring institution
35.8on behalf of an eligible clinical medical education program and must be received by
35.9October 31 of each year for distribution in the following year. An application for funds
35.10must contain the following information:
35.11(1) the official name and address of the sponsoring institution and the official
35.12name and site address of the clinical medical education programs on whose behalf the
35.13sponsoring institution is applying;
35.14(2) the name, title, and business address of those persons responsible for
35.15administering the funds;
35.16(3) for each clinical medical education program for which funds are being sought;
35.17the type and specialty orientation of trainees in the program; the name, site address, and
35.18medical assistance provider number or National Provider Identification number (NPI) of
35.19each training site used in the program; the total number of trainees at each training site;
35.20and the total number of eligible trainee FTEs at each site; and
35.21(4) other supporting information the commissioner deems necessary to determine
35.22program eligibility based on the criteria in paragraphs (a) and (b) and to ensure the
35.23equitable appropriate distribution of funds.
35.24(d) An application must include the information specified in clauses (1) to (3) for
35.25each clinical medical education program on an annual basis for three consecutive years.
35.26After that time, an application must include the information specified in clauses (1) to (3)
35.27when requested, at the discretion of the commissioner:
35.28(1) audited clinical training costs per trainee for each clinical medical education
35.29program when available or estimates of clinical training costs based on audited financial
35.30data;
35.31(2) a description of current sources of funding for clinical medical education costs,
35.32including a description and dollar amount of all state and federal financial support,
35.33including Medicare direct and indirect payments; and
35.34(3) other revenue received for the purposes of clinical training.
35.35(e) An applicant that does not provide information requested by the commissioner
35.36shall not be eligible for funds for the current funding cycle.
36.1    Subd. 4. Distribution of funds. (a) Following the distribution described under
36.2paragraph (b), the commissioner shall annually distribute the available medical education
36.3funds to all qualifying applicants based on a distribution formula that reflects a summation
36.4of two factors:
36.5    (1) a public program volume factor, which is determined by the total volume of
36.6public program revenue received by each training site as a percentage of all public
36.7program revenue received by all training sites in the fund pool; and.
36.8    (2) a supplemental public program volume factor, which is determined by providing
36.9a supplemental payment of 20 percent of each training site's grant to training sites whose
36.10public program revenue accounted for at least 0.98 percent of the total public program
36.11revenue received by all eligible training sites. Grants to training sites whose public
36.12program revenue accounted for less than 0.98 percent of the total public program revenue
36.13received by all eligible training sites shall be reduced by an amount equal to the total
36.14value of the supplemental payment.
36.15    Public program revenue for the distribution formula includes revenue from medical
36.16assistance, prepaid medical assistance, general assistance medical care, and prepaid
36.17general assistance medical care. Training sites that receive no public program revenue
36.18are ineligible for funds available under this subdivision. For purposes of determining
36.19training-site level grants to be distributed under paragraph (a), total statewide average
36.20costs per trainee for medical residents is based on audited clinical training costs per trainee
36.21in primary care clinical medical education programs for medical residents. Total statewide
36.22average costs per trainee for dental residents is based on audited clinical training costs
36.23per trainee in clinical medical education programs for dental students. Total statewide
36.24average costs per trainee for pharmacy residents is based on audited clinical training costs
36.25per trainee in clinical medical education programs for pharmacy students. Training sites
36.26whose training-site level grant is less than $1,000, based on the formula described in this
36.27paragraph, are ineligible for funds available under this subdivision.
36.28    (b) $5,350,000 $4,900,000 of the available medical education funds in fiscal year
36.292012 and $3,044,000 beginning in fiscal year 2013 shall be distributed to fund training
36.30designed to address health disparities as follows:
36.31    (1) $1,475,000 $500,000 in fiscal year 2012 and $200,000 beginning in fiscal year
36.322013 to the University of Minnesota Medical Center-Fairview the White Earth Band of
36.33Ojibwe Indians according to section 145.9271;
36.34    (2) $2,075,000 $600,000 in fiscal year 2012 and $200,000 beginning in fiscal
36.35year 2013 to the University of Minnesota School of Dentistry University of Minnesota
36.36according to section 137.395; and
37.1(3) $500,000 in fiscal year 2012 and $200,000 beginning in fiscal year 2013 shall
37.2be distributed to the community health centers development grants program according
37.3to section 145.987;
37.4(4) $500,000 in fiscal year 2012 and $200,000 beginning in fiscal year 2013 shall be
37.5distributed to the community mental health centers grant program according to section
37.6145.9272;
37.7(5) $1,000,000 in fiscal year 2012 and $444,000 beginning in fiscal year 2013 shall
37.8be distributed to the health careers opportunities grant program according to section
37.9144.1499; and
37.10    (3) (6) $1,800,000 to the Academic Health Center. $150,000 of the funds distributed
37.11to the Academic Health Center under this paragraph shall be used for a program to assist
37.12internationally trained physicians who are legal residents and who commit to serving
37.13underserved Minnesota communities in a health professional shortage area to successfully
37.14compete for family medicine residency programs at the University of Minnesota.
37.15    (c) Funds distributed shall not be used to displace current funding appropriations
37.16from federal or state sources.
37.17    (d) Funds shall be distributed to the sponsoring institutions indicating the amount
37.18to be distributed to each of the sponsor's clinical medical education programs based on
37.19the criteria in this subdivision and in accordance with the commissioner's approval letter.
37.20Each clinical medical education program must distribute funds allocated under paragraph
37.21(a) to the training sites as specified in the commissioner's approval letter. Sponsoring
37.22institutions, which are accredited through an organization recognized by the Department
37.23of Education or the Centers for Medicare and Medicaid Services, may contract directly
37.24with training sites to provide clinical training. To ensure the quality of clinical training,
37.25those accredited sponsoring institutions must:
37.26    (1) develop contracts specifying the terms, expectations, and outcomes of the clinical
37.27training conducted at sites; and
37.28    (2) take necessary action if the contract requirements are not met. Action may
37.29include the withholding of payments under this section or the removal of students from
37.30the site.
37.31    (e) Any funds not distributed in accordance with the commissioner's approval letter
37.32must be returned to the medical education and research fund within 30 days of receiving
37.33notice from the commissioner. The commissioner shall distribute returned funds to the
37.34appropriate training sites in accordance with the commissioner's approval letter.
38.1    (f) A maximum of $150,000 of the funds dedicated to the commissioner under
38.2section 297F.10, subdivision 1, clause (2), may be used by the commissioner for
38.3administrative expenses associated with implementing this section.
38.4    Subd. 5. Report. (a) Sponsoring institutions receiving funds under this section
38.5must sign and submit a medical education grant verification report (GVR) to verify that
38.6the correct grant amount was forwarded to each eligible training site. If the sponsoring
38.7institution fails to submit the GVR by the stated deadline, or to request and meet
38.8the deadline for an extension, the sponsoring institution is required to return the full
38.9amount of funds received to the commissioner within 30 days of receiving notice from
38.10the commissioner. The commissioner shall distribute returned funds to the appropriate
38.11training sites in accordance with the commissioner's approval letter.
38.12    (b) The reports must provide verification of the distribution of the funds and must
38.13include:
38.14    (1) the total number of eligible trainee FTEs in each clinical medical education
38.15program;
38.16    (2) the name of each funded program and, for each program, the dollar amount
38.17distributed to each training site;
38.18    (3) documentation of any discrepancies between the initial grant distribution notice
38.19included in the commissioner's approval letter and the actual distribution;
38.20    (4) a statement by the sponsoring institution stating that the completed grant
38.21verification report is valid and accurate; and
38.22    (5) other information the commissioner, with advice from the advisory committee,
38.23deems appropriate to evaluate the effectiveness of the use of funds for medical education.
38.24    (c) By February 15 of each year, the commissioner, with advice from the
38.25advisory committee, shall provide an annual summary report to the legislature on the
38.26implementation of this section.
38.27    Subd. 6. Other available funds. The commissioner is authorized to distribute, in
38.28accordance with subdivision 4, funds made available through:
38.29(1) voluntary contributions by employers or other entities;
38.30(2) allocations for the commissioner of human services to support medical education
38.31and research; and
38.32(3) other sources as identified and deemed appropriate by the legislature for
38.33inclusion in the fund.
38.34    Subd. 7. Transfers from the commissioner of human services. Of the amount
38.35transferred according to section 256B.69, subdivision 5c, paragraph (a), clauses (1) to (4),
38.36$21,714,000 shall be distributed as follows:
39.1(1) $2,157,000 shall be distributed by the commissioner to the University of
39.2Minnesota Board of Regents for the purposes described in sections 137.38 to 137.40;
39.3(2) $1,035,360 shall be distributed by the commissioner to the Hennepin County
39.4Medical Center for clinical medical education;
39.5(3) $17,400,000 shall be distributed by the commissioner to the University of
39.6Minnesota Board of Regents for purposes of medical education;
39.7(4) $1,121,640 $1,021,640 shall be distributed by the commissioner to clinical
39.8medical education dental innovation grants in accordance with subdivision 7a; and
39.9(5) $100,000 shall be distributed to the health careers opportunities grant program
39.10according to section 144.1499; and
39.11 (6) the remainder of the amount transferred according to section 256B.69,
39.12subdivision 5c, clauses (1) to (4), shall be distributed by the commissioner annually to
39.13clinical medical education programs that meet the qualifications of subdivision 3 based on
39.14the formula in subdivision 4, paragraph (a), or subdivision 11, as appropriate.
39.15    Subd. 7a. Clinical medical education innovations grants. (a) The commissioner
39.16shall award grants to teaching institutions and clinical training sites for projects that
39.17provide training to increase dental access for underserved populations and promote
39.18innovative clinical training of dental professionals and for racial, ethnic, or cultural
39.19populations in the state experiencing health disparities. In awarding the grants, the
39.20commissioner, in consultation with the commissioner of human services, shall consider
39.21the following:
39.22(1) potential to successfully increase access to an underserved population;
39.23(2) the long-term viability of the project to improve access beyond the period
39.24of initial funding;
39.25(3) evidence of collaboration between the applicant and local communities; and
39.26(4) the efficiency in the use of the funding; and
39.27(5) (3) the priority level of the project in relation to state clinical education, access,
39.28and health disparity workforce goals.
39.29(b) The commissioner shall periodically evaluate the priorities in awarding the
39.30innovations grants in order to ensure that the priorities meet the changing workforce
39.31needs of the state.
39.32    Subd. 8. Federal financial participation. The commissioner of human services
39.33shall seek to maximize federal financial participation in payments for medical education
39.34and research costs.
40.1    The commissioner shall use physician clinic rates where possible to maximize
40.2federal financial participation. Any additional funds that become available must be
40.3distributed under subdivision 4, paragraph (a), or 11, as appropriate.
40.4    Subd. 9. Review of eligible providers. The commissioner and the Medical
40.5Education and Research Costs Advisory Committee may review provider groups included
40.6in the definition of a clinical medical education program to assure that the distribution of
40.7the funds continue to be consistent with the purpose of this section. The results of any
40.8such reviews must be reported to the Legislative Commission on Health Care Access.
40.9    Subd. 11. Distribution of funds. (a) Upon receiving federal approval, the
40.10commissioner shall annually distribute the available medical education funds to all
40.11qualifying applicants based on the following distribution formula, which supersedes the
40.12formula described in subdivision 4, paragraphs (a) and (b):
40.13(1) funds received pursuant to section 297F.10 shall be distributed to eligible clinical
40.14training sites using a public program volume factor, which is determined by the total
40.15volume of public program revenue received by each eligible training site as a percentage
40.16of all public program revenue received by all eligible training sites in the fund pool. Only
40.17clinical training that occurs in a hospital that reports financial, utilization, and services
40.18data to the commissioner of health, pursuant to sections 144.564 and 144.695 to 144.703
40.19and Minnesota Rules, chapter 4650, is eligible for funding under this clause; and
40.20(2) funds transferred according to section 256B.69, subdivision 5c, paragraph (a),
40.21clauses (1) to (4), shall be distributed to eligible training sites based on the total number of
40.22eligible trainee FTEs and the total statewide average costs per FTE, by type of trainee, in
40.23each clinical medical education program. The number of eligible trainee FTEs for funds
40.24distributed under this clause is determined using the following steps:
40.25(i) each FTE trainee from an advanced practice nursing, physician assistant, family
40.26medicine, internal medicine, general pediatrics, or psychiatry program is weighted at 1.25.
40.27Each FTE trainee from any other eligible training program is weighted at 1.0;
40.28(ii) each FTE trainee at a clinical training site located in an isolated rural area
40.29according to the four category classification of the Rural Urban Commuting Area (RUCA)
40.30system developed for the United States Health Resources and Services Administration
40.31shall be weighted at the weight in item (i) multiplied by 1.5; each FTE trainee at a clinical
40.32training site located in a small rural area according to the RUCA system shall be weighted
40.33at the weight in item (i) multiplied by 1.25; each FTE trainee at a clinical training site
40.34located in a large rural area according to the RUCA system shall be weighted at the weight
40.35in item (i) multiplied by 1.1; and each FTE trainee at a clinical training site located in an
41.1urban area according to the RUCA system shall be weighted at the weight in item (i)
41.2multiplied by 1.0;
41.3(iii) each FTE trainee at a clinical training site that is a hospital eligible for funding
41.4under clause (1) shall be weighted at the weight in item (ii) multiplied by 0.85; and each
41.5FTE trainee at a clinical training site that is an ambulatory, nursing home, or other eligible
41.6nonhospital setting shall be weighted at the weight in item (ii) multiplied by 1.15; and
41.7(iv) grants to hospitals under this item are limited to a percentage share of the total
41.8pool of funds available under this item that is no more than 1.5 times the percentage of the
41.9hospital's total revenue that comes from public programs. Grants to hospitals in excess of
41.10this amount will be redistributed to other sites eligible for funding under this item. Each
41.11eligible clinical training site's grant under this item will be calculated by multiplying the
41.12training site's adjusted FTE count upon completion of items (i) to (iv) by the statewide
41.13average cost per trainee for each provider type to determine an adjusted clinical training
41.14cost for each site. The grant to each eligible clinical training site under this item shall
41.15equal that site's share of total adjusted clinical training costs for all eligible training sites
41.16receiving funding under this item. Any clinical training site with fewer than 0.1 FTE
41.17eligible trainees from all programs upon completion of items (i) to (iv) and any clinical
41.18training site that would receive less than a cumulative $1,000 under clauses (1) and (2)
41.19will be eliminated from the distribution.
41.20(b) Public program revenue for the distribution formula includes revenue for the
41.21relevant MERC reporting period from medical assistance, prepaid medical assistance,
41.22general assistance medical care, MinnesotaCare, and prepaid general assistance medical
41.23care, as reported to the Department of Health pursuant to sections 144.562, 144.564,
41.24and 144.695 to 144.703 and Minnesota Rules, chapter 4650, by December 31 of the
41.25year in which the MERC application is submitted. Training sites that receive no public
41.26program revenue are ineligible for funds available under this subdivision. For purposes
41.27of determining training-site level grants to be distributed under paragraph (a), clause
41.28(2), total statewide average costs per trainee for medical residents is based on audited
41.29clinical training costs per trainee in primary care clinical medical education programs for
41.30medical residents. Total statewide average costs per trainee for dental residents is based
41.31on audited clinical training costs per trainee in clinical medical education programs for
41.32dental students. Total statewide average costs per trainee for pharmacy residents is based
41.33on audited clinical training costs per trainee in clinical medical education programs for
41.34pharmacy students.

42.1    Sec. 7. [62U.15] ALZHEIMER'S DISEASE; PREVALENCE AND SCREENING
42.2MEASURES.
42.3    Subdivision 1. Data from providers. (a) By July 1, 2012, the commissioner
42.4shall review currently available quality measures and make recommendations for future
42.5measurement aimed at improving assessment and care related to Alzheimer's disease and
42.6other dementia diagnoses, including improved rates and results of cognitive screening,
42.7rates of Alzheimer's and other dementia diagnoses, and prescribed care and treatment
42.8plans.
42.9(b) The commissioner may contract with a private entity to complete the
42.10requirements in this subdivision. If the commissioner contracts with a private entity
42.11already under contract through section 62U.02, then the commissioner may use a sole
42.12source contract and is exempt from competitive procurement processes.
42.13    Subd. 2. Learning collaborative. By July 1, 2012, the commissioner shall
42.14develop a health care home learning collaborative curriculum that includes screening and
42.15education on best practices regarding identification and management of Alzheimer's and
42.16other dementia patients under section 256B.0751, subdivision 5, for providers, clinics,
42.17care coordinators, clinic administrators, patient partners and families, and community
42.18resources including public health.
42.19    Subd. 3. Comparison data. The commissioner, with the commissioner of human
42.20services, the Minnesota Board on Aging, and other appropriate state offices, shall jointly
42.21review existing and forthcoming literature in order to estimate differences in the outcomes
42.22and costs of current practices for caring for those with Alzheimer's disease and other
42.23dementias, compared to the outcomes and costs resulting from:
42.24(1) earlier identification of Alzheimer's and other dementias;
42.25(2) improved support of family caregivers; and
42.26(3) improved collaboration between medical care management and community-based
42.27supports.
42.28    Subd. 4. Reporting. By January 15, 2013, the commissioner must report to the
42.29legislature on progress toward establishment and collection of quality measures required
42.30under this section.

42.31    Sec. 8. [137.395] EDUCATION AND TRAINING FOR HEALTH DISPARITY
42.32POPULATIONS.
42.33    Subdivision 1. Condition. If the Board of Regents accepts the amount transferred
42.34under section 62J.692, subdivision 4, paragraph (b), clause (2), then it must be used for the
42.35purposes provided in this section.
43.1    Subd. 2. Purpose. The Board of Regents, through the Academic Health Center,
43.2is required to implement a scholarship program in order to increase the number of
43.3graduates of the Academic Health Center programs who are from racial, ethnic, or cultural
43.4populations in the state that experience health disparities.
43.5    Subd. 3. Scholarships. The Board of Regents is required to provide full
43.6scholarships to Academic Health Center programs for students who are from racial, ethnic,
43.7or cultural populations that experience health disparities. One-third of the scholarship
43.8funding available under this program must go to students at the University of Minnesota,
43.9Medical School, Duluth.

43.10    Sec. 9. Minnesota Statutes 2010, section 144.05, is amended by adding a subdivision
43.11to read:
43.12    Subd. 6. Elimination of certain provider reporting requirements; sunset of new
43.13requirements. (a) Notwithstanding any other law, rule, or provision to the contrary,
43.14effective July 1, 2012, the commissioner shall cease collecting from health care providers
43.15and purchasers all reports and data related to health care costs, quality, utilization, access,
43.16patient encounters, and disease surveillance and public health, and related to provider
43.17licensure, monitoring, finances, and regulation, unless the reports or data are necessary for
43.18federal compliance. For purposes of this subdivision, the term "health care providers and
43.19purchasers" has the meaning provided in section 62J.03, subdivision 8, except that it also
43.20includes nursing homes, health plan companies as defined in section 62Q.01, subdivision
43.214, and managed care and county-based purchasing plans delivering services under sections
43.22256B.69 and 256B.692.
43.23(b) The commissioner shall present to the 2012 legislature draft legislation to repeal,
43.24effective July 1, 2012, the provider reporting requirements identified under paragraph (a)
43.25that are not necessary for federal compliance.
43.26(c) The commissioner may establish new provider reporting requirements to take
43.27effect on or after July 1, 2012. These new reporting requirements must sunset five years
43.28from their effective date, unless they are renewed by the commissioner. All new provider
43.29reporting requirements and requests for their renewal shall not take effect unless they
43.30are enacted in state law.

43.31    Sec. 10. Minnesota Statutes 2010, section 144.1499, is amended to read:
43.32144.1499 PROMOTION OF HEALTH CARE AND LONG-TERM CARE
43.33CAREERS HEALTH CAREERS OPPORTUNITIES GRANT PROGRAM.
44.1    Subdivision. 1. Program. The commissioner of health, in consultation with
44.2an organization representing health care employers, long-term care employers, and
44.3educational institutions, may make grants to qualifying consortia as defined in section
44.4116L.11, subdivision 4, for intergenerational programs to encourage middle and high
44.5school students to work and volunteer in health care and long-term care settings.
44.6To qualify for a grant under this section, a consortium shall: health care employers,
44.7educational institutions, and related organizations for eligible activities intended to
44.8increase the number of people from racial, ethnic, or cultural populations that experience
44.9health disparities who are entering health careers in Minnesota.
44.10(1) develop a health and long-term care careers curriculum that provides career
44.11exploration and training in national skill standards for health care and long-term care and
44.12that is consistent with Minnesota graduation standards and other related requirements;
44.13(2) offer programs for high school students that provide training in health and
44.14long-term care careers with credits that articulate into postsecondary programs; and
44.15(3) provide technical support to the participating health care and long-term care
44.16employer to enable the use of the employer's facilities and programs for kindergarten to
44.17grade 12 health and long-term care careers education.
44.18    Subd. 2. Eligible activities. Eligible activities must focus on students from racial,
44.19ethnic, or cultural populations experiencing health disparities. Eligible activities include
44.20the following:
44.21(1) health careers exploration activities for students from racial, ethnic, or cultural
44.22populations experiencing health disparities;
44.23(2) elementary, secondary, and postsecondary education activities to improve the
44.24academic readiness to enter health professions education programs for students from
44.25racial, ethnic, or cultural populations experiencing health disparities;
44.26(3) health careers mentoring for students from racial, ethnic, or cultural populations
44.27experiencing health disparities, including support for faculty involved in mentoring these
44.28students enrolled in or interested in entering health professions education programs;
44.29(4) secondary and postsecondary summer health care internships that provide
44.30students from racial, ethnic, or cultural populations experiencing health disparities with
44.31formal exposure to a health care profession in an employment setting;
44.32(5) health careers preparation, guidance, and support for students from racial, ethnic,
44.33or cultural populations experiencing health disparities who are interested in entering health
44.34professions education programs;
44.35(6) health careers preparation, guidance, and support for students from racial,
44.36ethnic, or cultural populations experiencing health disparities who are enrolled in health
45.1professions education programs and other activities to improve retention of these students
45.2in health professions education programs; or
45.3(7) other activities the commissioner has reason to believe will prepare, attract, and
45.4educate for health careers students from racial, ethnic, or cultural populations experiencing
45.5health disparities.
45.6    Subd. 3. Applications. Applicants seeking a grant must apply to the commissioner.
45.7Applications must include the following:
45.8(1) a description of the need, challenges, or barriers that the proposed project will
45.9address;
45.10(2) a detailed description of the project and how it proposes to address the challenges
45.11or barriers;
45.12(3) a budget detailing all sources of funds for the project and how project funds
45.13will be used;
45.14(4) baseline data showing the current percentage of program applicants and current
45.15students who are from racial, ethnic, or cultural populations experiencing health disparities;
45.16(5) a description of achievable objectives that demonstrate how the project will
45.17contribute to increasing the number of students from racial, ethnic, or cultural populations
45.18experiencing health disparities who are entering health professions in Minnesota;
45.19(6) a timeline for completion of the project;
45.20(7) roles and capabilities of responsible individuals and organizations, including
45.21partner organizations;
45.22(8) a plan to evaluate project outcomes; and
45.23(9) other information the commissioner believes necessary to evaluate the
45.24application.
45.25    Subd. 4. Consideration of applications. The commissioner must review each
45.26application to determine whether or not the application is complete and whether
45.27the applicant and the project are eligible for a grant. In evaluating applications, the
45.28commissioner must evaluate each application based on the following:
45.29(1) the extent to which the applicant has demonstrated that its project is likely
45.30to contribute to increasing the number of American Indians and underrepresented
45.31populations of color entering health professions in Minnesota;
45.32(2) the application's clarity and thoroughness in describing the challenges and
45.33barriers it is addressing;
45.34(3) the extent to which the applicant appears likely to coordinate project efforts
45.35with other organizations;
45.36(4) the reasonableness of the project budget; and
46.1(5) the organizational capacity of the applicant and its partners.
46.2The commissioner may also take into account other relevant factors. During
46.3application review the commissioner may request additional information about a proposed
46.4project, including information on project cost. Failure to provide the information requested
46.5disqualifies an applicant.
46.6    Subd. 5. Program oversight. The commissioner shall determine the amount of a
46.7grant to be given to an eligible applicant based on the relative strength of each eligible
46.8application and the funds available to the commissioner. The commissioner may collect
46.9from grantees any information necessary to evaluate the program.

46.10    Sec. 11. Minnesota Statutes 2010, section 144.1501, subdivision 1, is amended to read:
46.11    Subdivision 1. Definitions. (a) For purposes of this section, the following definitions
46.12apply.
46.13(b) "Dentist" means an individual who is licensed to practice dentistry.
46.14(c) "Designated rural area" means:
46.15(1) an area in Minnesota outside the counties of Anoka, Carver, Dakota, Hennepin,
46.16Ramsey, Scott, and Washington, excluding the cities of Duluth, Mankato, Moorhead,
46.17Rochester, and St. Cloud; or
46.18(2) a municipal corporation, as defined under section 471.634, that is physically
46.19located, in whole or in part, in an area defined as a designated rural area under clause (1).
46.20an area defined as a small rural area or isolated rural area according to the four category
46.21classifications of the Rural Urban Commuting Area system developed for the United
46.22States Health Resources and Services Administration.
46.23(d) "Emergency circumstances" means those conditions that make it impossible for
46.24the participant to fulfill the service commitment, including death, total and permanent
46.25disability, or temporary disability lasting more than two years.
46.26(e) "Medical resident" means an individual participating in a medical residency in
46.27family practice, internal medicine, obstetrics and gynecology, pediatrics, or psychiatry.
46.28(f) "Midlevel practitioner" means a nurse practitioner, nurse-midwife, nurse
46.29anesthetist, advanced clinical nurse specialist, or physician assistant.
46.30(g) "Nurse" means an individual who has completed training and received all
46.31licensing or certification necessary to perform duties as a licensed practical nurse or
46.32registered nurse.
46.33(h) "Nurse-midwife" means a registered nurse who has graduated from a program of
46.34study designed to prepare registered nurses for advanced practice as nurse-midwives.
47.1(i) "Nurse practitioner" means a registered nurse who has graduated from a program
47.2of study designed to prepare registered nurses for advanced practice as nurse practitioners.
47.3(j) "Pharmacist" means an individual with a valid license issued under chapter 151.
47.4(k) "Physician" means an individual who is licensed to practice medicine in the areas
47.5of family practice, internal medicine, obstetrics and gynecology, pediatrics, or psychiatry.
47.6(l) "Physician assistant" means a person licensed under chapter 147A.
47.7(m) "Qualified educational loan" means a government, commercial, or foundation
47.8loan for actual costs paid for tuition, reasonable education expenses, and reasonable living
47.9expenses related to the graduate or undergraduate education of a health care professional.
47.10(n) "Underserved urban community" means a Minnesota urban area or population
47.11included in the list of designated primary medical care health professional shortage areas
47.12(HPSAs), medically underserved areas (MUAs), or medically underserved populations
47.13(MUPs) maintained and updated by the United States Department of Health and Human
47.14Services.

47.15    Sec. 12. Minnesota Statutes 2010, section 144.1501, subdivision 4, is amended to read:
47.16    Subd. 4. Loan forgiveness. The commissioner of health may select applicants
47.17each year for participation in the loan forgiveness program, within the limits of available
47.18funding. The commissioner shall distribute available funds for loan forgiveness
47.19proportionally among the eligible professions according to the vacancy rate for each
47.20profession in the required geographic area, facility type, teaching area, patient group,
47.21or specialty type specified in subdivision 2. The commissioner shall allocate funds for
47.22physician loan forgiveness so that 75 percent of the funds available are used for rural
47.23physician loan forgiveness and 25 percent of the funds available are used for underserved
47.24urban communities and pediatric psychiatry loan forgiveness. If the commissioner does
47.25not receive enough qualified applicants each year to use the entire allocation of funds for
47.26any eligible profession, the remaining funds may be allocated proportionally among the
47.27other eligible professions according to the vacancy rate for each profession in the required
47.28geographic area, patient group, or facility type specified in subdivision 2. Applicants are
47.29responsible for securing their own qualified educational loans. The commissioner shall
47.30select participants based on their suitability for practice serving the required geographic
47.31area or facility type specified in subdivision 2, as indicated by experience or training.
47.32The commissioner shall give preference to applicants from racial, ethnic, or cultural
47.33populations experiencing health disparities who are closest to completing their training
47.34and who agree to serve in settings in Minnesota that provide health care services to at least
47.3550 percent American Indian or other populations of color, such as a federally recognized
48.1Native American reservation. For each year that a participant meets the service obligation
48.2required under subdivision 3, up to a maximum of four years, the commissioner shall make
48.3annual disbursements directly to the participant equivalent to 15 percent of the average
48.4educational debt for indebted graduates in their profession in the year closest to the
48.5applicant's selection for which information is available, not to exceed the balance of the
48.6participant's qualifying educational loans. Before receiving loan repayment disbursements
48.7and as requested, the participant must complete and return to the commissioner an affidavit
48.8of practice form provided by the commissioner verifying that the participant is practicing
48.9as required under subdivisions 2 and 3. The participant must provide the commissioner
48.10with verification that the full amount of loan repayment disbursement received by the
48.11participant has been applied toward the designated loans. After each disbursement,
48.12verification must be received by the commissioner and approved before the next loan
48.13repayment disbursement is made. Participants who move their practice remain eligible for
48.14loan repayment as long as they practice as required under subdivision 2.

48.15    Sec. 13. [144.1503] HEALTH PROFESSIONS OPPORTUNITIES
48.16SCHOLARSHIP PROGRAM.
48.17    Subdivision 1. Definitions. For purposes of this section, the following definitions
48.18apply:
48.19(a) "Certified clinical nurse specialist" means an individual licensed in Minnesota as
48.20a registered nurse and certified by a national nurse certification organization acceptable to
48.21the Minnesota Board of Nursing to practice as a clinical nurse specialist.
48.22(b) "Certified nurse midwife" means an individual licensed in Minnesota as a
48.23registered nurse and certified by a national nurse certification organization acceptable to
48.24the Minnesota Board of Nursing to practice as a nurse midwife.
48.25(c) "Certified nurse practitioner" means an individual licensed in Minnesota as a
48.26registered nurse and certified by a national nurse certification organization acceptable to
48.27the Minnesota Board of Nursing to practice as a nurse practitioner.
48.28(d) "Chiropractor" means an individual licensed and regulated under sections 148.02
48.29to 148.108.
48.30(e) "Dental therapist" means an individual licensed in the state and includes
48.31advanced dental therapists certified under section 150A.106.
48.32(f) "Dentist" means an individual licensed in Minnesota as a dentist under chapter
48.33150A.
48.34(g) "Eligible scholarship placement site" means a nonprofit, private, or public
48.35entity located in Minnesota that provides at least 50 percent of its health care services to
49.1American Indian or other populations of color, such as federally recognized American
49.2Indian reservations.
49.3(h) "Emergency circumstances" means those conditions that make it impossible for
49.4the participant to fulfill the contractual requirements, including death, total and permanent
49.5disability, or temporary disability lasting more than two years.
49.6(i) "Participant" means an individual receiving a scholarship under this program.
49.7(j) "Physician assistant" means a person licensed in Minnesota under chapter 147A.
49.8(k) "Primary care physician" means an individual licensed in Minnesota as a
49.9physician and board-certified in family practice, internal medicine, obstetrics and
49.10gynecology, pediatrics, geriatrics, emergency medicine, hospital medicine, or psychiatry.
49.11(l) "Registered nurse" means an individual licensed by the Minnesota Board of
49.12Nursing to practice professional nursing.
49.13    Subd. 2. Establishment and purpose. The commissioner shall establish a health
49.14professions opportunities scholarship program. The purpose of the program is to increase
49.15the number of students from racial, ethnic, or cultural populations experiencing health
49.16disparities who enter health professions.
49.17    Subd. 3. Eligible students. To be eligible to apply to the commissioner for the
49.18scholarship program, an applicant must be:
49.19(1) accepted for full-time study in a program of study that will result in licensure as
49.20a primary care physician, certified nurse practitioner, certified nurse midwife, certified
49.21clinical nurse specialist, chiropractor, physician assistant, registered nurse, dentist, or
49.22dental therapist;
49.23(2) a Minnesota resident; and
49.24(3) an individual from a racial, ethnic, or cultural population experiencing health
49.25disparities in the state.
49.26    Subd. 4. Scholarship. The commissioner may award a scholarship for the cost of
49.27full tuition, fees, and living expenses up to $40,000 per year to eligible students. The
49.28commissioner will subtract the amount of other scholarship, grant, and gift awards to the
49.29participant from the award made by this program. Scholarship awards will be limited to
49.30the number of years for full-time enrollment in the applicant's program of study but will
49.31not include any years completed prior to applying. The commissioner shall determine the
49.32number of new scholarship awards made per fiscal year based on availability of state
49.33funding. Scholarship awards will be paid by the commissioner directly to the participant's
49.34educational institution after full-time enrollment is verified. Appropriations made to the
49.35scholarship program do not cancel and are available until expended.
50.1    Subd. 5. Obligated service. A participant shall agree in contract to fulfill a
50.2three-year service obligation at an eligible scholar placement site upon completion of
50.3training, including residency, and obtaining Minnesota licensure. Participants must
50.4provide at least 32 hours of direct patient care per week for at least 45 weeks per year.
50.5Obligated service must start by March 31 of the year following completion of required
50.6training.
50.7    Subd. 6. Affidavit of service required. Before starting a service obligation and
50.8annually thereafter, participants shall submit to the commissioner an affidavit of practice
50.9signed by a representative of their eligible scholar placement site verifying employment
50.10status and the number of weekly hours of direct patient care provided by the participant.
50.11Participants must also provide written notice to the commissioner within 30 days of:
50.12(1) a change in name or address;
50.13(2) a decision not to fulfill a service obligation; or
50.14(3) cessation of obligated practice.
50.15    Subd. 7. Penalty for nonfulfillment. If a participant does not complete the
50.16educational program, successfully obtain licensure, or fulfill the required minimum
50.17commitment of service according to subdivision 6, the commissioner of health shall collect
50.18from the participant the total amount awarded to the participant under the scholarship
50.19program plus interest at a rate established according to section 270C.40. Funds collected
50.20for nonfulfillment shall be credited to the health professions opportunities scholarship
50.21program. The commissioner shall allow waivers of all or part of the money owed the
50.22commissioner as a result of a nonfulfillment penalty due to emergency circumstances.

50.23    Sec. 14. [144.586] PATIENT SAFETY SURVEY.
50.24Hospitals licensed under section 144.55 must submit necessary information to the
50.25Leapfrog Group patient safety survey on an annual basis in order to publicly report patient
50.26safety information and track the progress of each hospital to improve quality, safety,
50.27and efficiency of care delivery.

50.28    Sec. 15. Minnesota Statutes 2010, section 144.98, subdivision 2a, is amended to read:
50.29    Subd. 2a. Standards. Notwithstanding the exemptions in subdivisions 8 and 9, the
50.30commissioner shall accredit laboratories according to the most current environmental
50.31laboratory accreditation standards under subdivision 1 and as accepted by the accreditation
50.32bodies recognized by the National Environmental Laboratory Accreditation Program
50.33(NELAP) of the NELAC Institute.

51.1    Sec. 16. Minnesota Statutes 2010, section 144.98, subdivision 7, is amended to read:
51.2    Subd. 7. Initial accreditation and annual accreditation renewal. (a) The
51.3commissioner shall issue or renew accreditation after receipt of the completed application
51.4and documentation required in this section, provided the laboratory maintains compliance
51.5with the standards specified in subdivision 2a, notwithstanding any exemptions under
51.6subdivisions 8 and 9, and attests to the compliance on the application form.
51.7(b) The commissioner shall prorate the fees in subdivision 3 for laboratories
51.8applying for accreditation after December 31. The fees are prorated on a quarterly basis
51.9beginning with the quarter in which the commissioner receives the completed application
51.10from the laboratory.
51.11(c) Applications for renewal of accreditation must be received by November 1 and
51.12no earlier than October 1 of each year. The commissioner shall send annual renewal
51.13notices to laboratories 90 days before expiration. Failure to receive a renewal notice does
51.14not exempt laboratories from meeting the annual November 1 renewal date.
51.15(d) The commissioner shall issue all accreditations for the calendar year for which
51.16the application is made, and the accreditation shall expire on December 31 of that year.
51.17(e) The accreditation of any laboratory that fails to submit a renewal application
51.18and fees to the commissioner expires automatically on December 31 without notice or
51.19further proceeding. Any person who operates a laboratory as accredited after expiration of
51.20accreditation or without having submitted an application and paid the fees is in violation
51.21of the provisions of this section and is subject to enforcement action under sections
51.22144.989 to 144.993, the Health Enforcement Consolidation Act. A laboratory with expired
51.23accreditation may reapply under subdivision 6.

51.24    Sec. 17. Minnesota Statutes 2010, section 144.98, is amended by adding a subdivision
51.25to read:
51.26    Subd. 8. Exemption from national standards for quality control and personnel
51.27requirements. Effective January 1, 2012, a laboratory that analyzes samples for
51.28compliance with a permit issued under section 115.03, subdivision 5, may request
51.29exemption from the personnel requirements and specific quality control provisions for
51.30microbiology and chemistry stated in the national standards as incorporated by reference
51.31in subdivision 2a. The commissioner shall grant the exemption if the laboratory:
51.32(1) complies with the methodology and quality control requirements, where
51.33available, in the most recent, approved edition of the Standard Methods for the
51.34Examination of Water and Wastewater as published by the Water Environment Federation;
51.35and
52.1(2) supplies the name of the person meeting the requirements in section 115.73, or
52.2the personnel requirements in the national standard pursuant to subdivision 2a.
52.3A laboratory applying for this exemption shall not apply for simultaneous
52.4accreditation under the national standard.

52.5    Sec. 18. Minnesota Statutes 2010, section 144.98, is amended by adding a subdivision
52.6to read:
52.7    Subd. 9. Exemption from national standards for proficiency testing frequency.
52.8(a) Effective January 1, 2012, a laboratory applying for or requesting accreditation under
52.9the exemption in subdivision 8 must obtain an acceptable proficiency test result for each
52.10of the laboratory's accredited or requested fields of testing. The laboratory must analyze
52.11proficiency samples selected from one of two annual proficiency testing studies scheduled
52.12by the commissioner.
52.13(b) If a laboratory fails to successfully complete the first scheduled proficiency
52.14study, the laboratory shall:
52.15(1) obtain and analyze a supplemental test sample within 15 days of receiving the
52.16test report for the initial failed attempt; and
52.17(2) participate in the second annual study as scheduled by the commissioner.
52.18(c) If a laboratory does not submit results or fails two consecutive proficiency
52.19samples, the commissioner will revoke the laboratory's accreditation for the affected
52.20fields of testing.
52.21(d) The commissioner may require a laboratory to analyze additional proficiency
52.22testing samples beyond what is required in this subdivision if information available to
52.23the commissioner indicates that the laboratory's analysis for the field of testing does not
52.24meet the requirements for accreditation.
52.25(e) The commissioner may collect from laboratories accredited under the exemption
52.26in subdivision 8 any additional costs required to administer this subdivision and
52.27subdivision 8.

52.28    Sec. 19. Minnesota Statutes 2010, section 144A.102, is amended to read:
52.29144A.102 WAIVER FROM FEDERAL RULES AND REGULATIONS;
52.30PENALTIES.
52.31(a) By January 2000, the commissioner of health shall work with providers to
52.32examine state and federal rules and regulations governing the provision of care in licensed
52.33nursing facilities and apply for federal waivers and identify necessary changes in state
52.34law to:
53.1(1) allow the use of civil money penalties imposed upon nursing facilities to abate
53.2any deficiencies identified in a nursing facility's plan of correction; and
53.3(2) stop the accrual of any fine imposed by the Health Department when a follow-up
53.4inspection survey is not conducted by the department within the regulatory deadline.
53.5(b) By January 2012, the commissioner of health shall work with providers and
53.6the ombudsman for long-term care to examine state and federal rules and regulations
53.7governing the provision of care in licensed nursing facilities and apply for federal waivers
53.8and identify necessary changes in state law to:
53.9(1) eliminate the requirement for written plans of correction from nursing homes for
53.10federal deficiencies issued at a scope and severity that is not widespread, harmful, or in
53.11immediate jeopardy; and
53.12(2) issue the federal survey form electronically to nursing homes.
53.13The commissioner shall issue a report to the legislative chairs of the committees
53.14with jurisdiction over health and human services by January 31, 2012, on the status of
53.15implementation of this paragraph.

53.16    Sec. 20. Minnesota Statutes 2010, section 144A.61, is amended by adding a
53.17subdivision to read:
53.18    Subd. 9. Electronic transmission. The commissioner of health must accept
53.19electronic transmission of applications and supporting documentation for interstate
53.20endorsement for the nursing assistant registry.

53.21    Sec. 21. Minnesota Statutes 2010, section 144E.123, is amended to read:
53.22144E.123 PREHOSPITAL CARE DATA.
53.23    Subdivision 1. Collection and maintenance. Until July 1, 2014, a licensee shall
53.24may collect and provide prehospital care data to the board in a manner prescribed by the
53.25board. At a minimum, the data must include items identified by the board that are part of
53.26the National Uniform Emergency Medical Services Data Set. A licensee shall maintain
53.27prehospital care data for every response.
53.28    Subd. 2. Copy to receiving hospital. If a patient is transported to a hospital, a copy
53.29of the ambulance report delineating prehospital medical care given shall be provided
53.30to the receiving hospital.
53.31    Subd. 3. Review. Prehospital care data may be reviewed by the board or its
53.32designees. The data shall be classified as private data on individuals under chapter 13, the
53.33Minnesota Government Data Practices Act.
54.1    Subd. 4. Penalty. Failure to report all information required by the board under this
54.2section shall constitute grounds for license revocation.
54.3    Subd. 5. Working group. By October 1, 2011, the board must convene a working
54.4group composed of six members, three of which must be appointed by the board and three
54.5of which must be appointed by the Minnesota Ambulance Association, to redesign the
54.6board's policies related to collection of data from licenses. The issues to be considered
54.7include, but are not limited to, the following: user-friendly reporting requirements; data
54.8sets; improved accuracy of reported information; appropriate use of information gathered
54.9through the reporting system; and methods for minimizing the financial impact of data
54.10reporting on licenses, particularly for rural volunteer services. The working group must
54.11report its findings and recommendations to the board no later than January 1, 2014.
54.12EFFECTIVE DATE.This section is effective the day following final enactment.

54.13    Sec. 22. [145.9271] WHITE EARTH BAND URBAN CLINIC.
54.14    Subdivision 1. Condition. If the White Earth Band of Ojibwe Indians accepts the
54.15amount transferred under section 62J.692, subdivision 4, paragraph (b), clause (1), then it
54.16must use the funds for purposes of this section.
54.17    Subd. 2. Establish urban clinic. The White Earth Band of Ojibwe Indians shall
54.18establish and operate one or more health care clinics in the Minneapolis area or greater
54.19Minnesota to serve members of the White Earth Tribe and may use funds received under
54.20section 62J.692, subdivision 4, paragraph (b), clause (1), for application to qualify as a
54.21federally qualified health center.
54.22    Subd. 3. Grant agreements. Before receiving the funds to be transferred under
54.23section 62J.692, subdivision 4, paragraph (b), clause (1), the White Earth Band of Ojibwe
54.24Indians is requested to submit to the commissioner of health a work plan and budget that
54.25describes its annual plan for the funds. The commissioner will incorporate the work
54.26plan and budget into a grant agreement between the commissioner and the White Earth
54.27Band of Ojibwe Indians. Before each successive disbursement, the White Earth Band of
54.28Ojibwe Indians is requested to submit a narrative progress report and an expenditure
54.29report to the commissioner.

54.30    Sec. 23. [145.9272] COMMUNITY MENTAL HEALTH CENTER GRANTS.
54.31    Subdivision 1. Definitions. For purposes of this section, "community mental
54.32health center" means an entity that is eligible for payment under section 256B.0625,
54.33subdivision 5.
55.1    Subd. 2. Allocation of subsidies. The commissioner of health shall distribute, from
55.2money appropriated for this purpose, grants to community mental health centers operating
55.3in the state on July 1 of the year 2011 and each subsequent year for community mental
55.4health center services to low-income consumers and patients with mental illness. The
55.5amount of each grant shall be in proportion to each community mental health center's
55.6revenues received from state health care programs in the most recent calendar year for
55.7which data is available.

55.8    Sec. 24. Minnesota Statutes 2010, section 145.928, subdivision 2, is amended to read:
55.9    Subd. 2. State-community partnerships; plan. The commissioner, in partnership
55.10with culturally based community organizations; the Indian Affairs Council under section
55.113.922 ; the Council on Affairs of Chicano/Latino People under section 3.9223; the Council
55.12on Black Minnesotans under section 3.9225; the Council on Asian-Pacific Minnesotans
55.13under section 3.9226; the Alliance for Racial and Cultural Health Equity; community
55.14health boards as defined in section 145A.02; and tribal governments, shall develop and
55.15implement a comprehensive, coordinated plan to reduce health disparities in the health
55.16disparity priority areas identified in subdivision 1.

55.17    Sec. 25. [145.929] PROFESSIONALS FROM POPULATIONS WITH HEALTH
55.18DISPARITIES.
55.19The commissioner of health shall survey the diversity of the work force for
55.20health-related professions and compare proportions in the allied health professions
55.21among populations experiencing health disparities, including cultural, racial, ethnic,
55.22and geographic factors, compared to the population of the state. Based on this survey,
55.23the commissioner shall determine on an annual basis the ratio of training and residency
55.24positions needed versus those available based on funding capacity.

55.25    Sec. 26. Minnesota Statutes 2010, section 145.986, is amended by adding a subdivision
55.26to read:
55.27    Subd. 7. Consultation and engagement of consumers and communities with
55.28poorer health and outcomes. Communities who receive state and federal health
55.29grants must demonstrate to the commissioner that the applicant or grantee consulted
55.30with and engaged local consumers, community organizations, and leaders representing
55.31the subgroups of the community that experience the greatest health disparities in the
55.32development of the local plan and that the plan incorporates components and activities
55.33that reflect the needs and preferences of these communities. The plan must also include
56.1a process for ongoing consultation and engagement of these consumers, community
56.2organizations, and leaders in the implementation of the plan and activities funded by
56.3state grants.

56.4    Sec. 27. Minnesota Statutes 2010, section 145.986, is amended by adding a subdivision
56.5to read:
56.6    Subd. 8. Coordination with payment reform demonstration projects. A
56.7community who received a health improvement plan grant under this section and
56.8a payment reform demonstration project authorized under section 256B.0755 shall
56.9coordinate activities to improve the health of the communities and patients served by both
56.10the health improvement plan and the demonstration project provider.

56.11    Sec. 28. [145.987] COMMUNITY HEALTH CENTERS DEVELOPMENT
56.12GRANTS FOR UNDERSERVED COMMUNITIES.
56.13(a) The commissioner of health shall award grants from money appropriated for this
56.14purpose to expand community health centers, as defined in section 145.9269, subdivision
56.151, in the state through the establishment of new community health centers or sites in
56.16areas defined as small rural areas or isolated rural areas according to the four category
56.17classification of the Rural Urban Commuting Area system developed for the United States
56.18Health Resources and Services Administration or serving underserved patient populations
56.19who experience the greatest disparities in health outcomes.
56.20(b) Grant funds may be used to pay for:
56.21(1) costs for an organization to develop and submit a proposal to the federal
56.22government for the designation of a new community health center or site;
56.23(2) costs of engaging underserved communities, health care providers, local
56.24government agencies, or businesses in a process of developing a plan for a new center or
56.25site to serve people in that community; and
56.26(3) costs of planning, designing, remodeling, constructing, or purchasing equipment
56.27for a new center or site.
56.28Funds may not be used for operating costs.
56.29(d) A proposal must demonstrate that racial and ethnic communities to be served by
56.30the community health center were consulted with and participated in the development of
56.31the proposal.
56.32(e) The commissioner shall award grants on a competitive basis based on the
56.33following criteria:
56.34(1) the unmet need in the underserved community;
57.1(2) the degree of disparities in health outcomes in the underserved community; and
57.2(3) the extent to which people from the underserved community participated in
57.3the development of the proposal.

57.4    Sec. 29. Minnesota Statutes 2010, section 145A.17, subdivision 3, is amended to read:
57.5    Subd. 3. Requirements for programs; process. (a) Community health boards
57.6and tribal governments that receive funding under this section must submit a plan to
57.7the commissioner describing a multidisciplinary approach to targeted home visiting for
57.8families. The plan must be submitted on forms provided by the commissioner. At a
57.9minimum, the plan must include the following:
57.10    (1) a description of outreach strategies to families prenatally or at birth;
57.11    (2) provisions for the seamless delivery of health, safety, and early learning services;
57.12    (3) methods to promote continuity of services when families move within the state;
57.13    (4) a description of the community demographics;
57.14    (5) a plan for meeting outcome measures; and
57.15    (6) a proposed work plan that includes:
57.16    (i) coordination to ensure nonduplication of services for children and families;
57.17    (ii) a description of the strategies to ensure that children and families at greatest risk
57.18receive appropriate services; and
57.19    (iii) collaboration with multidisciplinary partners including public health,
57.20ECFE, Head Start, community health workers, social workers, community home
57.21visiting programs, school districts, and other relevant partners. Letters of intent from
57.22multidisciplinary partners must be submitted with the plan.
57.23    (b) Each program that receives funds must accomplish the following program
57.24requirements:
57.25    (1) use a community-based strategy to provide preventive and early intervention
57.26home visiting services;
57.27    (2) offer a home visit by a trained home visitor. If a home visit is accepted, the first
57.28home visit must occur prenatally or as soon after birth as possible and must include a
57.29public health nursing assessment by a public health nurse;
57.30    (3) offer, at a minimum, information on infant care, child growth and development,
57.31positive parenting, preventing diseases, preventing exposure to environmental hazards,
57.32and support services available in the community;
57.33    (4) provide information on and referrals to health care services, if needed, including
57.34information on and assistance in applying for health care coverage for which the child or
58.1family may be eligible; and provide information on preventive services, developmental
58.2assessments, and the availability of public assistance programs as appropriate;
58.3    (5) provide youth development programs when appropriate;
58.4    (6) recruit home visitors who will represent, to the extent possible, the races,
58.5cultures, and languages spoken by families that may be served;
58.6    (7) train and supervise home visitors in accordance with the requirements established
58.7under subdivision 4;
58.8    (8) maximize resources and minimize duplication by coordinating or contracting
58.9with local social and human services organizations, education organizations, and other
58.10appropriate governmental entities and community-based organizations and agencies;
58.11    (9) utilize appropriate racial and ethnic approaches to providing home visiting
58.12services; and
58.13    (10) connect eligible families, as needed, to additional resources available in the
58.14community, including, but not limited to, early care and education programs, health or
58.15mental health services, family literacy programs, employment agencies, social services,
58.16and child care resources and referral agencies.
58.17    (c) When available, programs that receive funds under this section must offer or
58.18provide the family with a referral to center-based or group meetings that meet at least
58.19once per month for those families identified with additional needs. The meetings must
58.20focus on further enhancing the information, activities, and skill-building addressed during
58.21home visitation; offering opportunities for parents to meet with and support each other;
58.22and offering infants and toddlers a safe, nurturing, and stimulating environment for
58.23socialization and supervised play with qualified teachers.
58.24    (d) Funds available under this section shall not be used for medical services. The
58.25commissioner shall establish an administrative cost limit for recipients of funds. The
58.26outcome measures established under subdivision 6 must be specified to recipients of
58.27funds at the time the funds are distributed.
58.28    (e) Data collected on individuals served by the home visiting programs must remain
58.29confidential and must not be disclosed by providers of home visiting services without a
58.30specific informed written consent that identifies disclosures to be made. Upon request,
58.31agencies providing home visiting services must provide recipients with information on
58.32disclosures, including the names of entities and individuals receiving the information and
58.33the general purpose of the disclosure. Prospective and current recipients of home visiting
58.34services must be told and informed in writing that written consent for disclosure of data is
58.35not required for access to home visiting services.
59.1(f) Upon initial contact with a family, programs that receive funding under this
59.2section must request permission from the family to share with other family service
59.3providers information about services the family is receiving and unmet needs of the family
59.4in order to select a lead agency for the family and coordinate available resources. For
59.5purposes of this paragraph, the term "family service providers" includes local public
59.6health, social services, school districts, Head Start programs, health care providers, and
59.7other public agencies.

59.8    Sec. 30. Minnesota Statutes 2010, section 152.027, is amended by adding a subdivision
59.9to read:
59.10    Subd. 6. Sale or possession of synthetic cannabinoids. (a) A person who
59.11unlawfully sells any amount of a synthetic cannabinoid is guilty of a gross misdemeanor.
59.12(b) A person who unlawfully possesses any amount of a synthetic cannabinoid is
59.13guilty of a misdemeanor.
59.14(c) For purposes of this subdivision, "synthetic cannabinoid" includes, unless
59.15specifically excepted or unless listed in another schedule, any natural or synthetic material,
59.16compound, mixture, or preparation that contains any quantity of a substance that is a
59.17cannabinoid receptor agonist, including, but not limited to, the following substances and
59.18their analogs, including homologues; isomers, whether optical, positional, or geometric;
59.19esters; ethers; salts; and salts of isomers, esters, and ethers, whenever the existence of the
59.20isomers, esters, ethers, or salts is possible within the specific chemical designation:
59.211-pentyl-2-methyl-3-(1-naphthoyl)indole (JWH-007),
59.22(2-Methyl-1-propyl-1H-indol-3-yl)-1-naphthalenylmethanone (JWH-015),
59.231-Pentyl-3-(1-naphthoyl)indole (JWH-018), 1-hexyl-3-(naphthalen-1-oyl)indole
59.24(JWH-019), 1-Butyl-3-(1-naphthoyl)indole (JWH-073),
59.254-methoxynaphthalen-1-yl-(1-pentylindol-3-yl)methanone (JWH-081),
59.264-methoxynaphthalen-1-yl-(1-pentyl-2-methylindol-3-yl)methanone
59.27(JWH-098), (1-(2-morpholin-4-ylethyl)indol-3-yl)-naphthalen-1-ylmethanone
59.28(JWH-200), 7-methoxynaphthalen-1-yl-(1-pentylindol-3-yl)methanone
59.29(JWH-164), 2-(2-chlorophenyl)-1-(1-pentylindol-3-yl)ethanone (JWH-203),
59.304-ethylnaphthalen-1-yl-(1-pentylindol-3-yl)methanone (JWH-210),
59.312-(2-methoxyphenyl)-1-(1-pentylindol-3-yl)ethanone (JWH-250),
59.321-pentyl-3-(4-chloro-1-naphthoyl)indole (JWH-398), (6aR,10aR)-
59.339-(Hydroxymethyl)-6,6-dimethyl-3-(2-methyloctan-2-yl)-6a,7,10,10a-
59.34tetrahydrobenzo[c]chromen-1-ol (HU-210), (dexanabinol, (6aS,10aS)-9-
59.35(hydroxymethyl)-6,6-dimethyl-3-(2-methyloctan-2-yl)-6a,7,10,10a-
60.1tetrahydrobenzo[c]chromen-1-ol) (HU-211), (R)-(+)-[2,3-Dihydro-5-methyl-3-
60.2(4-morpholinylmethyl)pyrrolo[1,2,3-de)-1,4-benzoxazin-6-yl]-1-napthalenylmethanone
60.3(WIN-55/212-2), 2-[(1R,3S)-3-hydroxycyclohexyl]- 5-(2-methyloctan-2-yl)phenol
60.4(CP47,497), dimethylheptylpyran.
60.5EFFECTIVE DATE.This section is effective August 1, 2011, and applies to crimes
60.6committed on or after that date.

60.7    Sec. 31. Minnesota Statutes 2010, section 157.15, is amended by adding a subdivision
60.8to read:
60.9    Subd. 7a. Limited food establishment. "Limited food establishment" means a food
60.10and beverage service establishment that primarily provides beverages that consist of
60.11combining dry mixes and water or ice for immediate service to the consumer. Limited
60.12food establishments must use equipment and utensils that are nontoxic, durable, and retain
60.13their characteristic qualities under normal use conditions and may request a variance for
60.14plumbing requirements from the commissioner.

60.15    Sec. 32. Minnesota Statutes 2010, section 157.20, is amended by adding a subdivision
60.16to read:
60.17    Subd. 5. Waivers during inspection. Notwithstanding any provision of this
60.18chapter or Minnesota Rules, chapter 4626, any plumbing or other facility requirement,
60.19including sewage access charge and related local fees, may be waived by the inspector if
60.20the inspector deems a waiver appropriate and reasonable and determines that no significant
60.21adverse effects on public health, safety, or the environment would result from such waiver.

60.22    Sec. 33. Minnesota Statutes 2010, section 169A.20, subdivision 1, is amended to read:
60.23    Subdivision 1. Driving while impaired crime; motor vehicle. It is a crime for
60.24any person to drive, operate, or be in physical control of any motor vehicle, as defined
60.25in section 169A.03, subdivision 15, except for motorboats in operation and off-road
60.26recreational vehicles, within this state or on any boundary water of this state when:
60.27(1) the person is under the influence of alcohol;
60.28(2) the person is under the influence of a controlled substance or a substance listed in
60.29section 152.027, subdivision 6;
60.30(3) the person is knowingly under the influence of a hazardous substance that
60.31affects the nervous system, brain, or muscles of the person so as to substantially impair
60.32the person's ability to drive or operate the motor vehicle;
61.1(4) the person is under the influence of a combination of any two or more of the
61.2elements named in clauses (1) to (3);
61.3(5) the person's alcohol concentration at the time, or as measured within two hours
61.4of the time, of driving, operating, or being in physical control of the motor vehicle is
61.50.08 or more;
61.6(6) the vehicle is a commercial motor vehicle and the person's alcohol concentration
61.7at the time, or as measured within two hours of the time, of driving, operating, or being in
61.8physical control of the commercial motor vehicle is 0.04 or more; or
61.9(7) the person's body contains any amount of a controlled substance listed in
61.10Schedule I or II, or its metabolite, other than marijuana or tetrahydrocannabinols.
61.11EFFECTIVE DATE.This section is effective August 1, 2011, and applies to crimes
61.12committed on or after that date.

61.13    Sec. 34. Minnesota Statutes 2010, section 169A.20, subdivision 1a, is amended to read:
61.14    Subd. 1a. Driving while impaired crime; motorboat in operation. It is a crime
61.15for any person to operate or be in physical control of a motorboat in operation on any
61.16waters or boundary water of this state when:
61.17(1) the person is under the influence of alcohol;
61.18(2) the person is under the influence of a controlled substance or a substance listed in
61.19section 152.027, subdivision 6;
61.20(3) the person is knowingly under the influence of a hazardous substance that affects
61.21the nervous system, brain, or muscles of the person so as to substantially impair the
61.22person's ability to drive or operate the motorboat;
61.23(4) the person is under the influence of a combination of any two or more of the
61.24elements named in clauses (1) to (3);
61.25(5) the person's alcohol concentration at the time, or as measured within two hours
61.26of the time, of driving, operating, or being in physical control of the motorboat is 0.08 or
61.27more; or
61.28(6) the person's body contains any amount of a controlled substance listed in
61.29Schedule I or II, or its metabolite, other than marijuana or tetrahydrocannabinols.
61.30EFFECTIVE DATE.This section is effective August 1, 2011, and applies to crimes
61.31committed on or after that date.

61.32    Sec. 35. Minnesota Statutes 2010, section 169A.20, subdivision 1b, is amended to read:
62.1    Subd. 1b. Driving while impaired crime; snowmobile and all-terrain vehicle. It
62.2is a crime for any person to operate or be in physical control of a snowmobile as defined in
62.3section 84.81, subdivision 3, or all-terrain vehicle as defined in section 84.92, subdivision
62.48, anywhere in this state or on the ice of any boundary water of this state when:
62.5(1) the person is under the influence of alcohol;
62.6(2) the person is under the influence of a controlled substance or a substance listed in
62.7section 152.027, subdivision 6;
62.8(3) the person is knowingly under the influence of a hazardous substance that affects
62.9the nervous system, brain, or muscles of the person so as to substantially impair the
62.10person's ability to drive or operate the snowmobile or all-terrain vehicle;
62.11(4) the person is under the influence of a combination of any two or more of the
62.12elements named in clauses (1) to (3);
62.13(5) the person's alcohol concentration at the time, or as measured within two hours
62.14of the time, of driving, operating, or being in physical control of the snowmobile or
62.15all-terrain vehicle is 0.08 or more; or
62.16(6) the person's body contains any amount of a controlled substance listed in
62.17Schedule I or II, or its metabolite, other than marijuana or tetrahydrocannabinols.
62.18EFFECTIVE DATE.This section is effective August 1, 2011, and applies to crimes
62.19committed on or after that date.

62.20    Sec. 36. Minnesota Statutes 2010, section 169A.20, subdivision 1c, is amended to read:
62.21    Subd. 1c. Driving while impaired crime; off-highway motorcycle and off-road
62.22vehicle. It is a crime for any person to operate or be in physical control of any off-highway
62.23motorcycle as defined in section 84.787, subdivision 7, or any off-road vehicle as defined
62.24in section 84.797, subdivision 7, anywhere in this state or on the ice of any boundary
62.25water of this state when:
62.26(1) the person is under the influence of alcohol;
62.27(2) the person is under the influence of a controlled substance or a substance listed in
62.28section 152.027, subdivision 6;
62.29(3) the person is knowingly under the influence of a hazardous substance that affects
62.30the nervous system, brain, or muscles of the person so as to substantially impair the
62.31person's ability to drive or operate the off-highway motorcycle or off-road vehicle;
62.32(4) the person is under the influence of a combination of any two or more of the
62.33elements named in clauses (1) to (3);
63.1(5) the person's alcohol concentration at the time, or as measured within two hours of
63.2the time, of driving, operating, or being in physical control of the off-highway motorcycle
63.3or off-road vehicle is 0.08 or more; or
63.4(6) the person's body contains any amount of a controlled substance listed in
63.5Schedule I or II, or its metabolite, other than marijuana or tetrahydrocannabinols.
63.6EFFECTIVE DATE.This section is effective August 1, 2011, and applies to crimes
63.7committed on or after that date.

63.8    Sec. 37. Minnesota Statutes 2010, section 297F.10, subdivision 1, is amended to read:
63.9    Subdivision 1. Tax and use tax on cigarettes. Revenue received from cigarette
63.10taxes, as well as related penalties, interest, license fees, and miscellaneous sources of
63.11revenue shall be deposited by the commissioner in the state treasury and credited as
63.12follows:
63.13(1) $22,220,000 for fiscal year 2006 and $22,250,000 for fiscal year 2007 and each
63.14year thereafter must be credited to the Academic Health Center special revenue fund
63.15hereby created and is annually appropriated to the Board of Regents at the University of
63.16Minnesota for Academic Health Center funding at the University of Minnesota; and
63.17(2) $8,553,000 for fiscal year 2006 and, $8,550,000 for fiscal year 2007 and,
63.18$8,337,000 for fiscal year 2012, and $6,781,000 each year thereafter must be credited to
63.19the medical education and research costs account hereby created in the special revenue
63.20fund and is annually appropriated to the commissioner of health for distribution under
63.21section 62J.692, subdivision 4 or 11, as appropriate; and
63.22(3) the balance of the revenues derived from taxes, penalties, and interest (under
63.23this chapter) and from license fees and miscellaneous sources of revenue shall be credited
63.24to the general fund.

63.25    Sec. 38. TRANSFER OF HEALTH QUALITY DATA COLLECTION.
63.26    Subdivision 1. Transfer. The duties and activities of the commissioner of
63.27health conducted pursuant to Minnesota Statutes, chapter 62U, are transferred to the
63.28commissioner of human services.
63.29    Subd. 2. Effect of transfer. Minnesota Statutes, section 15.039 applies to the
63.30transfer required in subdivision 1.
63.31    Subd. 3. Effective date. The transfer required in subdivision 1 is effective July 1,
63.322011.
63.33    Subd. 4. Suspended data collection. Data collection under Minnesota Statutes,
63.34section 62U.04, subdivision 4, is suspended, effective July 1, 2011.
64.1    Subd. 5. Commissioner of human services. (a) During the 2012 legislative session,
64.2the commissioner of human services, in consultation with the revisor of statutes, shall
64.3submit to the legislature a bill making all statutory changes required by the reorganization
64.4required under subdivision 1.
64.5(b) By July 1, 2013, the commissioner must make recommendations to the legislature
64.6for collection of encounter data for state health care programs, including SEGIP, through a
64.7mechanism that allows a third-party contractor to capture data as it is transmitted through
64.8existing claims processing mechanisms.

64.9    Sec. 39. PATIENT AND COMMUNITY ENGAGEMENT IN PAYMENT
64.10REFORM AND HEALTH CARE PROGRAM REFORMS.
64.11    Subdivision 1. Implementation of data system improvements. The commissioners
64.12of health and human services shall implement the recommendations regarding data on
64.13health disparities that were contained in the report prepared under Laws 2010, First
64.14Special Session chapter 1, article 19, section 23, in consultation with an advisory work
64.15group representing racial and ethnic groups and representatives of government and private
64.16sector health care organizations. Among other activities, the commissioners shall:
64.17(1) continue engagement with diverse communities on collection of and access to
64.18racial and ethnic data from state agencies, health care providers, and health plans;
64.19(2) develop a plan to make data more accessible to communities;
64.20(3) develop consistent data elements across programs when feasible; and
64.21(4) develop consistent policies on data sampling.
64.22    Subd. 2. Patient and community engagement. The commissioner of health, in
64.23cooperation with the commissioners of human services and commerce, shall consult with
64.24an advisory committee representing racial and ethnic groups regarding the implementation
64.25of subdivision 1 and major agency activities related to state and federal health care reform,
64.26payment reform demonstration projects, state health care program reforms, improvements
64.27in quality and patient satisfaction measures, and major changes in state public health
64.28priorities and strategies. At the request of the advisory committee established under Laws
64.292010, First Special Session chapter 1, article 19, section 23, the commissioner shall
64.30designate a private sector organization of multiple racial and ethnic groups to serve as the
64.31advisory committee under this subdivision.

64.32    Sec. 40. EVALUATION OF HEALTH AND HUMAN SERVICES REGULATORY
64.33RESPONSIBILITIES.
65.1(a) The commissioner of health, in consultation with the commissioner of human
65.2services, shall evaluate and recommend options for reorganizing health and human
65.3services regulatory responsibilities in both agencies to provide better efficiency and
65.4operational cost savings while maintaining the protection of the health, safety, and welfare
65.5of the public. Regulatory responsibilities that are to be evaluated are those found in
65.6Minnesota Statutes, chapters 62D, 62N, 62R, 62T, 144A, 144D, 144G, 146A, 146B,
65.7149A, 153A, 245A, 245B, and 245C, and sections 62Q.19, 144.058, 144.0722, 144.50,
65.8144.651, 148.511, 148.6401, 148.995, 256B.692, 626.556, and 626.557.
65.9(b) The evaluation and recommendations shall be submitted in a report to the
65.10legislative committees with jurisdiction over health and human services no later than
65.11February 15, 2012, and shall include, at a minimum, the following:
65.12(1) whether the regulatory responsibilities of each agency should be combined into
65.13a separate agency;
65.14(2) whether the regulatory responsibilities of each agency should be merged into
65.15an existing agency;
65.16(3) what cost savings would result by merging the activities regardless of where
65.17they are located;
65.18(4) what additional costs would result if the activities were merged;
65.19(5) whether there are additional regulatory responsibilities in both agencies that
65.20should be considered in any reorganization; and
65.21(6) for each option recommended, projected cost and a timetable and identification
65.22of the necessary steps and requirements for a successful transition period.

65.23    Sec. 41. TRANSFER OF THE HEALTH ECONOMICS PROGRAM.
65.24    Subdivision 1. Transfer. The duties and activities of the health economics program
65.25at the Minnesota Department of Health conducted pursuant to Minnesota Statutes, chapter
65.2662J, are transferred to the commissioner of commerce.
65.27    Subd. 2. Effect of transfer. Minnesota Statutes, section 15.039, applies to the
65.28transfer required in subdivision 1.
65.29    Subd. 3. Commissioner of commerce. During the 2012 legislative session, the
65.30commissioner of commerce, in consultation with the revisor of statutes, shall submit to
65.31the legislature a bill making all statutory changes required by the reorganization required
65.32under subdivision 1.
65.33    Subd. 4. Effective date. The transfer required in subdivision 1 is effective July 1,
65.342011.

66.1    Sec. 42. STUDY OF FOR-PROFIT HEALTH MAINTENANCE
66.2ORGANIZATIONS.
66.3The commissioner of health shall contract with an entity with expertise in health
66.4economics and health care delivery and quality to study the efficiency, costs, service
66.5quality, and enrollee satisfaction of for-profit health maintenance organizations, relative to
66.6not-for-profit health maintenance organizations operating in Minnesota and other states.
66.7The study findings must address whether the state of Minnesota could: (1) reduce medical
66.8assistance and MinnesotaCare costs and costs of providing coverage to state employees;
66.9and (2) maintain or improve the quality of care provided to state health care program
66.10enrollees and state employees if for-profit health maintenance organizations were allowed
66.11to operate in the state. The commissioner shall require the entity under contract to report
66.12study findings to the commissioner and the legislature by January 15, 2012.

66.13    Sec. 43. MINNESOTA TASK FORCE ON PREMATURITY.
66.14    Subdivision 1. Establishment. The Minnesota Task Force on Prematurity is
66.15established to evaluate and make recommendations on methods for reducing prematurity
66.16and improving premature infant health care in the state.
66.17    Subd. 2. Membership; meetings; staff. (a) The task force shall be composed of at
66.18least the following members, who serve at the pleasure of their appointing authority:
66.19(1) 15 representatives of the Minnesota Prematurity Coalition including, but not
66.20limited to, health care providers who treat pregnant women or neonates, organizations
66.21focused on preterm births, early childhood education and development professionals, and
66.22families affected by prematurity;
66.23(2) one representative appointed by the commissioner of human services;
66.24(3) two representatives appointed by the commissioner of health;
66.25(4) one representative appointed by the commissioner of education;
66.26(5) two members of the house of representatives, one appointed by the speaker of
66.27the house and one appointed by the minority leader; and
66.28(6) two members of the senate, appointed according to the rules of the senate.
66.29(b) Members of the task force serve without compensation or payment of expenses.
66.30(c) The commissioner of health must convene the first meeting of the Minnesota
66.31Task Force on Prematurity by July 31, 2011. The task force must continue to meet at
66.32least quarterly. Staffing and technical assistance shall be provided by the Minnesota
66.33Perinatal Coalition.
67.1    Subd. 3. Duties. The task force must report the current state of prematurity in
67.2Minnesota and develop recommendations on strategies for reducing prematurity and
67.3improving premature infant health care in the state by considering the following:
67.4(1) standards of care for premature infants born less than 37 weeks gestational age,
67.5including recommendations to improve hospital discharge and follow-up care procedures;
67.6(2) coordination of information among appropriate professional and advocacy
67.7organizations on measures to improve health care for infants born prematurely;
67.8(3) identification and centralization of available resources to improve access and
67.9awareness for caregivers of premature infants;
67.10(4) development and dissemination of evidence-based practices through networking
67.11and educational opportunities;
67.12(5) a review of relevant evidence-based research regarding the causes and effects of
67.13premature births in Minnesota;
67.14(6) a review of relevant evidence-based research regarding premature infant health
67.15care, including methods for improving quality of and access to care for premature infants;
67.16and
67.17(7) identification of gaps in public reporting measures and possible effects of these
67.18measures on prematurity rates.
67.19    Subd. 4. Report; expiration. (a) By November 30, 2011, the task force must submit
67.20a report on the current state of prematurity in Minnesota to the chairs of the legislative
67.21policy committees on health and human services.
67.22(b) By January 15, 2013, the task force must report its final recommendations,
67.23including any draft legislation necessary for implementation, to the chairs of the legislative
67.24policy committees on health and human services.
67.25(c) This task force expires on January 31, 2013, or upon submission of the final
67.26report required in paragraph (b), whichever is earlier.

67.27    Sec. 44. NURSING HOME REGULATORY EFFICIENCY.
67.28The commissioner of health shall work with stakeholders to review, develop,
67.29implement, and recommend legislative changes in the nursing home licensure process that
67.30address efficiency, eliminate duplication, and ensure positive resident clinical outcomes.
67.31The commissioner shall ensure that the changes are cost-neutral.

67.32    Sec. 45. REPEALER.
67.33(a) Minnesota Statutes 2010, sections 62J.17, subdivisions 1, 3, 5a, 6a, and 8;
67.3462J.321, subdivision 5a; 62J.381; 62J.41, subdivisions 1 and 2; and 144.1464, are repealed.
68.1(b) Minnesota Statutes 2010, section 145A.14, subdivisions 1 and 2, are repealed
68.2effective January 1, 2012.
68.3(c) Minnesota Rules, parts 4651.0100, subparts 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12,
68.414, 15, 16, 16a, 18, 19, 20, 20a, 21, 22, and 23; 4651.0110, subparts 2, 2a, 3, 4, and 5;
68.54651.0120; 4651.0130; 4651.0140; and 4651.0150, are repealed effective July 1, 2011.

68.6ARTICLE 3

68.7MISCELLANEOUS

68.8    Section 1. Minnesota Statutes 2010, section 3.98, is amended by adding a subdivision
68.9to read:
68.10    Subd. 5. Health note. The commissioner of health, in consultation with other state
68.11agencies, shall develop a report and recommendations for the legislature for a process
68.12through which a health impact review of proposed legislation may be requested by a
68.13legislative committee chair and ranking minority members of the house of representatives
68.14and senate committees with jurisdiction over health and human services finance and policy
68.15issues and added to fiscal notes to estimate the impact of the proposed legislation on
68.16costs of health care for public employees, state health care programs, private employers,
68.17local governments, or Minnesota individuals and families, including costs related to the
68.18impact of the legislation on private insurance premiums and the health status of the state
68.19or a community. The commissioner may consult with local and private public health
68.20organizations and other persons or organizations in the development of the report and
68.21recommendations. The report and recommendations shall be provided to the legislature by
68.22January 15, 2012.

68.23    Sec. 2. Minnesota Statutes 2010, section 245A.14, subdivision 4, is amended to read:
68.24    Subd. 4. Special family day care homes. Nonresidential child care programs
68.25serving 14 or fewer children that are conducted at a location other than the license holder's
68.26own residence shall be licensed under this section and the rules governing family day
68.27care or group family day care if:
68.28(a) the license holder is the primary provider of care and the nonresidential child
68.29care program is conducted in a dwelling that is located on a residential lot;
68.30(b) the license holder is an employer who may or may not be the primary provider
68.31of care, and the purpose for the child care program is to provide child care services to
68.32children of the license holder's employees;
68.33(c) the license holder is a church or religious organization;
69.1(d) the license holder is a community collaborative child care provider. For
69.2purposes of this subdivision, a community collaborative child care provider is a provider
69.3participating in a cooperative agreement with a community action agency as defined in
69.4section 256E.31; or
69.5(e) the license holder is a not-for-profit agency that provides child care in a dwelling
69.6located on a residential lot and the license holder maintains two or more contracts with
69.7community employers or other community organizations to provide child care services.
69.8The county licensing agency may grant a capacity variance to a license holder licensed
69.9under this paragraph to exceed the licensed capacity of 14 children by no more than five
69.10children during transition periods related to the work schedules of parents, if the license
69.11holder meets the following requirements:
69.12(1) the program does not exceed a capacity of 14 children more than a cumulative
69.13total of four hours per day;
69.14(2) the program meets a one to seven staff-to-child ratio during the variance period;
69.15(3) all employees receive at least an extra four hours of training per year than
69.16required in the rules governing family child care each year;
69.17(4) the facility has square footage required per child under Minnesota Rules, part
69.189502.0425;
69.19(5) the program is in compliance with local zoning regulations;
69.20(6) the program is in compliance with the applicable fire code as follows:
69.21(i) if the program serves more than five children older than 2-1/2 years of age,
69.22but no more than five children 2-1/2 years of age or less, the applicable fire code is
69.23educational occupancy, as provided in Group E Occupancy under the Minnesota State
69.24Fire Code 2003, Section 202; or
69.25(ii) if the program serves more than five children 2-1/2 years of age or less, the
69.26applicable fire code is Group I-4 Occupancies, as provided in the Minnesota State Fire
69.27Code 2003, Section 202; and
69.28(7) any age and capacity limitations required by the fire code inspection and square
69.29footage determinations shall be printed on the license.; or
69.30(f) the license holder is the primary provider of care and has located the licensed
69.31child care program in a commercial space, if the license holder meets the following
69.32requirements:
69.33(1) the program is in compliance with local zoning regulations;
69.34(2) the program is in compliance with the applicable fire code as follows:
69.35(i) if the program serves more than five children older than 2-1/2 years of age,
69.36but no more than five children 2-1/2 years of age or less, the applicable fire code is
70.1educational occupancy, as provided in Group E Occupancy under the Minnesota State
70.2Fire Code 2003, Section 202; or
70.3(ii) if the program serves more than five children 2-1/2 years of age or less, the
70.4applicable fire code is Group I-4 Occupancies, as provided under the Minnesota State Fire
70.5Code 2003, Section 202;
70.6(3) any age and capacity limitations required by the fire code inspection and square
70.7footage determinations are printed on the license; and
70.8(4) the license holder prominently displays the license issued by the commissioner
70.9which contains the statement "This special family child care provider is not licensed as a
70.10child care center."

70.11    Sec. 3. Minnesota Statutes 2010, section 256.01, is amended by adding a subdivision
70.12to read:
70.13    Subd. 33. Combined application form; referral of veterans. The commissioner
70.14shall modify the combined application form to add a question asking applicants: "Are
70.15you a United States military veteran?" The commissioner shall ensure that all applicants
70.16who identify themselves as veterans are referred to a county veterans service officer for
70.17assistance in applying to the United States Department of Veterans Affairs for any benefits
70.18for which they may be eligible.

70.19    Sec. 4. Minnesota Statutes 2010, section 256B.04, subdivision 14a, is amended to read:
70.20    Subd. 14a. Level of need determination. Nonemergency medical transportation
70.21level of need determinations must be performed by a physician, a registered nurse working
70.22under direct supervision of a physician, a physician's assistant, a nurse practitioner, a
70.23licensed practical nurse, or a discharge planner.
70.24 Nonemergency medical transportation level of need determinations must not be
70.25performed more than annually on any individual, unless the individual's circumstances
70.26have sufficiently changed so as to require a new level of need determination. No entity
70.27shall charge, and the commissioner shall pay, no more than $25 for performing a level of
70.28need determination regarding any person receiving nonemergency medical transportation,
70.29including special transportation.
70.30Special transportation services to eligible persons who need a stretcher-accessible
70.31vehicle from a hospital are exempt from a level of need determination if the special
70.32transportation services have been ordered by the eligible person's physician, registered
70.33nurse working under direct supervision of a physician, physician's assistant, nurse
70.34practitioner, licensed practical nurse, or discharge planner pursuant to Medicare guidelines.
71.1 Individuals transported to or residing in licensed nursing facilities are exempt from a
71.2level of need determination and are eligible for special transportation services until the
71.3individual no longer resides in a licensed nursing facility. If a person authorized by this
71.4subdivision to perform a level of need determination determines that an individual requires
71.5stretcher transportation, the individual is presumed to maintain that level of need until
71.6otherwise determined by a person authorized to perform a level of need determination, or
71.7for six months, whichever is sooner.

71.8    Sec. 5. Minnesota Statutes 2010, section 256B.0625, subdivision 17, is amended to
71.9read:
71.10    Subd. 17. Transportation costs. (a) Medical assistance covers medical
71.11transportation costs incurred solely for obtaining emergency medical care or transportation
71.12costs incurred by eligible persons in obtaining emergency or nonemergency medical
71.13care when paid directly to an ambulance company, common carrier, or other recognized
71.14providers of transportation services. Medical transportation must be provided by:
71.15(1) an ambulance, as defined in section 144E.001, subdivision 2;
71.16(2) special transportation; or
71.17(3) common carrier including, but not limited to, bus, taxicab, other commercial
71.18carrier, or private automobile.
71.19(b) Medical assistance covers special transportation, as defined in Minnesota Rules,
71.20part 9505.0315, subpart 1, item F, if the recipient has a physical or mental impairment that
71.21would prohibit the recipient from safely accessing and using a bus, taxi, other commercial
71.22transportation, or private automobile.
71.23The commissioner may use an order by the recipient's attending physician to certify that
71.24the recipient requires special transportation services. Special transportation providers
71.25shall perform driver-assisted services for eligible individuals. Driver-assisted service
71.26includes passenger pickup at and return to the individual's residence or place of business,
71.27assistance with admittance of the individual to the medical facility, and assistance in
71.28passenger securement or in securing of wheelchairs or stretchers in the vehicle. Special
71.29transportation providers must obtain written documentation from the health care service
71.30provider who is serving the recipient being transported, identifying the time that the
71.31recipient arrived. Special transportation providers may not bill for separate base rates for
71.32the continuation of a trip beyond the original destination. Special transportation providers
71.33must take recipients to the nearest appropriate health care provider, using the most direct
71.34route as determined by a commercially available mileage software program approved by
72.1the commissioner. The minimum medical assistance reimbursement rates for special
72.2transportation services are:
72.3(1) (i) $17 for the base rate and $1.35 per mile for special transportation services to
72.4eligible persons who need a wheelchair-accessible van;
72.5(ii) $11.50 for the base rate and $1.30 per mile for special transportation services to
72.6eligible persons who do not need a wheelchair-accessible van; and
72.7(iii) $60 for the base rate and $2.40 per mile, and an attendant rate of $9 per trip, for
72.8special transportation services to eligible persons who need a stretcher-accessible vehicle;
72.9(2) the base rates for special transportation services in areas defined under RUCA
72.10to be super rural shall be equal to the reimbursement rate established in clause (1) plus
72.1111.3 percent; and
72.12(3) for special transportation services in areas defined under RUCA to be rural
72.13or super rural areas:
72.14(i) for a trip equal to 17 miles or less, mileage reimbursement shall be equal to 125
72.15percent of the respective mileage rate in clause (1); and
72.16(ii) for a trip between 18 and 50 miles, mileage reimbursement shall be equal to
72.17112.5 percent of the respective mileage rate in clause (1).
72.18(c) For purposes of reimbursement rates for special transportation services under
72.19paragraph (b), the zip code of the recipient's place of residence shall determine whether
72.20the urban, rural, or super rural reimbursement rate applies.
72.21(d) For purposes of this subdivision, "rural urban commuting area" or "RUCA"
72.22means a census-tract based classification system under which a geographical area is
72.23determined to be urban, rural, or super rural.

72.24    Sec. 6. Minnesota Statutes 2010, section 256B.14, is amended by adding a subdivision
72.25to read:
72.26    Subd. 3a. Spousal contribution. (a) For purposes of this subdivision, the following
72.27terms have the meanings given:
72.28(1) "commissioner" means the commissioner of human services;
72.29(2) "community spouse" means the spouse, who lives in the community, of an
72.30individual receiving long-term care services in a long-term care facility or home care
72.31services pursuant to the Medicaid waiver for elderly services under section 256B.0915
72.32or the alternative care program under section 256B.0913. A community spouse does not
72.33include a spouse living in the community who receives a monthly income allowance
72.34under section 256B.058, subdivision 2, or who receives home care services or home
73.1and community-based services under section 256B.0915, 256B.092, or 256B.49, or the
73.2alternative care program under section 256B.0913;
73.3(3) "cost of care" means the actual fee-for-service costs or capitated payments for
73.4the long-term care spouse;
73.5(4) "department" means the Department of Human Services;
73.6(5) "disabled child" means a blind or permanently and totally disabled son or
73.7daughter of any age as defined in the Supplemental Security Income program or the state
73.8medical review team;
73.9(6) "income" means earned and unearned income, attributable to the community
73.10spouse, used to calculate the adjusted gross income on the prior year's income tax return.
73.11Evidence of income includes, but is not limited to, W-2 and 1099 forms; and
73.12(7) "long-term care spouse" means the spouse who is receiving long-term care
73.13services in a long-term care facility or home care services pursuant to the Medicaid
73.14waiver for elderly services under section 256B.0915 or the alternative care program under
73.15section 256B.0913.
73.16(b) The community spouse of a long-term care spouse who receives medical
73.17assistance or alternative care services has an obligation to contribute to the cost of care.
73.18The community spouse must pay a monthly fee on a sliding fee scale based on the
73.19community spouse's income. If a minor or disabled child resides with and receives care
73.20from the community spouse, then no fee shall be assessed.
73.21(c) For a community spouse with an income equal to or greater than 250 percent of
73.22the federal poverty guidelines for a family of two and less than 545 percent of the federal
73.23poverty guidelines for a family of two, the spousal contribution shall be determined using
73.24a sliding fee scale established by the commissioner that begins at 7.5 percent of the
73.25community spouse's income and increases to 15 percent for those with an income of up to
73.26545 percent of the federal poverty guidelines for a family of two.
73.27(d) For a community spouse with an income equal to or greater than 545 percent of
73.28the federal poverty guidelines for a family of two and less than 750 percent of the federal
73.29poverty guidelines for a family of two, the spousal contribution shall be determined using
73.30a sliding fee scale established by the commissioner that begins at 15 percent of the
73.31community spouse's income and increases to 25 percent for those with an income of up to
73.32750 percent of the federal poverty guidelines for a family of two.
73.33(e) For a community spouse with an income equal to or greater than 750 percent of
73.34the federal poverty guidelines for a family of two and less than 975 percent of the federal
73.35poverty guidelines for a family of two, the spousal contribution shall be determined using
73.36a sliding fee scale established by the commissioner that begins at 25 percent of the
74.1community spouse's income and increases to 33 percent for those with an income of up to
74.2975 percent of the federal poverty guidelines for a family of two.
74.3(f) For a community spouse with an income equal to or greater than 975 percent of
74.4the federal poverty guidelines for a family of two, the spousal contribution shall be 33
74.5percent of the community spouse's income.
74.6(g) The spousal contribution shall be explained in writing at the time eligibility
74.7for medical assistance or alternative care is being determined. In addition to explaining
74.8the formula used to determine the fee, the county or tribal agency shall provide written
74.9information describing how to request a variance for undue hardship, how a contribution
74.10may be reviewed or redetermined, the right to appeal a contribution determination, and
74.11that the consequences for not complying with a request to provide information shall be
74.12an assessment against the community spouse for the full cost of care for the long-term
74.13care spouse.
74.14(h) The contribution shall be assessed for each month the long-term care spouse
74.15has a community spouse and is eligible for medical assistance payment of long-term
74.16care services or alternative care.
74.17(i) The spousal contribution shall be reviewed at least once every 12 months and
74.18when there is a loss or gain in income in excess of ten percent. Thirty days prior to a
74.19review or redetermination, written notice must be provided to the community spouse
74.20and must contain the amount the spouse is required to contribute, notice of the right to
74.21redetermination and appeal, and the telephone number of the division at the agency that is
74.22responsible for redetermination and review. If, after review, the contribution amount is to
74.23be adjusted, the county or tribal agency shall mail a written notice to the community spouse
74.2430 days in advance of the effective date of the change in the amount of the contribution.
74.25(1) The spouse shall notify the county or tribal agency within 30 days of a gain or
74.26loss in income in excess of ten percent and provide the agency supporting documentation
74.27to verify the need for redetermination of the fee.
74.28(2) When a spouse requests a review or redetermination of the contribution amount,
74.29a request for information shall be sent to the spouse within ten calendar days after the
74.30county or tribal agency receives the request for review.
74.31(3) No action shall be taken on a review or redetermination until the required
74.32information is received by the county or tribal agency.
74.33(4) The review of the spousal contribution shall be completed within ten days after
74.34the county or tribal agency receives completed information that verifies a loss or gain in
74.35income in excess of ten percent.
75.1(5) An increase in the contribution amount is effective in the month in which the
75.2increase in spousal income occurs.
75.3(6) A decrease in the contribution amount is effective in the month the spouse
75.4verifies the reduction in income, retroactive to no longer than six months.
75.5(j) In no case shall the spousal contribution exceed the amount of medical assistance
75.6expended or the cost of alternative care services for the care of the long-term care spouse.
75.7Annually, upon redetermination, or at termination of eligibility, the total amount of
75.8medical assistance paid or costs of alternative care for the care of the long-term care spouse
75.9and the total amount of the spousal contribution shall be compared. If the total amount
75.10of the spousal contribution exceeds the total amount of medical assistance expended or
75.11cost of alternative care, then the agency shall reimburse the community spouse the excess
75.12amount if the long-term care spouse is no longer receiving services, or apply the excess
75.13amount to the spousal contribution due until the excess amount is exhausted.
75.14(k) A community spouse may request a variance by submitting a written request
75.15and supporting documentation that payment of the calculated contribution would cause
75.16an undue hardship. An undue hardship is defined as the inability to pay the calculated
75.17contribution due to medical expenses incurred by the community spouse. Documentation
75.18must include proof of medical expenses incurred by the community spouse since the last
75.19annual redetermination of the contribution amount that are not reimbursable by any public
75.20or private source, and are a type, regardless of amount, that would be allowable as a
75.21federal tax deduction under the Internal Revenue Code.
75.22(1) A spouse who requests a variance from a notice of an increase in the amount
75.23of spousal contribution shall continue to make monthly payments at the lower amount
75.24pending determination of the variance request. A spouse who requests a variance from
75.25the initial determination shall not be required to make a payment pending determination
75.26of the variance request. Payments made pending outcome of the variance request that
75.27result in overpayment must be returned to the spouse, if the community spouse is no
75.28longer receiving services, or applied to the spousal contribution in the current year. If the
75.29variance is denied, the spouse shall pay the additional amount due from the effective date
75.30of the increase or the total amount due from the effective date of the original notice of
75.31determination of the spousal contribution.
75.32(2) A spouse who is granted a variance shall sign a written agreement in which the
75.33spouse agrees to report to the county or tribal agency any changes in circumstances that
75.34gave rise to the undue hardship variance.
75.35(3) When the county or tribal agency receives a request for a variance, written notice
75.36of a grant or denial of the variance shall be mailed to the spouse within 30 calendar days
76.1after the county or tribal agency receives the financial information required in this clause.
76.2The granting of a variance will necessitate a written agreement between the spouse and the
76.3county or tribal agency with regard to the specific terms of the variance. The variance
76.4will not become effective until the written agreement is signed by the spouse. If the
76.5county or tribal agency denies in whole or in part the request for a variance, the denial
76.6notice shall set forth in writing the reasons for the denial that address the specific hardship
76.7and right to appeal.
76.8(4) If a variance is granted, the term of the variance shall not exceed 12 months
76.9unless otherwise determined by the county or tribal agency.
76.10(5) Undue hardship does not include action taken by a spouse which divested or
76.11diverted income in order to avoid being assessed a spousal contribution.
76.12(l) A spouse aggrieved by an action under this subdivision has the right to appeal
76.13under subdivision 4. If the spouse appeals on or before the effective date of an increase
76.14in the spousal fee, the spouse shall continue to make payments to the county or tribal
76.15agency in the lower amount while the appeal is pending. A spouse appealing an initial
76.16determination of a spousal contribution shall not be required to make monthly payments
76.17pending an appeal decision. Payments made that result in an overpayment shall be
76.18reimbursed to the spouse if the long-term care spouse is no longer receiving services, or
76.19applied to the spousal contribution remaining in the current year. If the commissioner's
76.20determination is affirmed, the community spouse shall pay within 90 calendar days of the
76.21order the total amount due from the effective date of the original notice of determination
76.22of the spousal contribution. The commissioner's order is binding on the spouse and the
76.23agency and shall be implemented subject to section 256.045, subdivision 7. No additional
76.24notice is required to enforce the commissioner's order.
76.25(m) If the county or tribal agency finds that notice of the payment obligation was
76.26given to the community spouse and the spouse was determined to be able to pay, but that
76.27the spouse failed or refused to pay, a cause of action exists against the community spouse
76.28for that portion of medical assistance payment of long-term care services or alternative
76.29care services granted after notice was given to the community spouse. The action may be
76.30brought by the county or tribal agency in the county where assistance was granted for the
76.31assistance together with the costs of disbursements incurred due to the action. In addition
76.32to granting the county or tribal agency a money judgment, the court may, upon a motion or
76.33order to show cause, order continuing contributions by a community spouse found able to
76.34repay the county or tribal agency. The order shall be effective only for the period of time
76.35during which a contribution shall be assessed.
77.1    (n) Counties and tribes are entitled to one-half of the nonfederal share of
77.2contributions made under this section for long-term care spouses on medical assistance
77.3that are directly attributed to county or tribal efforts. Counties and tribes are entitled to
77.425 percent of the contributions made under this section for long-term care spouses on
77.5alternative care directly attributed to county or tribal efforts.

77.6    Sec. 7. Minnesota Statutes 2010, section 326B.175, is amended to read:
77.7326B.175 ELEVATORS, ENTRANCES SEALED.
77.8    Except as provided in section 326B.188, it shall be the duty of the department and
77.9the licensing authority of any municipality which adopts any such ordinance whenever
77.10it finds any such elevator under its jurisdiction in use in violation of any provision of
77.11sections 326B.163 to 326B.178 to seal the entrances of such elevator and attach a notice
77.12forbidding the use of such elevator until the provisions thereof are complied with.

77.13    Sec. 8. [326B.188] COMPLIANCE WITH ELEVATOR CODE CHANGES.
77.14(a) This section applies to code requirements for existing elevators and related
77.15devices under Minnesota Rules, chapter 1307, where the deadline set by law for meeting
77.16the code requirements is January 29, 2012, or later.
77.17(b) If the department or municipality conducting elevator inspections within its
77.18jurisdiction notifies the owner of an existing elevator or related device of the code
77.19requirements before the effective date of this section, the owner may submit a compliance
77.20plan by December 30, 2011. If the department or municipality does not notify the owner
77.21of an existing elevator or related device of the code requirements before the effective
77.22date of this section, the department or municipality shall notify the owner of the code
77.23requirements and permit the owner to submit a compliance plan by December 30, 2011, or
77.24within 60 days after the date of notification, whichever is later.
77.25(c) Any compliance plan submitted under this section must result in compliance with
77.26the code requirements by the later of January 29, 2012, or three years after submission of
77.27the compliance plan. Elevators and related devices that are not in compliance with the
77.28code requirements by the later of January 29, 2012, or three years after the submission of
77.29the compliance plan may be taken out of service as provided in section 326B.175.

77.30    Sec. 9. DEVELOPMENTAL DISABILITY WAIVERED SERVICES.
77.31    Subdivision 1. Purpose. All individuals in the state of Minnesota who are eligible
77.32for developmental disability waivered services are entitled to receive adequate services,
78.1within the limits of available funding, to ensure their basic needs for housing, food, health,
78.2and safety are met.
78.3    Subd. 2. Instructions to commissioner. (a) No later than November 1, 2011,
78.4the commissioner of human services shall convene a workgroup to define the essential
78.5services required to adequately meet the needs of individuals who receive developmental
78.6disability waivered services. The commissioner shall identify the essential services in
78.7each of the following tiers:
78.8(1) tier 1, services and costs associated with safety, food, housing, and health care;
78.9(2) tier 2, services and costs associated with enhancements toward self-sufficiency;
78.10and
78.11(3) tier 3, services and costs associated with quality of life improvements.
78.12(b) The commissioner, or designee, and a representative designated by the counties
78.13shall cochair the workgroup. The workgroup shall consider Tier 1 services to be the most
78.14important and of highest priority for available funds, and may choose to implement a policy
78.15that all waiver-eligible individuals receive Tier 1 services within the limits of available
78.16funding before services from Tier 2 or 3 are offered to waiver-eligible individuals.

78.17    Sec. 10. ANALYSIS OF PROGRAMS AND THEIR EFFECT ON MARRIAGES;
78.18REPORT.
78.19(a) The commissioner of human services shall conduct an analysis of how current
78.20human services programs affect the motivation and capacity of individuals to form and
78.21sustain marriages in which to raise children. Programs to be examined in this marriage
78.22impact analysis may include, but are not limited to, medical assistance, MinnesotaCare,
78.23Minnesota family investment program, child protection, child support enforcement, and
78.24child welfare services.
78.25(b) Before January 1, 2012, the commissioner shall submit a report to the legislature
78.26describing the results of this analysis and outline proposals to improve the ability of
78.27human services programs to help people who are interested in marriage to form and
78.28sustain marriages in which to raise children. The commissioner shall ensure that experts
78.29on marriage are consulted on the process of conducting the analysis and writing the report.

78.30    Sec. 11. LEGISLATIVE APPROVAL FOR FEDERAL FUNDS.
78.31In addition to the requirements of Minnesota Statutes, section 3.3005, the
78.32commissioners of human services and health shall not expend any funding received
78.33through federal grants or subsequent renewal of federal grants without the approval of
79.1three of the four chairs and ranking minority members of the legislative committees with
79.2jurisdiction over health and human services finance.

79.3    Sec. 12. NONEMERGENCY MEDICAL TRANSPORTATION SINGLE
79.4ADMINISTRATIVE STRUCTURE PROPOSAL.
79.5(a) The commissioner of human services shall develop a proposal to create a single
79.6administrative structure for providing nonemergency medical transportation services to
79.7fee-for-service medical assistance recipients. This proposal must consolidate access and
79.8special transportation into one administrative structure with the goal of standardizing
79.9eligibility determination processes, scheduling arrangements, billing procedures, data
79.10collection, and oversight mechanisms in order to enhance coordination, improve
79.11accountability, and lessen confusion.
79.12(b) In developing the proposal, the commissioner shall:
79.13(1) examine the current responsibilities performed by the counties and the
79.14Department of Human Services and consider the shift in costs if these responsibilities are
79.15changed;
79.16(2) identify key performance measures to assess the cost effectiveness of
79.17nonemergency medical transportation statewide, including a process to collect, audit,
79.18and report data;
79.19(3) develop a statewide complaint system for medical assistance recipients using
79.20special transportation;
79.21(4) establish a standardized billing process;
79.22(5) establish a process that provides public input from interested parties before
79.23special transportation eligibility policies are implemented or significantly changed;
79.24(6) establish specific eligibility criteria that include the frequency of eligibility
79.25assessments and the length of time a recipient remains eligible for special transportation;
79.26(7) develop a reimbursement method to compensate volunteers for no-load miles
79.27when transporting recipients to or from health-related appointments; and
79.28(8) establish specific eligibility criteria to maximize the use of public transportation
79.29by recipients who are without a physical, mental, or other impairment that would prohibit
79.30safely accessing and using public transportation.
79.31(c) In developing the proposal, the commissioner shall consult with the
79.32nonemergency medical transportation advisory council established under paragraph (d).
79.33(d) The commissioner shall establish the nonemergency medical transportation
79.34advisory council to assist the commissioner in developing a single administrative structure
80.1for providing nonemergency medical transportation services. The council shall be
80.2comprised of:
80.3(1) one representative each from the departments of human services and
80.4transportation;
80.5(2) one representative each from the following organizations: the Minnesota State
80.6Council on Disability, the Minnesota Consortium for Citizens with Disabilities, ARC of
80.7Minnesota, the Association of Minnesota Counties, the R-80 Medical Transportation
80.8Coalition, the Minnesota Para Transit Association, Legal Aid, the Minnesota Ambulance
80.9Association, the National Alliance on Mental Illness, the Minnesota Transportation
80.10Providers Alliance, and the Minnesota Inter-County Association; and
80.11(3) four members from the house of representatives, two from the majority party
80.12and two from the minority party, appointed by the speaker, and four members from the
80.13senate, two from the majority party and two from the minority party, appointed by the
80.14Subcommittee on Committees of the Committee on Rules and Administration.
80.15The council is governed by Minnesota Statutes, section 15.509, except that members
80.16shall not receive per diems. The commissioner of human services shall fund all costs
80.17related to the council from existing resources.
80.18(e) The commissioner shall submit the proposal and draft legislation necessary for
80.19implementation to the chairs and ranking minority members of the senate and house of
80.20representatives committees or divisions with jurisdiction over health care policy and
80.21finance by January 15, 2012.

80.22    Sec. 13. RECOVERY FROM BROKER.
80.23(a) If deemed appropriate after a review by the Attorney General's office, the
80.24commissioner of human services, in cooperation with the commissioner of management
80.25and budget, shall recover from any broker of nonemergency medical transportation
80.26services all administrative amounts paid in excess of the original agreed upon amount as
80.27stated in any contract or compensation agreement that provided for the total compensation
80.28for administrative services in each state fiscal year to not exceed a specific agreed amount
80.29for fiscal years 2005, 2006, 2007, 2008, 2009, and 2010.
80.30(b) Recoveries under this section shall be based on the findings of the Office of
80.31Legislative Auditor's report on medical nonemergency transportation released in February
80.322011.

81.1ARTICLE 4

81.2HEALTH LICENSING FEES

81.3    Section 1. Minnesota Statutes 2010, section 148.07, subdivision 1, is amended to read:
81.4    Subdivision 1. Renewal fees. All persons practicing chiropractic within this state,
81.5or licensed so to do, shall pay, on or before the date of expiration of their licenses, to the
81.6Board of Chiropractic Examiners a renewal fee set by the board in accordance with section
81.716A.1283, with a penalty set by the board for each month or portion thereof for which a
81.8license fee is in arrears and upon payment of the renewal and upon compliance with all the
81.9rules of the board, shall be entitled to renewal of their license.

81.10    Sec. 2. Minnesota Statutes 2010, section 148.108, is amended by adding a subdivision
81.11to read:
81.12    Subd. 4. Animal chiropractic. (a) Animal chiropractic registration fee is $125.
81.13(b) Animal chiropractic registration renewal fee is $75.
81.14(c) Animal chiropractic inactive renewal fee is $25.

81.15    Sec. 3. Minnesota Statutes 2010, section 148.191, subdivision 2, is amended to read:
81.16    Subd. 2. Powers. (a) The board is authorized to adopt and, from time to time, revise
81.17rules not inconsistent with the law, as may be necessary to enable it to carry into effect the
81.18provisions of sections 148.171 to 148.285. The board shall prescribe by rule curricula
81.19and standards for schools and courses preparing persons for licensure under sections
81.20148.171 to 148.285. It shall conduct or provide for surveys of such schools and courses
81.21at such times as it may deem necessary. It shall approve such schools and courses as
81.22meet the requirements of sections 148.171 to 148.285 and board rules. It shall examine,
81.23license, and renew the license of duly qualified applicants. It shall hold examinations
81.24at least once in each year at such time and place as it may determine. It shall by rule
81.25adopt, evaluate, and periodically revise, as necessary, requirements for licensure and for
81.26registration and renewal of registration as defined in section 148.231. It shall maintain a
81.27record of all persons licensed by the board to practice professional or practical nursing and
81.28all registered nurses who hold Minnesota licensure and registration and are certified as
81.29advanced practice registered nurses. It shall cause the prosecution of all persons violating
81.30sections 148.171 to 148.285 and have power to incur such necessary expense therefor.
81.31It shall register public health nurses who meet educational and other requirements
81.32established by the board by rule, including payment of a fee. Prior to the adoption of rules,
81.33the board shall use the same procedures used by the Department of Health to certify public
82.1health nurses. It shall have power to issue subpoenas, and to compel the attendance of
82.2witnesses and the production of all necessary documents and other evidentiary material.
82.3Any board member may administer oaths to witnesses, or take their affirmation. It shall
82.4keep a record of all its proceedings.
82.5(b) The board shall have access to hospital, nursing home, and other medical records
82.6of a patient cared for by a nurse under review. If the board does not have a written consent
82.7from a patient permitting access to the patient's records, the nurse or facility shall delete
82.8any data in the record that identifies the patient before providing it to the board. The board
82.9shall have access to such other records as reasonably requested by the board to assist the
82.10board in its investigation. Nothing herein may be construed to allow access to any records
82.11protected by section 145.64. The board shall maintain any records obtained pursuant to
82.12this paragraph as investigative data under chapter 13.
82.13(c) The board may accept and expend grants or gifts of money or in-kind services
82.14from a person, a public or private entity, or any other source for purposes consistent with
82.15the board's role and within the scope of its statutory authority.
82.16(d) The board may accept registration fees for meetings and conferences conducted
82.17for the purposes of board activities that are within the scope of its authority.

82.18    Sec. 4. Minnesota Statutes 2010, section 148.212, subdivision 1, is amended to read:
82.19    Subdivision 1. Issuance. Upon receipt of the applicable licensure or reregistration
82.20fee and permit fee, and in accordance with rules of the board, the board may issue
82.21a nonrenewable temporary permit to practice professional or practical nursing to an
82.22applicant for licensure or reregistration who is not the subject of a pending investigation
82.23or disciplinary action, nor disqualified for any other reason, under the following
82.24circumstances:
82.25(a) The applicant for licensure by examination under section 148.211, subdivision
82.261 , has graduated from an approved nursing program within the 60 days preceding board
82.27receipt of an affidavit of graduation or transcript and has been authorized by the board to
82.28write the licensure examination for the first time in the United States. The permit holder
82.29must practice professional or practical nursing under the direct supervision of a registered
82.30nurse. The permit is valid from the date of issue until the date the board takes action on
82.31the application or for 60 days whichever occurs first.
82.32(b) The applicant for licensure by endorsement under section 148.211, subdivision 2,
82.33is currently licensed to practice professional or practical nursing in another state, territory,
82.34or Canadian province. The permit is valid from submission of a proper request until the
82.35date of board action on the application or for 60 days, whichever comes first.
83.1(c) (b) The applicant for licensure by endorsement under section 148.211,
83.2subdivision 2 , or for reregistration under section 148.231, subdivision 5, is currently
83.3registered in a formal, structured refresher course or its equivalent for nurses that includes
83.4clinical practice.
83.5(d) The applicant for licensure by examination under section 148.211, subdivision
83.61 , who graduated from a nursing program in a country other than the United States or
83.7Canada has completed all requirements for licensure except registering for and taking the
83.8nurse licensure examination for the first time in the United States. The permit holder must
83.9practice professional nursing under the direct supervision of a registered nurse. The permit
83.10is valid from the date of issue until the date the board takes action on the application or for
83.1160 days, whichever occurs first.

83.12    Sec. 5. Minnesota Statutes 2010, section 148.231, is amended to read:
83.13148.231 REGISTRATION; FAILURE TO REGISTER; REREGISTRATION;
83.14VERIFICATION.
83.15    Subdivision 1. Registration. Every person licensed to practice professional or
83.16practical nursing must maintain with the board a current registration for practice as a
83.17registered nurse or licensed practical nurse which must be renewed at regular intervals
83.18established by the board by rule. No certificate of registration shall be issued by the board
83.19to a nurse until the nurse has submitted satisfactory evidence of compliance with the
83.20procedures and minimum requirements established by the board.
83.21The fee for periodic registration for practice as a nurse shall be determined by the
83.22board by rule law. A penalty fee shall be added for any application received after the
83.23required date as specified by the board by rule. Upon receipt of the application and the
83.24required fees, the board shall verify the application and the evidence of completion of
83.25continuing education requirements in effect, and thereupon issue to the nurse a certificate
83.26of registration for the next renewal period.
83.27    Subd. 4. Failure to register. Any person licensed under the provisions of sections
83.28148.171 to 148.285 who fails to register within the required period shall not be entitled to
83.29practice nursing in this state as a registered nurse or licensed practical nurse.
83.30    Subd. 5. Reregistration. A person whose registration has lapsed desiring to
83.31resume practice shall make application for reregistration, submit satisfactory evidence of
83.32compliance with the procedures and requirements established by the board, and pay the
83.33registration reregistration fee for the current period to the board. A penalty fee shall be
83.34required from a person who practiced nursing without current registration. Thereupon, the
84.1registration certificate shall be issued to the person who shall immediately be placed on
84.2the practicing list as a registered nurse or licensed practical nurse.
84.3    Subd. 6. Verification. A person licensed under the provisions of sections 148.171 to
84.4148.285 who requests the board to verify a Minnesota license to another state, territory,
84.5or country or to an agency, facility, school, or institution shall pay a fee to the board
84.6for each verification.

84.7    Sec. 6. [148.242] FEES.
84.8The fees specified in section 148.243 are nonrefundable and must be deposited in
84.9the state government special revenue fund.

84.10    Sec. 7. [148.243] FEE AMOUNTS.
84.11    Subdivision 1. Licensure by examination. The fee for licensure by examination is
84.12$105.
84.13    Subd. 2. Reexamination fee. The reexamination fee is $60.
84.14    Subd. 3. Licensure by endorsement. The fee for licensure by endorsement is $105.
84.15    Subd. 4. Registration renewal. The fee for registration renewal is $85.
84.16    Subd. 5. Reregistration. The fee for reregistration is $105.
84.17    Subd. 6. Replacement license. The fee for a replacement license is $20.
84.18    Subd. 7. Public health nurse certification. The fee for public health nurse
84.19certification is $30.
84.20    Subd. 8. Drug Enforcement Administration verification for Advanced Practice
84.21Registered Nurse (APRN). The Drug Enforcement Administration verification for
84.22APRN is $50.
84.23    Subd. 9. Licensure verification other than through Nursys. The fee for
84.24verification of licensure status other than through Nursys verification is $20.
84.25    Subd. 10. Verification of examination scores. The fee for verification of
84.26examination scores is $20.
84.27    Subd. 11. Microfilmed licensure application materials. The fee for a copy of
84.28microfilmed licensure application materials is $20.
84.29    Subd. 12. Nursing business registration; initial application. The fee for the initial
84.30application for nursing business registration is $100.
84.31    Subd. 13. Nursing business registration; annual application. The fee for the
84.32annual application for nursing business registration is $25.
84.33    Subd. 14. Practicing without current registration. The fee for practicing without
84.34current registration is two times the amount of the current registration renewal fee for any
85.1part of the first calendar month, plus the current registration renewal fee for any part of
85.2any subsequent month up to 24 months.
85.3    Subd. 15. Practicing without current APRN certification. The fee for practicing
85.4without current APRN certification is $200 for the first month or any part thereof, plus
85.5$100 for each subsequent month or part thereof.
85.6    Subd. 16. Dishonored check fee. The service fee for a dishonored check is as
85.7provided in section 604.113.
85.8    Subd. 17. Border state registry fee. The initial application fee for border state
85.9registration is $50. Any subsequent notice of employment change to remain or be
85.10reinstated on the registry is $50.

85.11    Sec. 8. Minnesota Statutes 2010, section 148B.17, is amended to read:
85.12148B.17 FEES.
85.13    Subdivision. 1. Fees; Board of Marriage and Family Therapy. Each board shall
85.14by rule establish The board's fees, including late fees, for licenses and renewals are
85.15established so that the total fees collected by the board will as closely as possible equal
85.16anticipated expenditures during the fiscal biennium, as provided in section 16A.1285.
85.17Fees must be credited to accounts the board's account in the state government special
85.18revenue fund.
85.19    Subd. 2. Licensure and application fees. Nonrefundable licensure and application
85.20fees charged by the board are as follows:
85.21(1) application fee for national examination is $220;
85.22(2) application fee for Licensed Marriage and Family Therapist (LMFT) state
85.23examination is $110;
85.24(3) initial LMFT license fee is prorated, but cannot exceed $125;
85.25(4) annual renewal fee for LMFT license is $125;
85.26(5) late fee for initial Licensed Associate Marriage and Family Therapist LAMFT
85.27license renewal is $50;
85.28(6) application fee for LMFT licensure by reciprocity is $340;
85.29(7) fee for initial Licensed Associate Marriage and Family Therapist (LAMFT)
85.30license is $75;
85.31(8) annual renewal fee for LAMFT license is $75;
85.32(9) late fee for LAMFT renewal is $50;
85.33(10) fee for reinstatement of license is $150; and
85.34(11) fee for emeritus status is $125.
85.35    Subd. 3. Other fees. Other fees charged by the board are as follows:
86.1(1) sponsor application fee for approval of a continuing education course is $60;
86.2(2) fee for license verification by mail is $10;
86.3(3) duplicate license fee is $25;
86.4(4) duplicate renewal card fee is $10;
86.5(5) fee for licensee mailing list is $60;
86.6(6) fee for a rule book is $10; and
86.7(7) fees as authorized by section 148B.175, subdivision 6, clause (7).

86.8    Sec. 9. Minnesota Statutes 2010, section 148B.33, subdivision 2, is amended to read:
86.9    Subd. 2. Fee. Each applicant shall pay a nonrefundable application fee set by
86.10the board under section 148B.17.

86.11    Sec. 10. Minnesota Statutes 2010, section 148B.52, is amended to read:
86.12148B.52 DUTIES OF THE BOARD.
86.13(a) The Board of Behavioral Health and Therapy shall:
86.14(1) establish by rule appropriate techniques, including examinations and other
86.15methods, for determining whether applicants and licensees are qualified under sections
86.16148B.50 to 148B.593;
86.17(2) establish by rule standards for professional conduct, including adoption of a
86.18Code of Professional Ethics and requirements for continuing education and supervision;
86.19(3) issue licenses to individuals qualified under sections 148B.50 to 148B.593;
86.20(4) establish by rule standards for initial education including coursework for
86.21licensure and content of professional education;
86.22(5) establish, maintain, and publish annually a register of current licensees and
86.23approved supervisors;
86.24(6) establish initial and renewal application and examination fees sufficient to cover
86.25operating expenses of the board and its agents in accordance with section 16A.1283;
86.26(7) educate the public about the existence and content of the laws and rules for
86.27licensed professional counselors to enable consumers to file complaints against licensees
86.28who may have violated the rules; and
86.29(8) periodically evaluate its rules in order to refine the standards for licensing
86.30professional counselors and to improve the methods used to enforce the board's standards.
86.31(b) The board may appoint a professional discipline committee for each occupational
86.32licensure regulated by the board, and may appoint a board member as chair. The
86.33professional discipline committee shall consist of five members representative of the
87.1licensed occupation and shall provide recommendations to the board with regard to rule
87.2techniques, standards, procedures, and related issues specific to the licensed occupation.

87.3    Sec. 11. Minnesota Statutes 2010, section 150A.091, subdivision 2, is amended to read:
87.4    Subd. 2. Application fees. Each applicant shall submit with a license, advanced
87.5dental therapist certificate, or permit application a nonrefundable fee in the following
87.6amounts in order to administratively process an application:
87.7(1) dentist, $140;
87.8(2) full faculty dentist, $140;
87.9(2) (3) limited faculty dentist, $140;
87.10(3) (4) resident dentist or dental provider, $55;
87.11(5) advanced dental therapist, $100;
87.12(4) (6) dental therapist, $100;
87.13(5) (7) dental hygienist, $55;
87.14(6) (8) licensed dental assistant, $55; and
87.15(7) (9) dental assistant with a permit as described in Minnesota Rules, part
87.163100.8500, subpart 3, $15.

87.17    Sec. 12. Minnesota Statutes 2010, section 150A.091, subdivision 3, is amended to read:
87.18    Subd. 3. Initial license or permit fees. Along with the application fee, each of the
87.19following applicants shall submit a separate prorated initial license or permit fee. The
87.20prorated initial fee shall be established by the board based on the number of months of the
87.21applicant's initial term as described in Minnesota Rules, part 3100.1700, subpart 1a, not to
87.22exceed the following monthly fee amounts:
87.23(1) dentist or full faculty dentist, $14 times the number of months of the initial term;
87.24(2) dental therapist, $10 times the number of months of the initial term;
87.25(3) dental hygienist, $5 times the number of months of the initial term;
87.26(4) licensed dental assistant, $3 times the number of months of the initial term; and
87.27(5) dental assistant with a permit as described in Minnesota Rules, part 3100.8500,
87.28subpart 3, $1 times the number of months of the initial term.

87.29    Sec. 13. Minnesota Statutes 2010, section 150A.091, subdivision 4, is amended to read:
87.30    Subd. 4. Annual license fees. Each limited faculty or resident dentist shall submit
87.31with an annual license renewal application a fee established by the board not to exceed
87.32the following amounts:
87.33(1) limited faculty dentist, $168; and
88.1(2) resident dentist or dental provider, $59.

88.2    Sec. 14. Minnesota Statutes 2010, section 150A.091, subdivision 5, is amended to read:
88.3    Subd. 5. Biennial license or permit fees. Each of the following applicants shall
88.4submit with a biennial license or permit renewal application a fee as established by the
88.5board, not to exceed the following amounts:
88.6(1) dentist or full faculty dentist, $336;
88.7(2) dental therapist, $180;
88.8(3) dental hygienist, $118;
88.9(4) licensed dental assistant, $80; and
88.10(5) dental assistant with a permit as described in Minnesota Rules, part 3100.8500,
88.11subpart 3, $24.

88.12    Sec. 15. Minnesota Statutes 2010, section 150A.091, subdivision 8, is amended to read:
88.13    Subd. 8. Duplicate license or certificate fee. Each applicant shall submit, with
88.14a request for issuance of a duplicate of the original license, or of an annual or biennial
88.15renewal certificate for a license or permit, a fee in the following amounts:
88.16(1) original dentist, full faculty dentist, dental therapist, dental hygiene, or dental
88.17assistant license, $35; and
88.18(2) annual or biennial renewal certificates, $10.

88.19    Sec. 16. Minnesota Statutes 2010, section 150A.091, is amended by adding a
88.20subdivision to read:
88.21    Subd. 16. Failure of professional development portfolio audit. A licensee shall
88.22submit a fee as established by the board not to exceed the amount of $250 after failing
88.23two consecutive professional development portfolio audits and, thereafter, for each failed
88.24professional development portfolio audit under Minnesota Rules, part 3100.5300.

88.25    Sec. 17. [151.065] FEE AMOUNTS.
88.26    Subdivision 1. Application fees. Application fees for licensure and registration
88.27are as follows:
88.28(1) pharmacist licensed by examination, $130;
88.29(2) pharmacist licensed by reciprocity, $225;
88.30(3) pharmacy intern, $30;
88.31(4) pharmacy technician, $30;
88.32(5) pharmacy, $190;
89.1(6) drug wholesaler, legend drugs only, $200;
89.2(7) drug wholesaler, legend and nonlegend drugs, $200;
89.3(8) drug wholesaler, nonlegend drugs, veterinary legend drugs, or both, $175;
89.4(9) drug wholesaler, medical gases, $150;
89.5(10) drug wholesaler, also licensed as a pharmacy in Minnesota, $125;
89.6(11) drug manufacturer, legend drugs only, $200;
89.7(12) drug manufacturer, legend and nonlegend drugs, $200;
89.8(13) drug manufacturer, nonlegend or veterinary legend drugs, $175;
89.9(14) drug manufacturer, medical gases, $150;
89.10(15) drug manufacturer, also licensed as a pharmacy in Minnesota, $125;
89.11(16) medical gas distributor, $75;
89.12(17) controlled substance researcher, $50; and
89.13(18) pharmacy professional corporation, $100.
89.14    Subd. 2. Original license fee. The pharmacist original licensure fee, $130.
89.15    Subd. 3. Annual renewal fees. Annual licensure and registration renewal fees
89.16are as follows:
89.17(1) pharmacist, $130;
89.18(2) pharmacy technician, $30;
89.19(3) pharmacy, $190;
89.20(4) drug wholesaler, legend drugs only, $200;
89.21(5) drug wholesaler, legend and nonlegend drugs, $200;
89.22(6) drug wholesaler, nonlegend drugs, veterinary legend drugs, or both, $175;
89.23(7) drug wholesaler, medical gases, $150;
89.24(8) drug wholesaler, also licensed as a pharmacy in Minnesota, $125;
89.25(9) drug manufacturer, legend drugs only, $200;
89.26(10) drug manufacturer, legend and nonlegend drugs, $200;
89.27(11) drug manufacturer, nonlegend, veterinary legend drugs, or both, $175;
89.28(12) drug manufacturer, medical gases, $150;
89.29(13) drug manufacturer, also licensed as a pharmacy in Minnesota, $125;
89.30(14) medical gas distributor, $75;
89.31(15) controlled substance researcher, $50; and
89.32(16) pharmacy professional corporation, $45.
89.33    Subd. 4. Miscellaneous fees. Fees for issuance of affidavits and duplicate licenses
89.34and certificates are as follows:
89.35(1) intern affidavit, $15;
89.36(2) duplicate small license, $15; and
90.1(3) duplicate large certificate, $25.
90.2    Subd. 5. Late fees. All annual renewal fees are subject to a 50 percent late fee if
90.3the renewal fee and application are not received by the board prior to the date specified
90.4by the board.
90.5    Subd. 6. Reinstatement fees. (a) A pharmacist who has allowed the pharmacist's
90.6license to lapse may reinstate the license with board approval and upon payment of any
90.7fees and late fees in arrears, up to a maximum of $1,000.
90.8(b) A pharmacy technician who has allowed the technician's registration to lapse
90.9may reinstate the registration with board approval and upon payment of any fees and late
90.10fees in arrears, up to a maximum of $90.
90.11(c) An owner of a pharmacy, a drug wholesaler, a drug manufacturer, or a medical
90.12gas distributor who has allowed the license of the establishment to lapse may reinstate the
90.13license with board approval and upon payment of any fees and late fees in arrears.
90.14(d) A controlled substance researcher who has allowed the researcher's registration
90.15to lapse may reinstate the registration with board approval and upon payment of any fees
90.16and late fees in arrears.
90.17(e) A pharmacist owner of a professional corporation who has allowed the
90.18corporation's registration to lapse may reinstate the registration with board approval and
90.19upon payment of any fees and late fees in arrears.

90.20    Sec. 18. Minnesota Statutes 2010, section 151.07, is amended to read:
90.21151.07 MEETINGS; EXAMINATION FEE.
90.22The board shall meet at times as may be necessary and as it may determine to
90.23examine applicants for licensure and to transact its other business, giving reasonable
90.24notice of all examinations by mail to known applicants therefor. The secretary shall record
90.25the names of all persons licensed by the board, together with the grounds upon which
90.26the right of each to licensure was claimed. The fee for examination shall be in such the
90.27 amount as the board may determine specified in section 151.065, which fee may in the
90.28discretion of the board be returned to applicants not taking the examination.

90.29    Sec. 19. Minnesota Statutes 2010, section 151.101, is amended to read:
90.30151.101 INTERNSHIP.
90.31Upon payment of the fee specified in section 151.065, the board may license register
90.32as an intern any natural persons who have satisfied the board that they are of good moral
90.33character, not physically or mentally unfit, and who have successfully completed the
90.34educational requirements for intern licensure registration prescribed by the board. The
91.1board shall prescribe standards and requirements for interns, pharmacist-preceptors, and
91.2internship training but may not require more than one year of such training.
91.3The board in its discretion may accept internship experience obtained in another
91.4state provided the internship requirements in such other state are in the opinion of the
91.5board equivalent to those herein provided.

91.6    Sec. 20. Minnesota Statutes 2010, section 151.102, is amended by adding a subdivision
91.7to read:
91.8    Subd. 3. Registration fee. The board shall not register an individual as a pharmacy
91.9technician unless all applicable fees specified in section 151.065 have been paid.

91.10    Sec. 21. Minnesota Statutes 2010, section 151.12, is amended to read:
91.11151.12 RECIPROCITY; LICENSURE.
91.12The board may in its discretion grant licensure without examination to any
91.13pharmacist licensed by the Board of Pharmacy or a similar board of another state which
91.14accords similar recognition to licensees of this state; provided, the requirements for
91.15licensure in such other state are in the opinion of the board equivalent to those herein
91.16provided. The fee for licensure shall be in such the amount as the board may determine by
91.17rule specified in section 151.065.

91.18    Sec. 22. Minnesota Statutes 2010, section 151.13, subdivision 1, is amended to read:
91.19    Subdivision 1. Renewal fee. Every person licensed by the board as a pharmacist
91.20shall pay to the board a the annual renewal fee to be fixed by it specified in section
91.21151.065. The board may promulgate by rule a charge to be assessed for the delinquent
91.22payment of a fee. the late fee specified in section 151.065 if the renewal fee and
91.23application are not received by the board prior to the date specified by the board. It shall
91.24be unlawful for any person licensed as a pharmacist who refuses or fails to pay such any
91.25applicable renewal or late fee to practice pharmacy in this state. Every certificate and
91.26license shall expire at the time therein prescribed.

91.27    Sec. 23. Minnesota Statutes 2010, section 151.19, is amended to read:
91.28151.19 REGISTRATION; FEES.
91.29    Subdivision 1. Pharmacy registration. The board shall require and provide for the
91.30annual registration of every pharmacy now or hereafter doing business within this state.
91.31Upon the payment of a any applicable fee to be set by the board specified in section
91.32151.065, the board shall issue a registration certificate in such form as it may prescribe to
92.1such persons as may be qualified by law to conduct a pharmacy. Such certificate shall be
92.2displayed in a conspicuous place in the pharmacy for which it is issued and expire on the
92.330th day of June following the date of issue. It shall be unlawful for any person to conduct
92.4a pharmacy unless such certificate has been issued to the person by the board.
92.5    Subd. 2. Nonresident pharmacies. The board shall require and provide for an
92.6annual nonresident special pharmacy registration for all pharmacies located outside of this
92.7state that regularly dispense medications for Minnesota residents and mail, ship, or deliver
92.8prescription medications into this state. Nonresident special pharmacy registration shall
92.9be granted by the board upon payment of any applicable fee specified in section 151.065
92.10and the disclosure and certification by a pharmacy:
92.11    (1) that it is licensed in the state in which the dispensing facility is located and from
92.12which the drugs are dispensed;
92.13    (2) the location, names, and titles of all principal corporate officers and all
92.14pharmacists who are dispensing drugs to residents of this state;
92.15    (3) that it complies with all lawful directions and requests for information from
92.16the Board of Pharmacy of all states in which it is licensed or registered, except that it
92.17shall respond directly to all communications from the board concerning emergency
92.18circumstances arising from the dispensing of drugs to residents of this state;
92.19    (4) that it maintains its records of drugs dispensed to residents of this state so that the
92.20records are readily retrievable from the records of other drugs dispensed;
92.21    (5) that it cooperates with the board in providing information to the Board of
92.22Pharmacy of the state in which it is licensed concerning matters related to the dispensing
92.23of drugs to residents of this state;
92.24    (6) that during its regular hours of operation, but not less than six days per week, for
92.25a minimum of 40 hours per week, a toll-free telephone service is provided to facilitate
92.26communication between patients in this state and a pharmacist at the pharmacy who has
92.27access to the patients' records; the toll-free number must be disclosed on the label affixed
92.28to each container of drugs dispensed to residents of this state; and
92.29    (7) that, upon request of a resident of a long-term care facility located within the
92.30state of Minnesota, the resident's authorized representative, or a contract pharmacy or
92.31licensed health care facility acting on behalf of the resident, the pharmacy will dispense
92.32medications prescribed for the resident in unit-dose packaging or, alternatively, comply
92.33with the provisions of section 151.415, subdivision 5.
92.34    Subd. 3. Sale of federally restricted medical gases. The board shall require and
92.35provide for the annual registration of every person or establishment not licensed as a
92.36pharmacy or a practitioner engaged in the retail sale or distribution of federally restricted
93.1medical gases. Upon the payment of a any applicable fee to be set by the board specified
93.2in section 151.065, the board shall issue a registration certificate in such form as it may
93.3prescribe to those persons or places that may be qualified to sell or distribute federally
93.4restricted medical gases. The certificate shall be displayed in a conspicuous place in the
93.5business for which it is issued and expire on the date set by the board. It is unlawful for
93.6a person to sell or distribute federally restricted medical gases unless a certificate has
93.7been issued to that person by the board.

93.8    Sec. 24. Minnesota Statutes 2010, section 151.25, is amended to read:
93.9151.25 REGISTRATION OF MANUFACTURERS; FEE; PROHIBITIONS.
93.10The board shall require and provide for the annual registration of every person
93.11engaged in manufacturing drugs, medicines, chemicals, or poisons for medicinal purposes,
93.12now or hereafter doing business with accounts in this state. Upon a payment of a any
93.13applicable fee as set by the board specified in section 151.065, the board shall issue a
93.14registration certificate in such form as it may prescribe to such manufacturer. Such
93.15registration certificate shall be displayed in a conspicuous place in such manufacturer's
93.16or wholesaler's place of business for which it is issued and expire on the date set by the
93.17board. It shall be unlawful for any person to manufacture drugs, medicines, chemicals,
93.18or poisons for medicinal purposes unless such a certificate has been issued to the person
93.19by the board. It shall be unlawful for any person engaged in the manufacture of drugs,
93.20medicines, chemicals, or poisons for medicinal purposes, or the person's agent, to sell
93.21legend drugs to other than a pharmacy, except as provided in this chapter.

93.22    Sec. 25. Minnesota Statutes 2010, section 151.47, subdivision 1, is amended to read:
93.23    Subdivision 1. Requirements. All wholesale drug distributors are subject to the
93.24requirements in paragraphs (a) to (f).
93.25(a) No person or distribution outlet shall act as a wholesale drug distributor without
93.26first obtaining a license from the board and paying the required any applicable fee
93.27specified in section 151.065.
93.28(b) No license shall be issued or renewed for a wholesale drug distributor to operate
93.29unless the applicant agrees to operate in a manner prescribed by federal and state law and
93.30according to the rules adopted by the board.
93.31(c) The board may require a separate license for each facility directly or indirectly
93.32owned or operated by the same business entity within the state, or for a parent entity
93.33with divisions, subsidiaries, or affiliate companies within the state, when operations
94.1are conducted at more than one location and joint ownership and control exists among
94.2all the entities.
94.3(d) As a condition for receiving and retaining a wholesale drug distributor license
94.4issued under sections 151.42 to 151.51, an applicant shall satisfy the board that it has
94.5and will continuously maintain:
94.6(1) adequate storage conditions and facilities;
94.7(2) minimum liability and other insurance as may be required under any applicable
94.8federal or state law;
94.9(3) a viable security system that includes an after hours central alarm, or comparable
94.10entry detection capability; restricted access to the premises; comprehensive employment
94.11applicant screening; and safeguards against all forms of employee theft;
94.12(4) a system of records describing all wholesale drug distributor activities set forth
94.13in section 151.44 for at least the most recent two-year period, which shall be reasonably
94.14accessible as defined by board regulations in any inspection authorized by the board;
94.15(5) principals and persons, including officers, directors, primary shareholders,
94.16and key management executives, who must at all times demonstrate and maintain their
94.17capability of conducting business in conformity with sound financial practices as well
94.18as state and federal law;
94.19(6) complete, updated information, to be provided to the board as a condition for
94.20obtaining and retaining a license, about each wholesale drug distributor to be licensed,
94.21including all pertinent corporate licensee information, if applicable, or other ownership,
94.22principal, key personnel, and facilities information found to be necessary by the board;
94.23(7) written policies and procedures that assure reasonable wholesale drug distributor
94.24preparation for, protection against, and handling of any facility security or operation
94.25problems, including, but not limited to, those caused by natural disaster or government
94.26emergency, inventory inaccuracies or product shipping and receiving, outdated product
94.27or other unauthorized product control, appropriate disposition of returned goods, and
94.28product recalls;
94.29(8) sufficient inspection procedures for all incoming and outgoing product
94.30shipments; and
94.31(9) operations in compliance with all federal requirements applicable to wholesale
94.32drug distribution.
94.33(e) An agent or employee of any licensed wholesale drug distributor need not seek
94.34licensure under this section.
94.35(f) A wholesale drug distributor shall file with the board an annual report, in a
94.36form and on the date prescribed by the board, identifying all payments, honoraria,
95.1reimbursement or other compensation authorized under section 151.461, clauses (3) to
95.2(5), paid to practitioners in Minnesota during the preceding calendar year. The report
95.3shall identify the nature and value of any payments totaling $100 or more, to a particular
95.4practitioner during the year, and shall identify the practitioner. Reports filed under this
95.5provision are public data.

95.6    Sec. 26. Minnesota Statutes 2010, section 151.48, is amended to read:
95.7151.48 OUT-OF-STATE WHOLESALE DRUG DISTRIBUTOR LICENSING.
95.8(a) It is unlawful for an out-of-state wholesale drug distributor to conduct business
95.9in the state without first obtaining a license from the board and paying the required any
95.10applicable fee specified in section 151.065.
95.11(b) Application for an out-of-state wholesale drug distributor license under this
95.12section shall be made on a form furnished by the board.
95.13(c) No person acting as principal or agent for any out-of-state wholesale drug
95.14distributor may sell or distribute drugs in the state unless the distributor has obtained
95.15a license.
95.16(d) The board may adopt regulations that permit out-of-state wholesale drug
95.17distributors to obtain a license on the basis of reciprocity to the extent that an out-of-state
95.18wholesale drug distributor:
95.19(1) possesses a valid license granted by another state under legal standards
95.20comparable to those that must be met by a wholesale drug distributor of this state as
95.21prerequisites for obtaining a license under the laws of this state; and
95.22(2) can show that the other state would extend reciprocal treatment under its own
95.23laws to a wholesale drug distributor of this state.

95.24    Sec. 27. Minnesota Statutes 2010, section 152.12, subdivision 3, is amended to read:
95.25    Subd. 3. Research project use of controlled substances. Any qualified person
95.26may use controlled substances in the course of a bona fide research project but cannot
95.27administer or dispense such drugs to human beings unless such drugs are prescribed,
95.28dispensed and administered by a person lawfully authorized to do so. Every person
95.29who engages in research involving the use of such substances shall apply annually for
95.30registration by the state Board of Pharmacy and shall pay any applicable fee specified in
95.31section 151.065, provided that such registration shall not be required if the person is
95.32covered by and has complied with federal laws covering such research projects.

96.1ARTICLE 5

96.2HEALTH CARE

96.3    Section 1. [1.06] FREEDOM OF CHOICE IN HEALTH CARE ACT.
96.4    Subdivision 1. Citation. This section shall be known as and may be cited as the
96.5"Freedom of Choice in Health Care Act."
96.6    Subd. 2. Definitions. (a) For purposes of this section, the following terms have
96.7the meanings given them.
96.8(b) "Health care service" means any service, treatment, or provision of a product for
96.9the care of a physical or mental disease, illness, injury, defect, or condition, or to otherwise
96.10maintain or improve physical or mental health, subject to all laws and rules regulating
96.11health service providers and products within the state of Minnesota.
96.12(c) "Mode of securing" means to purchase directly or on credit or by trade, or to
96.13contract for third-party payment by insurance or other legal means as authorized by the
96.14state of Minnesota, or to apply for or accept employer-sponsored or government-sponsored
96.15health care benefits under such conditions as may legally be required as a condition of
96.16such benefits, or any combination of the same.
96.17(d) "Penalty" means any civil or criminal fine, tax, salary or wage withholding,
96.18surcharge, fee, or any other imposed consequence established by law or rule of a
96.19government or its subdivision or agency that is used to punish or discourage the exercise
96.20of rights protected under this section.
96.21    Subd. 3. Statement of public policy. (a) The power to require or regulate a person's
96.22choice in the mode of securing health care services, or to impose a penalty related to that
96.23choice, is not found in the Constitution of the United States of America, and is therefore a
96.24power reserved to the people pursuant to the Ninth Amendment, and to the several states
96.25pursuant to the Tenth Amendment. The state of Minnesota hereby exercises its sovereign
96.26power to declare the public policy of the state of Minnesota regarding the right of all
96.27persons residing in the state in choosing the mode of securing health care services.
96.28(b) It is hereby declared that the public policy of the state of Minnesota, consistent
96.29with our constitutionally recognized and inalienable rights of liberty, is that every person
96.30within the state of Minnesota is and shall be free to choose or decline to choose any mode
96.31of securing health care services without penalty or threat of penalty.
96.32(c) The policy stated under this section shall not be applied to impair any right of
96.33contract related to the provision of health care services to any person or group.
96.34    Subd. 4. Enforcement. Upon penalty of suspension or revocation of any applicable
96.35license, no public official, employee, officer of the court, or agent of the state of
97.1Minnesota, or any branch or political subdivision thereof, shall act to impose, collect,
97.2enforce, or effectuate any penalty in the state of Minnesota that violates the public policy
97.3set forth in this section.

97.4    Sec. 2. Minnesota Statutes 2010, section 62E.08, subdivision 1, is amended to read:
97.5    Subdivision 1. Establishment. The association shall establish the following
97.6maximum premiums to be charged for membership in the comprehensive health insurance
97.7plan:
97.8(a) the premium for the number one qualified plan shall range from a minimum of
97.9101 percent to a maximum of 125 percent of the weighted average of rates charged by
97.10those insurers and health maintenance organizations with individuals enrolled in:
97.11(1) $1,000 annual deductible individual plans of insurance in force in Minnesota;
97.12(2) individual health maintenance organization contracts of coverage with a $1,000
97.13annual deductible which are in force in Minnesota; and
97.14(3) other plans of coverage similar to plans offered by the association based on
97.15generally accepted actuarial principles;
97.16(b) the premium for the number two qualified plan shall range from a minimum of
97.17101 percent to a maximum of 125 percent of the weighted average of rates charged by
97.18those insurers and health maintenance organizations with individuals enrolled in:
97.19(1) $500 annual deductible individual plans of insurance in force in Minnesota;
97.20(2) individual health maintenance organization contracts of coverage with a $500
97.21annual deductible which are in force in Minnesota; and
97.22(3) other plans of coverage similar to plans offered by the association based on
97.23generally accepted actuarial principles;
97.24(c) the premiums for the plans with a $2,000, $5,000, or $10,000 annual deductible
97.25shall range from a minimum of 101 percent to a maximum of 125 percent of the weighted
97.26average of rates charged by those insurers and health maintenance organizations with
97.27individuals enrolled in:
97.28(1) $2,000, $5,000, or $10,000 annual deductible individual plans, respectively, in
97.29force in Minnesota; and
97.30(2) individual health maintenance organization contracts of coverage with a $2,000,
97.31$5,000, or $10,000 annual deductible, respectively, which are in force in Minnesota; or
97.32(3) other plans of coverage similar to plans offered by the association based on
97.33generally accepted actuarial principles;
97.34(d) the premium for each type of Medicare supplement plan required to be offered
97.35by the association pursuant to section 62E.12 shall range from a minimum of 101 percent
98.1to a maximum of 125 percent of the weighted average of rates charged by those insurers
98.2and health maintenance organizations with individuals enrolled in:
98.3(1) Medicare supplement plans in force in Minnesota;
98.4(2) health maintenance organization Medicare supplement contracts of coverage
98.5which are in force in Minnesota; and
98.6(3) other plans of coverage similar to plans offered by the association based on
98.7generally accepted actuarial principles; and
98.8(e) the charge for health maintenance organization coverage shall be based on
98.9generally accepted actuarial principles.; and
98.10(f) the premium for a high-deductible, basic plan offered under section 62E.121 shall
98.11range from a minimum of 101 percent to a maximum of 125 percent of the weighted
98.12average of rates charged by those insurers and health maintenance organizations offering
98.13comparable plans outside of the Minnesota Comprehensive Health Association.
98.14The list of insurers and health maintenance organizations whose rates are used to
98.15establish the premium for coverage offered by the association pursuant to paragraphs (a)
98.16to (d) and (f) shall be established by the commissioner on the basis of information which
98.17shall be provided to the association by all insurers and health maintenance organizations
98.18annually at the commissioner's request. This information shall include the number of
98.19individuals covered by each type of plan or contract specified in paragraphs (a) to (d) and
98.20(f) that is sold, issued, and renewed by the insurers and health maintenance organizations,
98.21including those plans or contracts available only on a renewal basis. The information shall
98.22also include the rates charged for each type of plan or contract.
98.23In establishing premiums pursuant to this section, the association shall utilize
98.24generally accepted actuarial principles, provided that the association shall not discriminate
98.25in charging premiums based upon sex. In order to compute a weighted average for each
98.26type of plan or contract specified under paragraphs (a) to (d) and (f), the association
98.27shall, using the information collected pursuant to this subdivision, list insurers and health
98.28maintenance organizations in rank order of the total number of individuals covered by
98.29each insurer or health maintenance organization. The association shall then compute
98.30a weighted average of the rates charged for coverage by all the insurers and health
98.31maintenance organizations by:
98.32(1) multiplying the numbers of individuals covered by each insurer or health
98.33maintenance organization by the rates charged for coverage;
98.34(2) separately summing both the number of individuals covered by all the insurers
98.35and health maintenance organizations and all the products computed under clause (1); and
99.1(3) dividing the total of the products computed under clause (1) by the total number
99.2of individuals covered.
99.3The association may elect to use a sample of information from the insurers and
99.4health maintenance organizations for purposes of computing a weighted average. In no
99.5case, however, may a sample used by the association to compute a weighted average
99.6include information from fewer than the two insurers or health maintenance organizations
99.7highest in rank order.

99.8    Sec. 3. [62E.121] HIGH-DEDUCTIBLE, BASIC PLAN.
99.9    Subdivision 1. Required offering. The Minnesota Comprehensive Health
99.10Association shall offer a high-deductible, basic plan that meets the requirements specified
99.11in this section. The high-deductible, basic plan is a one-person plan. Any dependents
99.12must be covered separately.
99.13    Subd. 2. Annual deductible; out-of-pocket maximum. (a) The plan shall provide
99.14the following in-network annual deductible options: $3,000, $6,000, $9,000, and $12,000.
99.15The in-network annual out-of-pocket maximum for each annual deductible option shall be
99.16$1,000 greater than the amount of the annual deductible.
99.17(b) The deductible is subject to an annual increase based on the change in the
99.18Consumer Price Index (CPI).
99.19    Subd. 3. Office visits for nonpreventive care. The following co-payments shall
99.20apply for each of the first three office visits per calendar year for nonpreventive care:
99.21(1) $30 per visit for the $3,000 annual deductible option;
99.22(2) $40 per visit for the $6,000 annual deductible option;
99.23(3) $50 per visit for the $9,000 annual deductible option; and
99.24(4) $60 per visit for the $12,000 annual deductible option.
99.25For the fourth and subsequent visits during the calendar year, 80 percent coverage is
99.26provided under all deductible options, after the deductible is met.
99.27    Subd. 4. Preventive care. One hundred percent coverage is provided for preventive
99.28care, and no co-payment, coinsurance, or deductible requirements apply.
99.29    Subd. 5. Prescription drugs. A $10 co-payment applies to preferred generic drugs.
99.30Preferred brand-name drugs require an enrollee payment of 100 percent of the health
99.31plan's discounted rate.
99.32    Subd. 6. Convenience care center visits. A $20 co-payment applies for the first
99.33three convenience care center visits during a calendar year. For the fourth and subsequent
99.34visits during a calendar year, 80 percent coverage is provided after the deductible is met.
100.1    Subd. 7. Urgent care center visits. A $100 co-payment applies for the first urgent
100.2care center visit during a calendar year. For the second and subsequent visits during a
100.3calendar year, 80 percent coverage is provided after the deductible is met.
100.4    Subd. 8. Emergency room visits. A $200 co-payment applies for the first
100.5emergency room visit during a calendar year. For the second and subsequent visits during
100.6a calendar year, 80 percent coverage is provided after the deductible is met.
100.7    Subd. 9. Lab and x-ray; hospital services; ambulance; surgery. Lab and x-ray
100.8services, hospital services, ambulance services, and surgery are covered at 80 percent
100.9after the deductible is met.
100.10    Subd. 10. Eyewear. The health plan pays up to $50 per calendar year for eyewear.
100.11    Subd. 11. Maternity. Maternity, labor and delivery, and postpartum care are not
100.12covered. One hundred percent coverage is provided for prenatal care and no deductible
100.13applies.
100.14    Subd. 12. Other eligible health care services. Other eligible health care services
100.15are covered at 80 percent after the deductible is met.
100.16    Subd. 13. Option to remove mental health and substance abuse coverage.
100.17Enrollees have the option of removing mental health and substance abuse coverage in
100.18exchange for a reduced premium.
100.19    Subd. 14. Option to upgrade prescription drug coverage. Enrollees have
100.20the option to upgrade prescription drug coverage to include coverage for preferred
100.21brand-name drugs with a $50 co-payment and coverage for nonpreferred drugs with a
100.22$100 co-payment in exchange for an increased premium.
100.23    Subd. 15. Out-of-network services. (a) The out-of-network annual deductible is
100.24double the in-network annual deductible.
100.25(b) There is no out-of-pocket maximum for out-of-network services.
100.26(c) Benefits for out-of-network services are covered at 60 percent after the deductible
100.27is met.
100.28(d) The lifetime maximum benefit for out-of-network services is $1,000,000.
100.29    Subd. 16. Services not covered. Services not covered include: custodial care
100.30or rest care; most dental services; cosmetic services; refractive eye surgery; infertility
100.31services; and services that are investigational, not medically necessary, or received while
100.32on military duty.

100.33    Sec. 4. Minnesota Statutes 2010, section 62E.14, is amended by adding a subdivision
100.34to read:
101.1    Subd. 4f. Waiver of preexisting conditions for persons covered by healthy
101.2Minnesota contribution program. A person may enroll in the comprehensive plan with
101.3a waiver of the preexisting condition limitation in subdivision 3 if the person is eligible for
101.4the healthy Minnesota contribution program, and has been denied coverage as described
101.5under section 256L.031, subdivision 6.

101.6    Sec. 5. Minnesota Statutes 2010, section 62J.04, subdivision 9, is amended to read:
101.7    Subd. 9. Growth limits; federal programs. The commissioners of health and
101.8human services shall establish a rate methodology for Medicare and Medicaid risk-based
101.9contracting with health plan companies that is consistent with statewide growth limits.
101.10The methodology shall be presented for review by the Minnesota Health Care Commission
101.11and the Legislative Commission on Health Care Access prior to the submission of a
101.12waiver request to the Centers for Medicare and Medicaid Services and subsequent
101.13implementation of the methodology.

101.14    Sec. 6. Minnesota Statutes 2010, section 62J.692, subdivision 9, is amended to read:
101.15    Subd. 9. Review of eligible providers. The commissioner and the Medical
101.16Education and Research Costs Advisory Committee may review provider groups included
101.17in the definition of a clinical medical education program to assure that the distribution of
101.18the funds continue to be consistent with the purpose of this section. The results of any
101.19such reviews must be reported to the Legislative Commission on Health Care Access
101.20chairs and ranking minority members of the legislative committees with jurisdiction over
101.21health care policy and finance.

101.22    Sec. 7. [62J.824] BILLING FOR PROCEDURES TO CORRECT MEDICAL
101.23ERRORS PROHIBITED.
101.24A health care provider shall not bill a patient, and shall not be reimbursed, for
101.25any operation, treatment, or other care that is provided to reverse, correct, or otherwise
101.26minimize the affects of an adverse health care event, as described in section 144.7065,
101.27subdivisions 2 to 7, for which that health care provider is responsible.

101.28    Sec. 8. Minnesota Statutes 2010, section 62Q.32, is amended to read:
101.2962Q.32 LOCAL OMBUDSPERSON.
101.30County board or community health service agencies may establish an office of
101.31ombudsperson to provide a system of consumer advocacy for persons receiving health
102.1care services through a health plan company. The ombudsperson's functions may include,
102.2but are not limited to:
102.3(a) mediation or advocacy on behalf of a person accessing the complaint and appeal
102.4procedures to ensure that necessary medical services are provided by the health plan
102.5company; and
102.6(b) investigation of the quality of services provided to a person and determine the
102.7extent to which quality assurance mechanisms are needed or any other system change
102.8may be needed. The commissioner of health shall make recommendations for funding
102.9these functions including the amount of funding needed and a plan for distribution. The
102.10commissioner shall submit these recommendations to the Legislative Commission on
102.11Health Care Access by January 15, 1996.

102.12    Sec. 9. [62Q.46] PAYMENT TO OUT-OF-NETWORK PROVIDERS.
102.13    A health plan company may limit payments to out-of-network providers to the usual
102.14and customary payment rate that applies to similarly situated providers participating in the
102.15health plan company's provider network.

102.16    Sec. 10. Minnesota Statutes 2010, section 62U.04, subdivision 3, is amended to read:
102.17    Subd. 3. Provider peer grouping. (a) The commissioner shall develop a peer
102.18grouping system for providers based on a combined measure that incorporates both
102.19provider risk-adjusted cost of care and quality of care, and for specific conditions as
102.20determined by the commissioner. In developing this system, the commissioner shall
102.21consult and coordinate with health care providers, health plan companies, state agencies,
102.22and organizations that work to improve health care quality in Minnesota. For purposes of
102.23the final establishment of the peer grouping system, the commissioner shall not contract
102.24with any private entity, organization, or consortium of entities that has or will have a direct
102.25financial interest in the outcome of the system.
102.26    (b) By no later than October 15, 2010, the commissioner shall disseminate
102.27information to providers on their total cost of care, total resource use, total quality of care,
102.28and the total care results of the grouping developed under this subdivision in comparison
102.29to an appropriate peer group. Any analyses or reports that identify providers may only be
102.30published after the provider has been provided the opportunity by the commissioner to
102.31review the underlying data and submit comments. Providers may be given any data for
102.32which they are the subject of the data. The provider shall have 30 days to review the data
102.33for accuracy and initiate an appeal as specified in paragraph (d).
103.1    (c) By no later than January 1, 2011, the commissioner shall disseminate information
103.2to providers on their condition-specific cost of care, condition-specific resource use,
103.3condition-specific quality of care, and the condition-specific results of the grouping
103.4developed under this subdivision in comparison to an appropriate peer group. Any
103.5analyses or reports that identify providers may only be published after the provider has
103.6been provided the opportunity by the commissioner to review the underlying data and
103.7submit comments. Providers may be given any data for which they are the subject of the
103.8data. The provider shall have 30 days to review the data for accuracy and initiate an
103.9appeal as specified in paragraph (d).
103.10(d) The commissioner shall establish an appeals process to resolve disputes from
103.11providers regarding the accuracy of the data used to develop analyses or reports. When
103.12a provider appeals the accuracy of the data used to calculate the peer grouping system
103.13results, the provider shall:
103.14(1) clearly indicate the reason they believe the data used to calculate the peer group
103.15system results are not accurate;
103.16(2) provide evidence and documentation to support the reason that data was not
103.17accurate; and
103.18(3) cooperate with the commissioner, including allowing the commissioner access to
103.19data necessary and relevant to resolving the dispute.
103.20If a provider does not meet the requirements of this paragraph, a provider's appeal shall be
103.21considered withdrawn. The commissioner shall not publish results for a specific provider
103.22under paragraph (e) or (f) while that provider has an unresolved appeal.
103.23    (e) Beginning January 1, 2011, the commissioner shall, no less than annually,
103.24publish information on providers' total cost, total resource use, total quality, and the results
103.25of the total care portion of the peer grouping process. The results that are published must
103.26be on a risk-adjusted basis.
103.27(f) Beginning March 30, 2011, the commissioner shall no less than annually publish
103.28information on providers' condition-specific cost, condition-specific resource use, and
103.29condition-specific quality, and the results of the condition-specific portion of the peer
103.30grouping process. The results that are published must be on a risk-adjusted basis.
103.31(g) Prior to disseminating data to providers under paragraph (b) or (c) or publishing
103.32information under paragraph (e) or (f), the commissioner shall ensure the scientific
103.33validity and reliability of the results according to the standards described in paragraph (h).
103.34If additional time is needed to establish the scientific validity and reliability of the results,
103.35the commissioner may delay the dissemination of data to providers under paragraph (b)
103.36or (c), or the publication of information under paragraph (e) or (f). If the delay is more
104.1than 60 days, the commissioner shall report in writing to the Legislative Commission on
104.2Health Care Access chairs and ranking minority members of the legislative committees
104.3with jurisdiction over health care policy and finance the following information:
104.4(1) the reason for the delay;
104.5(2) the actions being taken to resolve the delay and establish the scientific validity
104.6and reliability of the results; and
104.7(3) the new dates by which the results shall be disseminated.
104.8If there is a delay under this paragraph, the commissioner must disseminate the
104.9information to providers under paragraph (b) or (c) at least 90 days before publishing
104.10results under paragraph (e) or (f).
104.11(h) The commissioner's assurance of valid and reliable clinic and hospital peer
104.12grouping performance results shall include, at a minimum, the following:
104.13(1) use of the best available evidence, research, and methodologies; and
104.14(2) establishment of an explicit minimum reliability threshold developed in
104.15collaboration with the subjects of the data and the users of the data, at a level not below
104.16nationally accepted standards where such standards exist.
104.17In achieving these thresholds, the commissioner shall not aggregate clinics that are not
104.18part of the same system or practice group. The commissioner shall consult with and solicit
104.19feedback from representatives of physician clinics and hospitals during the peer grouping
104.20data analysis process to obtain input on the methodological options prior to final analysis
104.21and on the design, development, and testing of provider reports.

104.22    Sec. 11. Minnesota Statutes 2010, section 62U.04, subdivision 9, is amended to read:
104.23    Subd. 9. Uses of information. (a) By no later than 12 months after the commissioner
104.24publishes the information in subdivision 3, paragraph (e): For product renewals or for
104.25new products that are offered, after 12 months have elapsed from publication by the
104.26commissioner of the information in subdivision 3, paragraph (e):
104.27    (1) the commissioner of management and budget shall use the information and
104.28methods developed under subdivision 3 to strengthen incentives for members of the state
104.29employee group insurance program to use high-quality, low-cost providers;
104.30    (2) all political subdivisions, as defined in section 13.02, subdivision 11, that offer
104.31health benefits to their employees must offer plans that differentiate providers on their
104.32cost and quality performance and create incentives for members to use better-performing
104.33providers;
105.1    (3) all health plan companies shall use the information and methods developed
105.2under subdivision 3 to develop products that encourage consumers to use high-quality,
105.3low-cost providers; and
105.4    (4) health plan companies that issue health plans in the individual market or the
105.5small employer market must offer at least one health plan that uses the information
105.6developed under subdivision 3 to establish financial incentives for consumers to choose
105.7higher-quality, lower-cost providers through enrollee cost-sharing or selective provider
105.8networks.
105.9    (b) By January 1, 2011, the commissioner of health shall report to the governor
105.10and the legislature on recommendations to encourage health plan companies to promote
105.11widespread adoption of products that encourage the use of high-quality, low-cost providers.
105.12The commissioner's recommendations may include tax incentives, public reporting of
105.13health plan performance, regulatory incentives or changes, and other strategies.

105.14    Sec. 12. Minnesota Statutes 2010, section 62U.06, subdivision 2, is amended to read:
105.15    Subd. 2. Legislative oversight. Beginning January 15, 2009, the commissioner
105.16of health shall submit to the Legislative Commission on Health Care Access chairs and
105.17ranking minority members of the legislative committees with jurisdiction over health care
105.18policy and finance periodic progress reports on the implementation of this chapter and
105.19sections 256B.0751 to 256B.0754.

105.20    Sec. 13. Minnesota Statutes 2010, section 256.01, subdivision 2b, is amended to read:
105.21    Subd. 2b. Performance payments. The commissioner shall develop and implement
105.22a pay-for-performance system to provide performance payments to eligible medical
105.23groups and clinics that demonstrate optimum care in serving individuals with chronic
105.24diseases who are enrolled in health care programs administered by the commissioner under
105.25chapters 256B, 256D, and 256L. The commissioner may receive any federal matching
105.26money that is made available through the medical assistance program for managed care
105.27oversight contracted through vendors, including consumer surveys, studies, and external
105.28quality reviews as required by the federal Balanced Budget Act of 1997, Code of Federal
105.29Regulations, title 42, part 438-managed care, subpart E-external quality review. Any
105.30federal money received for managed care oversight is appropriated to the commissioner
105.31for this purpose. The commissioner may expend the federal money received in either
105.32year of the biennium.

106.1    Sec. 14. Minnesota Statutes 2010, section 256.01, is amended by adding a subdivision
106.2to read:
106.3    Subd. 33. Contingency contract fees. When the commissioner enters into
106.4a contingency-based contract for the purpose of recovering medical assistance or
106.5MinnesotaCare funds, the commissioner may retain that portion of the recovered funds
106.6equal to the amount of the contingency fee.

106.7    Sec. 15. Minnesota Statutes 2010, section 256.01, is amended by adding a subdivision
106.8to read:
106.9    Subd. 34. Elimination of certain provider reporting requirements; sunset of
106.10new requirements. (a) Notwithstanding any other law, rule, or provision to the contrary,
106.11effective July 1, 2012, the commissioner shall cease collecting from health care providers
106.12and purchasers all reports and data related to health care costs, quality, utilization, access,
106.13patient encounters, and disease surveillance and public health, and related to provider
106.14licensure, monitoring, finances, and regulation, unless the reports or data are necessary for
106.15federal compliance. For purposes of this subdivision, the term "health care providers and
106.16purchasers" has the meaning provided in section 62J.03, subdivision 8, except that it also
106.17includes nursing homes, health plan companies as defined in section 62Q.01, subdivision
106.184, and managed care and county-based purchasing plans delivering services under sections
106.19256B.69 and 256B.692.
106.20(b) The commissioner shall present to the 2012 legislature draft legislation to repeal,
106.21effective July 1, 2012, the provider reporting requirements identified under paragraph (a)
106.22that are not necessary for federal compliance.
106.23(c) The commissioner may establish new provider reporting requirements to take
106.24effect on or after July 1, 2012. These new reporting requirements must sunset five years
106.25from their effective date, unless they are renewed by the commissioner. All new provider
106.26reporting requirements and requests for their renewal shall not take effect unless they
106.27are enacted in state law.

106.28    Sec. 16. Minnesota Statutes 2010, section 256.969, subdivision 2b, is amended to read:
106.29    Subd. 2b. Operating payment rates. In determining operating payment rates for
106.30admissions occurring on or after the rate year beginning January 1, 1991, and every two
106.31years after, or more frequently as determined by the commissioner, the commissioner
106.32shall obtain operating data from an updated base year and establish operating payment
106.33rates per admission for each hospital based on the cost-finding methods and allowable
106.34costs of the Medicare program in effect during the base year. Rates under the general
107.1assistance medical care, medical assistance, and MinnesotaCare programs shall not be
107.2rebased to more current data on January 1, 1997, January 1, 2005, for the first 24 months
107.3of the rebased period beginning January 1, 2009. For the first 24 months of the rebased
107.4period beginning January 1, 2011, rates shall not be rebased, except that a Minnesota
107.5long-term hospital shall be rebased effective January 1, 2011, based on its most recent
107.6Medicare cost report ending on or before September 1, 2008, with the provisions under
107.7subdivisions 9 and 23, based on the rates in effect on December 31, 2010. For subsequent
107.8rate setting periods in which the base years are updated, a Minnesota long-term hospital's
107.9base year shall remain within the same period as other hospitals. Effective January 1,
107.102013, rates shall be rebased at full value Rates must not be rebased to more current data
107.11for the first six months of the rebased period beginning January 1, 2013. The base year
107.12operating payment rate per admission is standardized by the case mix index and adjusted
107.13by the hospital cost index, relative values, and disproportionate population adjustment.
107.14The cost and charge data used to establish operating rates shall only reflect inpatient
107.15services covered by medical assistance and shall not include property cost information
107.16and costs recognized in outlier payments.

107.17    Sec. 17. Minnesota Statutes 2010, section 256.969, is amended by adding a subdivision
107.18to read:
107.19    Subd. 31. Initiatives to reduce incidence of low birth-weight. The commissioner
107.20shall require hospitals located in the seven-county metropolitan area, as a condition of
107.21contract, to implement strategies to reduce the incidence of low birth-weight in geographic
107.22areas identified by the commissioner as having a higher than average incidence of low
107.23birth-weight, with special emphasis on areas within a one-mile radius of the hospital.
107.24These strategies may focus on smoking prevention and cessation, ensuring that pregnant
107.25women get adequate nutrition, and addressing demographic, social, and environmental
107.26risk factors. The strategies must coordinate health care with social services and the
107.27local public health system, and offer patient education through appropriate means.
107.28The commissioner shall require hospitals to submit proposed initiatives for approval
107.29to the commissioner by January 1, 2012, and the commissioner shall require hospitals
107.30to implement approved initiatives by July 1, 2012. The commissioner shall evaluate
107.31the strategies adopted to reduce low birth-weight, and shall require hospitals to submit
107.32outcome and other data necessary for the evaluation.

107.33    Sec. 18. Minnesota Statutes 2010, section 256B.04, subdivision 18, is amended to read:
108.1    Subd. 18. Applications for medical assistance. (a) The state agency may
108.2take applications for medical assistance and conduct eligibility determinations for
108.3MinnesotaCare enrollees.
108.4    (b) The commissioner of human services shall modify the Minnesota health care
108.5programs application form to add a question asking applicants: "Are you a United States
108.6military veteran?"

108.7    Sec. 19. Minnesota Statutes 2010, section 256B.05, is amended by adding a
108.8subdivision to read:
108.9    Subd. 5. Technical assistance. The commissioner shall provide technical assistance
108.10to county agencies in processing complex medical assistance applications, including but
108.11not limited to applications for long-term care services. The commissioner shall provide
108.12this technical assistance using existing financial resources.

108.13    Sec. 20. Minnesota Statutes 2010, section 256B.055, subdivision 15, is amended to
108.14read:
108.15    Subd. 15. Adults without children. (a) Medical assistance may be paid for a
108.16person who is:
108.17(1) at least age 21 and under age 65;
108.18(2) not pregnant;
108.19(3) not entitled to Medicare Part A or enrolled in Medicare Part B under Title XVIII
108.20of the Social Security Act;
108.21(4) not an adult in a family with children as defined in section 256L.01, subdivision
108.223a; and
108.23(5) not described in another subdivision of this section.
108.24(b) If the federal government eliminates the federal Medicaid match or reduces the
108.25federal Medicaid matching rate beyond any adjustment required as part of the annual
108.26recalculation of the state's overall Medicaid matching rate for persons eligible under this
108.27subdivision, the commissioner shall eliminate coverage for persons enrolled under this
108.28subdivision and suspend new enrollment under this subdivision effective on the date
108.29of the elimination or reduction.
108.30EFFECTIVE DATE.The amendments to this section are effective the day
108.31following final enactment and expire January 1, 2014.

108.32    Sec. 21. Minnesota Statutes 2010, section 256B.056, subdivision 3, is amended to read:
109.1    Subd. 3. Asset limitations for individuals and families. (a) To be eligible for
109.2medical assistance, a person must not individually own more than $3,000 in assets, or if a
109.3member of a household with two family members, husband and wife, or parent and child,
109.4the household must not own more than $6,000 in assets, plus $200 for each additional
109.5legal dependent. In addition to these maximum amounts, an eligible individual or family
109.6may accrue interest on these amounts, but they must be reduced to the maximum at the
109.7time of an eligibility redetermination. The accumulation of the clothing and personal
109.8needs allowance according to section 256B.35 must also be reduced to the maximum at
109.9the time of the eligibility redetermination. The value of assets that are not considered in
109.10determining eligibility for medical assistance is the value of those assets excluded under
109.11the supplemental security income program for aged, blind, and disabled persons, with
109.12the following exceptions:
109.13    (1) household goods and personal effects are not considered;
109.14    (2) capital and operating assets of a trade or business that the local agency determines
109.15are necessary to the person's ability to earn an income are not considered;
109.16    (3) motor vehicles are excluded to the same extent excluded by the supplemental
109.17security income program;
109.18    (4) assets designated as burial expenses are excluded to the same extent excluded by
109.19the supplemental security income program. Burial expenses funded by annuity contracts
109.20or life insurance policies must irrevocably designate the individual's estate as contingent
109.21beneficiary to the extent proceeds are not used for payment of selected burial expenses; and
109.22    (5) effective upon federal approval, for a person who no longer qualifies as an
109.23employed person with a disability due to loss of earnings, assets allowed while eligible
109.24for medical assistance under section 256B.057, subdivision 9, are not considered for 12
109.25months, beginning with the first month of ineligibility as an employed person with a
109.26disability, to the extent that the person's total assets remain within the allowed limits of
109.27section 256B.057, subdivision 9, paragraph (c).
109.28    (b) No asset limit shall apply to persons eligible under section 256B.055, subdivision
109.2915.
109.30EFFECTIVE DATE.This section is effective January 1, 2012.

109.31    Sec. 22. Minnesota Statutes 2010, section 256B.056, subdivision 4, is amended to read:
109.32    Subd. 4. Income. (a) To be eligible for medical assistance, a person eligible under
109.33section 256B.055, subdivisions 7, 7a, and 12, may have income up to 100 percent of
109.34the federal poverty guidelines. Effective January 1, 2000, and each successive January,
110.1recipients of supplemental security income may have an income up to the supplemental
110.2security income standard in effect on that date.
110.3    (b) To be eligible for medical assistance, families and children may have an income
110.4up to 133-1/3 percent of the AFDC income standard in effect under the July 16, 1996,
110.5AFDC state plan. Effective July 1, 2000, the base AFDC standard in effect on July 16,
110.61996, shall be increased by three percent.
110.7    (c) Effective July 1, 2002, to be eligible for medical assistance, families and children
110.8may have an income up to 100 percent of the federal poverty guidelines for the family size.
110.9    (d) To be eligible for medical assistance under section 256B.055, subdivision 15, a
110.10person may have an income up to 75 percent of federal poverty guidelines for the family
110.11size.
110.12    (e) (d) In computing income to determine eligibility of persons under paragraphs
110.13(a) to (d) (c) who are not residents of long-term care facilities, the commissioner shall
110.14disregard increases in income as required by Public Law Numbers 94-566, section 503;
110.1599-272; and 99-509. Veterans aid and attendance benefits and Veterans Administration
110.16unusual medical expense payments are considered income to the recipient.
110.17EFFECTIVE DATE.This section is effective January 1, 2012.

110.18    Sec. 23. Minnesota Statutes 2010, section 256B.06, subdivision 4, is amended to read:
110.19    Subd. 4. Citizenship requirements. (a) Eligibility for medical assistance is limited
110.20to citizens of the United States, qualified noncitizens as defined in this subdivision, and
110.21other persons residing lawfully in the United States. Citizens or nationals of the United
110.22States must cooperate in obtaining satisfactory documentary evidence of citizenship or
110.23nationality according to the requirements of the federal Deficit Reduction Act of 2005,
110.24Public Law 109-171.
110.25(b) "Qualified noncitizen" means a person who meets one of the following
110.26immigration criteria:
110.27(1) admitted for lawful permanent residence according to United States Code, title 8;
110.28(2) admitted to the United States as a refugee according to United States Code,
110.29title 8, section 1157;
110.30(3) granted asylum according to United States Code, title 8, section 1158;
110.31(4) granted withholding of deportation according to United States Code, title 8,
110.32section 1253(h);
110.33(5) paroled for a period of at least one year according to United States Code, title 8,
110.34section 1182(d)(5);
111.1(6) granted conditional entrant status according to United States Code, title 8,
111.2section 1153(a)(7);
111.3(7) determined to be a battered noncitizen by the United States Attorney General
111.4according to the Illegal Immigration Reform and Immigrant Responsibility Act of 1996,
111.5title V of the Omnibus Consolidated Appropriations Bill, Public Law 104-200;
111.6(8) is a child of a noncitizen determined to be a battered noncitizen by the United
111.7States Attorney General according to the Illegal Immigration Reform and Immigrant
111.8Responsibility Act of 1996, title V, of the Omnibus Consolidated Appropriations Bill,
111.9Public Law 104-200; or
111.10(9) determined to be a Cuban or Haitian entrant as defined in section 501(e) of Public
111.11Law 96-422, the Refugee Education Assistance Act of 1980.
111.12(c) All qualified noncitizens who were residing in the United States before August
111.1322, 1996, who otherwise meet the eligibility requirements of this chapter, are eligible for
111.14medical assistance with federal financial participation.
111.15(d) All qualified noncitizens who entered the United States on or after August 22,
111.161996, and who otherwise meet the eligibility requirements of this chapter, are eligible for
111.17medical assistance with federal financial participation through November 30, 1996.
111.18Beginning December 1, 1996, qualified noncitizens who entered the United States
111.19on or after August 22, 1996, and who otherwise meet the eligibility requirements of this
111.20chapter are eligible for medical assistance with federal participation for five years if they
111.21meet one of the following criteria:
111.22(i) refugees admitted to the United States according to United States Code, title 8,
111.23section 1157;
111.24(ii) persons granted asylum according to United States Code, title 8, section 1158;
111.25(iii) persons granted withholding of deportation according to United States Code,
111.26title 8, section 1253(h);
111.27(iv) veterans of the United States armed forces with an honorable discharge for
111.28a reason other than noncitizen status, their spouses and unmarried minor dependent
111.29children; or
111.30(v) persons on active duty in the United States armed forces, other than for training,
111.31their spouses and unmarried minor dependent children.
111.32Beginning December 1, 1996, qualified noncitizens who do not meet one of the
111.33criteria in items (i) to (v) are eligible for medical assistance without federal financial
111.34participation as described in paragraph (j).
111.35Notwithstanding paragraph (j), beginning July 1, 2010, children and pregnant
111.36women who are noncitizens described in paragraph (b) or (e), are eligible for medical
112.1assistance with federal financial participation as provided by the federal Children's Health
112.2Insurance Program Reauthorization Act of 2009, Public Law 111-3.
112.3(e) Noncitizens who are not qualified noncitizens as defined in paragraph (b), who
112.4are lawfully present in the United States, as defined in Code of Federal Regulations, title
112.58, section 103.12, and who otherwise meet the eligibility requirements of this chapter, are
112.6eligible for medical assistance under clauses (1) to (3). These individuals must cooperate
112.7with the United States Citizenship and Immigration Services to pursue any applicable
112.8immigration status, including citizenship, that would qualify them for medical assistance
112.9with federal financial participation.
112.10(1) Persons who were medical assistance recipients on August 22, 1996, are eligible
112.11for medical assistance with federal financial participation through December 31, 1996.
112.12(2) Beginning January 1, 1997, persons described in clause (1) are eligible for
112.13medical assistance without federal financial participation as described in paragraph (j).
112.14(3) Beginning December 1, 1996, persons residing in the United States prior to
112.15August 22, 1996, who were not receiving medical assistance and persons who arrived on
112.16or after August 22, 1996, are eligible for medical assistance without federal financial
112.17participation as described in paragraph (j).
112.18(f) Nonimmigrants who otherwise meet the eligibility requirements of this chapter
112.19are eligible for the benefits as provided in paragraphs (g) to (i). For purposes of this
112.20subdivision, a "nonimmigrant" is a person in one of the classes listed in United States
112.21Code, title 8, section 1101(a)(15).
112.22(g) Payment shall also be made for care and services that are furnished to noncitizens,
112.23regardless of immigration status, who otherwise meet the eligibility requirements of
112.24this chapter, if such care and services are necessary for the treatment of an emergency
112.25medical condition, except for organ transplants and related care and services and routine
112.26prenatal care.
112.27(h) For purposes of this subdivision, the term "emergency medical condition" means
112.28a medical condition that meets the requirements of United States Code, title 42, section
112.291396b(v).
112.30(i)(1) Notwithstanding paragraph (h), services that are necessary for the treatment of
112.31an emergency medical condition are limited to the following:
112.32(i) services delivered in an emergency room that are directly related to the treatment
112.33of an emergency medical condition;
112.34(ii) services delivered in an inpatient hospital setting following admission from an
112.35emergency room or clinic for an acute emergency condition; and
113.1(iii) follow-up services that are directly related to the original service provided to
113.2treat the emergency medical condition and that are covered by the global payment made
113.3to the provider.
113.4    (2) Services for the treatment of emergency medical conditions do not include:
113.5(i) services delivered in an emergency room or inpatient setting to treat a
113.6nonemergency condition;
113.7(ii) organ and stem cell transplants and related care;
113.8(iii) services for routine prenatal care;
113.9(iv) continuing care, including long-term care, nursing facility services, home health
113.10care, adult day care, day training, or supportive living services;
113.11(v) elective surgery;
113.12(vi) outpatient prescription drugs, unless the drugs are administered or dispensed as
113.13part of an emergency room visit;
113.14(vii) preventative health care and family planning services;
113.15(viii) dialysis;
113.16(ix) chemotherapy or therapeutic radiation services;
113.17(x) rehabilitation services;
113.18(xi) physical, occupational, or speech therapy;
113.19(xii) transportation services;
113.20(xiii) case management;
113.21(xiv) prosthetics, orthotics, durable medical equipment, or medical supplies;
113.22(xv) dental services;
113.23(xvi) hospice care;
113.24(xvii) audiology services and hearing aids;
113.25(xviii) podiatry services;
113.26(xix) chiropractic services;
113.27(xx) immunizations;
113.28(xxi) vision services and eyeglasses;
113.29(xxii) waiver services;
113.30(xxiii) individualized education programs; or
113.31(xxiv) chemical dependency treatment.
113.32(i) (j) Beginning July 1, 2009, pregnant noncitizens who are undocumented,
113.33nonimmigrants, or lawfully present as designated in paragraph (e) and who are not
113.34covered by a group health plan or health insurance coverage according to Code of
113.35Federal Regulations, title 42, section 457.310, and who otherwise meet the eligibility
113.36requirements of this chapter, are eligible for medical assistance through the period of
114.1pregnancy, including labor and delivery, and 60 days postpartum, to the extent federal
114.2funds are available under title XXI of the Social Security Act, and the state children's
114.3health insurance program.
114.4(j) (k) Qualified noncitizens as described in paragraph (d), and all other noncitizens
114.5lawfully residing in the United States as described in paragraph (e), who are ineligible
114.6for medical assistance with federal financial participation and who otherwise meet the
114.7eligibility requirements of chapter 256B and of this paragraph, are eligible for medical
114.8assistance without federal financial participation. Qualified noncitizens as described
114.9in paragraph (d) are only eligible for medical assistance without federal financial
114.10participation for five years from their date of entry into the United States.
114.11(k) (l) Beginning October 1, 2003, persons who are receiving care and rehabilitation
114.12services from a nonprofit center established to serve victims of torture and are otherwise
114.13ineligible for medical assistance under this chapter are eligible for medical assistance
114.14without federal financial participation. These individuals are eligible only for the period
114.15during which they are receiving services from the center. Individuals eligible under this
114.16paragraph shall not be required to participate in prepaid medical assistance.

114.17    Sec. 24. Minnesota Statutes 2010, section 256B.0625, is amended by adding a
114.18subdivision to read:
114.19    Subd. 1b. Care coordination services provided through pediatric hospitals.
114.20(a) Medical assistance covers care coordination services provided by certain pediatric
114.21hospitals to children with high-cost medical conditions and children at risk of recurrent
114.22hospitalization for acute or chronic illnesses. There must be Level I and Level II pediatric
114.23care coordination services.
114.24(b) Level I pediatric care coordination services are provided by advanced practice
114.25nurses employed by or under contract with pediatric hospitals that have a neonatal
114.26intensive care unit and are either recipients of payments to support the training of residents
114.27from an approved graduate medical residency program under United States Code, title
114.2842, section 256e, or the major pediatric teaching hospital affiliate of the University of
114.29Minnesota Medical School, and that meet the criteria in this subdivision.
114.30(c) The services in paragraph (b) must be available through in-home video telehealth
114.31management and other methods, and must be designed to improve patient outcomes
114.32and reduce unnecessary hospital and emergency room utilization. The services must
114.33streamline communication, reduce redundancy, and eliminate unnecessary documentation
114.34through the use of a Web-accessible, uniform document that contains critical patient care
114.35management information, and which is accessible to all providers with patient consent.
115.1The commissioner shall develop the uniform document and associated Web site and shall
115.2implement procedures to assess patient outcomes and evaluate the effectiveness of the
115.3care coordination services provided under this subdivision.
115.4(d) Medical assistance also covers, as durable medical equipment, computers,
115.5webcams, and other technology necessary to allow in-home video telehealth management.
115.6(e) For purposes of paragraph (b), a child has a high-cost medical condition if
115.7inpatient hospital expenses for that child related to complex or chronic illnesses or
115.8conditions for the most recent calendar year exceeded $100,000, or if the expenses for that
115.9child are projected to exceed $100,000 for the current calendar year. For purposes of this
115.10subdivision, a child is at risk of recurrent hospitalization if the child was hospitalized three
115.11or more times for acute or chronic illness in the most recent calendar year.
115.12(f) For purposes of paragraph (b), "care coordination" means collaboration between
115.13the advanced practice nurse and primary care physicians and specialists to manage
115.14care and reduce hospitalizations, patient case management, development of medical
115.15management plans for chronic illnesses and recurrent acute illnesses, oversight and
115.16coordination of all aspects of care in partnership with families, organization of medical
115.17information into a summary of critical information, coordination and appropriate
115.18sequencing of tests and multiple appointments, information and assistance with accessing
115.19resources, and telephone triage for acute illnesses or problems.
115.20(g) The commissioner shall adjust managed care and county-based purchasing plan
115.21capitation rates to reflect savings from the coverage of this service.
115.22(h) Level II pediatric care coordination services are provided by registered nurses
115.23employed by or under contract with a pediatric hospital that has been designated as
115.24an essential community provider under section 62Q.19, subdivision 1, clause (4), and
115.25has been a recipient of payments to support the training of residents from an approved
115.26graduate medical residency program pursuant to United States Code, title 42, section
115.27256e, and that meets the following criteria:
115.28(1) the services must be provided through telehealth management and other methods,
115.29be available on a regular schedule seven days per week, and be designed to provide
115.30collaboration in patient care as provided by the patient's family, primary care providers,
115.31and the hospital and specialized physicians;
115.32(2) for purposes of this paragraph, a child has a high-cost medical condition if the
115.33child has a serious chronic physical disability caused by a congenital anomaly, birth
115.34injury or traumatic injury, complications which can be expected to cause further injury,
115.35hospitalization, or death, but that can be effectively addressed through ongoing family
116.1and primary care supported by communication of ongoing care information and care
116.2coordination; and
116.3(3) for purposes of this paragraph, "care coordination" means the ready availability
116.4of telehealth management services to support collaboration through a registered nurse
116.5between a child's family, the primary care professional that is available to care for the
116.6child, and appropriate professionals to address urgent questions about and minimize the
116.7consequences of medical complications, develop medical management plans for complex
116.8conditions, and avoid serious health consequences and hospitalizations to treat such
116.9complications.
116.10EFFECTIVE DATE.This section is effective January 1, 2012.

116.11    Sec. 25. Minnesota Statutes 2010, section 256B.0625, is amended by adding a
116.12subdivision to read:
116.13    Subd. 3q. Evidence-based childbirth program. (a) The commissioner shall
116.14implement a program to reduce the number of elective inductions of labor prior to 39
116.15weeks' gestation. In this subdivision, the term "elective induction of labor" means the
116.16use of artificial means to stimulate labor in a woman without the presence of a medical
116.17condition affecting the woman or the child that makes the onset of labor a medical
116.18necessity. The program must promote the implementation of policies within hospitals
116.19providing services to recipients of medical assistance or MinnesotaCare that prohibit the
116.20use of elective inductions prior to 39 weeks' gestation, and adherence to such policies by
116.21the attending providers.
116.22(b) For all births covered by medical assistance or MinnesotaCare on or after
116.23January 1, 2012, a payment for professional services associated with the delivery of a
116.24child in a hospital must not be made unless the provider has submitted information about
116.25the nature of the labor and delivery including any induction of labor that was performed
116.26in conjunction with that specific birth. The information must be on a form prescribed by
116.27the commissioner.
116.28(c) The requirements in paragraph (b) must not apply to deliveries performed
116.29at a hospital that has policies and processes in place that have been approved by the
116.30commissioner which prohibit elective inductions prior to 39 weeks' gestation. A process
116.31for review of hospital induction policies must be established by the commissioner and
116.32review of policies must occur at the discretion of the commissioner. The commissioner's
116.33decision to approve or rescind approval must include verification and review of items
116.34including, but not limited to:
116.35(1) policies that prohibit use of elective inductions for gestation less than 39 weeks;
117.1(2) policies that encourage providers to document and communicate with patients a
117.2final expected date of delivery by 20 weeks' gestation that includes data from ultrasound
117.3measurements as applicable;
117.4(3) policies that encourage patient education regarding elective inductions, and
117.5requires documentation of the processes used to educate patients;
117.6(4) ongoing quality improvement review as determined by the commissioner; and
117.7(5) any data that has been collected by the commissioner.
117.8(d) All hospitals must report annually to the commissioner induction information
117.9for all births that were covered by medical assistance or MinnesotaCare in a format and
117.10manner to be established by the commissioner.
117.11(e) The commissioner at any time may choose not to implement or may discontinue
117.12any or all aspects of the program if the commissioner is able to determine that hospitals
117.13representing at least 90 percent of births covered by medical assistance or MinnesotaCare
117.14have approved policies in place.
117.15EFFECTIVE DATE.This section is effective January 1, 2012.

117.16    Sec. 26. Minnesota Statutes 2010, section 256B.0625, subdivision 8e, is amended to
117.17read:
117.18    Subd. 8e. Chiropractic services. Payment for chiropractic services is limited to
117.19one annual evaluation and 12 24 visits per year unless prior authorization of a greater
117.20number of visits is obtained.

117.21    Sec. 27. Minnesota Statutes 2010, section 256B.0625, is amended by adding a
117.22subdivision to read:
117.23    Subd. 8f. Acupuncture services. Medical assistance covers acupuncture, as defined
117.24in section 147B.01, subdivision 3, only when provided by a licensed acupuncturist or by
117.25another Minnesota licensed practitioner for whom acupuncture is within the practitioner's
117.26scope of practice and who has specific acupuncture training or credentialing.

117.27    Sec. 28. Minnesota Statutes 2010, section 256B.0625, subdivision 13e, is amended to
117.28read:
117.29    Subd. 13e. Payment rates. (a) The basis for determining the amount of payment
117.30shall be the lower of the actual acquisition costs of the drugs plus a fixed dispensing fee;
117.31the maximum allowable cost set by the federal government or by the commissioner plus
117.32the fixed dispensing fee; or the usual and customary price charged to the public. The
117.33amount of payment basis must be reduced to reflect all discount amounts applied to the
118.1charge by any provider/insurer agreement or contract for submitted charges to medical
118.2assistance programs. The net submitted charge may not be greater than the patient liability
118.3for the service. The pharmacy dispensing fee shall be $3.65, except that the dispensing fee
118.4for intravenous solutions which must be compounded by the pharmacist shall be $8 per
118.5bag, $14 per bag for cancer chemotherapy products, and $30 per bag for total parenteral
118.6nutritional products dispensed in one liter quantities, or $44 per bag for total parenteral
118.7nutritional products dispensed in quantities greater than one liter. Actual acquisition cost
118.8includes quantity and other special discounts except time and cash discounts. Effective
118.9July 1, 2009, The actual acquisition cost of a drug shall be estimated by the commissioner,
118.10at average wholesale price minus 15 percent. The actual acquisition cost of antihemophilic
118.11factor drugs shall be estimated at the average wholesale price minus 30 percent. wholesale
118.12acquisition cost plus four percent for independently owned pharmacies located in a
118.13designated rural area within Minnesota, and at wholesale acquisition cost plus two percent
118.14for all other pharmacies. A pharmacy is "independently owned" if it is one of four or
118.15fewer pharmacies under the same ownership nationally. A "designated rural area" means
118.16an area defined as a small rural area or isolated rural area according to the four-category
118.17classification of the Rural Urban Commuting Area system developed for the United States
118.18Health Resources and Services Administration. Wholesale acquisition cost is defined as
118.19the manufacturer's list price for a drug or biological to wholesalers or direct purchasers
118.20in the United States, not including prompt pay or other discounts, rebates, or reductions
118.21in price, for the most recent month for which information is available, as reported in
118.22wholesale price guides or other publications of drug or biological pricing data. The
118.23maximum allowable cost of a multisource drug may be set by the commissioner and it
118.24shall be comparable to, but no higher than, the maximum amount paid by other third-party
118.25payors in this state who have maximum allowable cost programs. Establishment of the
118.26amount of payment for drugs shall not be subject to the requirements of the Administrative
118.27Procedure Act.
118.28    (b) An additional dispensing fee of $.30 may be added to the dispensing fee paid
118.29to pharmacists for legend drug prescriptions dispensed to residents of long-term care
118.30facilities when a unit dose blister card system, approved by the department, is used. Under
118.31this type of dispensing system, the pharmacist must dispense a 30-day supply of drug.
118.32The National Drug Code (NDC) from the drug container used to fill the blister card must
118.33be identified on the claim to the department. The unit dose blister card containing the
118.34drug must meet the packaging standards set forth in Minnesota Rules, part 6800.2700,
118.35that govern the return of unused drugs to the pharmacy for reuse. The pharmacy provider
118.36will be required to credit the department for the actual acquisition cost of all unused
119.1drugs that are eligible for reuse. Over-the-counter medications must be dispensed in the
119.2manufacturer's unopened package. The commissioner may permit the drug clozapine to be
119.3dispensed in a quantity that is less than a 30-day supply.
119.4    (c) Whenever a maximum allowable cost has been set for a multisource drug,
119.5payment shall be on the basis of the maximum allowable cost established by the
119.6commissioner unless prior authorization for the brand name product has been granted
119.7according to the criteria established by the Drug Formulary Committee as required by
119.8subdivision 13f, paragraph (a), and the prescriber has indicated "dispense as written" on
119.9the prescription in a manner consistent with section 151.21, subdivision 2.
119.10    (d) The basis for determining the amount of payment for drugs administered in an
119.11outpatient setting shall be the lower of the usual and customary cost submitted by the
119.12provider or the amount established for Medicare by the 106 percent of the average sales
119.13price as determined by the United States Department of Health and Human Services
119.14pursuant to title XVIII, section 1847a of the federal Social Security Act. If average sales
119.15price is unavailable, the amount of payment must be lower of the usual and customary cost
119.16submitted by the provider or the wholesale acquisition cost.
119.17    (e) The commissioner may negotiate lower reimbursement rates for specialty
119.18pharmacy products than the rates specified in paragraph (a). The commissioner may
119.19require individuals enrolled in the health care programs administered by the department
119.20to obtain specialty pharmacy products from providers with whom the commissioner has
119.21negotiated lower reimbursement rates. Specialty pharmacy products are defined as those
119.22used by a small number of recipients or recipients with complex and chronic diseases
119.23that require expensive and challenging drug regimens. Examples of these conditions
119.24include, but are not limited to: multiple sclerosis, HIV/AIDS, transplantation, hepatitis
119.25C, growth hormone deficiency, Crohn's Disease, rheumatoid arthritis, and certain forms
119.26of cancer. Specialty pharmaceutical products include injectable and infusion therapies,
119.27biotechnology drugs, antihemophilic factor products, high-cost therapies, and therapies
119.28that require complex care. The commissioner shall consult with the formulary committee
119.29to develop a list of specialty pharmacy products subject to this paragraph. In consulting
119.30with the formulary committee in developing this list, the commissioner shall take into
119.31consideration the population served by specialty pharmacy products, the current delivery
119.32system and standard of care in the state, and access to care issues. The commissioner shall
119.33have the discretion to adjust the reimbursement rate to prevent access to care issues.
119.34(f) Home infusion therapy services provided by home infusion therapy pharmacies
119.35must be paid at rates according to subdivision 8d.
120.1EFFECTIVE DATE.This section is effective July 1, 2011, or upon federal
120.2approval, whichever is later.

120.3    Sec. 29. Minnesota Statutes 2010, section 256B.0625, subdivision 13h, is amended to
120.4read:
120.5    Subd. 13h. Medication therapy management services. (a) Medical assistance
120.6and general assistance medical care cover medication therapy management services for
120.7a recipient taking four three or more prescriptions to treat or prevent two one or more
120.8chronic medical conditions, or; a recipient with a drug therapy problem that is identified
120.9by the commissioner or identified by a pharmacist and approved by the commissioner; or
120.10prior authorized by the commissioner that has resulted or is likely to result in significant
120.11nondrug program costs. The commissioner may cover medical therapy management
120.12services under MinnesotaCare if the commissioner determines this is cost-effective. For
120.13purposes of this subdivision, "medication therapy management" means the provision
120.14of the following pharmaceutical care services by a licensed pharmacist to optimize the
120.15therapeutic outcomes of the patient's medications:
120.16    (1) performing or obtaining necessary assessments of the patient's health status;
120.17    (2) formulating a medication treatment plan;
120.18    (3) monitoring and evaluating the patient's response to therapy, including safety
120.19and effectiveness;
120.20    (4) performing a comprehensive medication review to identify, resolve, and prevent
120.21medication-related problems, including adverse drug events;
120.22    (5) documenting the care delivered and communicating essential information to
120.23the patient's other primary care providers;
120.24    (6) providing verbal education and training designed to enhance patient
120.25understanding and appropriate use of the patient's medications;
120.26    (7) providing information, support services, and resources designed to enhance
120.27patient adherence with the patient's therapeutic regimens; and
120.28    (8) coordinating and integrating medication therapy management services within the
120.29broader health care management services being provided to the patient.
120.30Nothing in this subdivision shall be construed to expand or modify the scope of practice of
120.31the pharmacist as defined in section 151.01, subdivision 27.
120.32    (b) To be eligible for reimbursement for services under this subdivision, a pharmacist
120.33must meet the following requirements:
120.34    (1) have a valid license issued under chapter 151;
121.1    (2) have graduated from an accredited college of pharmacy on or after May 1996, or
121.2completed a structured and comprehensive education program approved by the Board of
121.3Pharmacy and the American Council of Pharmaceutical Education for the provision and
121.4documentation of pharmaceutical care management services that has both clinical and
121.5didactic elements;
121.6    (3) be practicing in an ambulatory care setting as part of a multidisciplinary team or
121.7have developed a structured patient care process that is offered in a private or semiprivate
121.8patient care area that is separate from the commercial business that also occurs in the
121.9setting, or in home settings, excluding including long-term care and settings, group homes,
121.10if the service is ordered by the provider-directed care coordination team and facilities
121.11providing assisted living services; and
121.12    (4) make use of an electronic patient record system that meets state standards.
121.13    (c) For purposes of reimbursement for medication therapy management services,
121.14the commissioner may enroll individual pharmacists as medical assistance and general
121.15assistance medical care providers. The commissioner may also establish contact
121.16requirements between the pharmacist and recipient, including limiting the number of
121.17reimbursable consultations per recipient.
121.18(d) If there are no pharmacists who meet the requirements of paragraph (b) practicing
121.19within a reasonable geographic distance of the patient, a pharmacist who meets the
121.20requirements may provide the services via two-way interactive video. Reimbursement
121.21shall be at the same rates and under the same conditions that would otherwise apply to
121.22the services provided. To qualify for reimbursement under this paragraph, the pharmacist
121.23providing the services must meet the requirements of paragraph (b), and must be located
121.24within an ambulatory care setting approved by the commissioner. The patient must also
121.25be located within an ambulatory care setting approved by the commissioner. Services
121.26provided under this paragraph may not be transmitted into the patient's residence.
121.27(e) The commissioner shall establish a pilot project for an intensive medication
121.28therapy management program for patients identified by the commissioner with multiple
121.29chronic conditions and a high number of medications who are at high risk of preventable
121.30hospitalizations, emergency room use, medication complications, and suboptimal
121.31treatment outcomes due to medication-related problems. For purposes of the pilot
121.32project, medication therapy management services may be provided in a patient's home
121.33or community setting, in addition to other authorized settings. The commissioner may
121.34waive existing payment policies and establish special payment rates for the pilot project.
121.35The pilot project must be designed to produce a net savings to the state compared to the
122.1estimated costs that would otherwise be incurred for similar patients without the program.
122.2The pilot project must begin by January 1, 2010, and end June 30, 2012.
122.3EFFECTIVE DATE.This section is effective July 1, 2011.

122.4    Sec. 30. Minnesota Statutes 2010, section 256B.0625, subdivision 17, is amended to
122.5read:
122.6    Subd. 17. Transportation costs. (a) Medical assistance covers medical
122.7transportation costs incurred solely for obtaining emergency medical care or transportation
122.8costs incurred by eligible persons in obtaining emergency or nonemergency medical
122.9care when paid directly to an ambulance company, common carrier, or other recognized
122.10providers of transportation services. Medical transportation must be provided by:
122.11(1) an ambulance, as defined in section 144E.001, subdivision 2;
122.12(2) special transportation; or
122.13(3) common carrier including, but not limited to, bus, taxicab, other commercial
122.14carrier, or private automobile.
122.15(b) Medical assistance covers special transportation, as defined in Minnesota Rules,
122.16part 9505.0315, subpart 1, item F, if the recipient has a physical or mental impairment that
122.17would prohibit the recipient from safely accessing and using a bus, taxi, other commercial
122.18transportation, or private automobile.
122.19The commissioner may use an order by the recipient's attending physician to certify that
122.20the recipient requires special transportation services. Special transportation providers shall
122.21perform driver-assisted services for eligible individuals. Driver-assisted service includes
122.22passenger pickup at and return to the individual's residence or place of business, assistance
122.23with admittance of the individual to the medical facility, and assistance in passenger
122.24securement or in securing of wheelchairs or stretchers in the vehicle. Special transportation
122.25providers must obtain written documentation from the health care service provider who
122.26is serving the recipient being transported, identifying the time that the recipient arrived.
122.27Special transportation providers may not bill for separate base rates for the continuation of
122.28a trip beyond the original destination. Special transportation providers must take recipients
122.29to the nearest appropriate health care provider, using the most direct route. The minimum
122.30medical assistance reimbursement rates for special transportation services are:
122.31(1) (i) $17 for the base rate and $1.35 per mile for special transportation services to
122.32eligible persons who need a wheelchair-accessible van;
122.33(ii) $11.50 for the base rate and $1.30 per mile for special transportation services to
122.34eligible persons who do not need a wheelchair-accessible van; and
123.1(iii) $60 for the base rate and $2.40 per mile, and an attendant rate of $9 per trip, for
123.2special transportation services to eligible persons who need a stretcher-accessible vehicle;
123.3(2) the base rates for special transportation services in areas defined under RUCA
123.4to be super rural shall be equal to the reimbursement rate established in clause (1) plus
123.511.3 percent; and
123.6(3) for special transportation services in areas defined under RUCA to be rural
123.7or super rural areas:
123.8(i) for a trip equal to 17 miles or less, mileage reimbursement shall be equal to 125
123.9percent of the respective mileage rate in clause (1); and
123.10(ii) for a trip between 18 and 50 miles, mileage reimbursement shall be equal to
123.11112.5 percent of the respective mileage rate in clause (1).
123.12(c) For purposes of reimbursement rates for special transportation services under
123.13paragraph (b), the zip code of the recipient's place of residence shall determine whether
123.14the urban, rural, or super rural reimbursement rate applies.
123.15(d) For purposes of this subdivision, "rural urban commuting area" or "RUCA"
123.16means a census-tract based classification system under which a geographical area is
123.17determined to be urban, rural, or super rural.
123.18(e) Effective for services provided on or after July 1, 2011, nonemergency
123.19transportation rates, including special transportation, taxi, and other commercial carriers,
123.20are reduced 4.5 percent. Payments made to managed care plans and county-based
123.21purchasing plans must be reduced for services provided on or after January 1, 2012,
123.22to reflect this reduction.

123.23    Sec. 31. Minnesota Statutes 2010, section 256B.0625, subdivision 17a, is amended to
123.24read:
123.25    Subd. 17a. Payment for ambulance services. (a) Medical assistance covers
123.26ambulance services. Providers shall bill ambulance services according to Medicare
123.27criteria. Nonemergency ambulance services shall not be paid as emergencies. Effective
123.28for services rendered on or after July 1, 2001, medical assistance payments for ambulance
123.29services shall be paid at the Medicare reimbursement rate or at the medical assistance
123.30payment rate in effect on July 1, 2000, whichever is greater.
123.31(b) Effective for services provided on or after July 1, 2011, ambulance services
123.32payment rates are reduced 4.5 percent. Payments made to managed care plans and
123.33county-based purchasing plans must be reduced for services provided on or after January
123.341, 2012, to reflect this reduction.

124.1    Sec. 32. Minnesota Statutes 2010, section 256B.0625, subdivision 18, is amended to
124.2read:
124.3    Subd. 18. Bus or taxicab transportation. To the extent authorized by rule of the
124.4state agency, medical assistance covers costs of the most appropriate and cost-effective
124.5form of transportation incurred by any ambulatory eligible person for obtaining
124.6nonemergency medical care.

124.7    Sec. 33. Minnesota Statutes 2010, section 256B.0625, is amended by adding a
124.8subdivision to read:
124.9    Subd. 25b. Authorization with third-party liability. (a) Except as otherwise
124.10allowed under this subdivision or required under federal or state regulations, the
124.11commissioner must not consider a request for authorization of a service when the recipient
124.12has coverage from a third-party payer unless the provider requesting authorization has
124.13made a good faith effort to receive payment or authorization from the third-party payer.
124.14A good faith effort is established by supplying with the authorization request to the
124.15commissioner the following:
124.16(1) a determination of payment for the service from the third-party payer, a
124.17determination of authorization for the service from the third-party payer, or a verification
124.18of noncoverage of the service by the third-party payer; and
124.19(2) the information or records required by the department to document the reason for
124.20the determination or to validate noncoverage from the third-party payer.
124.21(b) A provider requesting authorization for services covered by Medicare is not
124.22required to bill Medicare before requesting authorization from the commissioner if the
124.23provider has reason to believe that a service covered by Medicare is not eligible for
124.24payment. The provider must document that, because of recent claim experiences with
124.25Medicare or because of written communication from Medicare, coverage is not available
124.26for the service.
124.27(c) Authorization is not required if a third-party payer has made payment that is
124.28equal to or greater than 60 percent of the maximum payment amount for the service
124.29allowed under medical assistance.

124.30    Sec. 34. Minnesota Statutes 2010, section 256B.0625, subdivision 31a, is amended to
124.31read:
124.32    Subd. 31a. Augmentative and alternative communication systems. (a) Medical
124.33assistance covers augmentative and alternative communication systems consisting of
124.34electronic or nonelectronic devices and the related components necessary to enable a
125.1person with severe expressive communication limitations to produce or transmit messages
125.2or symbols in a manner that compensates for that disability.
125.3(b) Until the volume of systems purchased increases to allow a discount price, the
125.4commissioner shall reimburse augmentative and alternative communication manufacturers
125.5and vendors at the manufacturer's suggested retail price for augmentative and alternative
125.6communication systems and related components. The commissioner shall separately
125.7reimburse providers for purchasing and integrating individual communication systems
125.8which are unavailable as a package from an augmentative and alternative communication
125.9vendor. Augmentative and alternative communication systems must be paid the lower
125.10of the:
125.11(1) submitted charge; or
125.12(2)(i) manufacturer's suggested retail price minus 20 percent for providers that are
125.13manufacturers of augmentative and alternative communication systems; or
125.14(ii) manufacturer's invoice charge plus 20 percent for providers that are not
125.15manufacturers of augmentative and alternative communication systems.
125.16(c) Reimbursement rates established by this purchasing program are not subject to
125.17Minnesota Rules, part 9505.0445, item S or T.

125.18    Sec. 35. Minnesota Statutes 2010, section 256B.0625, is amended by adding a
125.19subdivision to read:
125.20    Subd. 55. Payment for multiple services provided on same day. The
125.21commissioner shall not prohibit payment, including any supplemental payments, for
125.22mental health services or dental services provided to a patient by a clinic or health care
125.23professional solely because the mental health services or dental services were provided on
125.24the same day as other covered health care services furnished by the same provider.

125.25    Sec. 36. Minnesota Statutes 2010, section 256B.0625, is amended by adding a
125.26subdivision to read:
125.27    Subd. 56. Medical care coordination. (a) Medical assistance covers in-reach
125.28community-based care coordination that is performed in a hospital emergency department
125.29as an eligible procedure under a state health care program or private insurance for a
125.30frequent user.
125.31(b) Reimbursement must be made in 15-minute increments under current Medicaid
125.32mental health social work reimbursement methodology and allowed for up to 60 days
125.33posthospital discharge based upon the specific identified emergency department visit or
125.34inpatient admitting event. A frequent user who is participating in care coordination within
126.1a health care home framework is ineligible for reimbursement under this subdivision.
126.2Eligible in-reach care coordinators must hold a minimum of a bachelor's degree in social
126.3work, public health, corrections, or related field. The commissioner shall submit any
126.4necessary application for waivers to the Centers for Medicare and Medicaid Services to
126.5implement this subdivision.
126.6(c) A frequent user is defined as an individual who:
126.7(1) has frequented the hospital emergency department for services three or more
126.8times in the previous six consecutive months;
126.9(2) would benefit from the provision of in-reach community-based services; and
126.10(3) has two or more of the following risk factors:
126.11(i) on one or more occasions within the last 24 months, the individual was diagnosed
126.12with a chronic or life-threatening condition that requires management of symptoms,
126.13medications, health care, or changes in lifestyle or risk-related behaviors that may
126.14include, but are not limited to, HIV/AIDS, hepatitis, diabetes, heart disease, hypertension,
126.15emphysema, asthma, or cancer;
126.16(ii) on one or more occasions within the last 24 months, the individual was diagnosed
126.17or, in the judgment of an emergency department physician, would likely be diagnosed,
126.18if provided a mental assessment, with an Axis I or II mental disorder identified in the
126.19Diagnostic and Statistical Manual of Mental Disorders;
126.20(iii) on one or more occasions within the last 24 months, the individual was
126.21diagnosed or, in the judgment of an emergency department physician, would likely be
126.22diagnosed, if provided an assessment, with a substance use problem that interferes with
126.23the individual's health or appropriate utilization of health services; or
126.24(iv) the individual is currently experiencing homelessness. "Homelessness" means
126.25lacking a fixed, regular, or adequate nighttime residence or a primary nighttime residence
126.26that is a supervised publicly or privately operated shelter designed to provide temporary
126.27living accommodations or a public or private place not designed for, or ordinarily used
126.28as, regular sleeping accommodations for human beings.
126.29(d) Any hospital choosing to participate in medical care coordination under this
126.30subdivision must, upon request by the commissioner of human services, make available
126.31program utilization data. Frequent users who are enrolled in a program must track:
126.32(1) the total number of program participants in the frequent user program for a
126.33defined period of time established by the commissioner;
126.34(2) the total number of program participants and what form of health care coverage
126.35they had at the time of enrollment and the number of beneficiaries who did not remain
126.36enrolled in the program for at least two months;
127.1(3) the frequency of emergency department visits during the 12 months prior to
127.2enrollment in the program and associated costs to the hospital;
127.3(4) the frequency of emergency department visits during the 12 months after
127.4program enrollment and the associated costs to the hospital;
127.5(5) the total number of inpatient admissions during the 12 months immediately
127.6preceding enrollment and the associated costs to the hospital;
127.7(6) the total number of inpatient admissions during the 12 months after enrollment in
127.8the program and the associated costs to the hospital;
127.9(7) the total number of inpatient days during the 12 months immediately preceding
127.10enrollment and the associated costs to the hospital; and
127.11(8) the total number of inpatient days during the 12 months after program enrollment
127.12and the associated costs to the hospital.
127.13(e) For the purposes of this subdivision, "in-reach community-based care
127.14coordination" means the practice of a community-based worker with training, knowledge,
127.15skills, and ability to access a continuum of services, including housing, transportation,
127.16chemical and mental health treatment, employment, and peer support services, by working
127.17with an organization's staff to transition an individual back into the individual's living
127.18environment. In-reach community-based care coordination includes working with the
127.19individual during their discharge and for up to a defined amount of time in the individual's
127.20living environment, reducing the individual's need for readmittance.

127.21    Sec. 37. Minnesota Statutes 2010, section 256B.0625, is amended by adding a
127.22subdivision to read:
127.23    Subd. 57. Payment for Part B Medicare crossover claims. Effective for services
127.24provided on or after January 1, 2012, medical assistance payment for an enrollee's cost
127.25sharing associated with Medicare Part B is limited to an amount up to the medical
127.26assistance total allowed, when the medical assistance rate exceeds the amount paid by
127.27Medicare.
127.28EFFECTIVE DATE.This section is effective January 1, 2012.

127.29    Sec. 38. Minnesota Statutes 2010, section 256B.0625, is amended by adding a
127.30subdivision to read:
127.31    Subd. 58. Early and periodic screening, diagnosis, and treatment services.
127.32Medical assistance covers early and periodic screening, diagnosis, and treatment services
127.33(EPSDT). The payment amount for a complete EPSDT screening shall not exceed the rate
127.34established per Minnesota Rules, part 9505.0445, item M, effective October 1, 2010.

128.1    Sec. 39. Minnesota Statutes 2010, section 256B.0625, is amended by adding a
128.2subdivision to read:
128.3    Subd. 59. Services provided by advanced dental therapists and dental
128.4therapists. Medical assistance covers services provided by advanced dental therapists
128.5and dental therapists when provided within the scope of practice identified in sections
128.6150A.105 and 150A.106.

128.7    Sec. 40. Minnesota Statutes 2010, section 256B.0625, is amended by adding a
128.8subdivision to read:
128.9    Subd. 60. Payment for noncovered services. (a) Except when specifically
128.10prohibited by the commissioner or federal law, a provider may seek payment from the
128.11recipient for services not eligible for payment under the medical assistance program when
128.12the provider, prior to delivering the service, reviews and considers all other available
128.13covered alternatives with the recipient and obtains a signed acknowledgment from the
128.14recipient of the potential of the recipient's liability. The signed acknowledgment must be
128.15in a form approved by the commissioner.
128.16    (b) Conditions under which a provider must not request payment from the recipient
128.17include, but are not limited to:
128.18    (1) a service that requires prior authorization, unless authorization has been denied
128.19as not medically necessary and all other therapeutic alternatives have been reviewed;
128.20    (2) a service for which payment has been denied for reasons relating to billing
128.21requirements;
128.22    (3) standard shipping or delivery and setup of medical equipment or medical
128.23supplies;
128.24    (4) services that are included in the recipient's long-term care per diem;
128.25    (5) the recipient is enrolled in the restricted recipient program and the provider is
128.26one of a provider type designated for the recipient's health care services; and
128.27    (6) the noncovered service is a prescriptive drug identified by the commissioner as
128.28having the potential for abuse and overuse, except where payment by the recipient is
128.29specifically approved by the commissioner on the date of service based upon compelling
128.30evidence supplied by the prescribing provider that establishes medical necessity for that
128.31particular drug.
128.32    (c) The payment requested from recipients for noncovered services under this
128.33subdivision must not exceed the provider's usual and customary charge for the actual
128.34service received by the recipient. A recipient must not be billed for the difference between
129.1what medical assistance paid for the service or would pay for a less costly alternative
129.2service.

129.3    Sec. 41. Minnesota Statutes 2010, section 256B.0631, subdivision 1, is amended to
129.4read:
129.5    Subdivision 1. Co-payments Cost-sharing. (a) Except as provided in subdivision
129.62, the medical assistance benefit plan shall include the following co-payments cost-sharing
129.7for all recipients, effective for services provided on or after October 1, 2003, and before
129.8January 1, 2009 July 1, 2011:
129.9    (1) $3 per nonpreventive visit, except as provided in paragraph (c). For purposes
129.10of this subdivision, a visit means an episode of service which is required because of
129.11a recipient's symptoms, diagnosis, or established illness, and which is delivered in an
129.12ambulatory setting by a physician or physician ancillary, chiropractor, podiatrist, nurse
129.13midwife, advanced practice nurse, audiologist, optician, or optometrist;
129.14    (2) $3 for eyeglasses;
129.15    (3) $6 $3.50 for nonemergency visits to a hospital-based emergency room, except
129.16that this co-payment shall be increased to $20 upon federal approval; and
129.17    (4) $3 per brand-name drug prescription and $1 per generic drug prescription,
129.18subject to a $12 per month maximum for prescription drug co-payments. No co-payments
129.19shall apply to antipsychotic drugs when used for the treatment of mental illness.;
129.20(5) a family deductible equal to the maximum amount allowed under Code of
129.21Federal Regulations, title 42, part 447.54; and
129.22    (b) Except as provided in subdivision 2, the medical assistance benefit plan shall
129.23include the following co-payments for all recipients, effective for services provided on
129.24or after January 1, 2009:
129.25    (1) $3.50 for nonemergency visits to a hospital-based emergency room;
129.26    (2) $3 per brand-name drug prescription and $1 per generic drug prescription,
129.27subject to a $7 per month maximum for prescription drug co-payments. No co-payments
129.28shall apply to antipsychotic drugs when used for the treatment of mental illness; and
129.29    (3) (6) for individuals identified by the commissioner with income at or below 100
129.30percent of the federal poverty guidelines, total monthly co-payments cost-sharing must
129.31not exceed five percent of family income. For purposes of this paragraph, family income
129.32is the total earned and unearned income of the individual and the individual's spouse, if
129.33the spouse is enrolled in medical assistance and also subject to the five percent limit on
129.34co-payments cost-sharing.
130.1    (c) (b) Recipients of medical assistance are responsible for all co-payments and
130.2deductibles in this subdivision.
130.3(c) Effective January 1, 2012, or upon federal approval, whichever is later, the
130.4following co-payments for nonpreventive visits shall apply to providers included in
130.5provider peer grouping:
130.6(1) $3 for visits to providers whose average, risk-adjusted, total annual cost of
130.7care per medical assistance enrollee is at the 60th percentile or lower for providers of
130.8the same type;
130.9(2) $6 for visits to providers whose average, risk-adjusted, total annual cost of care
130.10per medical assistance enrollee is greater than the 60th percentile but does not exceed the
130.1180th percentile for providers of the same type; and
130.12(3) $10 for visits to providers whose average, risk-adjusted, total annual cost of
130.13care per medical assistance enrollee is greater than the 80th percentile for providers of
130.14the same type.
130.15Each managed care and county-based purchasing plan shall calculate the average,
130.16risk-adjusted, total annual cost of care for providers under this paragraph using a
130.17methodology approved by the commissioner. The commissioner shall develop a
130.18methodology for calculating the average, risk-adjusted, total annual cost of care for
130.19fee-for-service providers.
130.20(d) The commissioner shall seek any federal waivers and approvals necessary to
130.21increase the co-payment for nonemergency visits to a hospital-based emergency room
130.22under paragraph (a), clause (3), and to implement paragraph (c).

130.23    Sec. 42. Minnesota Statutes 2010, section 256B.0631, subdivision 2, is amended to
130.24read:
130.25    Subd. 2. Exceptions. Co-payments and deductibles shall be subject to the following
130.26exceptions:
130.27(1) children under the age of 21;
130.28(2) pregnant women for services that relate to the pregnancy or any other medical
130.29condition that may complicate the pregnancy;
130.30(3) recipients expected to reside for at least 30 days in a hospital, nursing home, or
130.31intermediate care facility for the developmentally disabled;
130.32(4) recipients receiving hospice care;
130.33(5) 100 percent federally funded services provided by an Indian health service;
130.34(6) emergency services;
130.35(7) family planning services;
131.1(8) services that are paid by Medicare, resulting in the medical assistance program
131.2paying for the coinsurance and deductible; and
131.3(9) co-payments that exceed one per day per provider for nonpreventive visits,
131.4eyeglasses, and nonemergency visits to a hospital-based emergency room.

131.5    Sec. 43. Minnesota Statutes 2010, section 256B.0631, subdivision 3, is amended to
131.6read:
131.7    Subd. 3. Collection. (a) The medical assistance reimbursement to the provider shall
131.8be reduced by the amount of the co-payment or deductible, except that reimbursements
131.9shall not be reduced:
131.10    (1) once a recipient has reached the $12 per month maximum or the $7 per month
131.11maximum effective January 1, 2009, for prescription drug co-payments; or
131.12    (2) for a recipient identified by the commissioner under 100 percent of the federal
131.13poverty guidelines who has met their monthly five percent co-payment cost-sharing limit.
131.14    (b) The provider collects the co-payment or deductible from the recipient. Providers
131.15may not deny services to recipients who are unable to pay the co-payment or deductible.
131.16    (c) Medical assistance reimbursement to fee-for-service providers and payments to
131.17managed care plans shall not be increased as a result of the removal of co-payments or
131.18deductibles effective on or after January 1, 2009.

131.19    Sec. 44. Minnesota Statutes 2010, section 256B.0644, is amended to read:
131.20256B.0644 REIMBURSEMENT UNDER OTHER STATE HEALTH CARE
131.21PROGRAMS.
131.22    (a) A vendor of medical care, as defined in section 256B.02, subdivision 7, and a
131.23health maintenance organization, as defined in chapter 62D, must participate as a provider
131.24or contractor in the medical assistance program, general assistance medical care program,
131.25and MinnesotaCare as a condition of participating as a provider in health insurance plans
131.26and programs or contractor for state employees established under section 43A.18, the
131.27public employees insurance program under section 43A.316, for health insurance plans
131.28offered to local statutory or home rule charter city, county, and school district employees,
131.29the workers' compensation system under section 176.135, and insurance plans provided
131.30through the Minnesota Comprehensive Health Association under sections 62E.01 to
131.3162E.19 . The limitations on insurance plans offered to local government employees shall
131.32not be applicable in geographic areas where provider participation is limited by managed
131.33care contracts with the Department of Human Services.
132.1    (b) For providers other than health maintenance organizations, participation in the
132.2medical assistance program means that:
132.3     (1) the provider accepts new medical assistance, general assistance medical care,
132.4and MinnesotaCare patients;
132.5    (2) for providers other than dental service providers, at least 20 percent of the
132.6provider's patients are covered by medical assistance, general assistance medical care,
132.7and MinnesotaCare as their primary source of coverage; or
132.8    (3) for dental service providers, at least ten percent of the provider's patients are
132.9covered by medical assistance, general assistance medical care, and MinnesotaCare as
132.10their primary source of coverage, or the provider accepts new medical assistance and
132.11MinnesotaCare patients who are children with special health care needs. For purposes
132.12of this section, "children with special health care needs" means children up to age 18
132.13who: (i) require health and related services beyond that required by children generally;
132.14and (ii) have or are at risk for a chronic physical, developmental, behavioral, or emotional
132.15condition, including: bleeding and coagulation disorders; immunodeficiency disorders;
132.16cancer; endocrinopathy; developmental disabilities; epilepsy, cerebral palsy, and other
132.17neurological diseases; visual impairment or deafness; Down syndrome and other genetic
132.18disorders; autism; fetal alcohol syndrome; and other conditions designated by the
132.19commissioner after consultation with representatives of pediatric dental providers and
132.20consumers.
132.21    (c) Patients seen on a volunteer basis by the provider at a location other than
132.22the provider's usual place of practice may be considered in meeting the participation
132.23requirement in this section. The commissioner shall establish participation requirements
132.24for health maintenance organizations. The commissioner shall provide lists of participating
132.25medical assistance providers on a quarterly basis to the commissioner of management and
132.26budget, the commissioner of labor and industry, and the commissioner of commerce. Each
132.27of the commissioners shall develop and implement procedures to exclude as participating
132.28providers in the program or programs under their jurisdiction those providers who do
132.29not participate in the medical assistance program. The commissioner of management
132.30and budget shall implement this section through contracts with participating health and
132.31dental carriers.
132.32    (d) For purposes of paragraphs (a) and (b), participation in the general assistance
132.33medical care program applies only to pharmacy providers.
132.34    (e) A provider described in section 256B.76, subdivision 5, may limit the eligibility
132.35of new medical assistance, general assistance medical care, and MinnesotaCare patients
132.36for specific categories of rehabilitative services, if medical assistance, general assistance
133.1medical care, and MinnesotaCare patients served by the provider in the aggregate exceed
133.230 percent of the provider's overall patient population.

133.3    Sec. 45. Minnesota Statutes 2010, section 256B.0751, subdivision 1, is amended to
133.4read:
133.5    Subdivision 1. Definitions. (a) For purposes of sections 256B.0751 to 256B.0753,
133.6the following definitions apply.
133.7    (b) "Commissioner" means the commissioner of human services.
133.8    (c) "Commissioners" means the commissioner of humans services and the
133.9commissioner of health, acting jointly.
133.10    (d) "Health plan company" has the meaning provided in section 62Q.01, subdivision
133.114.
133.12    (e) "Personal clinician" means a physician licensed under chapter 147, a physician
133.13assistant licensed and practicing under chapter 147A, or a mental health professional
133.14licensed under section 245.462, subdivision 18, clauses (1) to (6); or 245.4871, subdivision
133.1527, clauses (1) to (6), or an advanced practice nurse licensed and registered to practice
133.16under chapter 148.
133.17    (f) "State health care program" means the medical assistance, MinnesotaCare, and
133.18general assistance medical care programs.

133.19    Sec. 46. Minnesota Statutes 2010, section 256B.0751, subdivision 2, is amended to
133.20read:
133.21    Subd. 2. Development and implementation of standards. (a) By July 1, 2009,
133.22the commissioners of health and human services shall develop and implement standards
133.23of certification for health care homes for state health care programs. In developing these
133.24standards, the commissioners shall consider existing standards developed by national
133.25independent accrediting and medical home organizations. The standards developed by the
133.26commissioners must meet the following criteria:
133.27    (1) emphasize, enhance, and encourage the use of primary care, and include the use
133.28of primary care physicians, advanced practice nurses, and mental health professionals,
133.29and physician assistants as personal clinicians but permitting multidisciplinary teams of
133.30other health professionals;
133.31    (2) focus on delivering high-quality, efficient, and effective health care services
133.32and providing, arranging, or coordinating related social and public health services and
133.33other services that directly affect an individual's health, access to services, quality and
133.34outcomes, and patient satisfaction;
134.1    (3) encourage patient-centered care and services, including active participation by
134.2the patient and family or a legal guardian, or a health care agent as defined in chapter
134.3145C, as appropriate in decision making and care plan development, and providing care
134.4that is appropriate to the patient's race, ethnicity, and language;
134.5    (4) provide patients with a consistent, ongoing contact with a personal clinician or
134.6team of clinical professionals to ensure continuous and appropriate care for the patient's
134.7condition;
134.8    (5) ensure that health care homes develop and maintain appropriate comprehensive
134.9care and wellness plans for their patients with complex or chronic conditions, including an
134.10assessment of health risks and, chronic conditions, and socioeconomic factors affecting
134.11health and treatment;
134.12    (6) enable and encourage utilization of a range of qualified health care professionals
134.13and other professionals or services related to the health and treatment of the patient,
134.14including dedicated care coordinators, in a manner that enables providers to practice to
134.15the fullest extent of their license;
134.16    (7) focus initially on patients who have or are at risk of developing chronic health
134.17conditions;
134.18    (8) incorporate measures of quality, resource use, cost of care, and patient
134.19experience, with appropriate adjustments for socioeconomic factors;
134.20    (9) ensure the use of health information technology and systematic follow-up,
134.21including the use of patient registries; and
134.22    (10) encourage the use of scientifically based health care, patient decision-making
134.23aids that provide patients with information about treatment and service options and their
134.24associated benefits, risks, costs, and comparative outcomes, and other clinical decision
134.25support tools.
134.26    (b) In developing these standards, the commissioners shall consult with national
134.27and local organizations working on health care home models, physicians, relevant
134.28state agencies, health plan companies, hospitals, other providers, patients, and patient
134.29advocates. The commissioners may satisfy this requirement by continuing the provider
134.30directed care coordination advisory committee.
134.31    (c) For the purposes of developing and implementing these standards, the
134.32commissioners may use the expedited rulemaking process under section 14.389.

134.33    Sec. 47. Minnesota Statutes 2010, section 256B.0751, subdivision 3, is amended to
134.34read:
135.1    Subd. 3. Requirements for clinicians certified as health care homes. (a) A
135.2personal clinician or, a primary care clinic, or community mental health center eligible for
135.3payment under section 256B.0625, subdivision 5, may be certified as a health care home.
135.4If a primary care clinic or mental health center is certified, all of the primary care clinic's
135.5or mental health center's clinicians who may provide care to persons enrolled with the
135.6health care home must meet the criteria of a health care home. In order to be certified as
135.7a health care home, a clinician or, clinic, or community mental health center must meet
135.8the standards set by the commissioners in accordance with this section. Certification as
135.9a health care home is voluntary. In order to maintain their status as health care homes,
135.10clinicians or clinics must renew their certification annually.
135.11    (b) Clinicians or, clinics, or mental health centers certified as health care homes must
135.12offer their health care home services to all their patients with complex or chronic health
135.13conditions who are interested in participation.
135.14    (c) Health care homes must participate in the health care home collaborative
135.15established under subdivision 5.

135.16    Sec. 48. Minnesota Statutes 2010, section 256B.0751, subdivision 4, is amended to
135.17read:
135.18    Subd. 4. Alternative models and waivers of requirements. (a) Nothing in this
135.19section shall preclude the continued development of existing medical or health care
135.20home projects currently operating or under development by the commissioner of human
135.21services or preclude the commissioner from establishing alternative models and payment
135.22mechanisms for persons who are enrolled in integrated Medicare and Medicaid programs
135.23under section 256B.69, subdivisions 23 and 28, are enrolled in managed care long-term
135.24care programs under section 256B.69, subdivision 6b, are dually eligible for Medicare and
135.25medical assistance, are in the waiting period for Medicare, or who have other primary
135.26coverage.
135.27(b) The commissioner of health shall modify the health care homes application
135.28for certification to add an item allowing an applicant to indicate status as a federally
135.29qualified health center or a federally qualified health center look-alike, as defined in
135.30section 145.9269, subdivision 1. Effective July 1, 2012, the commissioner shall certify as
135.31a health care home each applicant that indicates this status on a completed application for
135.32certification, without requiring the applicant to meet the standards in Minnesota Rules,
135.33part 4764.0040. In order to retain certification, a federally qualified health center or
135.34federally qualified health center look-alike certified under this paragraph must seek annual
136.1recertification by submitting a letter of intent stating its desire to be recertified but is not
136.2required to meet the standards for recertification in Minnesota Rules, part 4764.0040.
136.3(c) The commissioner of health shall waive health care home certification
136.4requirements if an applicant demonstrates that compliance with a certification requirement
136.5will create a major financial hardship or is not feasible, and the applicant establishes an
136.6alternative way to accomplish the objectives of the certification requirement.

136.7    Sec. 49. Minnesota Statutes 2010, section 256B.0751, is amended by adding a
136.8subdivision to read:
136.9    Subd. 8. Coordination with local services. The health care home and the county
136.10shall coordinate care and services provided to patients enrolled with a health care home
136.11who have complex medical or socioeconomic needs or a disability, and who need and are
136.12eligible for additional local services administered by counties, including but not limited
136.13to waivered services, mental health services, social services, public health services,
136.14transportation, and housing. The coordination of care and services must be as provided in
136.15the plan established by the patient and health care home.

136.16    Sec. 50. Minnesota Statutes 2010, section 256B.0751, is amended by adding a
136.17subdivision to read:
136.18    Subd. 9. Patient choice of health care home. Notwithstanding section 256B.69,
136.19subdivisions 4 and 23, and subject to any necessary federal approval, the commissioner
136.20may require a patient enrolled in a state health care program through a managed care
136.21plan, county-based purchasing plan, fee-for-service, or demonstration project under
136.22section 256B.0755 to select a health care home and agree to receive primary care and
136.23care coordination services through the health care home as a condition of enrollment in
136.24the state health care program. The patient must be allowed to choose from among all
136.25available qualified health care providers, including an essential community provider as
136.26defined in section 62Q.19, if the provider is certified as a health care home and agrees to
136.27accept the terms, conditions, and payment rates for participation in the managed care plan,
136.28county-based purchasing plan, fee-for-service program, or demonstration project, except
136.29that reimbursement to federally qualified health centers and federally qualified health
136.30center look-alikes as defined in section 145.9269 must comply with federal law.

136.31    Sec. 51. Minnesota Statutes 2010, section 256B.0751, is amended by adding a
136.32subdivision to read:
137.1    Subd. 10. Engagement of patients and communities in health care home. The
137.2commissioner of health shall require health care homes to demonstrate that their health
137.3care home patients, and the racial and ethnic communities of current or potential patients,
137.4participate in evaluating the health care home and recommending improvements and
137.5changes to the health care home's methods and procedures in order to improve health,
137.6quality, and patient satisfaction for patients from those communities. The commissioner
137.7shall consult with racial and ethnic communities to determine whether the requirements of
137.8this section and rules adopted under it are barriers to effective health care home methods
137.9and procedures for serving patients of racial and ethnic communities.

137.10    Sec. 52. Minnesota Statutes 2010, section 256B.0753, is amended by adding a
137.11subdivision to read:
137.12    Subd. 4. Waiver recipients. A health care home shall receive the highest care
137.13coordination payment established under section 256B.0753 for providing services to an
137.14enrollee receiving home and community-based waiver services.

137.15    Sec. 53. Minnesota Statutes 2010, section 256B.0754, is amended by adding a
137.16subdivision to read:
137.17    Subd. 3. Primary care provider tiering. (a) The commissioner shall establish
137.18a tiering system for all providers participating in Minnesota health care programs.
137.19The tiering system must differentiate providers on the basis of their ability to provide
137.20cost-effective, quality care and must incorporate the provider peer grouping measures
137.21established under section 62U.04. The tier assignments must be established annually based
137.22on the most recent peer grouping measures available. Differentiation of tier assignments
137.23must be statistically valid. The commissioner may set specific quality standards for
137.24providers designated as high-performing providers under this subdivision.
137.25(b) The commissioner may adjust the rates paid to providers within each tier group
137.26established under paragraph (a) on an annual basis. Adjustments to rates shall not include
137.27the rate paid for care coordination services to certified health care homes under section
137.28256B.0753. Providers designated high-performing providers under paragraph (c) are not
137.29eligible for rate increases unless the provider also meets the cost and quality criteria
137.30associated with that tier level.
137.31(c) Health care homes certified under section 256B.0751, rural health clinics, and
137.32federally qualified health care clinics are designated as high-performing providers under
137.33this subdivision.
138.1(d) Providers reimbursed on a cost basis are subject to rate adjustments under this
138.2section.
138.3(e) The commissioner may phase in the tiering system by service type.
138.4EFFECTIVE DATE.This section is effective one year from the public release of
138.5provider peer grouping measures under Minnesota Statutes, section 62U.04, or upon
138.6federal approval, whichever is later.

138.7    Sec. 54. Minnesota Statutes 2010, section 256B.0755, subdivision 4, is amended to
138.8read:
138.9    Subd. 4. Payment system. (a) In developing a payment system for health care
138.10delivery systems, the commissioner shall establish a total cost of care benchmark or a
138.11risk/gain sharing payment model to be paid for services provided to the recipients enrolled
138.12in a health care delivery system.
138.13(b) The payment system may include incentive payments to health care delivery
138.14systems that meet or exceed annual quality and performance targets realized through
138.15the coordination of care.
138.16(c) An amount equal to the savings realized to the general fund as a result of the
138.17demonstration project shall be transferred each fiscal year to the health care access fund.
138.18(d) The total cost of care benchmark for demonstration projects must be no
138.19greater than the capitation rate that would have been paid to a managed care plan for a
138.20substantially similar enrollee population based on the per-member per-month rate in
138.21effect on December 31, 2010. The commissioner shall adjust benchmark payment rates
138.22for demonstration projects as necessary to reflect the higher level of service and cost
138.23necessary to serve a patient population with a higher incidence of socioeconomic barriers
138.24and complexity, and shall make corresponding reductions in payment rates for projects
138.25with a lower concentration of patients with socioeconomic barriers and complexity.

138.26    Sec. 55. Minnesota Statutes 2010, section 256B.0755, is amended by adding a
138.27subdivision to read:
138.28    Subd. 8. Coordination with local services. The health care home and the county
138.29shall coordinate care and services provided to patients enrolled in a demonstration project
138.30who have complex medical or socioeconomic needs or a disability, and who need and are
138.31eligible for additional local services administered by counties, including but not limited
138.32to waivered services, mental health services, social services, public health services,
138.33transportation, or housing. The coordination of care and services must be as provided in
138.34the plan established by the patient and primary care provider or health care home.

139.1    Sec. 56. Minnesota Statutes 2010, section 256B.0755, is amended by adding a
139.2subdivision to read:
139.3    Subd. 9. Rural demonstration projects. For demonstration projects serving
139.4rural areas, the commissioner shall consult with rural hospitals, primary care providers,
139.5county boards, health plans, and other key stakeholders primarily domiciled in the
139.6service area regarding the development and approval of alternative rural health care
139.7delivery demonstration projects under this section. In addition to organizations eligible
139.8to establish a demonstration project under subdivision 1, a rural demonstration project
139.9may be established by a county public health or social services agency or a county-based
139.10purchasing plan. In a rural area where multiple, competing provider-based demonstration
139.11projects are not possible, the commissioner shall not approve more than one demonstration
139.12project to serve the primary geographic area and shall follow the applicable procedures
139.13and requirements in section 256B.692 regarding participation of county boards in
139.14reviewing and approving demonstration project proposals.

139.15    Sec. 57. Minnesota Statutes 2010, section 256B.0755, is amended by adding a
139.16subdivision to read:
139.17    Subd. 10. Patient choice of qualified provider. The commissioner shall implement
139.18and approve demonstration projects in a manner that allows a patient to choose a primary
139.19care provider and health care home from among all available qualified options. The
139.20commissioner may require the patient to remain with the chosen provider, health care
139.21home, or demonstration project organization for a period of time determined by the
139.22commissioner. The commissioner shall implement the demonstration projects in a manner
139.23that ensures that a patient has the option of receiving services, including health care home
139.24services, through a provider designated as an essential community provider under section
139.2562Q.19. Demonstration projects and essential community providers must comply with
139.26section 62Q.19, subdivisions 3 to 7, for purposes of participation of providers in the
139.27demonstration project, except that reimbursement to federally qualified health centers
139.28and federally qualified health center look-alikes as defined in section 145.9269 must be
139.29in compliance with federal law.

139.30    Sec. 58. Minnesota Statutes 2010, section 256B.0755, is amended by adding a
139.31subdivision to read:
139.32    Subd. 11. Patient and community engagement. As a condition of approval of
139.33a demonstration project, the commissioner shall require the applicant to demonstrate
139.34that consumers and communities to be served under the project were consulted with and
140.1engaged in the process of developing the project proposal. The proposal must identify the
140.2needs and preferences of consumers and communities that were identified through this
140.3process of consultation and engagement. The consumers and communities consulted with
140.4and engaged in the development of the proposal must generally reflect the demographics,
140.5race, and ethnicity of those likely to be served under the demonstration project, with a
140.6special focus on those who experience the greatest health disparities. The commissioner
140.7shall require that demonstration project providers continue to consult with and engage
140.8consumers and communities during implementation and operation of the demonstration
140.9project.

140.10    Sec. 59. Minnesota Statutes 2010, section 256B.0755, is amended by adding a
140.11subdivision to read:
140.12    Subd. 12. Care coordination system. The commissioner of human services, in
140.13consultation with the commissioner of health, shall convene an advisory committee of
140.14small, independent, rural, and safety net primary care clinics, community hospitals,
140.15mental health centers, dental clinics, and other providers to advise the commissioner
140.16on the establishment of a system that will allow providers participating in payment
140.17reform demonstration projects established under this section and section 256B.0756 to
140.18effectively coordinate and deliver care to patients. In consultation with the advisory
140.19committee, the commissioner shall develop a plan for the care coordination system, issue a
140.20request for proposals, and contract with a vendor or vendors to establish and maintain the
140.21technology for the care coordination system. Using appropriations made for this purpose,
140.22the commissioner shall fund the planning, development, and establishment of the system.
140.23Ongoing costs must be covered by payments made by the providers who use the system.

140.24    Sec. 60. Minnesota Statutes 2010, section 256B.0755, is amended by adding a
140.25subdivision to read:
140.26    Subd. 13. Approval and implementation. Beginning January 1, 2012, the
140.27commissioner of human services shall approve payment reform projects authorized under
140.28this section for medical assistance and MinnesotaCare. The commissioner may approve
140.29projects for persons enrolled in fee-for-service programs and may require managed care
140.30plans and county-based purchasing plans to contract with a demonstration project provider
140.31on the same terms, conditions, and payment arrangements as are established by the
140.32commissioner for fee-for-service programs.

141.1    Sec. 61. Minnesota Statutes 2010, section 256B.0756, is amended to read:
141.2256B.0756 HENNEPIN AND RAMSEY COUNTIES PILOT PROGRAM.
141.3(a) The commissioner, upon federal approval of a new waiver request or amendment
141.4of an existing demonstration, may establish a pilot program in Hennepin County or
141.5Ramsey County, or both, to test alternative and innovative integrated health care delivery
141.6networks.
141.7(b) Individuals eligible for the pilot program shall be individuals who are eligible for
141.8medical assistance under section 256B.055, subdivision 15, and who reside in Hennepin
141.9County or Ramsey County.
141.10(c) Individuals enrolled in the pilot program shall be enrolled in an integrated
141.11health care delivery network in their county of residence. The integrated health care
141.12delivery network in Hennepin County shall be a network, such as an accountable care
141.13organization or a community-based collaborative care network, created by or including
141.14Hennepin County Medical Center. The integrated health care delivery network in Ramsey
141.15County shall be a network, such as an accountable care organization or community-based
141.16collaborative care network, created by or including Regions Hospital.
141.17(d) The commissioner shall cap pilot program enrollment at 7,000 enrollees for
141.18Hennepin County and 3,500 enrollees for Ramsey County.
141.19(e) In developing a payment system for the pilot programs, the commissioner shall
141.20establish a total cost of care for the recipients enrolled in the pilot programs that equals
141.21the cost of care that would otherwise be spent for these enrollees in the prepaid medical
141.22assistance program.
141.23(f) Counties may transfer funds necessary to support the nonfederal share of
141.24payments for integrated health care delivery networks in their county. Such transfers per
141.25county shall not exceed 15 percent of the expected expenses for county enrollees.
141.26(g) The commissioner shall apply to the federal government for, or as appropriate,
141.27cooperate with counties, providers, or other entities that are applying for any applicable
141.28grant or demonstration under the Patient Protection and Affordable Health Care Act, Public
141.29Law 111-148, or the Health Care and Education Reconciliation Act of 2010, Public Law
141.30111-152, that would further the purposes of or assist in the creation of an integrated health
141.31care delivery network for the purposes of this subdivision, including, but not limited to, a
141.32global payment demonstration or the community-based collaborative care network grants.
141.33(h) A demonstration project established under this section must meet the
141.34requirements of section 256B.0755, subdivisions 8, 9, 10, and 11.

141.35    Sec. 62. [256B.0758] PREGNANCY CARE HOMES.
142.1    Subdivision 1. Definitions. (a) For purposes of this section, the following definitions
142.2apply.
142.3(b) "Pregnancy care home" means a health care home certified by the commissioner
142.4of health under section 256B.0751 that provides pregnancy care services in a way that
142.5is patient-centered, outcome-driven, comprehensive, and coordinated, and meets the
142.6standards specified and developed under subdivision 3.
142.7(c) "Pregnancy care services" means prenatal care, consultative perinatal services,
142.8intrapartum and postpartum care, and well-baby care for the first week.
142.9(d) "State health care program" means the medical assistance and MinnesotaCare
142.10programs.
142.11    Subd. 2. Development and implementation of standards. (a) The commissioners
142.12of human services and health shall develop and implement standards of certification
142.13of pregnancy care homes for state health care programs. In developing standards, the
142.14commissioners shall consult with representatives of the American College of Nurse
142.15Midwives, the American Congress of OB/GYN, the American Academy of Family
142.16Practice, the American Academy of Pediatrics, and relevant local consumer groups.
142.17    Subd. 3. Criteria for development of standards. (a) A pregnancy care home must
142.18meet the general health care home standards developed by the commissioners under
142.19section 256B.0751, subdivision 2, paragraph (a), clauses (1) to (4), (6), and (8) to (10), and
142.20must also meet specific standards for pregnancy care homes. The specific standards for
142.21pregnancy care homes developed by the commissioners must meet the criteria specified
142.22in this subdivision.
142.23(b) A pregnancy care home must provide pregnancy care services. Nonpregnancy
142.24complications, such as preexisting illness, shall be covered by medical assistance outside
142.25of the pregnancy care home. During a pregnancy episode, the pregnancy care home must
142.26coordinate necessary nonpregnancy health care services with the mother's primary care
142.27provider or another appropriate provider.
142.28(c) Each pregnancy care home must have adequate malpractice insurance that meets
142.29the standards specified by the commissioners.
142.30(d) A pregnancy care home may provide pregnancy services through any health care
142.31professional licensed to provide the service in Minnesota, including but not limited to
142.32licensed traditional midwives, certified nurse midwives, family practitioners, obstetricians,
142.33perinatologists, neonatologists, and other advanced practice registered nurses.
142.34(e) Pregnancy care within a pregnancy care home may be provided at any Minnesota
142.35facility licensed to provide pregnancy care and birth, including but not limited to
142.36freestanding birth centers, integrated birth centers, and hospitals. Each pregnancy care
143.1home must offer the option of midwife-directed pregnancy care services in a licensed
143.2integrated or freestanding birth center.
143.3(f) A pregnancy care home must have a governing board comprised of at least
143.4eight members. One-half of the governing board members must be providers licensed to
143.5attend births.
143.6(g) Each pregnancy care home must have a formal consultative relationship with at
143.7least one level III perinatal center to provide care for mothers and babies who develop
143.8pregnancy complications.
143.9(h) Each pregnancy care home must comply with state and federal requirements for
143.10the use of interoperable electronic medical records.
143.11(i) Each pregnancy care home must submit annual reports to the commissioners of
143.12human services and health that document:
143.13(1) all relevant pregnancy care outcomes and patient satisfaction measures; and
143.14(2) the financial status of the pregnancy care home.
143.15All reports are public data under section 13.02.
143.16(j) Each pregnancy care home must offer culturally competent care coordination
143.17services in a manner that is consistent with health care home requirements.
143.18(k) For the purposes of developing and implementing the standards in this
143.19subdivision, the commissioners may use the expedited rulemaking process under section
143.2014.389.
143.21    Subd. 4. Certification process. Providers seeking certification as a pregnancy care
143.22home must apply to the commissioner of health. Providers certified by the commissioner
143.23of health may provide pregnancy care services through pregnancy care homes beginning
143.24July 1, 2012. Certification as a pregnancy care home is voluntary, except that beginning
143.25July 1, 2014, all nonemergency pregnancy care services covered under state health care
143.26programs must be provided through providers certified as pregnancy care homes.
143.27    Subd. 5. Payments to pregnancy care homes. (a) The commissioner of human
143.28services, in coordination with the commissioner of health, shall develop a payment system
143.29that provides a single per-person payment to pregnancy care homes to cover all pregnancy
143.30care services provided to each mother and infant enrolled in a state health care program.
143.31Pregnancy care homes receiving payments under this subdivision remain eligible for care
143.32coordination payments under section 256B.0753.
143.33(b) Payment amounts for pregnancy care homes shall be uniform statewide and
143.34determined annually by the commissioner, based initially upon a specified percentage
143.35of the calculated average cost of care for mothers and infants under state health care
143.36programs for the three most recent fiscal years for which cost information is available.
144.1Beginning July 1, 2014, statewide payment amounts for pregnancy care homes shall be
144.2determined annually by the commissioner by adjusting the current payment amount by
144.3a measure of medical inflation selected by the commissioner that best represents the
144.4change in the cost of pregnancy-related services provided to patients covered by private
144.5sector health coverage.
144.6(c) Pregnancy care home payments must initially be made for pregnancy care
144.7services provided to pregnant women who are not high risk, beginning July 1, 2012.
144.8Beginning January 1, 2013, the commissioner shall phase in higher payments for high-risk
144.9pregnancy categories so that beginning July 1, 2014, pregnancy care services for all
144.10low-risk and high-risk pregnancies are reimbursed under this subdivision.

144.11    Sec. 63. [256B.0759] CARE COORDINATION FOR ENROLLEES.
144.12    Subdivision 1. Qualified enrollee. For purposes of this section, a "qualified
144.13enrollee" means: (1) a medical assistance enrollee eligible under this chapter; or (2) a
144.14MinnesotaCare enrollee eligible under chapter 256L.
144.15    Subd. 2. Selection of primary care provider. The commissioner shall require
144.16qualified enrollees who do not have a designated medical condition to select a primary
144.17care provider and agree to receive primary care services from that provider as a condition
144.18of medical assistance or MinnesotaCare enrollment.
144.19    Subd. 3. Selection of health care home; care coordination. (a) The commissioner
144.20shall require qualified enrollees who have a medical condition designated by the
144.21commissioner to select a health care home certified under section 256B.0751 and agree
144.22to receive primary care and care coordination services through that health care home as
144.23a condition of medical assistance or MinnesotaCare enrollment. For purposes of this
144.24subdivision, the commissioner shall designate medical conditions with a high likelihood
144.25of inappropriate inpatient hospital admissions for which care coordination and prior
144.26authorization of admissions are expected to improve the quality of care and lead to costs
144.27savings for state health care programs.
144.28(b) The commissioner shall include on Minnesota health care program enrollment
144.29cards a designation as to whether an enrollee meets the criteria in paragraph (a). In order
144.30to receive medical assistance or MinnesotaCare payment for nonemergency inpatient
144.31hospital admissions for enrollees meeting the criteria in paragraph (a), a hospital must
144.32receive prior authorization from the enrollee's health care home.
144.33EFFECTIVE DATE.This section is effective January 1, 2012, for MinnesotaCare
144.34enrollees not eligible for a federal match, and is effective January 1, 2012, or upon federal
145.1approval, whichever is later, for medical assistance enrollees and for MinnesotaCare
145.2enrollees eligible for a federal match.

145.3    Sec. 64. [256B.0760] ELECTIVE SURGERY.
145.4    Subdivision 1. Payment prohibition. The commissioner, in consultation with
145.5health care providers, health care homes certified under section 256B.0751, managed
145.6care plans providing services under section 256B.69, and county-based purchasing plans
145.7providing services under section 256B.692, shall identify elective or nonemergency
145.8surgical procedures for which less invasive and less costly alternative treatment methods
145.9are available, and shall prohibit payment for these elective or nonemergency surgical
145.10procedures if the alternative treatment methods have not first been evaluated for use
145.11and, if appropriate, provided to the enrollee.
145.12    Subd. 2. Implementation. The commissioner shall implement the payment
145.13prohibitions in paragraph (a) for fee-for-service medical assistance providers by January
145.141, 2012, and shall require managed care and county-based purchasing plans to implement
145.15the payment prohibitions in paragraph (a) for providers employed or under contract for
145.16services provided to medical assistance and MinnesotaCare enrollees beginning January
145.171, 2012.
145.18    Subd. 3. Reduction in capitation rates. The commissioner shall reduce medical
145.19assistance and MinnesotaCare capitation rates to managed care and county-based
145.20purchasing plans beginning January 1, 2012, to reflect cost-savings to plans resulting from
145.21implementation of the payment prohibitions required by this subdivision.

145.22    Sec. 65. Minnesota Statutes 2010, section 256B.37, subdivision 5, is amended to read:
145.23    Subd. 5. Private benefits to be used first. Private accident and health care
145.24coverage, including Medicare for medical services and coverage provided through the
145.25United States Department of Veterans Affairs, is primary coverage and must be exhausted
145.26before medical assistance or alternative care services are paid for medical services
145.27including home health care, personal care assistance services, hospice, supplies and
145.28equipment, or services covered under a Centers for Medicare and Medicaid Services
145.29waiver. When a person who is otherwise eligible for medical assistance has private
145.30accident or health care coverage, including Medicare or a prepaid health plan or coverage
145.31provided through the United States Department of Veterans Affairs, the private health care
145.32benefits available to the person must be used first and to the fullest extent.

145.33    Sec. 66. Minnesota Statutes 2010, section 256B.69, subdivision 3a, is amended to read:
146.1    Subd. 3a. County authority. (a) The commissioner, when implementing or
146.2administering the medical assistance prepayment program within a county, must include
146.3the county board in the process of development, approval, and issuance of the request for
146.4proposals to provide services to eligible individuals within the proposed county, including
146.5proposals for demonstration projects established under section 256B.0755. County boards
146.6must be given reasonable opportunity to make recommendations regarding assist in
146.7the development, issuance, review of responses, and changes needed in the request for
146.8proposals. The commissioner must provide county boards the opportunity to review
146.9each proposal based on the identification of community needs under chapters 145A and
146.10256E and county advocacy activities. If a county board finds that a proposal does not
146.11address certain community needs, the county board and commissioner shall continue
146.12efforts for improving the proposal and network prior to the approval of the contract.
146.13The county board shall make recommendations determinations regarding the approval
146.14of local networks and their operations to ensure adequate local availability and access to
146.15covered services. The provider or health plan must respond directly to county advocates
146.16and the state prepaid medical assistance ombudsperson regarding service delivery and
146.17must be accountable to the state regarding contracts with medical assistance funds. The
146.18county board may recommend shall decide a maximum number of participating health
146.19plans including county-based purchasing plans after considering the size of the enrolling
146.20population; ensuring adequate access and capacity; considering the client and county
146.21administrative complexity; and considering the need to promote the viability of locally
146.22developed health plans, managed care plans, or demonstration projects established under
146.23section 256B.0755. The county board or a single entity representing a group of county
146.24boards and the commissioner shall mutually select one or more qualified health plans or
146.25county-based purchasing plans for participation at the time of initial implementation of the
146.26prepaid medical assistance program or a demonstration project established under section
146.27256B.0755 in that county or group of counties and at the time of contract renewal. The
146.28commissioner shall also seek input for contract requirements from the county or single
146.29entity representing a group of county boards at each contract renewal and incorporate
146.30those recommendations into the contract negotiation process.
146.31    (b) At the option of the county board, the board may develop contract requirements
146.32related to the achievement of local public health goals and health care delivery and access
146.33goals to meet the health needs of medical assistance enrollees. These requirements must
146.34be reasonably related to the performance of health plan managed care or delivery system
146.35demonstration project functions and within the scope of the medical assistance benefit
146.36set. If the county board and the commissioner mutually agree to such requirements, the
147.1department The commissioner shall include such requirements in all health plan contracts
147.2governing the prepaid medical assistance program in that county at initial implementation
147.3of the program or demonstration project in that county and at the time of contract renewal.
147.4The county board may participate in the enforcement of the contract provisions related to
147.5local public health goals.
147.6    (c) For counties in which a prepaid medical assistance program has not been
147.7established, the commissioner shall not implement that program if a county board submits
147.8an acceptable and timely preliminary and final proposal under section 256B.692, until
147.9county-based purchasing is no longer operational in that county. For counties in which
147.10a prepaid medical assistance program is in existence on or after September 1, 1997, the
147.11commissioner must terminate contracts with health plans according to section 256B.692,
147.12subdivision 5 , if the county board submits and the commissioner accepts a preliminary and
147.13final proposal according to that subdivision. The commissioner is not required to terminate
147.14contracts that begin on or after September 1, 1997, according to section 256B.692 until
147.15two years have elapsed from the date of initial enrollment.
147.16    (d) In the event that a county board or a single entity representing a group of county
147.17boards and the commissioner cannot reach agreement regarding: (i) the selection of
147.18participating health plans or demonstration projects under section 256B.0755 in that
147.19county; (ii) contract requirements; or (iii) implementation and enforcement of county
147.20requirements including provisions regarding local public health goals, the commissioner
147.21shall resolve all disputes after taking into account by approving the recommendations of
147.22a three-person mediation panel. The panel shall be composed of one designee of the
147.23president of the association of Minnesota counties, one designee of the commissioner of
147.24human services, and one person selected jointly by the designee of the commissioner of
147.25human services and the designee of the Association of Minnesota Counties. Within a
147.26reasonable period of time before the hearing, the panelists must be provided all documents
147.27and information relevant to the mediation. The parties to the mediation must be given
147.2830 days' notice of a hearing before the mediation panel.
147.29    (e) If a county which elects to implement county-based purchasing ceases to
147.30implement county-based purchasing, it is prohibited from assuming the responsibility of
147.31county-based purchasing for a period of five years from the date it discontinues purchasing.
147.32    (f) The commissioner shall not require that contractual disputes between
147.33county-based purchasing entities and the commissioner be mediated by a panel that
147.34includes a representative of the Minnesota Council of Health Plans.
148.1    (g) At the request of a county-purchasing entity, the commissioner shall adopt a
148.2contract reprocurement or renewal schedule under which all counties included in the
148.3entity's service area are reprocured or renewed at the same time.
148.4    (h) The commissioner shall provide a written report under section 3.195 to the chairs
148.5of the legislative committees having jurisdiction over human services in the senate and the
148.6house of representatives describing in detail the activities undertaken by the commissioner
148.7to ensure full compliance with this section. The report must also provide an explanation
148.8for any decisions of the commissioner not to accept the recommendations of a county or
148.9group of counties required to be consulted under this section. The report must be provided
148.10at least 30 days prior to the effective date of a new or renewed prepaid or managed care
148.11contract in a county.
148.12(i) This section also applies to other Minnesota health care programs administered
148.13by the commissioner, including but not limited to the MinnesotaCare program.

148.14    Sec. 67. Minnesota Statutes 2010, section 256B.69, subdivision 4, is amended to read:
148.15    Subd. 4. Limitation of choice. (a) The commissioner shall develop criteria to
148.16determine when limitation of choice may be implemented in the experimental counties.
148.17The criteria shall ensure that all eligible individuals in the county have continuing access
148.18to the full range of medical assistance services as specified in subdivision 6.
148.19    (b) The commissioner shall exempt the following persons from participation in the
148.20project, in addition to those who do not meet the criteria for limitation of choice:
148.21    (1) persons eligible for medical assistance according to section 256B.055,
148.22subdivision 1 ;
148.23    (2) persons eligible for medical assistance due to blindness or disability as
148.24determined by the Social Security Administration or the state medical review team, unless:
148.25    (i) they are 65 years of age or older; or
148.26    (ii) they reside in Itasca County or they reside in a county in which the commissioner
148.27conducts a pilot project under a waiver granted pursuant to section 1115 of the Social
148.28Security Act;
148.29    (3) recipients who currently have private coverage through a health maintenance
148.30organization;
148.31    (4) recipients who are eligible for medical assistance by spending down excess
148.32income for medical expenses other than the nursing facility per diem expense;
148.33    (5) recipients who receive benefits under the Refugee Assistance Program,
148.34established under United States Code, title 8, section 1522(e);
149.1    (6) children who are both determined to be severely emotionally disturbed and
149.2receiving case management services according to section 256B.0625, subdivision 20,
149.3except children who are eligible for and who decline enrollment in an approved preferred
149.4integrated network under section 245.4682;
149.5    (7) adults who are both determined to be seriously and persistently mentally ill and
149.6received case management services according to section 256B.0625, subdivision 20;
149.7    (8) persons eligible for medical assistance according to section 256B.057,
149.8subdivision 10 ; and
149.9    (9) persons with access to cost-effective employer-sponsored private health
149.10insurance or persons enrolled in a non-Medicare individual health plan determined to be
149.11cost-effective according to section 256B.0625, subdivision 15.
149.12Children under age 21 who are in foster placement may enroll in the project on an elective
149.13basis. Individuals excluded under clauses (1), (6), and (7) may choose to enroll on an
149.14elective basis. The commissioner may enroll recipients in the prepaid medical assistance
149.15program for seniors who are (1) age 65 and over, and (2) eligible for medical assistance by
149.16spending down excess income.
149.17    (c) The commissioner may allow persons with a one-month spenddown who are
149.18otherwise eligible to enroll to voluntarily enroll or remain enrolled, if they elect to prepay
149.19their monthly spenddown to the state.
149.20    (d) The commissioner may require those individuals to enroll in the prepaid medical
149.21assistance program who otherwise would have been excluded under paragraph (b), clauses
149.22(1), (3), and (8), and under Minnesota Rules, part 9500.1452, subpart 2, items H, K, and L.
149.23    (e) Before limitation of choice is implemented, eligible individuals shall be notified
149.24and after notification, shall be allowed to choose only among demonstration providers.
149.25The commissioner may assign an individual with private coverage through a health
149.26maintenance organization, to the same health maintenance organization for medical
149.27assistance coverage, if the health maintenance organization is under contract for medical
149.28assistance in the individual's county of residence. After initially choosing a provider,
149.29the recipient is allowed to change that choice only at specified times as allowed by the
149.30commissioner. If a demonstration provider ends participation in the project for any reason,
149.31a recipient enrolled with that provider must select a new provider but may change providers
149.32without cause once more within the first 60 days after enrollment with the second provider.
149.33    (f) An infant born to a woman who is eligible for and receiving medical assistance
149.34and who is enrolled in the prepaid medical assistance program shall be retroactively
149.35enrolled to the month of birth in the same managed care plan as the mother once the
150.1child is enrolled in medical assistance unless the child is determined to be excluded from
150.2enrollment in a prepaid plan under this section.
150.3(g) For an eligible individual under the age of 65, in the absence of a specific
150.4managed care plan choice by the individual, the commissioner shall assign the individual to
150.5the county-based purchasing plan, if any, in the county of the individual's residence. For an
150.6eligible individual over the age of 65, the commissioner shall make the default assignment
150.7on the county-based purchasing plan entering into a contract with the commissioner to
150.8serve this population and receiving federal approval as a special needs plan.

150.9    Sec. 68. Minnesota Statutes 2010, section 256B.69, subdivision 5a, is amended to read:
150.10    Subd. 5a. Managed care contracts. (a) Managed care contracts under this section
150.11and section 256L.12 shall be entered into or renewed on a calendar year basis beginning
150.12January 1, 1996. Managed care contracts which were in effect on June 30, 1995, and set to
150.13renew on July 1, 1995, shall be renewed for the period July 1, 1995 through December
150.1431, 1995 at the same terms that were in effect on June 30, 1995. The commissioner may
150.15issue separate contracts with requirements specific to services to medical assistance
150.16recipients age 65 and older.
150.17    (b) A prepaid health plan providing covered health services for eligible persons
150.18pursuant to chapters 256B and 256L is responsible for complying with the terms of its
150.19contract with the commissioner. Requirements applicable to managed care programs
150.20under chapters 256B and 256L established after the effective date of a contract with the
150.21commissioner take effect when the contract is next issued or renewed.
150.22    (c) Effective for services rendered on or after January 1, 2003, the commissioner
150.23shall withhold five percent of managed care plan payments under this section and
150.24county-based purchasing plan payments under section 256B.692 for the prepaid medical
150.25assistance program pending completion of performance targets. Each performance target
150.26must be quantifiable, objective, measurable, and reasonably attainable, except in the case
150.27of a performance target based on a federal or state law or rule. Criteria for assessment
150.28of each performance target must be outlined in writing prior to the contract effective
150.29date. The managed care plan must demonstrate, to the commissioner's satisfaction,
150.30that the data submitted regarding attainment of the performance target is accurate. The
150.31commissioner shall periodically change the administrative measures used as performance
150.32targets in order to improve plan performance across a broader range of administrative
150.33services. The performance targets must include measurement of plan efforts to contain
150.34spending on health care services and administrative activities. The commissioner may
150.35adopt plan-specific performance targets that take into account factors affecting only one
151.1plan, including characteristics of the plan's enrollee population. The withheld funds
151.2must be returned no sooner than July of the following year if performance targets in the
151.3contract are achieved. The commissioner may exclude special demonstration projects
151.4under subdivision 23.
151.5    (d) Effective for services rendered on or after January 1, 2009, through December
151.631, 2009, the commissioner shall withhold three percent of managed care plan payments
151.7under this section and county-based purchasing plan payments under section 256B.692
151.8for the prepaid medical assistance program. The withheld funds must be returned no
151.9sooner than July 1 and no later than July 31 of the following year. The commissioner may
151.10exclude special demonstration projects under subdivision 23.
151.11(e) Effective for services provided on or after January 1, 2010, the commissioner
151.12shall require that managed care plans use the assessment and authorization processes,
151.13forms, timelines, standards, documentation, and data reporting requirements, protocols,
151.14billing processes, and policies consistent with medical assistance fee-for-service or the
151.15Department of Human Services contract requirements consistent with medical assistance
151.16fee-for-service or the Department of Human Services contract requirements for all
151.17personal care assistance services under section 256B.0659.
151.18(f) Effective for services rendered on or after January 1, 2010, through December
151.1931, 2010, the commissioner shall withhold 4.5 percent of managed care plan payments
151.20under this section and county-based purchasing plan payments under section 256B.692
151.21for the prepaid medical assistance program. The withheld funds must be returned no
151.22sooner than July 1 and no later than July 31 of the following year. The commissioner may
151.23exclude special demonstration projects under subdivision 23.
151.24(g) Effective for services rendered on or after January 1, 2011, the commissioner
151.25shall include as part of the performance targets described in paragraph (c) a reduction in
151.26the health plan's emergency room utilization rate for state health care program enrollees
151.27by a measurable rate of five percent from the plan's utilization rate for state health care
151.28program enrollees for the previous calendar year.
151.29The withheld funds must be returned no sooner than July 1 and no later than July 31
151.30of the following calendar year if the managed care plan demonstrates to the satisfaction of
151.31the commissioner that a reduction in the utilization rate was achieved.
151.32The withhold described in this paragraph shall continue for each consecutive
151.33contract period until the plan's emergency room utilization rate for state health care
151.34program enrollees is reduced by 25 percent of the plan's emergency room utilization
151.35rate for state health care program enrollees for calendar year 2009. Hospitals shall
151.36cooperate with the health plans in meeting this performance target and shall accept
152.1payment withholds that may be returned to the hospitals if the performance target is
152.2achieved. The commissioner shall structure the withhold so that the commissioner returns
152.3a portion of the withheld funds in amounts commensurate with achieved reductions in
152.4utilization less than the targeted amount. The withhold in this paragraph does not apply to
152.5county-based purchasing plans.
152.6(h) Effective for services rendered on or after January 1, 2012, the commissioner
152.7shall include as part of the performance targets described in paragraph (c) a reduction in
152.8the plan's hospitalization rates or subsequent hospitalizations within 30 days of a previous
152.9hospitalization of a patient regardless of the reason for the hospitalization for state health
152.10care program enrollees by a measurable rate of five percent from the plan's utilization rate
152.11for state health care program enrollees for the previous calendar year.
152.12The withheld funds must be returned no sooner than July 1 and no later than July 31
152.13of the following calendar year if the managed care plan or county-based purchasing plan
152.14demonstrates to the satisfaction of the commissioner that a reduction in the hospitalization
152.15rate was achieved.
152.16The withhold described in this paragraph must continue for each consecutive
152.17contract period until the plan's subsequent hospitalization rate for state health care
152.18program enrollees is reduced by 25 percent of the plan's subsequent hospitalization rate
152.19for state health care program enrollees for calendar year 2010. Hospitals shall cooperate
152.20with the plans in meeting this performance target and shall accept payment withholds that
152.21must be returned to the hospitals if the performance target is achieved. The commissioner
152.22shall structure the withhold so that the commissioner returns a portion of the withheld
152.23funds in amounts commensurate with achieved reductions in utilization less than the
152.24targeted amount.
152.25(h) (i) Effective for services rendered on or after January 1, 2011, through December
152.2631, 2011, the commissioner shall withhold 4.5 percent of managed care plan payments
152.27under this section and county-based purchasing plan payments under section 256B.692
152.28for the prepaid medical assistance program. The withheld funds must be returned no
152.29sooner than July 1 and no later than July 31 of the following year. The commissioner may
152.30exclude special demonstration projects under subdivision 23.
152.31(i) (j) Effective for services rendered on or after January 1, 2012, through December
152.3231, 2012, the commissioner shall withhold 4.5 percent of managed care plan payments
152.33under this section and county-based purchasing plan payments under section 256B.692
152.34for the prepaid medical assistance program. The withheld funds must be returned no
152.35sooner than July 1 and no later than July 31 of the following year. The commissioner may
152.36exclude special demonstration projects under subdivision 23.
153.1(j) (k) Effective for services rendered on or after January 1, 2013, through December
153.231, 2013, the commissioner shall withhold 4.5 percent of managed care plan payments
153.3under this section and county-based purchasing plan payments under section 256B.692
153.4for the prepaid medical assistance program. The withheld funds must be returned no
153.5sooner than July 1 and no later than July 31 of the following year. The commissioner may
153.6exclude special demonstration projects under subdivision 23.
153.7(k) (l) Effective for services rendered on or after January 1, 2014, the commissioner
153.8shall withhold three percent of managed care plan payments under this section and
153.9county-based purchasing plan payments under section 256B.692 for the prepaid medical
153.10assistance program. The withheld funds must be returned no sooner than July 1 and
153.11no later than July 31 of the following year. The commissioner may exclude special
153.12demonstration projects under subdivision 23.
153.13(l) (m) A managed care plan or a county-based purchasing plan under section
153.14256B.692 may include as admitted assets under section 62D.044 any amount withheld
153.15under this section that is reasonably expected to be returned.
153.16(m) (n) Contracts between the commissioner and a prepaid health plan are exempt
153.17from the set-aside and preference provisions of section 16C.16, subdivisions 6, paragraph
153.18(a), and 7.
153.19(n) (o) The return of the withhold under paragraphs (d), (f), and (h) to (k) is not
153.20subject to the requirements of paragraph (c).

153.21    Sec. 69. Minnesota Statutes 2010, section 256B.69, subdivision 5c, is amended to read:
153.22    Subd. 5c. Medical education and research fund. (a) The commissioner of human
153.23services shall transfer each year to the medical education and research fund established
153.24under section 62J.692, the following:
153.25(1) an amount equal to the reduction in the prepaid medical assistance payments as
153.26specified in this clause. Until January 1, 2002, the county medical assistance capitation
153.27base rate prior to plan specific adjustments and after the regional rate adjustments under
153.28subdivision 5b is reduced 6.3 percent for Hennepin County, two percent for the remaining
153.29metropolitan counties, and no reduction for nonmetropolitan Minnesota counties; and after
153.30January 1, 2002, the county medical assistance capitation base rate prior to plan specific
153.31adjustments is reduced 6.3 percent for Hennepin County, two percent for the remaining
153.32metropolitan counties, and 1.6 percent for nonmetropolitan Minnesota counties. Nursing
153.33facility and elderly waiver payments and demonstration project payments operating
153.34under subdivision 23 are excluded from this reduction. The amount calculated under
154.1this clause shall not be adjusted for periods already paid due to subsequent changes to
154.2the capitation payments;
154.3(2) beginning July 1, 2003, $4,314,000 from the capitation rates paid under this
154.4section;
154.5(3) beginning July 1, 2002, an additional $12,700,000 from the capitation rates
154.6paid under this section; and
154.7(4) beginning July 1, 2003, an additional $4,700,000 from the capitation rates paid
154.8under this section.
154.9(b) This subdivision shall be effective upon approval of a federal waiver which
154.10allows federal financial participation in the medical education and research fund. Effective
154.11July 1, 2009, and thereafter, the transfers required by paragraph (a), clauses (1) to (4),
154.12shall not exceed the total amount transferred for fiscal year 2009. Any excess shall first
154.13reduce the amounts otherwise required to be transferred under paragraph (a), clauses
154.14(2) to (4). Any excess following this reduction shall proportionally reduce the transfers
154.15under paragraph (a), clause (1).
154.16(c) Beginning July 1, 2009, of the amounts in paragraph (a), the commissioner shall
154.17transfer $21,714,000 each fiscal year to the medical education and research fund. The
154.18balance of the transfers under paragraph (a) shall be transferred to the medical education
154.19and research fund no earlier than July 1 of the following fiscal year.
154.20(d) Beginning in fiscal year 2012, the commissioner shall reduce the amount
154.21transferred to the medical education research fund under paragraph (a), by $4,500,000
154.22each fiscal year. This reduction must be applied to the amount available for general
154.23distribution under section 62J.692, subdivision 7, clause (5).

154.24    Sec. 70. Minnesota Statutes 2010, section 256B.69, subdivision 6, is amended to read:
154.25    Subd. 6. Service delivery. (a) Each demonstration provider shall be responsible for
154.26the health care coordination for eligible individuals. Demonstration providers:
154.27    (1) shall authorize and arrange for the provision of all needed health services
154.28including but not limited to the full range of services listed in sections 256B.02,
154.29subdivision 8 , and 256B.0625 in order to ensure appropriate health care is delivered to
154.30enrollees. Notwithstanding section 256B.0621, demonstration providers that provide
154.31nursing home and community-based services under this section shall provide relocation
154.32service coordination to enrolled persons age 65 and over;
154.33    (2) shall accept the prospective, per capita payment from the commissioner in return
154.34for the provision of comprehensive and coordinated health care services for eligible
154.35individuals enrolled in the program;
155.1    (3) may contract with other health care and social service practitioners to provide
155.2services to enrollees; and
155.3    (4) shall institute recipient grievance procedures according to the method established
155.4by the project, utilizing applicable requirements of chapter 62D. Disputes not resolved
155.5through this process shall be appealable to the commissioner as provided in subdivision 11.
155.6    (b) Demonstration providers must comply with the standards for claims settlement
155.7under section 72A.201, subdivisions 4, 5, 7, and 8, when contracting with other health
155.8care and social service practitioners to provide services to enrollees. A demonstration
155.9provider must pay a clean claim, as defined in Code of Federal Regulations, title 42,
155.10section 447.45(b), within 30 business days of the date of acceptance of the claim.
155.11(c) A demonstration provider must accept into its medical assistance and
155.12MinnesotaCare provider networks any health care or social service provider that agrees
155.13to accept payment, quality assurance, and other contract terms that the demonstration
155.14provider applies to other similarly situated providers in its provider network.
155.15EFFECTIVE DATE.This section is effective January 1, 2012, and applies to
155.16provider contracts that take effect on or after that date.

155.17    Sec. 71. Minnesota Statutes 2010, section 256B.69, is amended by adding a
155.18subdivision to read:
155.19    Subd. 30. Provider payment rates. (a) Each managed care and county-based plan
155.20shall, by October 1, 2011, array all providers within each provider type, employed by or
155.21under contract with the plan, by their average total annual cost of care for serving medical
155.22assistance and MinnesotaCare enrollees for the most recent reporting year for which data
155.23is available, risk-adjusted for enrollee demographics and health status.
155.24(b) Beginning January 1, 2012, and each contract year thereafter, each managed
155.25care and county-based purchasing plan shall implement a progressive payment withhold
155.26methodology for each provider type, under which the withhold for a provider increases
155.27proportionally as the provider's risk-adjusted total annual cost increases, relative to other
155.28providers of the same type. For purposes of this paragraph, the risk-adjusted total annual
155.29cost of care is the dollar amount calculated under paragraph (a).
155.30(c) At the end of each contract year, each plan shall array all providers within each
155.31provider type by their average total annual cost of care for serving medical assistance and
155.32MinnesotaCare enrollees for that contract year, risk-adjusted for enrollee demographics
155.33and health status. For each provider whose risk-adjusted total annual cost of care is at or
155.34below a benchmark percentile established by the plan, the plan shall return the full amount
155.35of any withhold. For each provider whose risk-adjusted total annual cost of care is above
156.1the benchmark percentile, the plan shall return only the portion of the withhold sufficient
156.2to bring the provider's payment rate to the average for providers within the provider type
156.3whose risk-adjusted total annual cost of care is at the benchmark percentile. Each plan shall
156.4establish the benchmark percentile at a level that allows the plan to adjust expenditures for
156.5provider payments to reflect the reduction in capitation rates under paragraph (f).
156.6(d) Each managed care and county-based purchasing plan must establish an appeals
156.7process to allow providers to appeal determinations of risk-adjusted total annual cost of
156.8care. Each plan's appeals process must be approved by the commissioner.
156.9(e) The commissioner shall require each plan to submit to the commissioner, in
156.10the form and manner specified by the commissioner, all provider payment data and
156.11information on the withhold methodology that the commissioner determines is necessary
156.12to verify compliance with this subdivision.
156.13(f) The commissioner, for the contract year beginning January 1, 2012, shall reduce
156.14plan capitation rates by 12 percent from the rates that would otherwise apply, absent
156.15application of this subdivision. The reduced rate shall be the historical base rate for
156.16negotiating capitation rates for future contract years. The commissioner may recommend
156.17additional reductions in capitation rates for future contract years to the legislature, if the
156.18commissioner determines this is necessary to ensure that health care providers under
156.19contract with managed care and county-based purchasing plans practice in an efficient
156.20manner. Effective for services rendered on or after January 1, 2012, managed care plans
156.21and county-based purchasing plans contracted with the state to administer the health
156.22care programs provided under sections 256B.69, 256B.692, and 256L.12, may reduce
156.23payments made to providers employed or under contract with the plan.
156.24(g) The commissioner of human services, in consultation with the commissioner of
156.25health, shall develop and provide to managed care and county-based purchasing plans, by
156.26September 1, 2011, standard criteria and definitions necessary for consistent calculation
156.27of the total annual risk-adjusted cost of care across plans. The commissioner may use
156.28encounter data to implement this subdivision, and may provide encounter data or analyses
156.29to plans.
156.30(h) For purposes of this subdivision, "provider" means a vendor of medical care
156.31as defined in section 256B.02, subdivision 7, for which sufficient encounter data on
156.32utilization and costs is available to implement this subdivision.
156.33(i) A managed care or county-based purchasing plan must use the methodology
156.34described in paragraphs (a) to (e), unless the plan develops an alternative model consistent
156.35with the purpose of this subdivision.
156.36EFFECTIVE DATE.This section is effective the day following final enactment.

157.1    Sec. 72. Minnesota Statutes 2010, section 256B.69, is amended by adding a
157.2subdivision to read:
157.3    Subd. 31. Initiatives to reduce incidence of low birth weight. The commissioner
157.4shall require managed care and county-based purchasing plans as a condition of contract
157.5to implement strategies to reduce the incidence of low birth weight in geographic areas
157.6identified by the commissioner as having a higher than average incidence of low birth
157.7weight, with special emphasis on areas within a one-mile radius of hospitals within their
157.8provider networks. These strategies may focus on smoking prevention and cessation,
157.9ensuring that pregnant women get adequate nutrition, and addressing demographic,
157.10social, and environmental risk factors. The strategies must coordinate health care with
157.11social services and the local public health system, and offer patient education through
157.12appropriate means. The commissioner shall require plans to submit proposed initiatives
157.13for approval to the commissioner by January 1, 2012, and the commissioner shall require
157.14plans to implement approved initiatives by July 1, 2012. The commissioner shall evaluate
157.15the strategies adopted to reduce low birth weight and shall require plans to submit outcome
157.16and other data necessary for the evaluation.

157.17    Sec. 73. Minnesota Statutes 2010, section 256B.69, is amended by adding a
157.18subdivision to read:
157.19    Subd. 32. Health education. The commissioner shall require managed care and
157.20county-based purchasing plans, as a condition of contract, to provide health education,
157.21wellness training, and information about the availability and benefits of preventive
157.22services to all medical assistance and MinnesotaCare enrollees, beginning January 1,
157.232012. Plan initiatives developed or implemented to comply with this requirement must be
157.24approved by the commissioner.

157.25    Sec. 74. Minnesota Statutes 2010, section 256B.692, subdivision 2, is amended to read:
157.26    Subd. 2. Duties of commissioner of health. (a) Notwithstanding chapters 62D and
157.2762N, a county that elects to purchase medical assistance in return for a fixed sum without
157.28regard to the frequency or extent of services furnished to any particular enrollee is not
157.29required to obtain a certificate of authority under chapter 62D or 62N. The county board
157.30of commissioners is the governing body of a county-based purchasing program. In a
157.31multicounty arrangement, the governing body is a joint powers board established under
157.32section 471.59.
157.33    (b) A county that elects to purchase medical assistance services under this section
157.34must satisfy the commissioner of health that the requirements for assurance of consumer
158.1protection, provider protection, and, effective January 1, 2010, fiscal solvency of chapter
158.262D, applicable to health maintenance organizations will be met according to the
158.3following schedule:
158.4    (1) for a county-based purchasing plan approved on or before June 30, 2008, the
158.5plan must have in reserve:
158.6    (i) at least 50 percent of the minimum amount required under chapter 62D as
158.7of January 1, 2010;
158.8    (ii) at least 75 percent of the minimum amount required under chapter 62D as of
158.9January 1, 2011;
158.10    (iii) at least 87.5 percent of the minimum amount required under chapter 62D as
158.11of January 1, 2012; and
158.12    (iv) at least 100 percent of the minimum amount required under chapter 62D as
158.13of January 1, 2013; and
158.14    (2) for a county-based purchasing plan first approved after June 30, 2008, the plan
158.15must have in reserve:
158.16    (i) at least 50 percent of the minimum amount required under chapter 62D at the
158.17time the plan begins enrolling enrollees;
158.18    (ii) at least 75 percent of the minimum amount required under chapter 62D after
158.19the first full calendar year;
158.20    (iii) at least 87.5 percent of the minimum amount required under chapter 62D after
158.21the second full calendar year; and
158.22    (iv) at least 100 percent of the minimum amount required under chapter 62D after
158.23the third full calendar year.
158.24    (c) Until a plan is required to have reserves equaling at least 100 percent of the
158.25minimum amount required under chapter 62D, the plan may demonstrate its ability
158.26to cover any losses by satisfying the requirements of chapter 62N. Notwithstanding
158.27this paragraph and paragraph (b), a county-based purchasing plan may satisfy its fiscal
158.28solvency requirements by obtaining written financial guarantees from participating
158.29counties in amounts equivalent to the minimum amounts that would otherwise apply.
158.30A county-based purchasing plan must also assure the commissioner of health that the
158.31requirements of sections 62J.041; 62J.48; 62J.71 to 62J.73; 62M.01 to 62M.16; all
158.32applicable provisions of chapter 62Q, including sections 62Q.075; 62Q.1055; 62Q.106;
158.3362Q.12 ; 62Q.135; 62Q.14; 62Q.145; 62Q.19; 62Q.23, paragraph (c); 62Q.43; 62Q.47;
158.3462Q.50 ; 62Q.52 to 62Q.56; 62Q.58; 62Q.68 to 62Q.72; and 72A.201 will be met.
159.1    (d) All enforcement and rulemaking powers available under chapters 62D, 62J, 62M,
159.262N, and 62Q are hereby granted to the commissioner of health with respect to counties
159.3that purchase medical assistance services under this section.
159.4    (e) The commissioner, in consultation with county government, shall develop
159.5administrative and financial reporting requirements for county-based purchasing programs
159.6relating to sections 62D.041, 62D.042, 62D.045, 62D.08, 62N.28, 62N.29, and 62N.31,
159.7and other sections as necessary, that are specific to county administrative, accounting, and
159.8reporting systems and consistent with other statutory requirements of counties.
159.9    (f) The commissioner shall collect from a county-based purchasing plan under
159.10this section the following fees:
159.11    (1) fees attributable to the costs of audits and other examinations of plan financial
159.12operations. These fees are subject to the provisions of Minnesota Rules, part 4685.2800,
159.13subpart 1, item F;
159.14    (2) an annual fee of $21,500, to be paid by June 15 of each calendar year, beginning
159.15in calendar year 2009; and
159.16    (3) for fiscal year 2009 only, a per-enrollee fee of 14.6 cents, based on the number of
159.17enrollees as of December 31, 2008.
159.18All fees collected under this paragraph shall be deposited in the state government special
159.19revenue fund.

159.20    Sec. 75. Minnesota Statutes 2010, section 256B.692, subdivision 5, is amended to read:
159.21    Subd. 5. County proposals. (a) On or before September 1, 1997, a county board
159.22that wishes to purchase or provide health care under this section must submit a preliminary
159.23proposal that substantially demonstrates the county's ability to meet all the requirements
159.24of this section in response to criteria for proposals issued by the department on or before
159.25July 1, 1997. Counties submitting preliminary proposals must establish a local planning
159.26process that involves input from medical assistance recipients, recipient advocates,
159.27providers and representatives of local school districts, labor, and tribal government to
159.28advise on the development of a final proposal and its implementation.
159.29(b) The county board must submit a final proposal on or before July 1, 1998, that
159.30demonstrates the ability to meet all the requirements of this section, including beginning
159.31enrollment on January 1, 1999, unless a delay has been granted under section 256B.69,
159.32subdivision 3a , paragraph (g).
159.33(c) After January 1, 1999, for a county in which the prepaid medical assistance
159.34program is in existence, the county board must submit a preliminary proposal at least 15
159.35months prior to termination of health plan contracts in that county and a final proposal
160.1that meets the requirements of this section six months prior to the health plan contract
160.2termination date in order to begin enrollment after the termination. Nothing in this section
160.3shall impede or delay implementation or continuation of the prepaid medical assistance
160.4program in counties for which the board does not submit a proposal, or submits a proposal
160.5that is not in compliance with this section.
160.6(d) The commissioner is not required to terminate contracts for the prepaid medical
160.7assistance program that begin on or after September 1, 1997, in a county for which a
160.8county board has submitted a proposal under this paragraph, until two years have elapsed
160.9from the date of initial enrollment in the prepaid medical assistance program.

160.10    Sec. 76. Minnesota Statutes 2010, section 256B.692, subdivision 7, is amended to read:
160.11    Subd. 7. Dispute resolution. In the event the commissioner rejects a proposal
160.12under subdivision 6, the county board may request the recommendation decision of a
160.13three-person mediation panel. The commissioner shall resolve all disputes after taking
160.14into account by following the recommendations decision of the mediation panel. The
160.15panel shall be composed of one designee of the president of the Association of Minnesota
160.16Counties, one designee of the commissioner of human services, and one person selected
160.17jointly by the designee of the commissioner of human services and the designee of
160.18the Association of Minnesota Counties. Within a reasonable period of time before the
160.19hearing, the panelists must be provided all documents and information relevant to the
160.20mediation. The parties to the mediation must be given 30 days' notice of a hearing before
160.21the mediation panel.

160.22    Sec. 77. Minnesota Statutes 2010, section 256B.692, is amended by adding a
160.23subdivision to read:
160.24    Subd. 11. Patient choice of qualified provider. Effective January 1, 2012, a county
160.25board operating a county-based purchasing plan must ensure that each enrollee has the
160.26option of choosing a primary care provider or a health care home from all qualified
160.27providers who agree to accept the terms, conditions, and payment rates offered by the
160.28plan to similarly situated providers. Notwithstanding this requirement, reimbursement
160.29to federally qualified health centers and federally qualified health center look-alikes as
160.30defined in section 145.9269 must be in compliance with federal law.

160.31    Sec. 78. Minnesota Statutes 2010, section 256B.694, is amended to read:
160.32256B.694 SOLE-SOURCE OR SINGLE-PLAN MANAGED CARE
160.33CONTRACT.
161.1    (a) Notwithstanding section 256B.692, subdivision 6, clause (1), paragraph (c),
161.2the commissioner of human services shall approve a county-based purchasing health
161.3plan proposal, submitted on behalf of Cass, Crow Wing, Morrison, Todd, and Wadena
161.4Counties, that requires county-based purchasing on a single-plan basis contract if the
161.5implementation of the single-plan purchasing proposal does not limit an enrollee's
161.6provider choice or access to services and all other requirements applicable to health plan
161.7purchasing are satisfied. The commissioner shall continue to use single-health plan,
161.8county-based purchasing arrangements for medical assistance and general assistance
161.9medical care programs and products for the counties that were in single-health plan,
161.10county-based purchasing arrangements on March 1, 2008. This paragraph does not require
161.11the commissioner to terminate an existing contract with a noncounty-based purchasing
161.12plan that had enrollment in a medical assistance program or product in these counties on
161.13March 1, 2008. This paragraph expires on December 31, 2010, or the effective date
161.14of a new contract for medical assistance and general assistance medical care managed
161.15care programs entered into at the conclusion of the commissioner's next scheduled
161.16reprocurement process for the county-based purchasing entities covered by this paragraph,
161.17whichever is later.
161.18    (b) At the request of a county or group of counties, the commissioner shall consider,
161.19and may approve, contracting on a single-health plan basis with other county-based
161.20purchasing plans, or with other qualified health plans that have coordination arrangements
161.21with counties, to serve persons with a disability who voluntarily enroll, enrolled in
161.22Minnesota health care programs in order to promote better coordination or integration
161.23of health care services, social services and other community-based services, provided
161.24that all requirements applicable to health plan purchasing, including those in section
161.25256B.69, subdivision 23 , are satisfied. Nothing in this paragraph supersedes or modifies
161.26the requirements in paragraph (a).

161.27    Sec. 79. Minnesota Statutes 2010, section 256B.76, subdivision 4, is amended to read:
161.28    Subd. 4. Critical access dental providers. (a) Effective for dental services
161.29rendered on or after January 1, 2002, the commissioner shall increase reimbursements
161.30to dentists and dental clinics deemed by the commissioner to be critical access dental
161.31providers. For dental services rendered on or after July 1, 2007, the commissioner shall
161.32increase reimbursement by 30 percent above the reimbursement rate that would otherwise
161.33be paid to the critical access dental provider. The commissioner shall pay the managed
161.34care plans and county-based purchasing plans in amounts sufficient to reflect increased
161.35reimbursements to critical access dental providers as approved by the commissioner.
162.1(b) The commissioner shall designate the following dentists and dental clinics as
162.2critical access dental providers:
162.3    (1) nonprofit community clinics that:
162.4(i) have nonprofit status in accordance with chapter 317A;
162.5(ii) have tax exempt status in accordance with the Internal Revenue Code, section
162.6501(c)(3);
162.7(iii) are established to provide oral health services to patients who are low income,
162.8uninsured, have special needs, and are underserved;
162.9(iv) have professional staff familiar with the cultural background of the clinic's
162.10patients;
162.11(v) charge for services on a sliding fee scale designed to provide assistance to
162.12low-income patients based on current poverty income guidelines and family size;
162.13(vi) do not restrict access or services because of a patient's financial limitations
162.14or public assistance status; and
162.15(vii) have free care available as needed;
162.16    (2) federally qualified health centers, rural health clinics, and public health clinics;
162.17    (3) county owned and operated hospital-based dental clinics;
162.18(4) a dental clinic or dental group owned and operated by a nonprofit corporation in
162.19accordance with chapter 317A with more than 10,000 patient encounters per year with
162.20patients who are uninsured or covered by medical assistance, general assistance medical
162.21care, or MinnesotaCare; and
162.22(5) a dental clinic associated with an oral health or dental education program owned
162.23and operated by the University of Minnesota or an institution within the Minnesota State
162.24Colleges and Universities system.
162.25     (c) The commissioner may designate a dentist or dental clinic as a critical access
162.26dental provider if the dentist or dental clinic is willing to provide care to patients covered
162.27by medical assistance, general assistance medical care, or MinnesotaCare at a level which
162.28significantly increases access to dental care in the service area.
162.29(d) Notwithstanding paragraph (a), critical access payments must not be made for
162.30dental services provided from April 1, 2010, through June 30, 2010.
162.31(e) Notwithstanding section 256B.04, subdivision 2, the commissioner of human
162.32services shall not adopt rules governing this section or section 256L.11, subdivision 7.
162.33EFFECTIVE DATE.This section is effective July 1, 2011.

162.34    Sec. 80. [256B.7671] PATIENT-CENTERED DECISION-MAKING.
163.1(a) For purposes of this section, "patient-centered decision-making process" means a
163.2process that involves directed interaction with the patient to assist the patient in arriving at
163.3an informed objective health care decision regarding the surgical procedure that is both
163.4informed and consistent with the patient's preference and values. The interaction may be
163.5conducted by a health care provider or through the electronic use of decision aids. If
163.6decision aids are used in the process, the aids must meet the criteria established by the
163.7International Patients Decision Aids Standards Collaboration or the Cochrane Decision
163.8Aid Registry.
163.9(b) Effective January 1, 2012, the commissioner of human services shall require
163.10active participation in a patient-centered decision-making process before authorization is
163.11approved or payment reimbursement is provided for any of the following:
163.12(1) a surgical procedure for abnormal uterine bleeding, benign prostate enlargement,
163.13chronic back pain, early stage of breast and prostate cancers, gastroesophageal reflux
163.14disease, hemorrhoids, spinal stenosis, temporomandibular joint dysfunction, ulcerative
163.15colitis, urinary incontinence, uterine fibroids, or varicose veins; and
163.16(2) bypass surgery for coronary disease, angioplasty for stable coronary artery
163.17disease, or total hip replacement.
163.18(c) A list of the procedures in paragraph (b) shall be published in the State Register
163.19by October 1, 2011. The list shall be reviewed no less than every two years by the
163.20commissioner, in consultation with the commissioner of health. The commissioner
163.21shall hold a public forum and receive public comment prior to any changes to the list in
163.22paragraph (b). Any changes made shall be published in the State Register.
163.23(d) Prior to receiving authorization or reimbursement for the procedures identified
163.24under this section, a health care provider must certify that the patient has participated in a
163.25patient-centered decision-making process. The format for this certification and the process
163.26for coordination between providers shall be developed by the Health Services Policy
163.27Committee under section 256B.0625, subdivision 3c.
163.28(e) This section does not apply if any of the procedures identified in this section are
163.29performed under an emergency situation.

163.30    Sec. 81. [256B.771] COMPLEMENTARY AND ALTERNATIVE MEDICINE
163.31DEMONSTRATION PROJECT.
163.32    Subdivision 1. Establishment and implementation. The commissioner of
163.33human services, in consultation with the commissioner of health, shall contract
163.34with a Minnesota-based academic and research institution specializing in providing
163.35complementary and alternative medicine education and clinical services to establish and
164.1implement a five-year demonstration project in conjunction with federally qualified health
164.2centers and federally qualified health center look-alikes as defined in section 145.9269, to
164.3improve the quality and cost-effectiveness of care provided under medical assistance to
164.4enrollees with neck and back problems. The demonstration project must maximize the use
164.5of complementary and alternative medicine-oriented primary care providers, including but
164.6not limited to physicians and chiropractors. The demonstration project must be designed
164.7to significantly improve physical and mental health for enrollees who present with
164.8neck and back problems while decreasing medical treatment costs. The commissioner,
164.9in consultation with the commissioner of health, shall deliver services through the
164.10demonstration project beginning July 1, 2011, or upon federal approval, whichever is later.
164.11    Subd. 2. RFP and project criteria. The commissioner, in consultation with the
164.12commissioner of health, shall develop and issue a request for proposal (RFP) for the
164.13demonstration project. The RFP must require the academic and research institution
164.14selected to demonstrate a proven track record over at least five years of conducting
164.15high-quality, federally funded clinical research. The institution and the federally qualified
164.16health centers and federally qualified health center look-alikes shall also:
164.17(1) provide patient education, provider education, and enrollment training
164.18components on health and lifestyle issues in order to promote enrollee responsibility for
164.19health care decisions, enhance productivity, prepare enrollees to reenter the workforce,
164.20and reduce future health care expenditures;
164.21(2) use high-quality and cost-effective integrated disease management that includes
164.22the best practices of traditional and complementary and alternative medicine;
164.23(3) incorporate holistic medical care, appropriate nutrition, exercise, medications,
164.24and conflict resolution techniques;
164.25(4) include a provider education component that makes use of professional
164.26organizations representing chiropractors, nurses, and other primary care providers
164.27and provides appropriate educational materials and activities in order to improve the
164.28integration of traditional medical care with licensed chiropractic services and other
164.29alternative health care services and achieve program enrollment objectives; and
164.30(5) provide to the commissioner the information and data necessary for the
164.31commissioner to prepare the annual reports required under subdivision 6.
164.32    Subd. 3. Enrollment. Enrollees from the program shall be selected by the
164.33commissioner from current enrollees in the prepaid medical assistance program who
164.34have, or are determined to be at significant risk of developing, neck and back problems.
164.35Participation in the demonstration project shall be voluntary. The commissioner shall
164.36seek to enroll, over the term of the demonstration project, ten percent of current and
165.1future medical assistance enrollees who have, or are determined to be at significant risk
165.2of developing, neck and back problems.
165.3    Subd. 4. Federal approval. The commissioner shall seek any federal waivers and
165.4approvals necessary to implement the demonstration project.
165.5    Subd. 5. Project costs. The commissioner shall require the academic and research
165.6institution selected, federally qualified health centers, and federally qualified health center
165.7look-alikes to fund all net costs of the demonstration project.
165.8    Subd. 6. Annual reports. The commissioner, in consultation with the commissioner
165.9of health, beginning December 15, 2011, and each December 15 thereafter through
165.10December 15, 2015, shall report annually to the legislature on the functional and mental
165.11improvements of the populations served by the demonstration project, patient satisfaction,
165.12and the cost-effectiveness of the program. The reports must also include data on hospital
165.13admissions, days in hospital, rates of outpatient surgery and other services, and drug
165.14utilization. The report, due December 15, 2015, must include recommendations on
165.15whether the demonstration project should be continued and expanded.

165.16    Sec. 82. [256B.841] WAIVER APPLICATION AND PROCESS.
165.17    Subdivision 1. Intent. It is the intent of the legislature that medical assistance be:
165.18(1) a sustainable, cost-effective, person-centered, and opportunity-driven program
165.19utilizing competitive and value-based purchasing to maximize available service options;
165.20and
165.21(2) a results-oriented system of coordinated care that focuses on independence
165.22and choice, promotes accountability and transparency, encourages and rewards healthy
165.23outcomes and responsible choices, and promotes efficiency.
165.24    Subd. 2. Waiver application. (a) By September 1, 2011, the commissioner of
165.25human services shall apply for a waiver and any necessary state plan amendments from
165.26the secretary of the United States Department of Health and Human Services, including,
165.27but not limited to, a waiver of the appropriate sections of title XIX of the federal Social
165.28Security Act, United States Code, title 42, section 1396 et seq., or other provisions of
165.29federal law that provide program flexibility and under which Minnesota will operate all
165.30facets of the state's medical assistance program.
165.31(b) The commissioner of human services shall provide the legislative committees
165.32with jurisdiction over health and human services finance and policy with the waiver
165.33application and financial and other related materials, at least ten days prior to submitting
165.34the application and materials to the federal Centers for Medicare and Medicaid Services.
166.1(c) If the state's waiver application is approved, the commissioner of human services
166.2shall:
166.3(1) notify the chairs of the legislative committees with jurisdiction over health and
166.4human services finance and policy and allow the legislative committees with jurisdiction
166.5over health and human services finance and policy to review the terms of the waiver; and
166.6(2) not implement the waiver until ten legislative days have passed following
166.7notification of the chairs.
166.8    Subd. 3. Rulemaking; legislative proposals. Upon acceptance of the terms of the
166.9waiver, the commissioner of human services shall:
166.10(1) adopt rules to implement the waiver; and
166.11(2) propose any legislative changes necessary to implement the terms of the waiver.
166.12    Subd. 4. Joint commission on waiver implementation. (a) After acceptance
166.13of the terms of the waiver, the governor shall establish a joint commission on waiver
166.14implementation. The commission shall consist of eight members; four of whom shall
166.15be members of the senate, not more than three from the same political party, to be
166.16appointed by the Subcommittee on Committees of the senate Committee on Rules and
166.17Administration, and four of whom shall be members of the house of representatives, not
166.18more than three from the same political party, to be appointed by the speaker of the house.
166.19(b) The commission shall:
166.20(1) oversee implementation of the waiver;
166.21(2) confer as necessary with state agency commissioners;
166.22(3) make recommendations on services covered under the medical assistance
166.23program;
166.24(4) monitor and make recommendations on quality and access to care under the
166.25global waiver; and
166.26(5) make recommendations for the efficient and cost-effective administration of the
166.27medical assistance program under the terms of the waiver.

166.28    Sec. 83. [256B.842] PRINCIPLES AND GOALS FOR MEDICAL ASSISTANCE
166.29REFORM.
166.30    Subdivision 1. Goals for reform. In developing the waiver application and
166.31implementing the waiver, the commissioner of human services shall ensure that the
166.32reformed medical assistance program is a person-centered, financially sustainable, and
166.33cost-effective program.
166.34    Subd. 2. Reformed medical assistance criteria. The reformed medical assistance
166.35program established through the waiver must:
167.1(1) empower consumers to make informed and cost-effective choices about their
167.2health and offer consumers rewards for healthy decisions;
167.3(2) ensure adequate access to needed services;
167.4(3) enable consumers to receive individualized health care that is outcome-oriented
167.5and focused on prevention, disease management, recovery, and maintaining independence;
167.6(4) promote competition between health care providers to ensure best value
167.7purchasing, leverage resources, and to create opportunities for improving service quality
167.8and performance;
167.9(5) redesign purchasing and payment methods and encourage and reward
167.10high-quality and cost-effective care by incorporating and expanding upon current payment
167.11reform and quality of care initiatives, including but not limited to those initiatives
167.12authorized under chapter 62U; and
167.13(6) continually improve technology to take advantage of recent innovations and
167.14advances that help decision makers, consumers, and providers make informed and
167.15cost-effective decisions regarding health care.
167.16    Subd. 3. Annual report. The commissioner of human services shall annually
167.17submit a report to the governor and the legislature, beginning December 1, 2012, and each
167.18December 1 thereafter, describing the status of the administration and implementation
167.19of the waiver.

167.20    Sec. 84. [256B.843] WAIVER APPLICATION REQUIREMENTS.
167.21    Subdivision 1. Requirements for waiver request. The commissioner shall seek
167.22federal approval to:
167.23(1) enter into a five-year agreement with the United States Department of Health and
167.24Human Services and Centers for Medicaid and Medicare Services (CMS) under section
167.251115a to waive provisions of title XIX of the federal Social Security Act, United States
167.26Code, title 42, section 1396 et seq., requiring:
167.27(i) statewideness to allow for the provision of different services in different areas or
167.28regions of the state;
167.29(ii) comparability of services to allow for the provision of different services to
167.30members of the same or different coverage groups;
167.31(iii) no prohibitions restricting the amount, duration, and scope of services included
167.32in the medical assistance state plan;
167.33(iv) no prohibitions limiting freedom of choice of providers; and
167.34(v) retroactive payment for medical assistance, at the state's discretion;
168.1(2) waive the applicable provisions of title XIX of the federal Social Security Act,
168.2United States Code, title 42, section 1396 et seq., in order to:
168.3(i) expand cost sharing requirements above the five percent of income threshold for
168.4beneficiaries in certain populations;
168.5(ii) establish health savings or power accounts that encourage and reward
168.6beneficiaries who reach certain prevention and wellness targets; and
168.7(iii) implement a tiered set of parameters to use as the basis for determining
168.8long-term service care and setting needs;
168.9(3) modify income and resource rules in a manner consistent with the goals of the
168.10reformed program;
168.11(4) provide enrollees with a choice of appropriate private sector health coverage
168.12options, with full federal financial participation;
168.13(5) treat payments made toward the cost of care as a monthly premium for
168.14beneficiaries receiving home and community-based services when applicable;
168.15(6) provide health coverage and services to individuals over the age of 65 that are
168.16limited in scope and are available only in the home and community-based setting;
168.17(7) consolidate all home and community-based services currently provided under
168.18title XIX of the federal Social Security Act, United States Code, title 42, section 1915(c),
168.19into a single program of home and community-based services that include options for
168.20consumer direction and shared living;
168.21(8) expand disease management, care coordination, and wellness programs for all
168.22medical assistance recipients; and
168.23(9) empower and encourage able-bodied medical assistance recipients to work,
168.24whenever possible.
168.25    Subd. 2. Agency coordination. The commissioner shall establish an intraagency
168.26assessment and coordination unit to ensure that decision making and program planning for
168.27recipients who may need long-term care, residential placement, and community support
168.28services are coordinated. The assessment and coordination unit shall determine level of
168.29care, develop service plans and a service budget, make referrals to appropriate settings,
168.30provide education and choice counseling to consumers and providers, track utilization,
168.31and monitor outcomes.

168.32    Sec. 85. Minnesota Statutes 2010, section 256D.03, subdivision 3, is amended to read:
168.33    Subd. 3. General assistance medical care; eligibility. (a) Beginning April 1,
168.342010 January 1, 2012, the general assistance medical care program shall be administered
168.35according to section 256D.031, unless otherwise stated, except for outpatient prescription
169.1drug coverage, which shall continue to be administered under this section and funded
169.2under section 256D.031, subdivision 9, beginning June 1, 2010.
169.3    (b) Outpatient prescription drug coverage under general assistance medical care is
169.4limited to prescription drugs that:
169.5    (1) are covered under the medical assistance program as described in section
169.6256B.0625, subdivisions 13 and 13d; and
169.7    (2) are provided by manufacturers that have fully executed general assistance
169.8medical care rebate agreements with the commissioner and comply with the agreements.
169.9Outpatient prescription drug coverage under general assistance medical care must conform
169.10to coverage under the medical assistance program according to section 256B.0625,
169.11subdivisions 13 to 13h.
169.12    (c) Outpatient prescription drug coverage does not include drugs administered in a
169.13clinic or other outpatient setting.
169.14    (d) For the period beginning April 1, 2010, to May 31, 2010, general assistance
169.15medical care covers the services listed in subdivision 4.
169.16EFFECTIVE DATE.This section is effective January 1, 2012.

169.17    Sec. 86. Minnesota Statutes 2010, section 256D.031, subdivision 6, is amended to read:
169.18    Subd. 6. Coordinated care delivery systems. (a) Effective June 1, 2010 January
169.191, 2012, the commissioner shall contract with hospitals or groups of hospitals, or
169.20county-based purchasing plans, that qualify under paragraph (b) and agree to deliver
169.21services according to this subdivision. Contracting hospitals or plans shall develop
169.22and implement a coordinated care delivery system to provide health care services to
169.23individuals who are eligible for general assistance medical care under this section and who
169.24either choose to receive services through the coordinated care delivery system or who are
169.25enrolled by the commissioner under paragraph (c). The health care services provided by
169.26the system must include: (1) the services described in subdivision 4 with the exception
169.27of outpatient prescription drug coverage but shall include drugs administered in a clinic
169.28or other outpatient setting; or (2) a set of comprehensive and medically necessary health
169.29services that the recipients might reasonably require to be maintained in good health and
169.30that has been approved by the commissioner, including at a minimum, but not limited
169.31to, emergency care, medical transportation services, inpatient hospital and physician
169.32care, outpatient health services, preventive health services, mental health services,
169.33and prescription drugs administered in a clinic or other outpatient setting. Outpatient
169.34prescription drug coverage is covered on a fee-for-service basis in accordance with section
169.35256D.03, subdivision 3, and funded under subdivision 9. A hospital or plan establishing a
170.1coordinated care delivery system under this subdivision must ensure that the requirements
170.2of this subdivision are met.
170.3    (b) A hospital or group of hospitals, or a county-based purchasing plan established
170.4under section 256B.692, may contract with the commissioner to develop and implement a
170.5coordinated care delivery system as follows: if the hospital or group of hospitals or plan
170.6agrees to satisfy the requirements of this subdivision.
170.7    (1) effective June 1, 2010, a hospital qualifies under this subdivision if: (i) during
170.8calendar year 2008, it received fee-for-service payments for services to general assistance
170.9medical care recipients (A) equal to or greater than $1,500,000, or (B) equal to or greater
170.10than 1.3 percent of net patient revenue; or (ii) a contract with the hospital is necessary to
170.11provide geographic access or to ensure that at least 80 percent of enrollees have access to
170.12a coordinated care delivery system; and
170.13    (2) effective December 1, 2010, a Minnesota hospital not qualified under clause
170.14(1) may contract with the commissioner under this subdivision if it agrees to satisfy the
170.15requirements of this subdivision.
170.16Participation by hospitals or plans shall become effective quarterly on June 1, September
170.171, December 1, or March 1 January 1, April 1, July 1, or October 1. Hospital or plan
170.18participation is effective for a period of 12 months and may be renewed for successive
170.1912-month periods.
170.20    (c) Applicants and recipients may enroll in any available coordinated care delivery
170.21system statewide. If more than one coordinated care delivery system is available, the
170.22applicant or recipient shall be allowed to choose among the systems. The commissioner
170.23may assign an applicant or recipient to a coordinated care delivery system if no choice
170.24is made by the applicant or recipient. The commissioner shall consider a recipient's zip
170.25code, city of residence, county of residence, or distance from a participating coordinated
170.26care delivery system when determining default assignment. An applicant or recipient may
170.27decline enrollment in a coordinated care delivery system but services are only available
170.28through a coordinated care delivery system. Upon enrollment into a coordinated care
170.29delivery system, the recipient must agree to receive all nonemergency services through the
170.30coordinated care delivery system. Enrollment in a coordinated care delivery system is
170.31for six months and may be renewed for additional six-month periods, except that initial
170.32enrollment is for six months or until the end of a recipient's period of general assistance
170.33medical care eligibility, whichever occurs first. A recipient who continues to meet the
170.34eligibility requirements of this section is not eligible to enroll in MinnesotaCare during
170.35a period of enrollment in a coordinated care delivery system. From June 1, 2010, to
170.36February 28, 2011, applicants and recipients not enrolled in a coordinated care delivery
171.1system may seek services from a hospital eligible for reimbursement under the temporary
171.2uncompensated care pool established under subdivision 8. After February 28, 2011,
171.3services are available only through a coordinated care delivery system.
171.4    (d) The hospital or plan may contract and coordinate with providers and clinics
171.5for the delivery of services and shall contract with essential community providers as
171.6defined under section 62Q.19, subdivision 1, paragraph (a), clauses (1) and (2), to the
171.7extent practicable. When contracting with providers and clinics, the hospital or plan
171.8shall give preference to providers and clinics certified as health care homes under section
171.9256B.0751. The hospital or plan must contract with federally qualified health centers or
171.10federally qualified health center look-alikes, as defined in section 145.9269, subdivision 1,
171.11and essential community providers as defined in section 62Q.19, that agree to accept the
171.12terms, conditions, and payment rates offered by the hospital or plan to similarly situated
171.13providers, except that reimbursement to federally qualified health centers and federally
171.14qualified health center look-alikes must comply with federal law. If a provider or clinic or
171.15health center contracts with a hospital or plan to provide services through the coordinated
171.16care delivery system, the provider may not refuse to provide services to any recipient
171.17enrolled in the system, and payment for services shall be negotiated with the hospital or
171.18plan and paid by the hospital or plan from the system's allocation under subdivision 7.
171.19    (e) A coordinated care delivery system must:
171.20    (1) provide the covered services required under paragraph (a) to recipients enrolled
171.21in the coordinated care delivery system, and comply with the requirements of subdivision
171.224, paragraphs (b) to (g);
171.23    (2) establish a process to monitor enrollment and ensure the quality of care provided;
171.24    (3) in cooperation with counties, coordinate the delivery of health care services with
171.25existing homeless prevention, supportive housing, and rent subsidy programs and funding
171.26administered by the Minnesota Housing Finance Agency under chapter 462A; and
171.27    (4) adopt innovative and cost-effective methods of care delivery and coordination,
171.28which may include the use of allied health professionals, telemedicine, patient educators,
171.29care coordinators, and community health workers.
171.30    (f) The hospital or plan may require a recipient to designate a primary care provider
171.31or a primary care clinic. The hospital or plan may limit the delivery of services to a
171.32network of providers who have contracted with the hospital or plan to deliver services in
171.33accordance with this subdivision, and require a recipient to seek services only within this
171.34network. The hospital or plan may also require a referral to a provider before the service
171.35is eligible for payment. A coordinated care delivery system is not required to provide
171.36payment to a provider who is not employed by or under contract with the system for
172.1services provided to a recipient enrolled in the system, except in cases of an emergency.
172.2For purposes of this section, emergency services are defined in accordance with Code of
172.3Federal Regulations, title 42, section 438.114 (a).
172.4    (g) A recipient enrolled in a coordinated care delivery system has the right to appeal
172.5to the commissioner according to section 256.045.
172.6    (h) The state shall not be liable for the payment of any cost or obligation incurred
172.7by the coordinated care delivery system.
172.8    (i) The hospital or plan must provide the commissioner with data necessary for
172.9assessing enrollment, quality of care, cost, and utilization of services. Each hospital or
172.10plan must provide, on a quarterly basis on a form prescribed by the commissioner for each
172.11recipient served by the coordinated care delivery system, the services provided, the cost of
172.12services provided, and the actual payment amount for the services provided and any other
172.13information the commissioner deems necessary to claim federal Medicaid match. The
172.14commissioner must provide this data to the legislature on a quarterly basis.
172.15    (j) Effective June 1, 2010, The provisions of section 256.9695, subdivision 2,
172.16paragraph (b), do not apply to general assistance medical care provided under this section.
172.17    (k) Notwithstanding any other provision in this section to the contrary, for
172.18participation beginning September 1, 2010, the commissioner shall offer the same contract
172.19terms related to shall negotiate an enrollment threshold formula and financial liability
172.20protections to with a hospital or group of hospitals or plan qualified under this subdivision
172.21to develop and implement a coordinated care delivery system as those contained in the
172.22coordinated care delivery system contracts effective June 1, 2010.
172.23    (l) If sections 256B.055, subdivision 15, and 256B.056, subdivisions 3 and 4, are
172.24implemented effective July 1, 2010, this subdivision must not be implemented.
172.25EFFECTIVE DATE.This section is effective January 1, 2012.

172.26    Sec. 87. Minnesota Statutes 2010, section 256D.031, subdivision 7, is amended to read:
172.27    Subd. 7. Payments; rate setting for the hospital coordinated care delivery
172.28system. (a) Effective for general assistance medical care services, with the exception
172.29of outpatient prescription drug coverage, provided on or after June 1, 2010, through a
172.30coordinated care delivery system, the commissioner shall allocate the annual appropriation
172.31for the coordinated care delivery system to hospitals or plans participating under
172.32subdivision 6 in quarterly payments, beginning on the first scheduled warrant on or after
172.33June 1, 2010 March 1, 2012. The payment shall be allocated among all hospitals or plans
172.34qualified to participate on the allocation date as follows: based upon the enrollment
172.35thresholds negotiated with the commissioner.
173.1    (1) each hospital or group of hospitals shall be allocated an initial amount based on
173.2the hospital's or group of hospitals' pro rata share of calendar year 2008 payments for
173.3general assistance medical care services to all participating hospitals;
173.4    (2) the initial allocations to Hennepin County Medical Center; Regions Hospital;
173.5Saint Mary's Medical Center; and the University of Minnesota Medical Center, Fairview,
173.6shall be increased to 110 percent of the value determined in clause (1);
173.7    (3) the initial allocation to hospitals not listed in clause (2) shall be reduced a pro rata
173.8amount in order to keep the allocations within the limit of available appropriations; and
173.9    (4) the amounts determined under clauses (1) to (3) shall be allocated to participating
173.10hospitals.
173.11The commissioner may prospectively reallocate payments to participating hospitals or
173.12plans on a biannual basis to ensure that final allocations reflect actual coordinated care
173.13delivery system enrollment. The 2008 base year shall be updated by one calendar year
173.14each June 1, beginning June 1, 2011.
173.15    (b) Beginning June 1, 2010, and every quarter beginning in June thereafter, the
173.16commissioner shall make one-third of the quarterly payment in June and the remaining
173.17two-thirds of the quarterly payment in July to each participating hospital or group of
173.18hospitals.
173.19    (c) (b) In order to be reimbursed under this section, nonhospital providers of health
173.20care services shall contract with one or more hospitals or plans described in paragraph (a)
173.21to provide services to general assistance medical care recipients through the coordinated
173.22care delivery system established by the hospital or plan. The hospital or plan shall
173.23reimburse bills submitted by nonhospital providers participating under this paragraph at a
173.24rate negotiated between the hospital or plan and the nonhospital provider.
173.25    (d) (c) The commissioner shall apply for federal matching funds under section
173.26256B.199 , paragraphs (a) to (d), for expenditures under this subdivision.
173.27    (e) (d) Outpatient prescription drug coverage is provided in accordance with section
173.28256D.03, subdivision 3 , and paid on a fee-for-service basis under subdivision 9.
173.29EFFECTIVE DATE.This section is effective January 1, 2012.

173.30    Sec. 88. Minnesota Statutes 2010, section 256D.031, subdivision 10, is amended to
173.31read:
173.32    Subd. 10. Assistance for veterans. Hospitals and plans participating in the
173.33coordinated care delivery system under subdivision 6 shall consult with counties, county
174.1veterans service officers, and the Veterans Administration to identify other programs for
174.2which general assistance medical care recipients enrolled in their system are qualified.

174.3    Sec. 89. Minnesota Statutes 2010, section 256L.01, subdivision 4a, is amended to read:
174.4    Subd. 4a. Gross individual or gross family income. (a) "Gross individual or gross
174.5family income" for nonfarm self-employed means income calculated for the 12-month
174.6six-month period of eligibility using as a baseline the adjusted gross income reported
174.7on the applicant's federal income tax form for the previous year and adding back in
174.8depreciation, and carryover net operating loss amounts that apply to the business in which
174.9the family is currently engaged.
174.10(b) "Gross individual or gross family income" for farm self-employed means
174.11income calculated for the 12-month six-month period of eligibility using as the baseline
174.12the adjusted gross income reported on the applicant's federal income tax form for the
174.13previous year.
174.14(c) "Gross individual or gross family income" means the total income for all family
174.15members, calculated for the 12-month six-month period of eligibility.

174.16    Sec. 90. Minnesota Statutes 2010, section 256L.02, subdivision 3, is amended to read:
174.17    Subd. 3. Financial management. (a) The commissioner shall manage spending for
174.18the MinnesotaCare program in a manner that maintains a minimum reserve. As part of
174.19each state revenue and expenditure forecast, the commissioner must make an assessment
174.20of the expected expenditures for the covered services for the remainder of the current
174.21biennium and for the following biennium. The estimated expenditure, including the
174.22reserve, shall be compared to an estimate of the revenues that will be available in the health
174.23care access fund. Based on this comparison, and after consulting with the chairs of the
174.24house of representatives Ways and Means Committee and the senate Finance Committee,
174.25and the Legislative Commission on Health Care Access, the commissioner shall, as
174.26necessary, make the adjustments specified in paragraph (b) to ensure that expenditures
174.27remain within the limits of available revenues for the remainder of the current biennium
174.28and for the following biennium. The commissioner shall not hire additional staff using
174.29appropriations from the health care access fund until the commissioner of management
174.30and budget makes a determination that the adjustments implemented under paragraph (b)
174.31are sufficient to allow MinnesotaCare expenditures to remain within the limits of available
174.32revenues for the remainder of the current biennium and for the following biennium.
174.33(b) The adjustments the commissioner shall use must be implemented in this order:
174.34first, stop enrollment of single adults and households without children; second, upon 45
175.1days' notice, stop coverage of single adults and households without children already
175.2enrolled in the MinnesotaCare program; third, upon 90 days' notice, decrease the premium
175.3subsidy amounts by ten percent for children in families with gross annual income above
175.4200 percent of the federal poverty guidelines; fourth, upon 90 days' notice, decrease the
175.5premium subsidy amounts by ten percent for children in families with gross annual income
175.6at or below 200 percent; and fifth, require applicants to be uninsured for at least six months
175.7prior to eligibility in the MinnesotaCare program. If these measures are insufficient to
175.8limit the expenditures to the estimated amount of revenue, the commissioner shall further
175.9limit enrollment or decrease premium subsidies.
175.10EFFECTIVE DATE.This section is effective January 1, 2012, or upon federal
175.11approval, whichever is later, and expires June 30, 2013. The commissioner shall notify
175.12the revisor of statutes when federal approval is obtained and publish a notice in the State
175.13Register.

175.14    Sec. 91. Minnesota Statutes 2010, section 256L.02, subdivision 3, is amended to read:
175.15    Subd. 3. Financial management. (a) The commissioner shall manage spending for
175.16the MinnesotaCare program in a manner that maintains a minimum reserve. As part of
175.17each state revenue and expenditure forecast, the commissioner must make an assessment
175.18of the expected expenditures for the covered services for the remainder of the current
175.19biennium and for the following biennium. The estimated expenditure, including the
175.20reserve, shall be compared to an estimate of the revenues that will be available in the health
175.21care access fund. Based on this comparison, and after consulting with the chairs of the
175.22house of representatives Ways and Means Committee and the senate Finance Committee,
175.23and the Legislative Commission on Health Care Access, the commissioner shall, as
175.24necessary, make the adjustments specified in paragraph (b) to ensure that expenditures
175.25remain within the limits of available revenues for the remainder of the current biennium
175.26and for the following biennium. The commissioner shall not hire additional staff using
175.27appropriations from the health care access fund until the commissioner of management
175.28and budget makes a determination that the adjustments implemented under paragraph (b)
175.29are sufficient to allow MinnesotaCare expenditures to remain within the limits of available
175.30revenues for the remainder of the current biennium and for the following biennium.
175.31(b) The adjustments the commissioner shall use must be implemented in this order:
175.32first, stop enrollment of single adults and households without children; second, upon 45
175.33days' notice, stop coverage of single adults and households without children already
175.34enrolled in the MinnesotaCare program; third, upon 90 days' notice, decrease the premium
175.35subsidy amounts by ten percent for families with gross annual income above 200 percent
176.1of the federal poverty guidelines; fourth, upon 90 days' notice, decrease the premium
176.2subsidy amounts by ten percent for families with gross annual income at or below 200
176.3percent; and fifth, require applicants to be uninsured for at least six months prior to
176.4eligibility in the MinnesotaCare program. If these measures are insufficient to limit the
176.5expenditures to the estimated amount of revenue, the commissioner shall further limit
176.6enrollment or decrease premium subsidies.

176.7    Sec. 92. Minnesota Statutes 2010, section 256L.03, subdivision 3, is amended to read:
176.8    Subd. 3. Inpatient hospital services. (a) Covered health services shall include
176.9inpatient hospital services, including inpatient hospital mental health services and inpatient
176.10hospital and residential chemical dependency treatment, subject to those limitations
176.11necessary to coordinate the provision of these services with eligibility under the medical
176.12assistance spenddown. The inpatient hospital benefit for adult enrollees who qualify under
176.13section 256L.04, subdivision 7, or who qualify under section 256L.04, subdivisions 1 and
176.142 , with family gross income that exceeds 200 percent of the federal poverty guidelines or
176.15215 percent of the federal poverty guidelines on or after July 1, 2009, and who are not
176.16pregnant, is subject to an annual limit of $10,000.
176.17    (b) Admissions for inpatient hospital services paid for under section 256L.11,
176.18subdivision 3 , must be certified as medically necessary in accordance with Minnesota
176.19Rules, parts 9505.0500 to 9505.0540, except as provided in clauses (1) and (2):
176.20    (1) all admissions must be certified, except those authorized under rules established
176.21under section 254A.03, subdivision 3, or approved under Medicare; and
176.22    (2) payment under section 256L.11, subdivision 3, shall be reduced by five percent
176.23for admissions for which certification is requested more than 30 days after the day of
176.24admission. The hospital may not seek payment from the enrollee for the amount of the
176.25payment reduction under this clause.
176.26EFFECTIVE DATE.This section is effective January 1, 2012, or upon federal
176.27approval, whichever is later, and expires June 30, 2013. The commissioner shall notify
176.28the revisor of statutes when federal approval is obtained and publish a notice in the State
176.29Register.

176.30    Sec. 93. Minnesota Statutes 2010, section 256L.03, subdivision 5, is amended to read:
176.31    Subd. 5. Co-payments and coinsurance Cost-sharing. (a) Except as provided in
176.32paragraphs (b) and, (c), and (h), the MinnesotaCare benefit plan shall include the following
176.33co-payments and coinsurance cost-sharing requirements for all enrollees:
177.1    (1) ten percent of the paid charges for inpatient hospital services for adult enrollees,
177.2subject to an annual inpatient out-of-pocket maximum of $1,000 per individual;
177.3    (2) $3 per prescription for adult enrollees;
177.4    (3) $25 for eyeglasses for adult enrollees;
177.5    (4) $3 per nonpreventive visit. For purposes of this subdivision, a "visit" means an
177.6episode of service which is required because of a recipient's symptoms, diagnosis, or
177.7established illness, and which is delivered in an ambulatory setting by a physician or
177.8physician ancillary, chiropractor, podiatrist, nurse midwife, advanced practice nurse,
177.9audiologist, optician, or optometrist; and
177.10    (5) $6 for nonemergency visits to a hospital-based emergency room for services
177.11provided through December 31, 2010, and $3.50 effective January 1, 2011; and
177.12(6) a family deductible equal to the maximum amount allowed under Code of
177.13Federal Regulations, title 42, part 447.54.
177.14    (b) Paragraph (a), clause (1), does and paragraph (e) do not apply to parents and
177.15relative caretakers of children under the age of 21.
177.16    (c) Paragraph (a) does not apply to pregnant women and children under the age of 21.
177.17    (d) Paragraph (a), clause (4), does not apply to mental health services.
177.18    (e) Adult enrollees with family gross income that exceeds 200 percent of the federal
177.19poverty guidelines or 215 percent of the federal poverty guidelines on or after July 1, 2009,
177.20and who are not pregnant shall be financially responsible for the coinsurance amount, if
177.21applicable, and amounts which exceed the $10,000 inpatient hospital benefit limit.
177.22    (f) When a MinnesotaCare enrollee becomes a member of a prepaid health plan,
177.23or changes from one prepaid health plan to another during a calendar year, any charges
177.24submitted towards the $10,000 annual inpatient benefit limit, and any out-of-pocket
177.25expenses incurred by the enrollee for inpatient services, that were submitted or incurred
177.26prior to enrollment, or prior to the change in health plans, shall be disregarded.
177.27(g) MinnesotaCare reimbursements to fee-for-service providers and payments to
177.28managed care plans or county-based purchasing plans shall not be increased as a result of
177.29the reduction of the co-payments in paragraph (a), clause (5), effective January 1, 2011.
177.30(h) Effective January 1, 2012, the following co-payments for nonpreventive visits
177.31shall apply to enrollees who are adults without children eligible under section 256L.04,
177.32subdivision 7:
177.33(1) $3 for visits to providers whose average, risk-adjusted, total annual cost of care
177.34per MinnesotaCare enrollee is at the 60th percentile or lower for providers of the same
177.35type;
178.1(2) $6 for visits to providers whose average, risk-adjusted, total annual cost of care
178.2per MinnesotaCare enrollee is greater than the 60th percentile but does not exceed the
178.380th percentile for providers of the same type; and
178.4(3) $10 for visits to providers whose average, risk-adjusted, total annual cost of
178.5care per MinnesotaCare enrollee is greater than the 80th percentile for providers of the
178.6same type.
178.7Each managed care and county-based purchasing plan shall calculate the average,
178.8risk-adjusted, total annual cost of care for providers under this paragraph using a
178.9methodology that has been approved by the commissioner.
178.10EFFECTIVE DATE.The amendments to paragraph (e) are effective January 1,
178.112012, or upon federal approval, whichever is later, and expires June 30, 2013. The
178.12commissioner shall notify the revisor of statutes when federal approval is obtained and
178.13publish a notice in the State Register.

178.14    Sec. 94. [256L.031] HEALTHY MINNESOTA CONTRIBUTION PROGRAM.
178.15    Subdivision 1. Defined contributions to enrollees. (a) Beginning January 1, 2012,
178.16the commissioner shall provide each MinnesotaCare enrollee eligible under section
178.17256L.04, subdivision 7, with gross family income equal to or greater than 133 percent
178.18of the federal poverty guidelines, with a monthly defined contribution to purchase health
178.19coverage under a health plan as defined in section 62A.011, subdivision 3. Beginning
178.20January 1, 2012, or upon federal approval, whichever is later, the commissioner shall
178.21provide each MinnesotaCare enrollee eligible under section 256L.04, subdivision 1, with
178.22gross family income equal to or greater than 133 percent of the federal poverty guidelines,
178.23with a monthly defined contribution to purchase health coverage under a health plan as
178.24defined in section 62A.011, subdivision 3, offered by a health plan company as defined
178.25in section 62Q.01, subdivision 4.
178.26(b) Enrollees eligible under paragraph (a) shall not be charged premiums under
178.27section 256L.15 and are exempt from the managed care enrollment requirement of section
178.28256L.12.
178.29(c) Sections 256L.03; 256L.05, subdivision 3; and 256L.11 do not apply to
178.30enrollees eligible under paragraph (a). Covered services, cost-sharing, disenrollment
178.31for nonpayment of premium, enrollee appeal rights and complaint procedures, and the
178.32effective date of coverage for enrollees eligible under paragraph (a) shall be as provided
178.33under the terms of the health plan purchased by the enrollee.
179.1(d) Unless otherwise provided in this section, all MinnesotaCare requirements
179.2related to eligibility, income and asset methodology, income reporting, and program
179.3administration continue to apply to enrollees obtaining coverage under this section.
179.4    Subd. 2. Use of defined contribution. An enrollee may use up to the monthly
179.5defined contribution to pay premiums for coverage under a health plan as defined in
179.6section 62A.011, subdivision 3.
179.7    Subd. 3. Determination of defined contribution amount. (a) The commissioner
179.8shall determine the defined contribution sliding scale using the base contribution specified
179.9in paragraph (b) for the specified age ranges. The commissioner shall use a sliding scale
179.10for defined contributions that provides:
179.11(1) persons with household incomes equal to 133 percent of the federal poverty
179.12guidelines with a defined contribution of 150 percent of the base contribution;
179.13(2) persons with household incomes equal to 175 percent of the federal poverty
179.14guidelines with a defined contribution of 100 percent of the base contribution;
179.15(3) persons with household incomes equal to or greater than 250 percent of
179.16the federal poverty guidelines with a defined contribution of 80 percent of the base
179.17contribution; and
179.18(4) persons with household incomes in evenly spaced increments between the
179.19percentages of the federal poverty guideline specified in clauses (1) to (3) with a base
179.20contribution that is a percentage interpolated from the defined contribution percentages
179.21specified in clauses (1) to (3).

179.22	Age	Monthly Per-Person Base Contribution
179.23	Under 21	$122.79
179.24	21-29	122.79
179.25	30-31	129.19
179.26	32-33	132.38
179.27	34-35	134.31
179.28	36-37	136.06
179.29	38-39	141.02
179.30	40-41	151.25
179.31	42-43	159.89
179.32	44-45	175.08
179.33	46-47	191.71
179.34	48-49	213.13
179.35	50-51	239.51
179.36	52-53	266.69
179.37	54-55	293.88
179.38	56-57	323.77
180.1	58-59	341.20
180.2	60+	357.19

180.3(b) The commissioner shall multiply the defined contribution amounts developed
180.4under paragraph (a) by 1.20 for enrollees who are denied coverage under an individual
180.5health plan by a health plan company and who purchase coverage through the Minnesota
180.6Comprehensive Health Association.
180.7(c) Notwithstanding paragraphs (a) and (b), the monthly defined contribution shall
180.8not exceed 90 percent of the monthly premium for the health plan purchased by the
180.9enrollee. If the enrollee purchases coverage under a health plan that does not include
180.10mental health services and chemical dependency treatment services, the monthly defined
180.11contribution amount determined under this subdivision shall be reduced by five percent.
180.12    Subd. 4. Administration by commissioner. The commissioner shall administer the
180.13defined contributions. The commissioner shall:
180.14    (1) calculate and process defined contributions for enrollees; and
180.15    (2) pay the defined contribution amount to health plan companies or the Minnesota
180.16Comprehensive Health Association, as applicable, for enrollee health plan coverage.
180.17    Subd. 5. Assistance to enrollees. The commissioner of human services, in
180.18consultation with the commissioner of commerce, shall develop an efficient and
180.19cost-effective method of referring eligible applicants to professional insurance agent
180.20associations.
180.21    Subd. 6. Minnesota Comprehensive Health Association (MCHA). Beginning
180.22January 1, 2012, MinnesotaCare enrollees who are denied coverage under an individual
180.23health plan by a health plan company are eligible for coverage through a health plan
180.24offered by the MCHA and may enroll in MCHA according to section 62E.14. Any
180.25difference between the revenue and covered losses to the MCHA related to implementation
180.26of this section shall be paid to the MCHA from the health care access fund.
180.27    Subd. 7. Federal approval. The commissioner shall seek all federal waivers
180.28and approvals necessary to implement coverage under this section for MinnesotaCare
180.29enrollees eligible under section 256L.04, subdivision 1, with gross family incomes equal
180.30to or greater than 133 percent of the federal poverty guidelines, while continuing to
180.31receive federal matching funds.

180.32    Sec. 95. Minnesota Statutes 2010, section 256L.04, subdivision 1, is amended to read:
180.33    Subdivision 1. Families with children. (a) Families with Children with family
180.34income equal to or less than 275 percent of the federal poverty guidelines for the
180.35applicable family size and adults in families with children with family income equal to or
181.1less than 200 percent of the federal poverty guidelines for the applicable family size, shall
181.2be eligible for MinnesotaCare according to this section. All other provisions of sections
181.3256L.01 to 256L.18, including the insurance-related barriers to enrollment under section
181.4256L.07 , shall apply unless otherwise specified.
181.5    (b) Parents who enroll in the MinnesotaCare program must also enroll their children,
181.6if the children are eligible. Children may be enrolled separately without enrollment by
181.7parents. However, if one parent in the household enrolls, both parents must enroll, unless
181.8other insurance is available. If one child from a family is enrolled, all children must
181.9be enrolled, unless other insurance is available. If one spouse in a household enrolls,
181.10the other spouse in the household must also enroll, unless other insurance is available.
181.11Families cannot choose to enroll only certain uninsured members.
181.12    (c) Beginning October 1, 2003, the dependent sibling definition no longer applies
181.13to the MinnesotaCare program. These persons are no longer counted in the parental
181.14household and may apply as a separate household.
181.15    (d) Beginning July 1, 2010, or upon federal approval, whichever is later, parents are
181.16not eligible for MinnesotaCare if their gross income exceeds $57,500.
181.17    (e) Children formerly enrolled in medical assistance and automatically deemed
181.18eligible for MinnesotaCare according to section 256B.057, subdivision 2c, are exempt
181.19from the requirements of this section until renewal.
181.20(f) [Reserved.]
181.21EFFECTIVE DATE.This section is effective January 1, 2012, or upon federal
181.22approval, whichever is later, and expires June 30, 2013, except that the amendment
181.23striking paragraph (e) is effective retroactively from October 1, 2008, does not expire,
181.24and federal approval is no longer necessary. The commissioner shall notify the revisor of
181.25statutes when federal approval is obtained and publish a notice in the State Register.

181.26    Sec. 96. Minnesota Statutes 2010, section 256L.04, subdivision 7, is amended to read:
181.27    Subd. 7. Single adults and households with no children. (a) The definition of
181.28eligible persons, through December 31, 2011, includes all individuals and households with
181.29no children who have gross family incomes that are equal to or less than 200 percent
181.30of the federal poverty guidelines.
181.31    (b) Effective July 1, 2009 January 1, 2012, the definition of eligible persons includes
181.32all individuals and households with no children who have gross family incomes that are
181.33greater than 75 percent of the federal poverty guidelines and equal to or less than 250 200
181.34percent of the federal poverty guidelines. Effective July 1, 2013, the maximum income
181.35limit under this paragraph is increased to 250 percent of the federal poverty guidelines.
182.1EFFECTIVE DATE.This section is effective January 1, 2012.

182.2    Sec. 97. Minnesota Statutes 2010, section 256L.05, subdivision 2, is amended to read:
182.3    Subd. 2. Commissioner's duties. (a) The commissioner or county agency shall
182.4use electronic verification as the primary method of income verification. If there is a
182.5discrepancy between reported income and electronically verified income, an individual
182.6may be required to submit additional verification. In addition, the commissioner shall
182.7perform random audits to verify reported income and eligibility. The commissioner
182.8may execute data sharing arrangements with the Department of Revenue and any other
182.9governmental agency in order to perform income verification related to eligibility and
182.10premium payment under the MinnesotaCare program.
182.11(b) In determining eligibility for MinnesotaCare, the commissioner shall require
182.12applicants and enrollees seeking renewal of eligibility to verify both earned and unearned
182.13income. The commissioner shall also require applicants and enrollees to submit the
182.14names of their employers and a contact name with a phone number for each employer
182.15for purposes of verifying whether the applicant or enrollee, and any dependents, are
182.16eligible for employer-subsidized coverage. Data collected is nonpublic data as defined
182.17in section 13.02, subdivision 9.

182.18    Sec. 98. Minnesota Statutes 2010, section 256L.05, subdivision 3a, is amended to read:
182.19    Subd. 3a. Renewal of eligibility. (a) Beginning July 1, 2007 2011, an enrollee's
182.20eligibility must be renewed every 12 six months. The 12-month period begins in the
182.21month after the month the application is approved.
182.22    (b) The first six-month period of eligibility begins the month the application is
182.23received by the commissioner. The effective date of coverage within the first six-month
182.24period of eligibility is as provided in subdivision 3. Each new period of eligibility must
182.25take into account any changes in circumstances that impact eligibility and premium
182.26amount. An enrollee must provide all the information needed to redetermine eligibility
182.27by the first day of the month that ends the eligibility period. If there is no change in
182.28circumstances, the enrollee may renew eligibility at designated locations that include
182.29community clinics and health care providers' offices. The designated sites shall forward
182.30the renewal forms to the commissioner. The commissioner may establish criteria and
182.31timelines for sites to forward applications to the commissioner or county agencies. The
182.32premium for the new period of eligibility must be received as provided in section 256L.06
182.33in order for eligibility to continue.
183.1    (c) An enrollee who fails to submit renewal forms and related documentation
183.2necessary for verification of continued eligibility in a timely manner shall remain eligible
183.3for one additional month beyond the end of the current eligibility period before being
183.4disenrolled. The enrollee remains responsible for MinnesotaCare premiums for the
183.5additional month.

183.6    Sec. 99. Minnesota Statutes 2010, section 256L.05, subdivision 5, is amended to read:
183.7    Subd. 5. Availability of private insurance. The commissioner, in consultation with
183.8the commissioners of health and commerce, shall provide information regarding the
183.9availability of private health insurance coverage and the possibility of disenrollment
183.10under section 256L.07, subdivision 1, paragraphs (b) and (c), to all: (1) families enrolled
183.11in the MinnesotaCare program whose gross family income is equal to or more than 225
183.12percent of the federal poverty guidelines; and (2) single adults and households without
183.13children enrolled in the MinnesotaCare program whose gross family income is equal to
183.14or more than 165 percent of the federal poverty guidelines. This information must be
183.15provided upon initial enrollment and annually thereafter. The commissioner shall also
183.16include information regarding the availability of private health insurance coverage in the
183.17notice of ineligibility provided to persons subject to disenrollment under section 256L.07,
183.18subdivision 1 , paragraphs (b) and (c).
183.19EFFECTIVE DATE.This section is effective January 1, 2012, and expires June
183.2030, 2013.

183.21    Sec. 100. Minnesota Statutes 2010, section 256L.05, is amended by adding a
183.22subdivision to read:
183.23    Subd. 6. Referral of veterans. The commissioner shall ensure that all applicants
183.24for MinnesotaCare with incomes less than 133 percent of the federal poverty guidelines
183.25who identify themselves as veterans are referred to a county veterans service officer for
183.26assistance in applying to the United States Department of Veterans Affairs for any veterans
183.27benefits for which they may be eligible.

183.28    Sec. 101. Minnesota Statutes 2010, section 256L.07, subdivision 1, is amended to read:
183.29    Subdivision 1. General requirements. (a) Children enrolled in the original
183.30children's health plan as of September 30, 1992, children who enrolled in the
183.31MinnesotaCare program after September 30, 1992, pursuant to Laws 1992, chapter 549,
183.32article 4, section 17, and children who have family gross incomes that are equal to or
183.33less than 150 percent of the federal poverty guidelines are eligible without meeting
184.1the requirements of subdivision 2 and the four-month requirement in subdivision 3, as
184.2long as they maintain continuous coverage in the MinnesotaCare program or medical
184.3assistance. Children who apply for MinnesotaCare on or after the implementation date
184.4of the employer-subsidized health coverage program as described in Laws 1998, chapter
184.5407, article 5, section 45, who have family gross incomes that are equal to or less than 150
184.6percent of the federal poverty guidelines, must meet the requirements of subdivision 2 to
184.7be eligible for MinnesotaCare.
184.8    (b) Families enrolled in MinnesotaCare under section 256L.04, subdivision 1, whose
184.9income increases above 275 percent of the federal poverty guidelines, are no longer
184.10eligible for the program and shall be disenrolled by the commissioner. Beginning January
184.111, 2008,
184.12(c) Individuals enrolled in MinnesotaCare under section 256L.04, subdivision 7,
184.13whose income increases above 200 percent of the federal poverty guidelines or 250
184.14percent of the federal poverty guidelines on or after July 1, 2009, the limits described
184.15in section 256L.04, subdivision 7, are no longer eligible for the program and shall be
184.16disenrolled by the commissioner.
184.17(d) For persons disenrolled under this subdivision, MinnesotaCare coverage
184.18terminates the last day of the calendar month following the month in which the
184.19commissioner determines that the income of a family or individual exceeds program
184.20income limits.
184.21    (b) (e) Notwithstanding paragraph (a), children may remain enrolled in
184.22MinnesotaCare if ten percent of their gross individual or gross family income as defined
184.23in section 256L.01, subdivision 4, is less than the annual premium for a six-month
184.24policy with a $500 deductible available through the Minnesota Comprehensive Health
184.25Association. Children who are no longer eligible for MinnesotaCare under this clause shall
184.26be given a 12-month notice period from the date that ineligibility is determined before
184.27disenrollment. The premium for children remaining eligible under this clause shall be the
184.28maximum premium determined under section 256L.15, subdivision 2, paragraph (b).
184.29    (c) (f) Notwithstanding paragraphs (a) and (b) (e), parents are not eligible for
184.30MinnesotaCare if gross household income exceeds $57,500 for the 12-month $25,000 for
184.31the six-month period of eligibility.
184.32EFFECTIVE DATE.This section is effective January 1, 2012, and expires June
184.3330, 2013, except the amendments to the new paragraphs (e) and (f) are effective July 1,
184.342011, and do not expire.

184.35    Sec. 102. Minnesota Statutes 2010, section 256L.07, subdivision 1, is amended to read:
185.1    Subdivision 1. General requirements. (a) Children enrolled in the original
185.2children's health plan as of September 30, 1992, children who enrolled in the
185.3MinnesotaCare program after September 30, 1992, pursuant to Laws 1992, chapter 549,
185.4article 4, section 17, and children who have family gross incomes that are equal to or
185.5less than 150 percent of the federal poverty guidelines are eligible without meeting
185.6the requirements of subdivision 2 and the four-month requirement in subdivision 3, as
185.7long as they maintain continuous coverage in the MinnesotaCare program or medical
185.8assistance. Children who apply for MinnesotaCare on or after the implementation date
185.9of the employer-subsidized health coverage program as described in Laws 1998, chapter
185.10407, article 5, section 45, who have family gross incomes that are equal to or less than 150
185.11percent of the federal poverty guidelines, must meet the requirements of subdivision 2 to
185.12be eligible for MinnesotaCare.
185.13    (b) Families enrolled in MinnesotaCare under section 256L.04, subdivision 1, whose
185.14income increases above 275 percent of the federal poverty guidelines the limits described
185.15in section 256L.04, subdivision 1, are no longer eligible for the program and shall be
185.16disenrolled by the commissioner.
185.17(c) Beginning January 1, 2008, individuals enrolled in MinnesotaCare under section
185.18256L.04, subdivision 7 , whose income increases above 200 percent of the federal poverty
185.19guidelines or 250 percent of the federal poverty guidelines on or after July 1, 2009, are no
185.20longer eligible for the program and shall be disenrolled by the commissioner.
185.21(d) For persons disenrolled under this subdivision, MinnesotaCare coverage
185.22terminates the last day of the calendar month following the month in which the
185.23commissioner determines that the income of a family or individual exceeds program
185.24income limits.
185.25    (b) (e) Notwithstanding paragraph (a), children may remain enrolled in
185.26MinnesotaCare if ten percent of their gross individual or gross family income as defined in
185.27section 256L.01, subdivision 4, is less than the annual premium for a policy with a $500
185.28deductible available through the Minnesota Comprehensive Health Association. Children
185.29who are no longer eligible for MinnesotaCare under this clause shall be given a 12-month
185.30notice period from the date that ineligibility is determined before disenrollment. The
185.31premium for children remaining eligible under this clause shall be the maximum premium
185.32determined under section 256L.15, subdivision 2, paragraph (b).
185.33    (c) (f) Notwithstanding paragraphs (a) and (b) (e), parents are not eligible for
185.34MinnesotaCare if gross household income exceeds $57,500 for the 12-month period
185.35of eligibility.
186.1EFFECTIVE DATE.The amendment in paragraph (b) is effective January 1, 2012,
186.2or upon federal approval whichever is later, and expires June 30, 2013. The commissioner
186.3shall notify the revisor of statutes when federal approval is obtained and publish a notice
186.4in the State Register.

186.5    Sec. 103. Minnesota Statutes 2010, section 256L.09, subdivision 4, is amended to read:
186.6    Subd. 4. Eligibility as Minnesota resident. (a) For purposes of this section, a
186.7permanent Minnesota resident is a person who has demonstrated, through persuasive and
186.8objective evidence, that the person is domiciled in the state and intends to live in the
186.9state permanently.
186.10    (b) To be eligible as a permanent resident, an applicant must demonstrate the
186.11requisite intent to live in the state permanently by:
186.12    (1) showing that the applicant maintains a residence at a verified address other than a
186.13place of public accommodation, unless the place of public accommodation is the person's
186.14primary or only residence, through the use of evidence of residence described in section
186.15256D.02, subdivision 12a , paragraph (b), clause (2) (1);
186.16    (2) demonstrating that the applicant has been continuously domiciled in the state for
186.17no less than 180 days immediately before the application; and
186.18    (3) signing an affidavit declaring that (A) the applicant currently resides in the state
186.19and intends to reside in the state permanently; and (B) the applicant did not come to the
186.20state for the primary purpose of obtaining medical coverage or treatment.
186.21    (c) A person who is temporarily absent from the state does not lose eligibility for
186.22MinnesotaCare. "Temporarily absent from the state" means the person is out of the state
186.23for a temporary purpose and intends to return when the purpose of the absence has been
186.24accomplished. A person is not temporarily absent from the state if another state has
186.25determined that the person is a resident for any purpose. If temporarily absent from the
186.26state, the person must follow the requirements of the health plan in which the person is
186.27enrolled to receive services.

186.28    Sec. 104. Minnesota Statutes 2010, section 256L.11, subdivision 7, is amended to read:
186.29    Subd. 7. Critical access dental providers. Effective for dental services provided to
186.30MinnesotaCare enrollees on or after January 1, 2007, July 1, 2011, the commissioner shall
186.31increase payment rates to dentists and dental clinics deemed by the commissioner to be
186.32critical access providers under section 256B.76, subdivision 4, by 50 30 percent above
186.33the payment rate that would otherwise be paid to the provider. The commissioner shall
186.34pay the prepaid health plans under contract with the commissioner amounts sufficient to
187.1reflect this rate increase. The prepaid health plan must pass this rate increase to providers
187.2who have been identified by the commissioner as critical access dental providers under
187.3section 256B.76, subdivision 4.

187.4    Sec. 105. Minnesota Statutes 2010, section 256L.12, subdivision 9, is amended to read:
187.5    Subd. 9. Rate setting; performance withholds. (a) Rates will be prospective,
187.6per capita, where possible. The commissioner may allow health plans to arrange for
187.7inpatient hospital services on a risk or nonrisk basis. The commissioner shall consult with
187.8an independent actuary to determine appropriate rates.
187.9    (b) For services rendered on or after January 1, 2004, the commissioner shall
187.10withhold five percent of managed care plan payments and county-based purchasing
187.11plan payments under this section pending completion of performance targets. Each
187.12performance target must be quantifiable, objective, measurable, and reasonably attainable,
187.13except in the case of a performance target based on a federal or state law or rule. Criteria
187.14for assessment of each performance target must be outlined in writing prior to the
187.15contract effective date. The managed care plan must demonstrate, to the commissioner's
187.16satisfaction, that the data submitted regarding attainment of the performance target is
187.17accurate. The commissioner shall periodically change the administrative measures used
187.18as performance targets in order to improve plan performance across a broader range of
187.19administrative services. The performance targets must include measurement of plan
187.20efforts to contain spending on health care services and administrative activities. The
187.21commissioner may adopt plan-specific performance targets that take into account factors
187.22affecting only one plan, such as characteristics of the plan's enrollee population. The
187.23withheld funds must be returned no sooner than July 1 and no later than July 31 of the
187.24following calendar year if performance targets in the contract are achieved.
187.25(c) For services rendered on or after January 1, 2011, the commissioner shall
187.26withhold an additional three percent of managed care plan or county-based purchasing
187.27plan payments under this section. The withheld funds must be returned no sooner than
187.28July 1 and no later than July 31 of the following calendar year. The return of the withhold
187.29under this paragraph is not subject to the requirements of paragraph (b).
187.30(d) Effective for services rendered on or after January 1, 2011, the commissioner
187.31shall include as part of the performance targets described in paragraph (b) a reduction in
187.32the plan's emergency room utilization rate for state health care program enrollees by a
187.33measurable rate of five percent from the plan's utilization rate for the previous calendar
187.34year.
188.1The withheld funds must be returned no sooner than July 1 and no later than July 31
188.2of the following calendar year if the managed care plan demonstrates to the satisfaction of
188.3the commissioner that a reduction in the utilization rate was achieved.
188.4The withhold described in this paragraph shall continue for each consecutive
188.5contract period until the plan's emergency room utilization rate for state health care
188.6program enrollees is reduced by 25 percent of the plan's emergency room utilization rate
188.7for state health care program enrollees for calendar year 2009. Hospitals shall cooperate
188.8with the health plans in meeting this performance target and shall accept payment
188.9withholds that may be returned to the hospitals if the performance target is achieved. The
188.10commissioner shall structure the withhold so that the commissioner returns a portion of
188.11the withheld funds in amounts commensurate with achieved reductions in utilization less
188.12than the targeted amount. The withhold described in this paragraph does not apply to
188.13county-based purchasing plans.
188.14(e) Effective for services provided on or after January 1, 2012, the commissioner
188.15shall include as part of the performance targets described in paragraph (b) a reduction in
188.16the plan's hospitalization rate for a subsequent hospitalization within 30 days of a previous
188.17hospitalization of a patient regardless of the reason for the hospitalization for state health
188.18care program enrollees by a measurable rate of five percent from the plan's hospitalization
188.19rate for the previous calendar year.
188.20The withheld funds must be returned no sooner than July 1 and no later than July 31
188.21of the following calendar year if the managed care plan or county-based purchasing plan
188.22demonstrates to the satisfaction of the commissioner that a reduction in the hospitalization
188.23rate was achieved.
188.24The withhold described in this paragraph must continue for each consecutive
188.25contract period until the plan's subsequent hospitalization rate for state health care
188.26program enrollees is reduced by 25 percent of the plan's subsequent hospitalization rate
188.27for state health care program enrollees for calendar year 2010. Hospitals shall cooperate
188.28with the plans in meeting this performance target and shall accept payment withholds that
188.29must be returned to the hospitals if the performance target is achieved. The commissioner
188.30shall structure the withhold so that the commissioner returns a portion of the withheld
188.31funds in amounts commensurate with achieved reductions in utilizations less than the
188.32targeted amount. The withhold described in this paragraph does not apply to county-based
188.33purchasing plans.
188.34(e) (f) A managed care plan or a county-based purchasing plan under section
188.35256B.692 may include as admitted assets under section 62D.044 any amount withheld
188.36under this section that is reasonably expected to be returned.

189.1    Sec. 106. Minnesota Statutes 2010, section 256L.15, subdivision 1a, is amended to
189.2read:
189.3    Subd. 1a. Payment options. The commissioner may offer the following payment
189.4options to an enrollee:
189.5(1) payment by check;
189.6(2) payment by credit card;
189.7(3) payment by recurring automatic checking withdrawal;
189.8(4) payment by onetime electronic transfer of funds;
189.9(5) payment by wage withholding with the consent of the employer and the
189.10employee; or
189.11(6) payment by using state tax refund payments.
189.12The commissioner shall include information about the payment options on each
189.13premium notice. At application or reapplication, a MinnesotaCare applicant or enrollee
189.14may authorize the commissioner to use the Revenue Recapture Act in chapter 270A to
189.15collect funds from the applicant's or enrollee's refund for the purposes of meeting all or
189.16part of the applicant's or enrollee's MinnesotaCare premium obligation. The applicant or
189.17enrollee may authorize the commissioner to apply for the state working family tax credit
189.18on behalf of the applicant or enrollee. The setoff due under this subdivision shall not be
189.19subject to the $10 fee under section 270A.07, subdivision 1.

189.20    Sec. 107. Laws 2008, chapter 363, article 18, section 3, subdivision 5, is amended to
189.21read:

189.22

Subd. 5.Basic Health Care Grants

189.23

(a) MinnesotaCare Grants

189.24

Health Care Access

-0-

(770,000)

189.25Incentive Program and Outreach Grants.
189.26Of the appropriation for the Minnesota health
189.27care outreach program in Laws 2007, chapter
189.28147, article 19, section 3, subdivision 7,
189.29paragraph (b):
189.30(1) $400,000 in fiscal year 2009 from the
189.31general fund and $200,000 in fiscal year 2009
189.32from the health care access fund are for the
189.33incentive program under Minnesota Statutes,
189.34section 256.962, subdivision 5. For the
190.1biennium beginning July 1, 2009, base level
190.2funding for this activity shall be $360,000
190.3from the general fund and $160,000 from the
190.4health care access fund; and
190.5(2) $100,000 in fiscal year 2009 from the
190.6general fund and $50,000 in fiscal year 2009
190.7from the health care access fund are for the
190.8outreach grants under Minnesota Statutes,
190.9section 256.962, subdivision 2. For the
190.10biennium beginning July 1, 2009, base level
190.11funding for this activity shall be $90,000
190.12from the general fund and $40,000 from the
190.13health care access fund.

190.14 190.15

(b) MA Basic Health Care Grants - Families and Children

-0-

(17,280,000)

190.16Third-Party Liability. (a) During
190.17fiscal year 2009, the commissioner shall
190.18employ a contractor paid on a percentage
190.19basis to improve third-party collections.
190.20Improvement initiatives may include, but not
190.21be limited to, efforts to improve postpayment
190.22collection from nonresponsive claims and
190.23efforts to uncover third-party payers the
190.24commissioner has been unable to identify.
190.25(b) In fiscal year 2009, the first $1,098,000
190.26of recoveries, after contract payments and
190.27federal repayments, is appropriated to
190.28the commissioner for technology-related
190.29expenses.
190.30Administrative Costs. (a) For contracts
190.31effective on or after January 1, 2009,
190.32the commissioner shall limit aggregate
190.33administrative costs paid to managed care
190.34plans under Minnesota Statutes, section
190.35256B.69 , and to county-based purchasing
191.1plans under Minnesota Statutes, section
191.2256B.692 , to an overall average of 6.6 6.1
191.3percent of total contract payments under
191.4Minnesota Statutes, sections 256B.69 and
191.5256B.692 , for each calendar year. For
191.6purposes of this paragraph, administrative
191.7costs do not include premium taxes paid
191.8under Minnesota Statutes, section 297I.05,
191.9subdivision 5 , and provider surcharges paid
191.10under Minnesota Statutes, section 256.9657,
191.11subdivision 3 .
191.12(b) Notwithstanding any law to the contrary,
191.13the commissioner may reduce or eliminate
191.14administrative requirements to meet the
191.15administrative target under paragraph (a).
191.16(c) Notwithstanding any contrary provision
191.17of this article, this rider shall not expire.
191.18Hospital Payment Delay. Notwithstanding
191.19Laws 2005, First Special Session chapter 4,
191.20article 9, section 2, subdivision 6, payments
191.21from the Medicaid Management Information
191.22System that would otherwise have been made
191.23for inpatient hospital services for medical
191.24assistance enrollees are delayed as follows:
191.25(1) for fiscal year 2008, June payments must
191.26be included in the first payments in fiscal
191.27year 2009; and (2) for fiscal year 2009,
191.28June payments must be included in the first
191.29payment of fiscal year 2010. The provisions
191.30of Minnesota Statutes, section 16A.124,
191.31do not apply to these delayed payments.
191.32Notwithstanding any contrary provision in
191.33this article, this paragraph expires on June
191.3430, 2010.

191.35 191.36

(c) MA Basic Health Care Grants - Elderly and Disabled

(14,028,000)

(9,368,000)

192.1Minnesota Disability Health Options Rate
192.2Setting Methodology. The commissioner
192.3shall develop and implement a methodology
192.4for risk adjusting payments for community
192.5alternatives for disabled individuals (CADI)
192.6and traumatic brain injury (TBI) home
192.7and community-based waiver services
192.8delivered under the Minnesota disability
192.9health options program (MnDHO) effective
192.10January 1, 2009. The commissioner shall
192.11take into account the weighting system used
192.12to determine county waiver allocations in
192.13developing the new payment methodology.
192.14Growth in the number of enrollees receiving
192.15CADI or TBI waiver payments through
192.16MnDHO is limited to an increase of 200
192.17enrollees in each calendar year from January
192.182009 through December 2011. If those limits
192.19are reached, additional members may be
192.20enrolled in MnDHO for basic care services
192.21only as defined under Minnesota Statutes,
192.22section 256B.69, subdivision 28, and the
192.23commissioner may establish a waiting list for
192.24future access of MnDHO members to those
192.25waiver services.
192.26MA Basic Elderly and Disabled
192.27Adjustments. For the fiscal year ending June
192.2830, 2009, the commissioner may adjust the
192.29rates for each service affected by rate changes
192.30under this section in such a manner across
192.31the fiscal year to achieve the necessary cost
192.32savings and minimize disruption to service
192.33providers, notwithstanding the requirements
192.34of Laws 2007, chapter 147, article 7, section
192.3571.

192.36

(d) General Assistance Medical Care Grants

-0-

(6,971,000)

193.1

(e) Other Health Care Grants

-0-

(17,000)

193.2MinnesotaCare Outreach Grants Special
193.3Revenue Account. The balance in the
193.4MinnesotaCare outreach grants special
193.5revenue account on July 1, 2009, estimated
193.6to be $900,000, must be transferred to the
193.7general fund.
193.8Grants Reduction. Effective July 1, 2008,
193.9base level funding for nonforecast, general
193.10fund health care grants issued under this
193.11paragraph shall be reduced by 1.8 percent at
193.12the allotment level.

193.13    Sec. 108. Laws 2010, First Special Session chapter 1, article 25, section 3, subdivision
193.146, is amended to read:

193.15

Subd. 6.Health Care Grants

193.16

(a) MinnesotaCare Grants

998,000

(13,376,000)

193.17This appropriation is from the health care
193.18access fund.
193.19Health Care Access Fund Transfer to
193.20General Fund. The commissioner of
193.21management and budget shall transfer the
193.22following amounts in the following years
193.23from the health care access fund to the
193.24general fund: $998,000 $0 in fiscal year
193.252010; $176,704,000 $59,901,000 in fiscal
193.26year 2011; $141,041,000 in fiscal year 2012;
193.27and $286,150,000 in fiscal year 2013. If at
193.28any time the governor issues an executive
193.29order not to participate in early medical
193.30assistance expansion, no funds shall be
193.31transferred from the health care access
193.32fund to the general fund until early medical
193.33assistance expansion takes effect. This
194.1paragraph is effective the day following final
194.2enactment.
194.3MinnesotaCare Ratable Reduction.
194.4Effective for services rendered on or after
194.5July 1, 2010, to December 31, 2013,
194.6MinnesotaCare payments to managed care
194.7plans under Minnesota Statutes, section
194.8256L.12 , for single adults and households
194.9without children whose income is greater
194.10than 75 percent of federal poverty guidelines
194.11shall be reduced by 15 percent. Effective
194.12for services provided from July 1, 2010, to
194.13June 30, 2011, this reduction shall apply to
194.14all services. Effective for services provided
194.15from July 1, 2011, to December 31, 2013, this
194.16reduction shall apply to all services except
194.17inpatient hospital services. Notwithstanding
194.18any contrary provision of this article, this
194.19paragraph shall expire on December 31,
194.202013.

194.21 194.22

(b) Medical Assistance Basic Health Care Grants - Families and Children

-0-

295,512,000

194.23Critical Access Dental. Of the general
194.24fund appropriation, $731,000 in fiscal year
194.252011 is to the commissioner for critical
194.26access dental provider reimbursement
194.27payments under Minnesota Statutes, section
194.28256B.76 subdivision 4. This is a onetime
194.29appropriation.
194.30Nonadministrative Rate Reduction. For
194.31services rendered on or after July 1, 2010,
194.32to December 31, 2013, the commissioner
194.33shall reduce contract rates paid to managed
194.34care plans under Minnesota Statutes,
194.35sections 256B.69 and 256L.12, and to
194.36county-based purchasing plans under
195.1Minnesota Statutes, section 256B.692, by
195.2three percent of the contract rate attributable
195.3to nonadministrative services in effect on
195.4June 30, 2010. Notwithstanding any contrary
195.5provision in this article, this rider expires on
195.6December 31, 2013.

195.7 195.8

(c) Medical Assistance Basic Health Care Grants - Elderly and Disabled

-0-

(30,265,000)

195.9 195.10

(d) General Assistance Medical Care Grants

-0-

(75,389,000) (59,583,000)

195.11The reduction to general assistance medical
195.12care grants is contingent upon the effective
195.13date in Laws 2010, First Special Session
195.14chapter 1, article 16, section 48. The
195.15reduction shall be reestimated based upon
195.16the actual effective date of the law. The
195.17commissioner of management and budget
195.18shall make adjustments in fiscal year
195.192011 to general assistance medical care
195.20appropriations to conform to the total
195.21expected expenditure reductions specified in
195.22this section.

195.23

(e) Other Health Care Grants

-0-

(7,000,000)

195.24Cobra Carryforward. Unexpended funds
195.25appropriated in fiscal year 2010 for COBRA
195.26grants under Laws 2009, chapter 79, article
195.275, section 78, do not cancel and are available
195.28to the commissioner for fiscal year 2011
195.29COBRA grant expenditures. Up to $111,000
195.30of the fiscal year 2011 appropriation for
195.31COBRA grants provided in Laws 2009,
195.32chapter 79, article 13, section 3, subdivision
195.336, may be used by the commissioner for costs
195.34related to administration of the COBRA
195.35grants.

196.1    Sec. 109. COMMISSIONER'S ACTIONS; REPEAL OF EARLY MEDICAL
196.2ASSISTANCE EXPANSION.
196.3    Effective January 1, 2012, the commissioner of human services shall suspend
196.4implementation and administration of Minnesota Statutes 2010, sections 256B.055,
196.5subdivision 15; 256B.056, subdivision 3, paragraph (b); and 256B.056, subdivision 4,
196.6paragraph (d). The commissioner shall refer persons enrolled under these provisions, and
196.7applicants for coverage under these provisions, to the general assistance medical care
196.8program established under Minnesota Statutes, section 256D.031.

196.9    Sec. 110. GENERAL ASSISTANCE MEDICAL CARE PROGRAM;
196.10PROVISIONS REVIVED.
196.11    Notwithstanding their contingent repeal in Laws 2010, First Special Session chapter
196.121, article 16, section 47, the following statutes are revived and have the force of law
196.13effective January 1, 2012:
196.14    (1) Minnesota Statutes 2010, section 256D.03, subdivisions 3, 3a, 6, 7, and 8;
196.15    (2) Minnesota Statutes 2010, section 256D.031, subdivisions 1, 2, 3, 4, 6, 7, and
196.1610; and
196.17    (3) Laws 2010, chapter 200, article 1, section 18.

196.18    Sec. 111. PLAN TO COORDINATE CARE FOR CHILDREN WITH
196.19HIGH-COST MENTAL HEALTH CONDITIONS.
196.20The commissioner of human services shall develop and submit to the legislature
196.21by December 15, 2011, a plan to provide care coordination to medical assistance and
196.22MinnesotaCare enrollees who are children with high-cost mental health conditions. For
196.23purposes of this section, a child has a "high-cost mental health condition" if mental health
196.24and medical expenses over the past year totalled $100,000 or more. For purposes of this
196.25section, "care coordination" means collaboration between an advanced practice nurse and
196.26primary care physicians and specialists to manage care; development of mental health
196.27management plans for recurrent mental health issues; oversight and coordination of all
196.28aspects of care in partnership with families; organization of medical, treatment, and
196.29therapy information into a summary of critical information; coordination and appropriate
196.30sequencing of evaluations and multiple appointments; information and assistance with
196.31accessing resources; and telephone triage for behavior or other problems.

196.32    Sec. 112. DATA ON CLAIMS AND UTILIZATION.
197.1The commissioner of human services, in consultation with the Health and Human
197.2Services Reform Committee, shall develop and provide to the legislature by December 15,
197.32011, a methodology and any draft legislation necessary to allow for the release, upon
197.4request, of summary data as defined in Minnesota Statutes, section 13.02, subdivision 19,
197.5on claims and utilization for medical assistance, general assistance medical care, and
197.6MinnesotaCare enrollees at no charge to the University of Minnesota Medical School, the
197.7Mayo Medical School, Northwestern Health Sciences University, the Institute for Clinical
197.8Systems Improvement, and other research institutions to conduct analyses of health care
197.9outcomes and treatment effectiveness, provided the research institutions do not release
197.10private or nonpublic data or data for which dissemination is prohibited by law.

197.11    Sec. 113. REDUCTION OF STATE-MANDATED ADMINISTRATIVE
197.12REPORTS.
197.13(a) The commissioner of management and budget shall convene a report reduction
197.14working group of persons designated by the commissioners of health, human services, and
197.15commerce to eliminate redundant, unnecessary, obsolete, and low-priority state-mandated
197.16administrative reports required of health plans and county-based purchasing plans
197.17that serve persons enrolled in Minnesota health care programs. The commissioner of
197.18management and budget and the report reduction working group shall develop a plan to
197.19oversee the report reduction activities of the individual state agencies and coordinate the
197.20activities of multiple state agencies to consolidate reports or eliminate redundant reports
197.21required by more than one state agency on the same or a similar topic.
197.22(b) The commissioners of health, human services, and commerce shall reduce,
197.23eliminate, or consolidate state-mandated reports according to the plan developed by the
197.24commissioner of management and budget through the report reduction working group.
197.25In addition to other report reduction actions the commissioners or the working group
197.26may undertake, the commissioners shall:
197.27(1) collect encounter data, including provider payment data if collected, in a
197.28consolidated report provided to a single state agency, with the data collected by that state
197.29agency to be shared with other state agencies who need the data;
197.30(2) collect only one provider network report annually through a single state agency,
197.31with the data collected by that state agency to be shared with other state agencies who
197.32need the data;
197.33(3) collect only one standard financial report through a single state agency, with
197.34the data collected by that state agency to be shared with other state agencies who need
197.35the data. Data collected must be of a nature and in a format to allow comparison of the
198.1cost-effectiveness of fee-for-service payment systems and prepaid programs administered
198.2by health plans and county-based purchasing plans;
198.3(4) consolidate and simplify reports and documentation requirements relating to
198.4member communications and marketing materials, and establish a single review process
198.5for all programs, products, and agencies in order to ensure uniform and consistent
198.6regulation of health plan contracts;
198.7(5) consolidate state regulation and oversight of health plans and county-based
198.8purchasing plans so that activities of multiple agencies are administered through an
198.9efficient and uniform multiagency process of oversight and audits, with consistent
198.10standards, measures, and definitions for state oversight of quality, utilization management,
198.11care management, delegation accountability, access to care, appeals and grievances, and
198.12financial management;
198.13(6) establish uniform requirements and procedures for denial, termination, or
198.14reduction of services and member appeals and grievances, and align state requirements
198.15and procedures with federal requirements and procedures; and
198.16(7) reform the state's performance improvement projects, requirements, and
198.17procedures to be more flexible and efficient, and to place greater focus on measuring
198.18improvement of outcomes and less on mandating detailed or prescriptive requirements for
198.19specific performance improvement projects or activities.
198.20(d) New reporting requirements or ad hoc report requests shall be established by a
198.21state agency only:
198.22(1) if required by a federal agency;
198.23(2) if needed for a state regulatory audit or corrective action plan; or
198.24(3) after the completion of a review and analysis, and the development of
198.25recommendations by the commissioner of management and budget, in consultation
198.26with the report reduction working group, regarding the necessity, importance, and
198.27administrative cost of the new report, and after completing a review to determine
198.28whether the information sought can be obtained through another available state or federal
198.29report. The results of the review, analysis, and recommendations of the commissioner of
198.30management and budget must be provided to health plans and county-based purchasing
198.31plans for review and comment at least 60 days before a new report or requirement is
198.32established.
198.33(e) To the extent possible, all state agencies shall use the procedures, reports,
198.34and audits of the Centers for Medicare and Medicaid Services instead of requiring an
198.35additional state-mandated report on the same or a similar topic.
199.1(f) By January 15, 2012, the commissioner of management and budget shall provide
199.2a report on the activities and results of the report reduction project to the legislature.
199.3The report must include:
199.4(1) a timetable for report reduction actions already taken or planned by the
199.5commissioners or the report reduction working group;
199.6(2) the specific reports that have been or will be eliminated or consolidated;
199.7(3) the amount of money that will be saved through reductions in administrative
199.8costs of health plans and county-based purchasing plans as a result of the report reduction
199.9project; and
199.10(4) proposed legislation for changes to laws or rules that are needed to allow state
199.11agencies to further reduce, consolidate, or eliminate reports when the changes cannot
199.12be made administratively.

199.13    Sec. 114. COMPETITIVE BIDDING PILOT.
199.14For managed care contracts effective January 1, 2012, the commissioner of
199.15human services is required to establish a competitive price bidding pilot for nonelderly,
199.16nondisabled adults and children in medical assistance and MinnesotaCare in the
199.17seven-county metropolitan area. The pilot must allow a minimum of two managed care
199.18organizations to serve the metropolitan area. The pilot shall expire after two full calendar
199.19years on December 31, 2013. The commissioner of human service shall conduct an
199.20evaluation of the pilot to determine the cost-effectiveness and impacts to provider access at
199.21the end of the two-year period. The commissioner must consult with other states that have
199.22experience implementing competitive bidding in their medical assistance population and
199.23incorporate best practices from those states in designing this pilot. The commissioner, prior
199.24to implementation, must also consult with stakeholders on the design and implementation
199.25of the pilot, including providers, plans, advocacy groups, and other interested parties.

199.26    Sec. 115. REQUEST FOR PROPOSAL; PROVIDER BILLING PATTERNS.
199.27(a) The commissioner of human services shall issue a request for proposal, using
199.28existing resources, to identify abnormal provider billing patterns in order to prevent and
199.29identify improper medical assistance payments.
199.30(b) The request for proposal must include the following requirements for the
199.31contractor:
199.32(1) identification and reporting of improper claims, outlier claims, and improper
199.33payments, both prior to and subsequent to reimbursement;
200.1(2) utilization of fraud detection methods that maximize contemporary predictive
200.2analytic tools, including but not limited to identity analytics, link analysis, and matching
200.3capabilities;
200.4(3) utilization of data analytics that improve fraud detection through the identification
200.5of outlier reimbursement;
200.6(4) reduction in state expenditures by reducing or eliminating payouts of improper
200.7medical assistance claims; and
200.8(5) demonstrated success with other states and state agencies using the specified
200.9proposed solution, deployment, and implementation.
200.10(c) The commissioner shall enter into a contract for the services in this section by
200.11October 1, 2011. The contract must incorporate a performance-based vendor financing
200.12mechanism under which the vendor shares in the risk of the project's success.

200.13    Sec. 116. HEALTH SERVICES POLICY COMMITTEE STUDIES.
200.14(a) The commissioner of human services, through the health services policy
200.15committee established under Minnesota Statutes, section 256B.0625, subdivision 3c, shall
200.16identify and review medical assistance services provided by health care professionals who
200.17are not trained to provide the services in a high-quality manner. The commissioner shall
200.18develop a process to limit payment for medical assistance services to providers who are
200.19not appropriately trained to provide the service, and shall present recommendations and
200.20draft legislation by January 15, 2012, to the legislature.
200.21(b) The commissioner of human services, through the health services policy
200.22committee established under Minnesota Statutes, section 256B.0625, subdivision 3c, shall
200.23study the effectiveness of new strategies for wound care treatment for medical assistance
200.24and MinnesotaCare enrollees with diabetes, including but not limited to the use of new
200.25wound care technologies, assessment tools, and reporting programs. The commissioner
200.26shall present recommendations by December 15, 2011, to the legislature on whether these
200.27new strategies for wound care treatment should be covered under medical assistance
200.28and MinnesotaCare.

200.29    Sec. 117. SPECIALIZED MAINTENANCE THERAPY.
200.30The commissioner of human services shall evaluate whether providing medical
200.31assistance coverage for specialized maintenance therapy for enrollees with serious and
200.32persistent mental illness who are at risk of hospitalization will improve the quality of
200.33care and lower medical assistance spending by reducing rates of hospitalization. The
200.34commissioner shall present findings and recommendations to the chairs and ranking
201.1minority members of the legislative committees with jurisdiction over health and human
201.2services finance and policy by December 15, 2011.

201.3    Sec. 118. COVERAGE FOR LOWER-INCOME MINNESOTACARE
201.4ENROLLEES.
201.5The commissioner of human services shall develop and present to the legislature,
201.6by December 15, 2011, a plan to redesign service delivery for MinnesotaCare enrollees
201.7eligible under Minnesota Statutes, section 256L.04, subdivisions 1 and 7, with incomes
201.8less than 133 percent of the federal poverty guidelines. The plan must be designed to
201.9improve continuity and quality of care, reduce unnecessary emergency room visits, and
201.10reduce average per-enrollee costs. In developing the plan, the commissioner shall consider
201.11innovative methods of service delivery, including but not limited to increasing the use
201.12and choice of private sector health plan coverage and encouraging the use of community
201.13health clinics, as defined in the federal Community Health Care Act of 1964, as health
201.14care homes.

201.15    Sec. 119. DIRECTION TO COMMISSIONER; FEDERAL WAIVERS.
201.16(a) The commissioner of human services shall apply to the Centers for Medicare
201.17and Medicaid Services (CMS) for federal waivers to cover:
201.18(1) families with children eligible under Minnesota Statutes, section 256L.04,
201.19subdivision 1; and
201.20(2) adults eligible under Minnesota Statutes, section 256L.04, subdivision 1,
201.21under the MinnesotaCare healthy Minnesota contribution program established under
201.22Minnesota Statutes, section 256L.031, by July 1, 2011. The commissioner shall report to
201.23the legislative committees with jurisdiction over health and human services policy and
201.24finance whether or not the federal waiver application was accepted within ten working
201.25days of receipt of the decision.
201.26(b) The commissioner of human services shall apply to the CMS for a section
201.271115(a) demonstration waiver, and any other necessary federal waivers and amendments,
201.28including, but not limited to, a waiver of the appropriate sections of title XIX, United
201.29States Code, title 42, section 1396a, and a waiver of any applicable federal maintenance of
201.30effort provisions that would provide Minnesota with medical assistance program flexibility
201.31in exchange for federal budget certainty. The commissioner shall seek federal approval to
201.32enter into an agreement with CMS under which Minnesota would:
202.1(1) accept an aggregate annual allotment for the medical assistance program, trended
202.2forward at an agreed upon rate, with protections to cover medical inflation and projected
202.3caseload growth; and
202.4(2) receive federal waivers of Medicaid requirements related to: statewideness and
202.5comparability of services; the amount, duration, and scope of services; freedom of choice;
202.6cost-sharing; and other areas of program administration specified by the commissioner.
202.7EFFECTIVE DATE.This section is effective the day following final enactment.

202.8    Sec. 120. TRANSPARENCY AND QUALITY REPORTING FOR PUBLIC
202.9HEALTH CARE PROGRAMS.
202.10When negotiating with external vendors to provide managed care services, the
202.11commissioner of human services shall require use of an advanced request for information
202.12tool. This tool must provide the department with an evidence-based assessment that
202.13focuses on the cost control, quality, and information transparency of the health care
202.14vendor. The assessment may include evidence-based performance measures that have
202.15been shown to influence better health, better health care, and more cost-effective use of
202.16resources including, but not limited to, areas that determine each plan's capabilities and
202.17performance with respect to:
202.18(1) consumer engagement, support, and incentives;
202.19(2) processes and outcomes for closing gaps in care according to clinical guideline
202.20expectations;
202.21(3) provider management, including outcome and population-based reimbursement,
202.22transparent measurement of provider performance, and support of physician practice
202.23structures that lead to better care; and
202.24(4) measures of clinical outcomes and waste approved by the National Quality
202.25Forum.

202.26    Sec. 121. RISK CORRIDORS.
202.27(a) Effective for services rendered on or after January 1, 2012, the commissioner
202.28shall establish risk corridors for state public programs that are actuarially sound for each
202.29managed care plan and each county-based purchasing plan. The risk corridors will be
202.30calculated annually based on the calendar year's net underwriting gain or loss. If the
202.31managed care plan or county-based purchasing plan has achieved a net underwriting gain
202.32of greater than three percent of revenue, 80 percent of any excess must be repaid to the
202.33commissioner by July 31 of the year following calculation of the risk corridor year, and
202.3420 percent must be invested by the plan directly into programs for improving quality of
203.1care or access to care for state public health care program enrollees. If the managed
203.2care plan or county-based purchasing plan has incurred a net underwriting loss greater
203.3than three percent of total revenue, 50 percent of any excess must be repaid to the plan
203.4by the commissioner by July 31 of the year following calculation of the risk corridor
203.5year. Determination of total revenues and net underwriting gain or loss must be based
203.6on the Minnesota Supplement Report #1 which is filed on April 1 of the year following
203.7calculation of the risk corridor and adjusted for the actual withhold calculation under
203.8sections 256B.69, subdivision 5a, and 256L.12, subdivision 9. The report must be filed
203.9with and publicly disclosed by the Department of Health.
203.10(b) For purposes of this section, "state public programs" means those prepaid
203.11medical assistance and MinnesotaCare programs for which a managed care plan or
203.12county-based purchasing plan contracts with the commissioner to provide coverage under
203.13sections 256B.69, 256B.692, and 256L.12. The risk corridors shall not apply to plans for
203.14persons who are enrolled in integrated Medicare and medical assistance programs under
203.15section 256B.69, subdivisions 23 and 28.
203.16(c) This section expires January 1, 2014.

203.17    Sec. 122. REPEALER.
203.18(a) Minnesota Statutes 2010, section 62J.07, subdivisions 1, 2, and 3, (Legislative
203.19Commission on Health Care Access) are repealed.
203.20(b) Laws 2009, chapter 79, article 5, section 64, (256L.07, subdivision 2) is repealed
203.21retroactively from July 1, 2009, and federal approval is no longer necessary.
203.22(c) Laws 2009, chapter 79, article 5, section 65, (256L.07, subdivision 3) is repealed
203.23retroactively from July 1, 2009, and federal approval is no longer necessary.
203.24(d) Laws 2009, chapter 79, article 5, section 68, (256L.15, subdivision 2, exemption
203.25of low-income children from MinnesotaCare premiums and insurance barriers) is
203.26repealed retroactively from July 1, 2009, and federal approval is no longer necessary.
203.27(e) Minnesota Statutes 2010, section 256L.07, subdivision 7, exempting eligibility
203.28for children formally under medical assistance, is repealed retroactively from October
203.291, 2008, and federal approval is no longer necessary.
203.30(f) The amendment in Laws 2009, chapter 79, article 5, section 55, as amended by
203.31Laws 2009, chapter 173, article 1, section 36, (256L.04, subdivision 1, children deemed
203.32eligible are exempt from eligibility requirements) is repealed retroactively from January
203.331, 2009, and federal approval is no longer necessary.
204.1(g) Laws 2009, chapter 79, article 5, section 56, (256L.04, subdivision 1b,
204.2exemption from income limit for children) is repealed retroactively from July 1, 2009,
204.3and federal approval is no longer necessary.
204.4(h) Laws 2009, chapter 79, article 5, section 60, (256L.05, subdivision 1c, open
204.5enrollment and streamlined application) is repealed retroactively from July 1, 2009,
204.6and federal approval is no longer necessary.
204.7(i) Laws 2009, chapter 79, article 5, section 66, (256L.07, subdivision 8, automatic
204.8eligibility certain children) is repealed retroactively from July 1, 2009, and federal
204.9approval is no longer necessary.
204.10(j) The amendment in Laws 2009, chapter 79, article 5, section 57, (256L.04,
204.11subdivision 7a, ineligibility for adults with certain income) is repealed retroactively
204.12from July 1, 2009, and federal approval is no longer necessary.
204.13(k) The amendment in Laws 2009, chapter 79, article 5, section 61, (256L.05,
204.14subdivision 3, children eligibility following termination from foster care) is repealed
204.15retroactively from July 1, 2009, and federal approval is no longer necessary.
204.16(l) The amendment in Laws 2009, chapter 79, article 5, section 62, (256L.05,
204.17subdivision 3a, exemption from cancellation for nonrenewal for children) is repealed
204.18retroactively from July 1, 2009, and federal approval is no longer necessary.
204.19(m) The amendment in Laws 2009, chapter 79, article 5, section 63, (256L.07,
204.20subdivision 1, children whose gross family income is greater than 275 percent FPG
204.21may remain enrolled) is repealed retroactively from July 1, 2009, and federal approval is
204.22no longer necessary.
204.23(n) The amendment in Laws 2009, chapter 79, article 5, section 64, (256L.07,
204.24subdivision 2, exempts children from requirement not to have employer-subsidized
204.25coverage) is repealed retroactively from July 1, 2009, and federal approval is no longer
204.26necessary.
204.27(o) The amendment in Laws 2009, chapter 79, article 5, section 65, (256L.07,
204.28subdivision 3, requires children with family gross income over 200 percent of FPG
204.29to have had no health coverage for four months prior to application) is repealed
204.30retroactively from July 1, 2009, and federal approval is no longer necessary.
204.31(p) The amendment in Laws 2009, chapter 79, article 5, section 68, (256L.15,
204.32subdivision 2, children in families with income less than 200 percent FPG pay no
204.33premium) is repealed retroactively from July 1, 2009, and federal approval is no longer
204.34necessary.
204.35(q) The amendment in Laws 2009, chapter 79, article 5, section 69, (256L.15,
204.36subdivision 3, exempts children with family income below 200 percent FPG from
205.1sliding fee scale) is repealed retroactively from July 1, 2009, and federal approval is
205.2no longer necessary.
205.3(r) Laws 2009, chapter 79, article 5, section 79, (uncoded federal approval) is
205.4repealed the day following final enactment.
205.5(s) Minnesota Statutes 2010, section 256B.057, subdivision 2c, (extended medical
205.6assistance for certain children) is repealed.
205.7(t) The amendments in Laws 2008, chapter 358, article 3, sections 8; and 9, (renewal
205.8rolling month and premium grace month) are repealed.

205.9    Sec. 123. REPEALER; EARLY MEDICAL ASSISTANCE EXPANSION.
205.10Minnesota Statutes 2010, section 256B.055, subdivision 15, is repealed January
205.111, 2012.

205.12ARTICLE 6

205.13CONTINUING CARE

205.14    Section 1. Minnesota Statutes 2010, section 144A.071, is amended by adding a
205.15subdivision to read:
205.16    Subd. 4d. Consolidation of nursing facilities. (a) The commissioner of health,
205.17in consultation with the commissioner of human services, may approve a request for
205.18consolidation of nursing facilities which includes the closure of one or more facilities
205.19and the upgrading of the physical plant of the remaining nursing facility or facilities,
205.20the costs of which exceed the threshold project limit under subdivision 2, clause (a).
205.21The commissioners shall consider the criteria in this section, section 144A.073, and
205.22section 256B.437, in approving or rejecting a consolidation proposal. In the event the
205.23commissioners approve the request, the commissioner of human services shall calculate a
205.24property rate adjustment according to clauses (1) to (3):
205.25(1) the closure of beds shall not be eligible for a planned closure rate adjustment
205.26under section 256B.437, subdivision 6;
205.27(2) the construction project permitted in this clause shall not be eligible for a
205.28threshold project rate adjustment under section 256B.434, subdivision 4f, or a moratorium
205.29exception adjustment under section 144A.073; and
205.30(3) the property payment rate for a remaining facility or facilities shall be increased
205.31by an amount equal to 65 percent of the projected net cost savings to the state calculated in
205.32paragraph (b), divided by the state's medical assistance percentage of medical assistance
205.33dollars, and then divided by estimated medical assistance resident days, as determined in
205.34paragraph (c), of the remaining nursing facility or facilities in the request in this paragraph.
206.1(b) For purposes of calculating the net cost savings to the state, the commissioner
206.2shall consider clauses (1) to (7):
206.3(1) the annual savings from estimated medical assistance payments from the net
206.4number of beds closed taking into consideration only beds that are in active service on the
206.5date of the request and that have been in active service for at least three years;
206.6(2) the estimated annual cost of increased case load of individuals receiving services
206.7under the elderly waiver;
206.8(3) the estimated annual cost of elderly waiver recipients receiving support under
206.9group residential housing;
206.10(4) the estimated annual cost of increased case load of individuals receiving services
206.11under the alternative care program;
206.12(5) the annual loss of license surcharge payments on closed beds;
206.13(6) the savings from not paying planned closure rate adjustments that the facilities
206.14would otherwise be eligible for under section 256B.437; and
206.15(7) the savings from not paying property payment rate adjustments from submission
206.16of renovation costs that would otherwise be eligible as threshold projects under section
206.17256B.434, subdivision 4f.
206.18(c) For purposes of the calculation in paragraph (a), clause (3), the estimated medical
206.19assistance resident days of the remaining facility or facilities shall be computed assuming
206.2095 percent occupancy multiplied by the historical percentage of medical assistance
206.21resident days of the remaining facility or facilities, as reported on the facility's or facilities'
206.22most recent nursing facility statistical and cost report filed before the plan of closure
206.23is submitted, multiplied by 365.
206.24(d) For purposes of net cost of savings to the state in paragraph (b), the average
206.25occupancy percentages will be those reported on the facility's or facilities' most recent
206.26nursing facility statistical and cost report filed before the plan of closure is submitted, and
206.27the average payment rates shall be calculated based on the approved payment rates in
206.28effect at the time the consolidation request is submitted.
206.29(e) To qualify for the property payment rate adjustment under this provision, the
206.30closing facilities shall:
206.31(1) submit an application for closure according to section 256B.437, subdivision
206.323; and
206.33(2) follow the resident relocation provisions of section 144A.161.
206.34(f) The county or counties in which a facility or facilities are closed under this
206.35subdivision shall not be eligible for designation as a hardship area under section 144A.071,
206.36subdivision 3, for five years from the date of the approval of the proposed consolidation.
207.1The applicant shall notify the county of this limitation and the county shall acknowledge
207.2this in a letter of support.

207.3    Sec. 2. Minnesota Statutes 2010, section 252.27, subdivision 2a, is amended to read:
207.4    Subd. 2a. Contribution amount. (a) The natural or adoptive parents of a minor
207.5child, including a child determined eligible for medical assistance without consideration of
207.6parental income, must contribute to the cost of services used by making monthly payments
207.7on a sliding scale based on income, unless the child is married or has been married,
207.8parental rights have been terminated, or the child's adoption is subsidized according to
207.9section 259.67 or through title IV-E of the Social Security Act. The parental contribution
207.10is a partial or full payment for medical services provided for diagnostic, therapeutic,
207.11curing, treating, mitigating, rehabilitation, maintenance, and personal care services as
207.12defined in United States Code, title 26, section 213, needed by the child with a chronic
207.13illness or disability.
207.14    (b) For households with adjusted gross income equal to or greater than 100 percent
207.15of federal poverty guidelines, the parental contribution shall be computed by applying the
207.16following schedule of rates to the adjusted gross income of the natural or adoptive parents:
207.17    (1) if the adjusted gross income is equal to or greater than 100 percent of federal
207.18poverty guidelines and less than 175 percent of federal poverty guidelines, the parental
207.19contribution is $4 per month;
207.20    (2) if the adjusted gross income is equal to or greater than 175 percent of federal
207.21poverty guidelines and less than or equal to 545 525 percent of federal poverty guidelines,
207.22the parental contribution shall be determined using a sliding fee scale established by the
207.23commissioner of human services which begins at one percent of adjusted gross income at
207.24175 percent of federal poverty guidelines and increases to 7.5 eight percent of adjusted
207.25gross income for those with adjusted gross income up to 545 525 percent of federal
207.26poverty guidelines;
207.27    (3) if the adjusted gross income is greater than 545 525 percent of federal
207.28poverty guidelines and less than 675 percent of federal poverty guidelines, the parental
207.29contribution shall be 7.5 9.5 percent of adjusted gross income;
207.30    (4) if the adjusted gross income is equal to or greater than 675 percent of federal
207.31poverty guidelines and less than 975 900 percent of federal poverty guidelines, the parental
207.32contribution shall be determined using a sliding fee scale established by the commissioner
207.33of human services which begins at 7.5 9.5 percent of adjusted gross income at 675 percent
207.34of federal poverty guidelines and increases to ten 12 percent of adjusted gross income for
207.35those with adjusted gross income up to 975 900 percent of federal poverty guidelines; and
208.1    (5) if the adjusted gross income is equal to or greater than 975 900 percent of
208.2federal poverty guidelines, the parental contribution shall be 12.5 13.5 percent of adjusted
208.3gross income.
208.4    If the child lives with the parent, the annual adjusted gross income is reduced by
208.5$2,400 prior to calculating the parental contribution. If the child resides in an institution
208.6specified in section 256B.35, the parent is responsible for the personal needs allowance
208.7specified under that section in addition to the parental contribution determined under this
208.8section. The parental contribution is reduced by any amount required to be paid directly to
208.9the child pursuant to a court order, but only if actually paid.
208.10    (c) The household size to be used in determining the amount of contribution under
208.11paragraph (b) includes natural and adoptive parents and their dependents, including the
208.12child receiving services. Adjustments in the contribution amount due to annual changes
208.13in the federal poverty guidelines shall be implemented on the first day of July following
208.14publication of the changes.
208.15    (d) For purposes of paragraph (b), "income" means the adjusted gross income of the
208.16natural or adoptive parents determined according to the previous year's federal tax form,
208.17except, effective retroactive to July 1, 2003, taxable capital gains to the extent the funds
208.18have been used to purchase a home shall not be counted as income.
208.19    (e) The contribution shall be explained in writing to the parents at the time eligibility
208.20for services is being determined. The contribution shall be made on a monthly basis
208.21effective with the first month in which the child receives services. Annually upon
208.22redetermination or at termination of eligibility, if the contribution exceeded the cost of
208.23services provided, the local agency or the state shall reimburse that excess amount to
208.24the parents, either by direct reimbursement if the parent is no longer required to pay a
208.25contribution, or by a reduction in or waiver of parental fees until the excess amount is
208.26exhausted. All reimbursements must include a notice that the amount reimbursed may be
208.27taxable income if the parent paid for the parent's fees through an employer's health care
208.28flexible spending account under the Internal Revenue Code, section 125, and that the
208.29parent is responsible for paying the taxes owed on the amount reimbursed.
208.30    (f) The monthly contribution amount must be reviewed at least every 12 months;
208.31when there is a change in household size; and when there is a loss of or gain in income
208.32from one month to another in excess of ten percent. The local agency shall mail a written
208.33notice 30 days in advance of the effective date of a change in the contribution amount.
208.34A decrease in the contribution amount is effective in the month that the parent verifies a
208.35reduction in income or change in household size.
209.1    (g) Parents of a minor child who do not live with each other shall each pay the
209.2contribution required under paragraph (a). An amount equal to the annual court-ordered
209.3child support payment actually paid on behalf of the child receiving services shall be
209.4deducted from the adjusted gross income of the parent making the payment prior to
209.5calculating the parental contribution under paragraph (b).
209.6    (h) The contribution under paragraph (b) shall be increased by an additional five
209.7percent if the local agency determines that insurance coverage is available but not
209.8obtained for the child. For purposes of this section, "available" means the insurance is a
209.9benefit of employment for a family member at an annual cost of no more than five percent
209.10of the family's annual income. For purposes of this section, "insurance" means health
209.11and accident insurance coverage, enrollment in a nonprofit health service plan, health
209.12maintenance organization, self-insured plan, or preferred provider organization.
209.13    Parents who have more than one child receiving services shall not be required
209.14to pay more than the amount for the child with the highest expenditures. There shall
209.15be no resource contribution from the parents. The parent shall not be required to pay
209.16a contribution in excess of the cost of the services provided to the child, not counting
209.17payments made to school districts for education-related services. Notice of an increase in
209.18fee payment must be given at least 30 days before the increased fee is due.
209.19    (i) The contribution under paragraph (b) shall be reduced by $300 per fiscal year if,
209.20in the 12 months prior to July 1:
209.21    (1) the parent applied for insurance for the child;
209.22    (2) the insurer denied insurance;
209.23    (3) the parents submitted a complaint or appeal, in writing to the insurer, submitted
209.24a complaint or appeal, in writing, to the commissioner of health or the commissioner of
209.25commerce, or litigated the complaint or appeal; and
209.26    (4) as a result of the dispute, the insurer reversed its decision and granted insurance.
209.27    For purposes of this section, "insurance" has the meaning given in paragraph (h).
209.28    A parent who has requested a reduction in the contribution amount under this
209.29paragraph shall submit proof in the form and manner prescribed by the commissioner or
209.30county agency, including, but not limited to, the insurer's denial of insurance, the written
209.31letter or complaint of the parents, court documents, and the written response of the insurer
209.32approving insurance. The determinations of the commissioner or county agency under this
209.33paragraph are not rules subject to chapter 14.
209.34(j) Notwithstanding paragraph (b), for the period from July 1, 2010, to June 30,
209.352013, the parental contribution shall be computed by applying the following contribution
209.36schedule to the adjusted gross income of the natural or adoptive parents:
210.1(1) if the adjusted gross income is equal to or greater than 100 percent of federal
210.2poverty guidelines and less than 175 percent of federal poverty guidelines, the parental
210.3contribution is $4 per month;
210.4(2) if the adjusted gross income is equal to or greater than 175 percent of federal
210.5poverty guidelines and less than or equal to 525 percent of federal poverty guidelines,
210.6the parental contribution shall be determined using a sliding fee scale established by the
210.7commissioner of human services which begins at one percent of adjusted gross income
210.8at 175 percent of federal poverty guidelines and increases to eight percent of adjusted
210.9gross income for those with adjusted gross income up to 525 percent of federal poverty
210.10guidelines;
210.11(3) if the adjusted gross income is greater than 525 percent of federal poverty
210.12guidelines and less than 675 percent of federal poverty guidelines, the parental contribution
210.13shall be 9.5 percent of adjusted gross income;
210.14(4) if the adjusted gross income is equal to or greater than 675 percent of federal
210.15poverty guidelines and less than 900 percent of federal poverty guidelines, the parental
210.16contribution shall be determined using a sliding fee scale established by the commissioner
210.17of human services which begins at 9.5 percent of adjusted gross income at 675 percent of
210.18federal poverty guidelines and increases to 12 percent of adjusted gross income for those
210.19with adjusted gross income up to 900 percent of federal poverty guidelines; and
210.20(5) if the adjusted gross income is equal to or greater than 900 percent of federal
210.21poverty guidelines, the parental contribution shall be 13.5 percent of adjusted gross
210.22income. If the child lives with the parent, the annual adjusted gross income is reduced by
210.23$2,400 prior to calculating the parental contribution. If the child resides in an institution
210.24specified in section 256B.35, the parent is responsible for the personal needs allowance
210.25specified under that section in addition to the parental contribution determined under this
210.26section. The parental contribution is reduced by any amount required to be paid directly to
210.27the child pursuant to a court order, but only if actually paid.

210.28    Sec. 3. Minnesota Statutes 2010, section 256.01, subdivision 24, is amended to read:
210.29    Subd. 24. Disability Linkage Line. The commissioner shall establish the Disability
210.30Linkage Line, a to serve as Minnesota's neutral access point for statewide consumer
210.31disability information, referral, and assistance system for people with disabilities and
210.32chronic illnesses that. The Disability Linkage Line shall:
210.33(1) deliver information and assistance based on national and state standards;
210.34    (1) provides (2) provide information about state and federal eligibility requirements,
210.35benefits, and service options;
211.1(3) provide benefits and options counseling;
211.2    (2) makes (4) make referrals to appropriate support entities;
211.3    (3) delivers information and assistance based on national and state standards;
211.4    (4) assists (5) educate people to on their options so they can make well-informed
211.5decisions choices; and
211.6    (5) supports (6) help support the timely resolution of service access and benefit
211.7issues.;
211.8(7) inform people of their long-term community services and supports;
211.9(8) provide necessary resources and supports that can lead to employment and
211.10increased economic stability of people with disabilities; and
211.11(9) serve as the technical assistance and help center for the Web-based tool,
211.12Minnesota's Disability Benefits 101.org.
211.13EFFECTIVE DATE.This section is effective July 1, 2011.

211.14    Sec. 4. Minnesota Statutes 2010, section 256.01, subdivision 29, is amended to read:
211.15    Subd. 29. State medical review team. (a) To ensure the timely processing of
211.16determinations of disability by the commissioner's state medical review team under
211.17sections 256B.055, subdivision 7, paragraph (b), 256B.057, subdivision 9, paragraph
211.18(j), and 256B.055, subdivision 12, the commissioner shall review all medical evidence
211.19submitted by county agencies with a referral and seek additional information from
211.20providers, applicants, and enrollees to support the determination of disability where
211.21necessary. Disability shall be determined according to the rules of title XVI and title
211.22XIX of the Social Security Act and pertinent rules and policies of the Social Security
211.23Administration.
211.24    (b) Prior to a denial or withdrawal of a requested determination of disability due
211.25to insufficient evidence, the commissioner shall (1) ensure that the missing evidence is
211.26necessary and appropriate to a determination of disability, and (2) assist applicants and
211.27enrollees to obtain the evidence, including, but not limited to, medical examinations
211.28and electronic medical records.
211.29(c) The commissioner shall provide the chairs of the legislative committees with
211.30jurisdiction over health and human services finance and budget the following information
211.31on the activities of the state medical review team by February 1 of each year:
211.32(1) the number of applications to the state medical review team that were denied,
211.33approved, or withdrawn;
211.34(2) the average length of time from receipt of the application to a decision;
212.1(3) the number of appeals, appeal results, and the length of time taken from the date
212.2the person involved requested an appeal for a written decision to be made on each appeal;
212.3(4) for applicants, their age, health coverage at the time of application, hospitalization
212.4history within three months of application, and whether an application for Social Security
212.5or Supplemental Security Income benefits is pending; and
212.6(5) specific information on the medical certification, licensure, or other credentials
212.7of the person or persons performing the medical review determinations and length of
212.8time in that position.
212.9(d) Any appeal made under section 256.045, subdivision 3, of a disability
212.10determination made by the state medical review team must be decided according to the
212.11timelines under section 256.0451, subdivision 22, paragraph (a). If a written decision is
212.12not issued within the timelines under section 256.0451, subdivision 22, paragraph (a), the
212.13appeal must be immediately reviewed by the chief appeals referee.
212.14EFFECTIVE DATE.This section is effective July 1, 2011.

212.15    Sec. 5. Minnesota Statutes 2010, section 256.045, subdivision 4a, is amended to read:
212.16    Subd. 4a. Case management appeals. (a) Any recipient of case management
212.17services pursuant to section 256B.0625 or 256B.092, personal care assistance services
212.18under section 256B.0625, or other services who contests the county agency's action,
212.19reduction, suspension, denial, or termination of services, or failure to act in the provision
212.20of those services, other than a failure to act with reasonable promptness or a suspension,
212.21reduction, denial, or termination of services, must submit a written request for a
212.22conciliation conference with the recipient's case worker and the county social service
212.23director or designee to the county agency prior to filing an appeal under this section.
212.24    (b) For purposes of this subdivision, a county agency's actions include actions by
212.25the department with respect to these services. The request must be filed no later than 30
212.26days from the date of a notice of action on personal care assistance services or ten days
212.27from the date of a notice of agency action on case management or other services. The
212.28county agency or the state may implement the action, reduction, suspension, denial, or
212.29termination of services described in the notice of action unless the recipient includes a
212.30request for continuation of services. The recipient may request a 30-day continuation of
212.31personal care assistance services or ten-day continuation for case management or other
212.32services. The county agency may hold the conference by telephone or by electronic media
212.33unless the recipient requests the conference take place in person in their written request for
212.34conference. The county agency shall have discretion to continue the conference.
213.1    (c) The county agency shall inform the commissioner of the receipt of a request
213.2when it is submitted and shall schedule a conciliation conference to be held in person, by
213.3telephone, or by electronic media within ten days of the receipt of the recipient's written
213.4request. The county agency shall notify the recipient, the commissioner, and all interested
213.5persons of the time, date, and location of the conciliation conference. The commissioner
213.6may assist the county by providing mediation services or by identifying other resources
213.7that may assist in the mediation between the parties. Within 30 15 days after the conference
213.8has been held, the county agency shall conduct the conciliation conference and inform the
213.9recipient in writing of the action the county agency is going to take and when that action
213.10will be taken and notify the recipient of the right to a hearing under this subdivision.
213.11    The conciliation conference shall be conducted in a manner consistent with the
213.12commissioner's instructions. (d) If the county fails to conduct the conciliation conference
213.13and issue its report within 30 days, or, at any time up to 90 days after the conciliation
213.14conference is held as provided in paragraph (b) and the recipient disputes the county
213.15agency's notice of its intended action, or if a recipient is otherwise entitled to a fair hearing
213.16under subdivision 3a, a recipient may submit to the commissioner a written request for a
213.17fair hearing before a state human services referee to determine whether case management
213.18services have been provided in accordance with applicable laws and rules or whether the
213.19county agency has assured that the services identified in the recipient's individual service
213.20plan have been delivered in accordance with the laws and rules governing the provision of
213.21those services under this section.
213.22    (e) Hearings involving claims the county agency failed to comply with the
213.23requirement to schedule and hold a conference or to notify the recipient of its intended
213.24action according to this subdivision shall be limited in scope to those issues only, and the
213.25human services judge may recommend an order to the commissioner remanding the case
213.26to the county agency with directions to schedule and hold the conference and to notify
213.27the recipient of its intended action. The state human services referee shall recommend an
213.28order to the commissioner, who shall, in accordance with the procedure in subdivision 5,
213.29issue a final order within 60 days of the receipt of the request for a hearing involving case
213.30management services only, unless the commissioner refuses to accept the recommended
213.31order, in which event a final order shall issue within 90 days of the receipt of that request.
213.32The order may direct the county agency to take those actions necessary to comply with
213.33applicable laws or rules. The commissioner may issue a temporary order prohibiting the
213.34demission of a recipient of case management services under section 256B.092, from
213.35a residential or day habilitation program licensed under chapter 245A, while a county
213.36agency review process or an appeal brought by a recipient under this subdivision is
214.1pending, or for the period of time necessary for the county agency to implement the
214.2commissioner's order. The commissioner shall not issue a final order staying the demission
214.3of a recipient of case management services from a residential or day habilitation program
214.4licensed under chapter 245A.
214.5    (f) Any recipient of case management services under section 256B.0625 or
214.6256B.092, or personal care assistance services under section 256B.0625, must be informed
214.7in writing at the time of application and at the time of any change in services that they
214.8must submit a written request to the county agency for a conference with the case manager
214.9and the county social service director before they can file an appeal under this section,
214.10of their right to continue receiving services pending the outcome of the conference
214.11and notice from the county agency, and that their time for requesting a hearing under
214.12subdivision 3a and requesting continuation of services begins to run when they receive the
214.13postconference notice of the county's intended actions. For purposes of this paragraph,
214.14recipients are presumed to have received notice of the agency's intended actions three
214.15business days after the date of the notice. Recipients have the burden of overcoming this
214.16presumption by a preponderance of the evidence.
214.17EFFECTIVE DATE.This section is effective for all notices of action dated on
214.18or after January 1, 2012.

214.19    Sec. 6. Minnesota Statutes 2010, section 256.9657, subdivision 1, is amended to read:
214.20    Subdivision 1. Nursing home license surcharge. (a) Effective July 1, 1993,
214.21each non-state-operated nursing home licensed under chapter 144A shall pay to the
214.22commissioner an annual surcharge according to the schedule in subdivision 4. The
214.23surcharge shall be calculated as $620 per licensed bed. If the number of licensed beds
214.24is reduced, the surcharge shall be based on the number of remaining licensed beds the
214.25second month following the receipt of timely notice by the commissioner of human
214.26services that beds have been delicensed. The nursing home must notify the commissioner
214.27of health in writing when beds are delicensed. The commissioner of health must notify
214.28the commissioner of human services within ten working days after receiving written
214.29notification. If the notification is received by the commissioner of human services by
214.30the 15th of the month, the invoice for the second following month must be reduced
214.31to recognize the delicensing of beds. Beds on layaway status continue to be subject to
214.32the surcharge. The commissioner of human services must acknowledge a medical care
214.33surcharge appeal within 30 days of receipt of the written appeal from the provider.
214.34(b) Effective July 1, 1994, the surcharge in paragraph (a) shall be increased to $625.
215.1(c) Effective August 15, 2002, the surcharge under paragraph (b) shall be increased
215.2to $990.
215.3(d) Effective July 15, 2003, the surcharge under paragraph (c) shall be increased
215.4to $2,815.
215.5(e) Effective July 15, 2013, the surcharge under paragraph (d) shall apply only to
215.6occupied, licensed nursing home beds that are not in layaway under section 144A.071,
215.7subdivision 4b. Beginning January 1, 2013, nursing facilities may, on a quarterly basis,
215.8report data on occupancy as a percent of capacity days, on a form and in a manner
215.9prescribed by the commissioner. This data must be provided by the end of the month
215.10following the calendar quarter. The commissioner shall use this data to adjust the
215.11surcharge amount due for the calendar quarter following submission of the data. This
215.12adjustment shall be allowed only for a nursing facility that provides complete and timely
215.13data allowed in this paragraph. The commissioner shall apply a monthly surcharge
215.14computed as the occupancy percentage as reported in this paragraph times the number of
215.15licensed nursing home beds times $2,815 divided by 12.
215.16(f) The commissioner may reduce, and may subsequently restore, the surcharge
215.17under paragraph (d) based on the commissioner's determination of a permissible surcharge.
215.18(f) (g) Between April 1, 2002, and August 15, 2004, a facility governed by this
215.19subdivision may elect to assume full participation in the medical assistance program
215.20by agreeing to comply with all of the requirements of the medical assistance program,
215.21including the rate equalization law in section 256B.48, subdivision 1, paragraph (a), and
215.22all other requirements established in law or rule, and to begin intake of new medical
215.23assistance recipients. Rates will be determined under Minnesota Rules, parts 9549.0010
215.24to 9549.0080. Notwithstanding section 256B.431, subdivision 27, paragraph (i), rate
215.25calculations will be subject to limits as prescribed in rule and law. Other than the
215.26adjustments in sections 256B.431, subdivisions 30 and 32; 256B.437, subdivision 3,
215.27paragraph (b), Minnesota Rules, part 9549.0057, and any other applicable legislation
215.28enacted prior to the finalization of rates, facilities assuming full participation in medical
215.29assistance under this paragraph are not eligible for any rate adjustments until the July 1
215.30following their settle-up period.

215.31    Sec. 7. Minnesota Statutes 2010, section 256B.056, subdivision 3, is amended to read:
215.32    Subd. 3. Asset limitations for individuals and families. (a) To be eligible for
215.33medical assistance, a person must not individually own more than $3,000 in assets, or if a
215.34member of a household with two family members, husband and wife, or parent and child,
215.35the household must not own more than $6,000 in assets, plus $200 for each additional
216.1legal dependent. In addition to these maximum amounts, an eligible individual or family
216.2may accrue interest on these amounts, but they must be reduced to the maximum at the
216.3time of an eligibility redetermination. The accumulation of the clothing and personal
216.4needs allowance according to section 256B.35 must also be reduced to the maximum at
216.5the time of the eligibility redetermination. The value of assets that are not considered in
216.6determining eligibility for medical assistance is the value of those assets excluded under
216.7the supplemental security income program for aged, blind, and disabled persons, with
216.8the following exceptions:
216.9(1) household goods and personal effects are not considered;
216.10(2) capital and operating assets of a trade or business that the local agency determines
216.11are necessary to the person's ability to earn an income are not considered;
216.12(3) motor vehicles are excluded to the same extent excluded by the supplemental
216.13security income program;
216.14(4) assets designated as burial expenses are excluded to the same extent excluded by
216.15the supplemental security income program. Burial expenses funded by annuity contracts
216.16or life insurance policies must irrevocably designate the individual's estate as contingent
216.17beneficiary to the extent proceeds are not used for payment of selected burial expenses; and
216.18(5) effective upon federal approval, for a person who no longer qualifies as an
216.19employed person with a disability due to loss of earnings, assets allowed while eligible
216.20for medical assistance under section 256B.057, subdivision 9, are not considered for 12
216.21months, beginning with the first month of ineligibility as an employed person with a
216.22disability, to the extent that the person's total assets remain within the allowed limits of
216.23section 256B.057, subdivision 9, paragraph (c) (d).
216.24(b) No asset limit shall apply to persons eligible under section 256B.055, subdivision
216.2515.
216.26EFFECTIVE DATE.This section is effective January 1, 2014.

216.27    Sec. 8. Minnesota Statutes 2010, section 256B.056, is amended by adding a
216.28subdivision to read:
216.29    Subd. 5d. Spenddown adjustments. When income is projected for a six-month
216.30budget period, retroactive adjustments to income determined to be available to a person
216.31under section 256B.0575 must be made at the end of each six-month budget period
216.32based on changes occurring during the budget period. For changes occurring outside the
216.33six-month budget period, such retroactive adjustments are limited to the six full calendar
216.34months before the month the change is reported or discovered.

217.1    Sec. 9. Minnesota Statutes 2010, section 256B.057, subdivision 9, is amended to read:
217.2    Subd. 9. Employed persons with disabilities. (a) Medical assistance may be paid
217.3for a person who is employed and who:
217.4(1) but for excess earnings or assets, meets the definition of disabled under the
217.5Supplemental Security Income program;
217.6(2) is at least 16 but less than 65 years of age;
217.7(3) meets the asset limits in paragraph (c) (d); and
217.8(4) pays a premium and other obligations under paragraph (e).
217.9    (b) For purposes of eligibility, there is a $65 earned income disregard. To be eligible
217.10for medical assistance under this subdivision, a person must have more than $65 of earned
217.11income. Earned income must have Medicare, Social Security, and applicable state and
217.12federal taxes withheld. The person must document earned income tax withholding. Any
217.13spousal income or assets shall be disregarded for purposes of eligibility and premium
217.14determinations.
217.15(b) (c) After the month of enrollment, a person enrolled in medical assistance under
217.16this subdivision who:
217.17(1) is temporarily unable to work and without receipt of earned income due to a
217.18medical condition, as verified by a physician, may retain eligibility for up to four calendar
217.19months; or
217.20(2) effective January 1, 2004, loses employment for reasons not attributable to the
217.21enrollee, and is without receipt of earned income may retain eligibility for up to four
217.22consecutive months after the month of job loss. To receive a four-month extension,
217.23enrollees must verify the medical condition or provide notification of job loss. All other
217.24eligibility requirements must be met and the enrollee must pay all calculated premium
217.25costs for continued eligibility.
217.26(c) (d) For purposes of determining eligibility under this subdivision, a person's
217.27assets must not exceed $20,000, excluding:
217.28(1) all assets excluded under section 256B.056;
217.29(2) retirement accounts, including individual accounts, 401(k) plans, 403(b) plans,
217.30Keogh plans, and pension plans; and
217.31(3) medical expense accounts set up through the person's employer.; and
217.32(4) spousal assets, including spouse's share of jointly held assets.
217.33(d)(1) Effective January 1, 2004, for purposes of eligibility, there will be a $65
217.34earned income disregard. To be eligible, a person applying for medical assistance under
217.35this subdivision must have earned income above the disregard level.
218.1(2) Effective January 1, 2004, to be considered earned income, Medicare, Social
218.2Security, and applicable state and federal income taxes must be withheld. To be eligible,
218.3a person must document earned income tax withholding.
218.4(e)(1) A person whose earned and unearned income is equal to or greater than 100
218.5percent of federal poverty guidelines for the applicable family size must pay a premium
218.6to be eligible for medical assistance under this subdivision. (e) All enrollees must pay a
218.7premium to be eligible for medical assistance under this subdivision, except as provided
218.8under section 256.01, subdivision 18b.
218.9(1) An enrollee must pay the greater of a $65 premium or the premium shall be
218.10calculated based on the person's gross earned and unearned income and the applicable
218.11family size using a sliding fee scale established by the commissioner, which begins at
218.12one percent of income at 100 percent of the federal poverty guidelines and increases
218.13to 7.5 percent of income for those with incomes at or above 300 percent of the federal
218.14poverty guidelines.
218.15(2) Annual adjustments in the premium schedule based upon changes in the federal
218.16poverty guidelines shall be effective for premiums due in July of each year.
218.17(2) Effective January 1, 2004, all enrollees must pay a premium to be eligible for
218.18medical assistance under this subdivision. An enrollee shall pay the greater of a $35
218.19premium or the premium calculated in clause (1).
218.20(3) Effective November 1, 2003, All enrollees who receive unearned income must
218.21pay one-half of one five percent of unearned income in addition to the premium amount,
218.22except as provided under section 256.01, subdivision 18b.
218.23(4) Effective November 1, 2003, for enrollees whose income does not exceed 200
218.24percent of the federal poverty guidelines and who are also enrolled in Medicare, the
218.25commissioner must reimburse the enrollee for Medicare Part B premiums under section
218.26256B.0625, subdivision 15, paragraph (a).
218.27(5) (4) Increases in benefits under title II of the Social Security Act shall not be
218.28counted as income for purposes of this subdivision until July 1 of each year.
218.29(f) A person's eligibility and premium shall be determined by the local county
218.30agency. Premiums must be paid to the commissioner. All premiums are dedicated to
218.31the commissioner.
218.32(g) Any required premium shall be determined at application and redetermined at
218.33the enrollee's six-month income review or when a change in income or household size is
218.34reported. Enrollees must report any change in income or household size within ten days
218.35of when the change occurs. A decreased premium resulting from a reported change in
218.36income or household size shall be effective the first day of the next available billing month
219.1after the change is reported. Except for changes occurring from annual cost-of-living
219.2increases, a change resulting in an increased premium shall not affect the premium amount
219.3until the next six-month review.
219.4(h) Premium payment is due upon notification from the commissioner of the
219.5premium amount required. Premiums may be paid in installments at the discretion of
219.6the commissioner.
219.7(i) Nonpayment of the premium shall result in denial or termination of medical
219.8assistance unless the person demonstrates good cause for nonpayment. Good cause exists
219.9if the requirements specified in Minnesota Rules, part 9506.0040, subpart 7, items B to
219.10D, are met. Except when an installment agreement is accepted by the commissioner,
219.11all persons disenrolled for nonpayment of a premium must pay any past due premiums
219.12as well as current premiums due prior to being reenrolled. Nonpayment shall include
219.13payment with a returned, refused, or dishonored instrument. The commissioner may
219.14require a guaranteed form of payment as the only means to replace a returned, refused,
219.15or dishonored instrument.
219.16(j) The commissioner shall notify enrollees annually beginning at least 24 months
219.17before the person's 65th birthday of the medical assistance eligibility rules affecting
219.18income, assets, and treatment of a spouse's income and assets that will be applied upon
219.19reaching age 65.
219.20(k) For enrollees whose income does not exceed 200 percent of the federal poverty
219.21guidelines and who are also enrolled in Medicare, the commissioner shall reimburse
219.22the enrollee for Medicare part B premiums under section 256B.0625, subdivision 15,
219.23paragraph (a).
219.24EFFECTIVE DATE.This section is effective January 1, 2014, for adults age 21 or
219.25older, and October 1, 2019, for children age 16 to before the child's 21st birthday.

219.26    Sec. 10. Minnesota Statutes 2010, section 256B.0657, is amended to read:
219.27256B.0657 SELF-DIRECTED SUPPORTS OPTION OPTIONS.
219.28    Subdivision 1. Definition. (a) "Lead agency" has the meaning given in section
219.29256B.0911, subdivision 1a, paragraph (d).
219.30(b) "Legal representative" means a legal guardian of a child or an adult, or parent of
219.31a minor child.
219.32(c) "Individual representative" means an individual who has been authorized, in
219.33a written statement by the person or the person's legal representative, to speak on the
219.34person's behalf and help the person understand and make informed choices in matters
220.1related to identification of needs and choice of services and supports and assist the person
220.2to implement an approved support plan and has no financial interest in the provision of any
220.3services included in the individual's plan unless related by blood, adoption, or marriage.
220.4(d) "Self-directed supports option options" means personal assistance, supports,
220.5items, and related services purchased under an approved budget plan and budget by a
220.6recipient.
220.7    Subd. 2. Eligibility. (a) The self-directed supports option is available to a person
220.8who:
220.9    (1) is a recipient of medical assistance as determined under sections 256B.055,
220.10256B.056 , and 256B.057, subdivision 9;
220.11    (2) is eligible for personal care assistance services under section 256B.0659, or
220.12for a home and community-based services waiver program under section 256B.0915,
220.13256B.092, or 256B.49, or alternative care under section 256B.0913;
220.14    (3) lives in the person's own apartment or home, which is not owned, operated, or
220.15controlled by a provider of services not except for services provided by those related by
220.16blood or, adoption, marriage, or family foster care consistent with the requirements of
220.17section 256B.0651, subdivision 1, paragraph (e);
220.18    (4) has the ability to hire, fire, supervise, establish staff compensation for, and
220.19manage the individuals providing services, and to choose and obtain items, related
220.20services, and supports as described in the participant's plan. If the recipient is not able
220.21to carry out these functions but has a legal guardian, individual representative, or parent
220.22to carry them out, the guardian, individual representative, or parent may fulfill these
220.23functions on behalf of the recipient; and
220.24    (5) has not been excluded or disenrolled by the commissioner.
220.25    (b) The commissioner may disenroll or, exclude, or require other measures such as
220.26training, increased assistance, reporting, or oversight for recipients, including guardians
220.27and, parents, and individual representatives under the following circumstances:
220.28    (1) recipients who have been restricted by the Primary Care Utilization Review
220.29Committee Minnesota restricted recipient program may be excluded for a specified time
220.30period;
220.31    (2) recipients who exit the self-directed supports option during the recipient's
220.32service plan year shall not access the self-directed supports option for the remainder of
220.33that service plan year; and
220.34    (3) when the department determines that the recipient cannot manage recipient
220.35responsibilities under the program.
221.1(c) For vendors or other self-directed service providers, the commissioner may
221.2take any action authorized under surveillance and integrity review in Minnesota Rules,
221.3parts 9505.2160 to 9505.2245.
221.4    Subd. 3. Eligibility for other services. Selection of the self-directed supports
221.5option by a recipient shall not restrict access to other medically necessary care and
221.6services furnished under the state plan medical assistance benefit, including home care
221.7targeted case management, except that a person receiving choosing lead agency managed
221.8home and community-based waiver services, agency-provided personal care assistance
221.9services, a family support grant, or a consumer support grant is not eligible for funding
221.10under the self-directed supports option.
221.11    Subd. 4. Assessment requirements. (a) The self-directed supports option
221.12assessment must meet the following requirements:
221.13    (1) it shall be conducted by the county public health nurse or a certified public health
221.14nurse under contract with the county consistent with the requirements of personal care
221.15assistance services under section 256B.0659, subdivision 3a; home and community-based
221.16waiver services programs under section 256B.0915, 256B.092, or 256B.49; and the
221.17alternative care program under section 256B.0913, until section 256B.0911, subdivision
221.183a, has been implemented;
221.19    (2) it shall be conducted face-to-face in the recipient's home initially, and at least
221.20annually thereafter; when there is a significant change in the recipient's condition; and
221.21when there is a change in the person's need for personal care assistance services under the
221.22programs listed in subdivision 2, paragraph (a), clause (2). A recipient who is residing in a
221.23facility may be assessed for the self-directed support option for the purpose of returning
221.24to the community using this option; and
221.25    (3) it shall be completed using the format established by the commissioner.
221.26    (b) The results of the personal care assistance assessment and recommendations shall
221.27be communicated to the commissioner and the recipient by the county public health nurse
221.28or certified public health nurse under contract with the county as required under section
221.29256B.0659, subdivision 3a. The person's annual and monthly average authorization for
221.30the self-directed budget amount shall be provided within 40 days after the personal care
221.31assessment or reassessment, or within ten days after a request not related to an assessment.
221.32(c) The lead agency responsible for administration of home and community-based
221.33waiver services under section 256B.0915, 256B.092, or 256B.49, and alternative care
221.34under section 256B.0913, shall provide annual and monthly average authorization for the
221.35self-directed services budget amounts for all eligible persons within 40 days after an
222.1initial assessment or annual review and within ten days if requested at a time unrelated to
222.2the assessment or annual review.
222.3    Subd. 5. Self-directed supports option plan requirements. (a) The plan and
222.4provider for the self-directed supports option must meet the following requirements:
222.5    (1) the plan must be completed using a person-centered process that:
222.6    (i) builds upon the recipient's capacity to engage in activities that promote
222.7community life;
222.8    (ii) respects the recipient's preferences, choices, and abilities;
222.9    (iii) involves families, friends, and professionals in the planning or delivery of
222.10services or supports as desired or required by the recipient; and
222.11    (iv) addresses the need for personal care assistance and other services and supports
222.12identified in the recipient's self-directed supports option assessment;
222.13    (2) the plan shall be developed by the recipient, legal representative, or by the
222.14guardian of an adult recipient or by a parent or guardian of a minor child, individual
222.15representative, and may be assisted by a provider who meets the requirements established
222.16for using a person-centered planning process and shall be reviewed at least annually upon
222.17reassessment or when there is a significant change in the recipient's condition; and
222.18    (3) the plan must include the total budget amount available divided into monthly
222.19amounts that cover the number of months of personal care assistance services or home
222.20and community-based waiver or alternative care authorization included in the budget.
222.21A recipient may reserve funds monthly for the purchase of items that meet the standards
222.22in subdivision 6, paragraph (a), clause (2), and are reflected in the support plan. The
222.23amount used each month may vary, but additional funds shall not be provided above the
222.24annual personal care assistance services authorized amount unless a change in condition
222.25is documented.
222.26    (b) The commissioner or the commissioner's designee shall:
222.27    (1) ensure that outreach activities and information materials on self-directed options
222.28are developed and provided across the state to persons who use or are seeking community
222.29support services;
222.30    (1) (2) establish the format and criteria for the plan as well as the requirements for
222.31providers who assist with plan development;
222.32    (2) (3) review the assessment and plan and, within 30 days after receiving the
222.33assessment and plan, make a decision on approval of the plan;
222.34    (3) (4) notify the recipient, parent, or guardian legal representative, or individual
222.35representative of approval or denial of the plan and provide notice of the right to appeal
222.36under section 256.045; and
223.1    (4) (5) provide a copy of the plan to the fiscal support entity selected by the recipient
223.2from among at least three certified entities.
223.3    (c) The commissioner shall:
223.4    (1) establish provider enrollment requirements for provision of fiscal support entity
223.5services and person-centered support plan services, including benefits counseling to
223.6support employment; and
223.7    (2) collect a fee to cover the costs of certifying providers for the services described
223.8in this subdivision.
223.9    Subd. 6. Services covered. (a) Services covered under the self-directed supports
223.10option include:
223.11    (1) personal care assistance services under section 256B.0659, and services under
223.12the home and community-based waivers, except those provided in licensed or registered
223.13residential settings unless the services are provided in a family foster care setting which
223.14meets the requirements of section 256B.0651, subdivision 1, paragraph (e); and
223.15    (2) items, related services, and supports, including assistive technology, that increase
223.16independence or substitute for human assistance to the extent expenditures would
223.17otherwise be used for human assistance.
223.18    (b) Items, supports, and related services purchased under this option shall not be
223.19considered home care services for the purposes of section 144A.43.
223.20    Subd. 7. Noncovered services. Services or supports that are not eligible for
223.21payment under the self-directed supports option include:
223.22    (1) services, goods, or supports that do not benefit the recipient;
223.23    (2) any fees incurred by the recipient, such as Minnesota health care program fees
223.24and co-pays, legal fees, or costs related to advocate agencies;
223.25    (3) insurance, except for insurance costs related to employee coverage or fiscal
223.26support entity payments;
223.27    (4) room and board and personal items that are not related to the disability, except
223.28that medically prescribed specialized diet items may be covered if they reduce the need for
223.29human assistance;
223.30    (5) home modifications that add square footage, except those modifications that
223.31configure a bathroom to accommodate a wheelchair;
223.32    (6) home modifications for a residence other than the primary residence of the
223.33recipient, or in the event of a minor with parents not living together, the primary residences
223.34of the parents;
224.1    (7) expenses for travel, lodging, or meals related to training the recipient, the
224.2parent or guardian of an adult recipient, or the parent or guardian of a minor child legal
224.3representative, or paid or unpaid caregivers that exceed $500 in a 12-month period;
224.4    (8) experimental treatment;
224.5    (9) any service or item to the extent the service or item is covered by other medical
224.6assistance state plan services, including prescription and over-the-counter medications,
224.7compounds, and solutions and related fees, including premiums and co-payments;
224.8    (10) membership dues or costs, except when the service is necessary and appropriate
224.9to treat a physical condition or to improve or maintain the recipient's physical condition.
224.10The condition must be identified in the recipient's plan of care and monitored by a
224.11Minnesota health care program enrolled physician;
224.12    (11) vacation expenses other than the cost of direct services;
224.13    (12) vehicle maintenance or modifications not related to the disability;
224.14    (13) tickets and related costs to attend sporting or other recreational events; and
224.15    (14) costs related to Internet access, except when necessary for operation of assistive
224.16technology, to increase independence, or to substitute for human assistance.
224.17    Subd. 8. Self-directed budget requirements. (a) The budget for the provision of
224.18the self-directed service option shall be established for persons eligible for personal care
224.19assistance services under section 256B.0659 based on:
224.20    (1) assessed personal care assistance units, not to exceed the maximum number of
224.21personal care assistance units available, as determined by section 256B.0659; and
224.22    (2) the personal care assistance unit rate:
224.23    (i) with a reduction to the unit rate to pay for a program administrator as defined in
224.24subdivision 10; and
224.25    (ii) an additional adjustment to the unit rate as needed to ensure cost neutrality for
224.26the state.
224.27(b) The budget for persons eligible for programs listed in subdivision 2, paragraph
224.28(a), clause (2), is based on the approved budget methodologies for each program.
224.29    Subd. 9. Quality assurance and risk management. (a) The commissioner
224.30shall establish quality assurance and risk management measures for use in developing
224.31and implementing self-directed plans and budgets that (1) recognize the roles and
224.32responsibilities involved in obtaining services in a self-directed manner, and (2) assure
224.33the appropriateness of such plans and budgets based upon a recipient's resources and
224.34capabilities. These measures must include (i) background studies, and (ii) backup and
224.35emergency plans, including disaster planning, and (iii) for persons using home and
225.1community-based waiver services, monitoring by the lead agency on quality assurance
225.2measures and recipient health, safety, and welfare.
225.3    (b) The commissioner shall provide ongoing technical assistance and resource
225.4and educational materials for families and recipients selecting the self-directed option,
225.5including information on the quality assurance efforts.
225.6    (c) Performance assessments measures, such as of a recipient's functioning,
225.7satisfaction with the services and supports, and ongoing monitoring of health and
225.8well-being shall be identified in consultation with the stakeholder group.
225.9    Subd. 10. Fiscal support entity. (a) Each recipient or legal representative shall
225.10choose a fiscal support entity provider certified by the commissioner to make payments
225.11for services, items, supports, and administrative costs related to managing a self-directed
225.12service plan authorized for payment in the approved plan and budget. Recipients The
225.13recipient or legal representative shall also choose the payroll, agency with choice, or the
225.14fiscal conduit model of financial and service management.
225.15    (b) The fiscal support entity:
225.16    (1) may not limit or restrict the recipient's choice of service or support providers,
225.17including use of the payroll, agency with choice, or fiscal conduit model of financial
225.18and service management;
225.19    (2) must have a written agreement with the recipient, individual representative, or
225.20the recipient's legal representative that identifies the duties and responsibilities to be
225.21performed and the specific related charges;
225.22    (3) must provide the recipient and the home care targeted case manager, legal
225.23representative, and individual representative with a monthly written summary of the
225.24self-directed supports option services that were billed, including charges from the fiscal
225.25support entity;
225.26    (4) must be knowledgeable of and comply with Internal Revenue Service
225.27requirements necessary to process employer and employee deductions, provide appropriate
225.28and timely submission of employer tax liabilities, and maintain documentation to support
225.29medical assistance claims;
225.30    (5) must have current and adequate liability insurance and bonding and sufficient
225.31cash flow and have on staff or under contract a certified public accountant or an individual
225.32with a baccalaureate degree in accounting; and
225.33    (6) must maintain records to track all self-directed supports option services
225.34expenditures, including time records of persons paid to provide supports and receipts for
225.35any goods purchased. The records must be maintained for a minimum of five years from
225.36the claim date and be available for audit or review upon request. Claims submitted by
226.1the fiscal support entity must correspond with services, amounts, and time periods as
226.2authorized in the recipient's self-directed supports option plan.
226.3    (c) The commissioner shall have authority to:
226.4    (1) set or negotiate rates with fiscal support entities;
226.5    (2) limit the number of fiscal support entities;
226.6    (3) identify a process to certify and recertify fiscal support entities and assure fiscal
226.7support entities are available to recipients throughout the state; and
226.8    (4) establish a uniform format and protocol to be used by eligible fiscal support
226.9entities.
226.10    Subd. 11. Stakeholder consultation. The commissioner shall consult with
226.11a statewide consumer-directed self-directed services stakeholder group, including
226.12representatives of all types of consumer-directed self-directed service users, advocacy
226.13organizations, counties, and consumer-directed self-directed service providers. The
226.14commissioner shall seek recommendations from this stakeholder group in developing,
226.15monitoring, evaluating, and modifying:
226.16    (1) the self-directed plan format;
226.17    (2) requirements and guidelines for the person-centered plan assessment and
226.18planning process;
226.19    (3) implementation of the option and the quality assurance and risk management
226.20techniques; and
226.21    (4) standards and requirements, including rates for the personal support plan
226.22development provider and the fiscal support entity; policies; training; and implementation;
226.23and
226.24(5) the self-directed supports options available through the home and
226.25community-based waivers under section 256B.0916 and the personal care assistance
226.26program under section 256B.0659, including recommendations on possible ways to
226.27increase participation, improve flexibility, and provide incentives for recipients to
226.28participate in a life transition and crisis funding pool with others to save and contribute
226.29part of their authorized budgets, which can be carried over year to year and used according
226.30to priority standards under section 256B.092, subdivision 12, paragraph (a), clauses (1),
226.31(3), (4), (5), and (6).
226.32The stakeholder group shall provide recommendations on the repeal of the personal
226.33care assistance choice option, transition issues, and whether the consumer support grant
226.34program under section 256.476 should be modified. The stakeholder group shall meet
226.35at least three times each year to provide advice on policy, implementation, and other
226.36aspects of consumer and self-directed services.
227.1    Subd. 12. Enrollment and evaluation. Enrollment in the self-directed supports
227.2option is available to current personal care assistance recipients upon annual personal
227.3care assistance reassessment, with a maximum enrollment of 1,000 2,000 people in the
227.4first fiscal year of implementation and an additional 1,000 3,000 people in the second
227.5fiscal year. The commissioner shall evaluate the self-directed supports option during the
227.6first two years of implementation and make any necessary changes prior to the option
227.7becoming available statewide.
227.8EFFECTIVE DATE.This section is effective July 1, 2012.

227.9    Sec. 11. Minnesota Statutes 2010, section 256B.0659, subdivision 11, is amended to
227.10read:
227.11    Subd. 11. Personal care assistant; requirements. (a) A personal care assistant
227.12must meet the following requirements:
227.13    (1) be at least 18 years of age with the exception of persons who are 16 or 17 years
227.14of age with these additional requirements:
227.15    (i) supervision by a qualified professional every 60 days; and
227.16    (ii) employment by only one personal care assistance provider agency responsible
227.17for compliance with current labor laws;
227.18    (2) be employed by a personal care assistance provider agency;
227.19    (3) enroll with the department as a personal care assistant after clearing a background
227.20study. Except as provided in subdivision 11a, before a personal care assistant provides
227.21services, the personal care assistance provider agency must initiate a background study on
227.22the personal care assistant under chapter 245C, and the personal care assistance provider
227.23agency must have received a notice from the commissioner that the personal care assistant
227.24is:
227.25    (i) not disqualified under section 245C.14; or
227.26    (ii) is disqualified, but the personal care assistant has received a set aside of the
227.27disqualification under section 245C.22;
227.28    (4) be able to effectively communicate with the recipient and personal care
227.29assistance provider agency;
227.30    (5) be able to provide covered personal care assistance services according to the
227.31recipient's personal care assistance care plan, respond appropriately to recipient needs,
227.32and report changes in the recipient's condition to the supervising qualified professional
227.33or physician;
227.34    (6) not be a consumer of personal care assistance services;
228.1    (7) maintain daily written records including, but not limited to, time sheets under
228.2subdivision 12;
228.3    (8) effective January 1, 2010, complete standardized training as determined
228.4by the commissioner before completing enrollment. The training must be available
228.5in languages other than English and to those who need accommodations due to
228.6disabilities. Personal care assistant training must include successful completion of the
228.7following training components: basic first aid, vulnerable adult, child maltreatment,
228.8OSHA universal precautions, basic roles and responsibilities of personal care assistants
228.9including information about assistance with lifting and transfers for recipients, emergency
228.10preparedness, orientation to positive behavioral practices, fraud issues, and completion of
228.11time sheets. Upon completion of the training components, the personal care assistant must
228.12demonstrate the competency to provide assistance to recipients;
228.13    (9) complete training and orientation on the needs of the recipient within the first
228.14seven days after the services begin; and
228.15    (10) be limited to providing and being paid for up to 275 hours per month, except
228.16that this limit shall be 275 hours per month for the period July 1, 2009, through June 30,
228.172011, of personal care assistance services regardless of the number of recipients being
228.18served or the number of personal care assistance provider agencies enrolled with. The
228.19number of hours worked per day shall not be disallowed by the department unless in
228.20violation of the law.
228.21    (b) A legal guardian may be a personal care assistant if the guardian is not being paid
228.22for the guardian services and meets the criteria for personal care assistants in paragraph (a).
228.23    (c) Effective January 1, 2010, persons who do not qualify as a personal care assistant
228.24include parents and stepparents of minors, spouses, paid legal guardians, family foster
228.25care providers, except as otherwise allowed in section 256B.0625, subdivision 19a, or
228.26staff of a residential setting. When the personal care assistant is a relative of the recipient,
228.27the commissioner shall pay 80 percent of the provider rate. For purposes of this section,
228.28relative means the parent or adoptive parent of an adult child, a sibling aged 16 years or
228.29older, an adult child, a grandparent, or a grandchild.

228.30    Sec. 12. Minnesota Statutes 2010, section 256B.0659, subdivision 28, is amended to
228.31read:
228.32    Subd. 28. Personal care assistance provider agency; required documentation.
228.33(a) Required documentation must be completed and kept in the personal care assistance
228.34provider agency file or the recipient's home residence. The required documentation
228.35consists of:
229.1(1) employee files, including:
229.2(i) applications for employment;
229.3(ii) background study requests and results;
229.4(iii) orientation records about the agency policies;
229.5(iv) trainings completed with demonstration of competence;
229.6(v) supervisory visits;
229.7(vi) evaluations of employment; and
229.8(vii) signature on fraud statement;
229.9(2) recipient files, including:
229.10(i) demographics;
229.11(ii) emergency contact information and emergency backup plan;
229.12(iii) personal care assistance service plan;
229.13(iv) personal care assistance care plan;
229.14(v) month-to-month service use plan;
229.15(vi) all communication records;
229.16(vii) start of service information, including the written agreement with recipient; and
229.17(viii) date the home care bill of rights was given to the recipient;
229.18(3) agency policy manual, including:
229.19(i) policies for employment and termination;
229.20(ii) grievance policies with resolution of consumer grievances;
229.21(iii) staff and consumer safety;
229.22(iv) staff misconduct; and
229.23(v) staff hiring, service delivery, staff and consumer safety, staff misconduct, and
229.24resolution of consumer grievances;
229.25(4) time sheets for each personal care assistant along with completed activity sheets
229.26for each recipient served; and
229.27(5) agency marketing and advertising materials and documentation of marketing
229.28activities and costs; and
229.29(6) for each personal care assistant, whether or not the personal care assistant is
229.30providing care to a relative as defined in subdivision 11.
229.31(b) The commissioner may assess a fine of up to $500 on provider agencies that do
229.32not consistently comply with the requirements of this subdivision.

229.33    Sec. 13. Minnesota Statutes 2010, section 256B.0911, subdivision 1a, is amended to
229.34read:
229.35    Subd. 1a. Definitions. For purposes of this section, the following definitions apply:
230.1    (a) "Long-term care consultation services" means:
230.2    (1) assistance in identifying services needed to maintain an individual in the most
230.3inclusive environment;
230.4    (2) providing recommendations on cost-effective community services that are
230.5available to the individual;
230.6    (3) development of an individual's person-centered community support plan;
230.7    (4) providing information regarding eligibility for Minnesota health care programs;
230.8    (5) face-to-face long-term care consultation assessments, which may be completed
230.9in a hospital, nursing facility, intermediate care facility for persons with developmental
230.10disabilities (ICF/DDs), regional treatment centers, or the person's current or planned
230.11residence;
230.12    (6) federally mandated screening to determine the need for an institutional level of
230.13care under subdivision 4a;
230.14    (7) determination of home and community-based waiver service eligibility
230.15including level of care determination for individuals who need an institutional level of
230.16care as defined under section 144.0724, subdivision 11, or 256B.092, service eligibility
230.17including state plan home care services identified in sections 256B.0625, subdivisions
230.186 , 7, and 19, paragraphs (a) and (c), and 256B.0657, based on assessment and support
230.19plan development with appropriate referrals, including the option for consumer-directed
230.20community self-directed supports;
230.21    (8) providing recommendations for nursing facility placement when there are no
230.22cost-effective community services available; and
230.23    (9) assistance to transition people back to community settings after facility
230.24admission; and
230.25(10) providing notice to the individual or legal representative of the annual and
230.26monthly average authorized amount for traditional agency services and self-directed
230.27services under section 256B.0657 for which the recipient is found eligible.
230.28    (b) "Long-term care options counseling" means the services provided by the linkage
230.29lines as mandated by sections 256.01 and 256.975, subdivision 7, and also includes
230.30telephone assistance and follow up once a long-term care consultation assessment has
230.31been completed.
230.32    (c) "Minnesota health care programs" means the medical assistance program under
230.33chapter 256B and the alternative care program under section 256B.0913.
230.34    (d) "Lead agencies" means counties or a collaboration of counties, tribes, and health
230.35plans administering long-term care consultation assessment and support planning services.
230.36EFFECTIVE DATE.This section is effective January 1, 2012.

231.1    Sec. 14. Minnesota Statutes 2010, section 256B.0911, subdivision 3a, is amended to
231.2read:
231.3    Subd. 3a. Assessment and support planning. (a) Persons requesting assessment,
231.4services planning, or other assistance intended to support community-based living,
231.5including persons who need assessment in order to determine waiver or alternative
231.6care program eligibility, must be visited by a long-term care consultation team within
231.715 calendar 20 calendar days after the date on which an assessment was requested or
231.8recommended. After January 1, 2011, these requirements also apply to personal care
231.9assistance services, private duty nursing, and home health agency services, on timelines
231.10established in subdivision 5. Face-to-face assessments must be conducted according
231.11to paragraphs (b) to (i).
231.12    (b) The county may utilize a team of either the social worker or public health nurse,
231.13or both. After January 1, 2011, lead agencies shall use certified assessors to conduct the
231.14assessment in a face-to-face interview. The consultation team members must confer
231.15regarding the most appropriate care for each individual screened or assessed.
231.16    (c) The assessment must be comprehensive and include a person-centered
231.17assessment of the health, psychological, functional, environmental, and social needs of
231.18referred individuals and provide information necessary to develop a support plan that
231.19meets the consumers needs, using an assessment form provided by the commissioner.
231.20    (d) The assessment must be conducted in a face-to-face interview with the person
231.21being assessed and the person's legal representative, as required by legally executed
231.22documents, and other individuals as requested by the person, who can provide information
231.23on the needs, strengths, and preferences of the person necessary to develop a support plan
231.24that ensures the person's health and safety, but who is not a provider of service or has any
231.25financial interest in the provision of services.
231.26    (e) The person, or the person's legal representative, must be provided with
231.27written recommendations for community-based services, including consumer-directed
231.28self-directed options, or institutional care that include documentation that the most
231.29cost-effective alternatives available were offered to the individual. For purposes of
231.30this requirement, "cost-effective alternatives" means community services and living
231.31arrangements that cost the same as or less than institutional care. For persons determined
231.32eligible for services defined under subdivision 1a, paragraph (a), clauses (7) to (9), the
231.33community support plan must also include the estimated annual and monthly average
231.34authorized budget amount for those services.
231.35    (f) If the person chooses to use community-based services, the person or the person's
231.36legal representative must be provided with a written community support plan, regardless
232.1of whether the individual is eligible for Minnesota health care programs. The written
232.2community support plan must include:
232.3    (1) a summary of assessed needs as defined in paragraphs (c) and (d);
232.4    (2) the individual's options and choices to meet identified needs, including all
232.5available options for case management services and providers;
232.6    (3) identification of health and safety risks and how those risks will be addressed,
232.7including personal risk management strategies;
232.8    (4) referral information; and
232.9    (5) informal caregiver supports, if applicable.
232.10    For persons determined eligible for services defined under subdivision 1a, paragraph
232.11(a), clauses (7) to (10), the community support plan must also include:
232.12    (6) identification of individual goals;
232.13    (7) identification of short-term and long-term service outcomes. Short-term service
232.14outcomes are defined as achievable within six months;
232.15    (8) a recommended schedule for case management visits. When achievement of
232.16short-term service outcomes may affect the amount of service required, the schedule must
232.17be at least every six months and must reflect evaluation and progress toward identified
232.18short-term service outcomes; and
232.19    (9) the estimated annual and monthly budget amount for services.
232.20    In addition, for persons determined eligible for state plan home care under
232.21subdivision 1a, paragraph (a), clause (8), the person or person's representative must also
232.22receive a copy of the home care service plan developed by a certified assessor.
232.23A person may request assistance in identifying community supports without
232.24participating in a complete assessment. Upon a request for assistance identifying
232.25community support, the person must be transferred or referred to the services available
232.26under sections 256.975, subdivision 7, and 256.01, subdivision 24, for telephone
232.27assistance and follow up.
232.28    (g) The person has the right to make the final decision between institutional
232.29placement and community placement after the recommendations have been provided,
232.30except as provided in subdivision 4a, paragraph (c).
232.31    (h) The team must give the person receiving assessment or support planning, or
232.32the person's legal representative, materials, and forms supplied by the commissioner
232.33containing the following information:
232.34    (1) the need for and purpose of preadmission screening if the person selects nursing
232.35facility placement;
233.1    (2) the role of the long-term care consultation assessment and support planning in
233.2waiver and alternative care program eligibility determination;
233.3    (3) information about Minnesota health care programs;
233.4    (4) the person's freedom to accept or reject the recommendations of the team;
233.5    (5) the person's right to confidentiality under the Minnesota Government Data
233.6Practices Act, chapter 13;
233.7    (6) the long-term care consultant's decision regarding the person's need for
233.8institutional level of care as determined under criteria established in section 144.0724,
233.9subdivision 11 , or 256B.092; and
233.10(7) the person's right to appeal the decision regarding the need for nursing facility
233.11level of care or the county's final decisions regarding public programs eligibility according
233.12to section 256.045, subdivision 3.
233.13    (i) Face-to-face assessment completed as part of eligibility determination for
233.14the alternative care, elderly waiver, community alternatives for disabled individuals,
233.15community alternative care, and traumatic brain injury waiver programs under sections
233.16256B.0915 , 256B.0917, and 256B.49 is valid to establish service eligibility for no more
233.17than 60 calendar days after the date of assessment. The effective eligibility start date
233.18for these programs can never be prior to the date of assessment. If an assessment was
233.19completed more than 60 days before the effective waiver or alternative care program
233.20eligibility start date, assessment and support plan information must be updated in a
233.21face-to-face visit and documented in the department's Medicaid Management Information
233.22System (MMIS). The updated assessment may be completed by face-to-face visit, written
233.23communication, or telephone as determined by the commissioner to establish statewide
233.24consistency. The effective date of program eligibility in this case cannot be prior to the
233.25date the updated assessment is completed.
233.26EFFECTIVE DATE.This section is effective January 1, 2012.

233.27    Sec. 15. Minnesota Statutes 2010, section 256B.0911, subdivision 4a, is amended to
233.28read:
233.29    Subd. 4a. Preadmission screening activities related to nursing facility
233.30admissions. (a) All applicants to Medicaid certified nursing facilities, including certified
233.31boarding care facilities, must be screened prior to admission regardless of income, assets,
233.32or funding sources for nursing facility care, except as described in subdivision 4b. The
233.33purpose of the screening is to determine the need for nursing facility level of care as
233.34described in paragraph (d) and to complete activities required under federal law related to
233.35mental illness and developmental disability as outlined in paragraph (b).
234.1(b) A person who has a diagnosis or possible diagnosis of mental illness or
234.2developmental disability must receive a preadmission screening before admission
234.3regardless of the exemptions outlined in subdivision 4b, paragraph (b), to identify the need
234.4for further evaluation and specialized services, unless the admission prior to screening is
234.5authorized by the local mental health authority or the local developmental disabilities case
234.6manager, or unless authorized by the county agency according to Public Law 101-508.
234.7The following criteria apply to the preadmission screening:
234.8(1) the county must use forms and criteria developed by the commissioner to identify
234.9persons who require referral for further evaluation and determination of the need for
234.10specialized services; and
234.11(2) the evaluation and determination of the need for specialized services must be
234.12done by:
234.13(i) a qualified independent mental health professional, for persons with a primary or
234.14secondary diagnosis of a serious mental illness; or
234.15(ii) a qualified developmental disability professional, for persons with a primary or
234.16secondary diagnosis of developmental disability. For purposes of this requirement, a
234.17qualified developmental disability professional must meet the standards for a qualified
234.18developmental disability professional under Code of Federal Regulations, title 42, section
234.19483.430.
234.20(c) The local county mental health authority or the state developmental disability
234.21authority under Public Law Numbers 100-203 and 101-508 may prohibit admission to a
234.22nursing facility if the individual does not meet the nursing facility level of care criteria or
234.23needs specialized services as defined in Public Law Numbers 100-203 and 101-508. For
234.24purposes of this section, "specialized services" for a person with developmental disability
234.25means active treatment as that term is defined under Code of Federal Regulations, title
234.2642, section 483.440 (a)(1).
234.27(d) The determination of the need for nursing facility level of care must be made
234.28according to criteria established developed by the commissioner, and in section 144.0724,
234.29subdivision 11 , and 256B.092, using forms developed by the commissioner. Effective no
234.30sooner than on or after January 1, 2014, for individuals age 21 and older, and on or after
234.31October 1, 2019, for individuals under age 21, the determination of need for nursing
234.32facility level of care shall be based on criteria in section 144.0724, subdivision 11. In
234.33assessing a person's needs, consultation team members shall have a physician available for
234.34consultation and shall consider the assessment of the individual's attending physician, if
234.35any. The individual's physician must be included if the physician chooses to participate.
234.36Other personnel may be included on the team as deemed appropriate by the county.

235.1    Sec. 16. Minnesota Statutes 2010, section 256B.0911, subdivision 6, is amended to
235.2read:
235.3    Subd. 6. Payment for long-term care consultation services. (a) Seventy-five
235.4percent of the total payment for each county must be paid monthly by certified nursing
235.5facilities in the county. The monthly amount to be paid by each nursing facility for each
235.6fiscal year must be determined by dividing the county's annual allocation for long-term
235.7care consultation services by 12 to determine the monthly payment and allocating the
235.8monthly payment to each nursing facility based on the number of licensed beds in the
235.9nursing facility. Payments to counties in which there is no certified nursing facility must be
235.10made by increasing the payment rate of the two facilities located nearest to the county seat.
235.11    (b) The commissioner shall include the total annual payment determined under
235.12paragraph (a) for each nursing facility reimbursed under section 256B.431 or 256B.434
235.13according to section 256B.431, subdivision 2b, paragraph (g).
235.14    (c) In the event of the layaway, delicensure and decertification, or removal from
235.15layaway of 25 percent or more of the beds in a facility, the commissioner may adjust
235.16the per diem payment amount in paragraph (b) and may adjust the monthly payment
235.17amount in paragraph (a). The effective date of an adjustment made under this paragraph
235.18shall be on or after the first day of the month following the effective date of the layaway,
235.19delicensure and decertification, or removal from layaway.
235.20    (d) Payments for long-term care consultation services are available to the county
235.21or counties to cover staff salaries and expenses to provide the services described in
235.22subdivision 1a. The county shall employ, or contract with other agencies to employ, within
235.23the limits of available funding, sufficient personnel to provide long-term care consultation
235.24services while meeting the state's long-term care outcomes and objectives as defined in
235.25section 256B.0917, subdivision 1. The county shall be accountable for meeting local
235.26objectives as approved by the commissioner in the biennial home and community-based
235.27services quality assurance plan on a form provided by the commissioner.
235.28    (e) Notwithstanding section 256B.0641, overpayments attributable to payment of the
235.29screening costs under the medical assistance program may not be recovered from a facility.
235.30    (f) The commissioner of human services shall amend the Minnesota medical
235.31assistance plan to include reimbursement for the local consultation teams.
235.32    (g) The county may bill, as case management services, assessments, support
235.33planning, and follow-along provided to persons determined to be eligible for case
235.34management under Minnesota health care programs. No individual or family member
235.35shall be charged for an initial assessment or initial support plan development provided
235.36under subdivision 3a or 3b. Counties may set a fee schedule for initial assessments and
236.1support plan development for individuals who are not financially eligible for medical
236.2assistance or MinnesotaCare. The maximum fee must not be greater than the actual cost
236.3of the initial assessment and support plan development.
236.4(h) The commissioner shall develop an alternative payment methodology for
236.5long-term care consultation services that includes the funding available under this
236.6subdivision, and sections 256B.092 and 256B.0659. In developing the new payment
236.7methodology, the commissioner shall consider the maximization of federal funding for
236.8this activity.

236.9    Sec. 17. Minnesota Statutes 2010, section 256B.0913, subdivision 4, is amended to
236.10read:
236.11    Subd. 4. Eligibility for funding for services for nonmedical assistance recipients.
236.12    (a) Funding for services under the alternative care program is available to persons who
236.13meet the following criteria:
236.14    (1) the person has been determined by a community assessment under section
236.15256B.0911 to be a person who would require the level of care provided in a nursing
236.16facility, as determined under section 256B.0911, subdivision 4a, paragraph (d), but for
236.17the provision of services under the alternative care program. Effective January 1, 2011,
236.18this determination must be made according to the criteria established in section 144.0724,
236.19subdivision 11 ;
236.20    (2) the person is age 65 or older;
236.21    (3) the person would be eligible for medical assistance within 135 days of admission
236.22to a nursing facility;
236.23    (4) the person is not ineligible for the payment of long-term care services by the
236.24medical assistance program due to an asset transfer penalty under section 256B.0595 or
236.25equity interest in the home exceeding $500,000 as stated in section 256B.056;
236.26    (5) the person needs long-term care services that are not funded through other
236.27state or federal funding, or other health insurance or other third-party insurance such as
236.28long-term care insurance;
236.29    (6) except for individuals described in clause (7), the monthly cost of the alternative
236.30care services funded by the program for this person does not exceed 75 percent of the
236.31monthly limit described under section 256B.0915, subdivision 3a. This monthly limit
236.32does not prohibit the alternative care client from payment for additional services, but in no
236.33case may the cost of additional services purchased under this section exceed the difference
236.34between the client's monthly service limit defined under section 256B.0915, subdivision
236.353 , and the alternative care program monthly service limit defined in this paragraph. If
237.1care-related supplies and equipment or environmental modifications and adaptations are or
237.2will be purchased for an alternative care services recipient, the costs may be prorated on a
237.3monthly basis for up to 12 consecutive months beginning with the month of purchase.
237.4If the monthly cost of a recipient's other alternative care services exceeds the monthly
237.5limit established in this paragraph, the annual cost of the alternative care services shall be
237.6determined. In this event, the annual cost of alternative care services shall not exceed 12
237.7times the monthly limit described in this paragraph;
237.8    (7) for individuals assigned a case mix classification A as described under section
237.9256B.0915, subdivision 3a , paragraph (a), with (i) no dependencies in activities of daily
237.10living, or (ii) only one dependency up to two dependencies in bathing, dressing, grooming,
237.11or walking, or (iii) a dependency score of less than three if eating is the only dependency
237.12and eating when the dependency score in eating is three or greater as determined by
237.13an assessment performed under section 256B.0911, the monthly cost of alternative
237.14care services funded by the program cannot exceed $600 $593 per month for all new
237.15participants enrolled in the program on or after July 1, 2009 2011. This monthly limit
237.16shall be applied to all other participants who meet this criteria at reassessment. This
237.17monthly limit shall be increased annually as described in section 256B.0915, subdivision
237.183a , paragraph (a). This monthly limit does not prohibit the alternative care client from
237.19payment for additional services, but in no case may the cost of additional services
237.20purchased exceed the difference between the client's monthly service limit defined in this
237.21clause and the limit described in clause (6) for case mix classification A; and
237.22(8) the person is making timely payments of the assessed monthly fee.
237.23A person is ineligible if payment of the fee is over 60 days past due, unless the person
237.24agrees to:
237.25    (i) the appointment of a representative payee;
237.26    (ii) automatic payment from a financial account;
237.27    (iii) the establishment of greater family involvement in the financial management of
237.28payments; or
237.29    (iv) another method acceptable to the lead agency to ensure prompt fee payments.
237.30    The lead agency may extend the client's eligibility as necessary while making
237.31arrangements to facilitate payment of past-due amounts and future premium payments.
237.32Following disenrollment due to nonpayment of a monthly fee, eligibility shall not be
237.33reinstated for a period of 30 days.
237.34    (b) Alternative care funding under this subdivision is not available for a person
237.35who is a medical assistance recipient or who would be eligible for medical assistance
237.36without a spenddown or waiver obligation. A person whose initial application for medical
238.1assistance and the elderly waiver program is being processed may be served under the
238.2alternative care program for a period up to 60 days. If the individual is found to be eligible
238.3for medical assistance, medical assistance must be billed for services payable under the
238.4federally approved elderly waiver plan and delivered from the date the individual was
238.5found eligible for the federally approved elderly waiver plan. Notwithstanding this
238.6provision, alternative care funds may not be used to pay for any service the cost of which:
238.7(i) is payable by medical assistance; (ii) is used by a recipient to meet a waiver obligation;
238.8or (iii) is used to pay a medical assistance income spenddown for a person who is eligible
238.9to participate in the federally approved elderly waiver program under the special income
238.10standard provision.
238.11    (c) Alternative care funding is not available for a person who resides in a licensed
238.12nursing home, certified boarding care home, hospital, or intermediate care facility, except
238.13for case management services which are provided in support of the discharge planning
238.14process for a nursing home resident or certified boarding care home resident to assist with
238.15a relocation process to a community-based setting.
238.16    (d) Alternative care funding is not available for a person whose income is greater
238.17than the maintenance needs allowance under section 256B.0915, subdivision 1d, but equal
238.18to or less than 120 percent of the federal poverty guideline effective July 1 in the fiscal
238.19year for which alternative care eligibility is determined, who would be eligible for the
238.20elderly waiver with a waiver obligation.

238.21    Sec. 18. Minnesota Statutes 2010, section 256B.0915, subdivision 3a, is amended to
238.22read:
238.23    Subd. 3a. Elderly waiver cost limits. (a) The monthly limit for the cost of
238.24waivered services to an individual elderly waiver client except for individuals described
238.25in paragraph (b) shall be the weighted average monthly nursing facility rate of the case
238.26mix resident class to which the elderly waiver client would be assigned under Minnesota
238.27Rules, parts 9549.0050 to 9549.0059, less the recipient's maintenance needs allowance
238.28as described in subdivision 1d, paragraph (a), until the first day of the state fiscal year in
238.29which the resident assessment system as described in section 256B.438 for nursing home
238.30rate determination is implemented. Effective on the first day of the state fiscal year in
238.31which the resident assessment system as described in section 256B.438 for nursing home
238.32rate determination is implemented and the first day of each subsequent state fiscal year, the
238.33monthly limit for the cost of waivered services to an individual elderly waiver client shall
238.34be the rate of the case mix resident class to which the waiver client would be assigned
238.35under Minnesota Rules, parts 9549.0050 to 9549.0059, in effect on the last day of the
239.1previous state fiscal year, adjusted by the greater of any legislatively adopted home and
239.2community-based services percentage rate increase or the average statewide percentage
239.3increase in nursing facility payment rates adjustment.
239.4    (b) The monthly limit for the cost of waivered services to an individual elderly
239.5waiver client assigned to a case mix classification A under paragraph (a) with:
239.6(1) no dependencies in activities of daily living,; or
239.7(2) only one dependency up to two dependencies in bathing, dressing, grooming, or
239.8walking, or (3) a dependency score of less than three if eating is the only dependency,
239.9and eating when the dependency score in eating is three or greater as determined by an
239.10assessment performed under section 256B.0911
239.11 shall be the lower of the case mix classification amount for case mix A as determined
239.12under paragraph (a) or the case mix classification amount for case mix A $1,750 per
239.13month effective on October July 1, 2008 2011, per month for all new participants enrolled
239.14in the program on or after July 1, 2009 2011. This monthly limit shall be applied to all
239.15other participants who meet this criteria at reassessment. This monthly limit shall be
239.16increased annually as described in paragraph (a).
239.17(c) If extended medical supplies and equipment or environmental modifications are
239.18or will be purchased for an elderly waiver client, the costs may be prorated for up to
239.1912 consecutive months beginning with the month of purchase. If the monthly cost of a
239.20recipient's waivered services exceeds the monthly limit established in paragraph (a) or
239.21(b), the annual cost of all waivered services shall be determined. In this event, the annual
239.22cost of all waivered services shall not exceed 12 times the monthly limit of waivered
239.23services as described in paragraph (a) or (b).

239.24    Sec. 19. Minnesota Statutes 2010, section 256B.0915, subdivision 3b, is amended to
239.25read:
239.26    Subd. 3b. Cost limits for elderly waiver applicants who reside in a nursing
239.27facility. (a) For a person who is a nursing facility resident at the time of requesting a
239.28determination of eligibility for elderly waivered services, a monthly conversion budget
239.29limit for the cost of elderly waivered services may be requested. The monthly conversion
239.30budget limit for the cost of elderly waiver services shall be the resident class assigned
239.31under Minnesota Rules, parts 9549.0050 to 9549.0059, for that resident in the nursing
239.32facility where the resident currently resides until July 1 of the state fiscal year in which
239.33the resident assessment system as described in section 256B.438 for nursing home rate
239.34determination is implemented. Effective on July 1 of the state fiscal year in which the
239.35resident assessment system as described in section 256B.438 for nursing home rate
240.1determination is implemented, the monthly conversion budget limit for the cost of elderly
240.2waiver services shall be based on the per diem nursing facility rate as determined by the
240.3resident assessment system as described in section 256B.438 for that resident residents
240.4in the nursing facility where the resident elderly waiver applicant currently resides
240.5multiplied. The monthly conversion budget limit shall be calculated by multiplying the
240.6per diem by 365 and, divided by 12, less and reduced by the recipient's maintenance needs
240.7allowance as described in subdivision 1d. The initially approved monthly conversion rate
240.8may budget limit shall be adjusted by the greater of any subsequent legislatively adopted
240.9home and community-based services percentage rate increase or the average statewide
240.10percentage increase in nursing facility payment rates annually as described in subdivision
240.113a, paragraph (a). The limit under this subdivision only applies to persons discharged from
240.12a nursing facility after a minimum 30-day stay and found eligible for waivered services
240.13on or after July 1, 1997. For conversions from the nursing home to the elderly waiver
240.14with consumer directed community support services, the conversion rate limit is equal to
240.15the nursing facility rate per diem used to calculate the monthly conversion budget limit
240.16must be reduced by a percentage equal to the percentage difference between the consumer
240.17directed services budget limit that would be assigned according to the federally approved
240.18waiver plan and the corresponding community case mix cap, but not to exceed 50 percent.
240.19    (b) The following costs must be included in determining the total monthly costs
240.20for the waiver client:
240.21    (1) cost of all waivered services, including extended medical specialized supplies
240.22and equipment and environmental modifications and accessibility adaptations; and
240.23    (2) cost of skilled nursing, home health aide, and personal care services reimbursable
240.24by medical assistance.

240.25    Sec. 20. Minnesota Statutes 2010, section 256B.0915, subdivision 3e, is amended to
240.26read:
240.27    Subd. 3e. Customized living service rate. (a) Payment for customized living
240.28services shall be a monthly rate authorized by the lead agency within the parameters
240.29established by the commissioner. The payment agreement must delineate the amount of
240.30each component service included in the recipient's customized living service plan. The
240.31lead agency shall ensure that there is a documented need within the parameters established
240.32by the commissioner for all component customized living services authorized.
240.33(b) The payment rate must be based on the amount of component services to be
240.34provided utilizing component rates established by the commissioner. Counties and tribes
241.1shall use tools issued by the commissioner to develop and document customized living
241.2service plans and rates.
241.3(c) Component service rates must not exceed payment rates for comparable elderly
241.4waiver or medical assistance services and must reflect economies of scale. Customized
241.5living services must not include rent or raw food costs.
241.6    (d) With the exception of individuals described in subdivision 3a, paragraph (b), the
241.7individualized monthly authorized payment for the customized living service plan shall
241.8not exceed 50 percent of the greater of either the statewide or any of the geographic
241.9groups' weighted average monthly nursing facility rate of the case mix resident class
241.10to which the elderly waiver eligible client would be assigned under Minnesota Rules,
241.11parts 9549.0050 to 9549.0059, less the maintenance needs allowance as described
241.12in subdivision 1d, paragraph (a), until the July 1 of the state fiscal year in which the
241.13resident assessment system as described in section 256B.438 for nursing home rate
241.14determination is implemented. Effective on July 1 of the state fiscal year in which
241.15the resident assessment system as described in section 256B.438 for nursing home
241.16rate determination is implemented and July 1 of each subsequent state fiscal year, the
241.17individualized monthly authorized payment for the services described in this clause shall
241.18not exceed the limit which was in effect on June 30 of the previous state fiscal year
241.19updated annually based on legislatively adopted changes to all service rate maximums for
241.20home and community-based service providers.
241.21(e) Effective July 1, 2011, the individualized monthly payment for the customized
241.22living service plan for individuals described in subdivision 3a, paragraph (b), must be the
241.23monthly authorized payment limit for customized living for individuals classified as case
241.24mix A, reduced by 25 percent. This rate limit must be applied to all new participants
241.25enrolled in the program on or after July 1, 2011, who meet the criteria described in
241.26subdivision 3a, paragraph (b). This monthly limit also applies to all other participants who
241.27meet the criteria described in subdivision 3a, paragraph (b), at reassessment.
241.28    (e) (f) Customized living services are delivered by a provider licensed by the
241.29Department of Health as a class A or class F home care provider and provided in a
241.30building that is registered as a housing with services establishment under chapter 144D.
241.31Licensed home care providers are subject to section 256B.0651, subdivision 14.
241.32(g) A provider may not bill or otherwise charge an elderly waiver participant or their
241.33family for additional units of any allowable component service beyond those available
241.34under the service rate limits described in paragraph (d), nor for additional units of any
241.35allowable component service beyond those approved in the service plan by the lead agency.

242.1    Sec. 21. Minnesota Statutes 2010, section 256B.0915, subdivision 3h, is amended to
242.2read:
242.3    Subd. 3h. Service rate limits; 24-hour customized living services. (a) The
242.4payment rate for 24-hour customized living services is a monthly rate authorized by the
242.5lead agency within the parameters established by the commissioner of human services.
242.6The payment agreement must delineate the amount of each component service included in
242.7each recipient's customized living service plan. The lead agency shall ensure that there is a
242.8documented need within the parameters established by the commissioner for all component
242.9customized living services authorized. The lead agency shall not authorize 24-hour
242.10customized living services unless there is a documented need for 24-hour supervision.
242.11(b) For purposes of this section, "24-hour supervision" means that the recipient
242.12requires assistance due to needs related to one or more of the following:
242.13    (1) intermittent assistance with toileting, positioning, or transferring;
242.14    (2) cognitive or behavioral issues;
242.15    (3) a medical condition that requires clinical monitoring; or
242.16    (4) for all new participants enrolled in the program on or after January July 1, 2011,
242.17and all other participants at their first reassessment after January July 1, 2011, dependency
242.18in at least two three of the following activities of daily living as determined by assessment
242.19under section 256B.0911: bathing; dressing; grooming; walking; or eating when the
242.20dependency score in eating is three or greater; and needs medication management and at
242.21least 50 hours of service per month. The lead agency shall ensure that the frequency and
242.22mode of supervision of the recipient and the qualifications of staff providing supervision
242.23are described and meet the needs of the recipient.
242.24(c) The payment rate for 24-hour customized living services must be based on the
242.25amount of component services to be provided utilizing component rates established by the
242.26commissioner. Counties and tribes will use tools issued by the commissioner to develop
242.27and document customized living plans and authorize rates.
242.28(d) Component service rates must not exceed payment rates for comparable elderly
242.29waiver or medical assistance services and must reflect economies of scale.
242.30(e) The individually authorized 24-hour customized living payments, in combination
242.31with the payment for other elderly waiver services, including case management, must not
242.32exceed the recipient's community budget cap specified in subdivision 3a. Customized
242.33living services must not include rent or raw food costs.
242.34(f) The individually authorized 24-hour customized living payment rates shall not
242.35exceed the 95 percentile of statewide monthly authorizations for 24-hour customized
242.36living services in effect and in the Medicaid management information systems on March
243.131, 2009, for each case mix resident class under Minnesota Rules, parts 9549.0050
243.2to 9549.0059, to which elderly waiver service clients are assigned. When there are
243.3fewer than 50 authorizations in effect in the case mix resident class, the commissioner
243.4shall multiply the calculated service payment rate maximum for the A classification by
243.5the standard weight for that classification under Minnesota Rules, parts 9549.0050 to
243.69549.0059, to determine the applicable payment rate maximum. Service payment rate
243.7maximums shall be updated annually based on legislatively adopted changes to all service
243.8rates for home and community-based service providers.
243.9    (g) Notwithstanding the requirements of paragraphs (d) and (f), the commissioner
243.10may establish alternative payment rate systems for 24-hour customized living services in
243.11housing with services establishments which are freestanding buildings with a capacity of
243.1216 or fewer, by applying a single hourly rate for covered component services provided
243.13in either:
243.14    (1) licensed corporate adult foster homes; or
243.15    (2) specialized dementia care units which meet the requirements of section 144D.065
243.16and in which:
243.17    (i) each resident is offered the option of having their own apartment; or
243.18    (ii) the units are licensed as board and lodge establishments with maximum capacity
243.19of eight residents, and which meet the requirements of Minnesota Rules, part 9555.6205,
243.20subparts 1, 2, 3, and 4, item A.
243.21(h) A provider may not bill or otherwise charge an elderly waiver participant or their
243.22family for additional units of any allowable component service beyond those available
243.23under the service rate limits described in paragraph (e), nor for additional units of any
243.24allowable component service beyond those approved in the service plan by the lead agency.

243.25    Sec. 22. Minnesota Statutes 2010, section 256B.0915, subdivision 5, is amended to
243.26read:
243.27    Subd. 5. Assessments and reassessments for waiver clients. (a) Each client
243.28shall receive an initial assessment of strengths, informal supports, and need for services
243.29in accordance with section 256B.0911, subdivisions 3, 3a, and 3b. A reassessment of a
243.30client served under the elderly waiver must be conducted at least every 12 months and
243.31at other times when the case manager determines that there has been significant change
243.32in the client's functioning. This may include instances where the client is discharged
243.33from the hospital. There must be a determination that the client requires nursing facility
243.34level of care as defined in section 144.0724, subdivision 11 256B.0911, subdivision 4a,
244.1paragraph (d), at initial and subsequent assessments to initiate and maintain participation
244.2in the waiver program.
244.3(b) Regardless of other assessments identified in section 144.0724, subdivision
244.44, as appropriate to determine nursing facility level of care for purposes of medical
244.5assistance payment for nursing facility services, only face-to-face assessments conducted
244.6according to section 256B.0911, subdivisions 3a and 3b, that result in a nursing facility
244.7level of care determination will be accepted for purposes of initial and ongoing access to
244.8waiver service payment.

244.9    Sec. 23. Minnesota Statutes 2010, section 256B.0915, subdivision 10, is amended to
244.10read:
244.11    Subd. 10. Waiver payment rates; managed care organizations. The
244.12commissioner shall adjust the elderly waiver capitation payment rates for managed care
244.13organizations paid under section 256B.69, subdivisions 6a and 23, to reflect the maximum
244.14service rate limits for customized living services and 24-hour customized living services
244.15under subdivisions 3e and 3h for the contract period beginning October 1, 2009. Medical
244.16assistance rates paid to customized living providers by managed care organizations under
244.17this section shall not exceed the maximum service rate limits and component rates as
244.18determined by the commissioner under subdivisions 3e and 3h.

244.19    Sec. 24. Minnesota Statutes 2010, section 256B.0916, subdivision 6a, is amended to
244.20read:
244.21    Subd. 6a. Statewide availability of consumer-directed community self-directed
244.22 support services. (a) The commissioner shall submit to the federal Health Care Financing
244.23Administration by August 1, 2001, an amendment to the home and community-based
244.24waiver for persons with developmental disabilities under section 256B.092 and by April 1,
244.252005, for waivers under sections 256B.0915 and 256B.49, to make consumer-directed
244.26community self-directed support services available in every county of the state by January
244.271, 2002.
244.28(b) Until the waiver amendment for self-directed community supports under
244.29section 51 is effective, if a county declines to meet the requirements for provision of
244.30consumer-directed community self-directed supports, the commissioner shall contract
244.31with another county, a group of counties, or a private agency to plan for and administer
244.32consumer-directed community self-directed supports in that county.
244.33(c) The state of Minnesota, county agencies, tribal governments, or administrative
244.34entities under contract to participate in the implementation and administration of the home
245.1and community-based waiver for persons with developmental disabilities, shall not be
245.2liable for damages, injuries, or liabilities sustained through the purchase of support by the
245.3individual, the individual's family, legal representative, or the authorized representative
245.4with funds received through the consumer-directed community self-directed support
245.5service under this section. Liabilities include but are not limited to: workers' compensation
245.6liability, the Federal Insurance Contributions Act (FICA), or the Federal Unemployment
245.7Tax Act (FUTA).
245.8EFFECTIVE DATE.This section is effective July 1, 2011.

245.9    Sec. 25. Minnesota Statutes 2010, section 256B.092, subdivision 1a, is amended to
245.10read:
245.11    Subd. 1a. Case management administration and services. (a) The administrative
245.12functions of case management provided to or arranged for a person include:
245.13(1) review of eligibility for services;
245.14(2) screening;
245.15(3) intake;
245.16(4) diagnosis;
245.17(5) the review and authorization of services based upon an individualized service
245.18plan; and
245.19(6) responding to requests for conciliation conferences and appeals according
245.20to section 256.045 made by the person, the person's legal guardian or conservator, or
245.21the parent if the person is a minor. Case management services must be provided by a
245.22public or private agency that is enrolled as a medical assistance provider determined by
245.23the commissioner to meet all of the requirements in the approved federal waiver plans.
245.24Case management services cannot be provided to a recipient by a private agency that has
245.25any financial interest in the provisions of any other services included in the recipient's
245.26coordinated service and support plan.
245.27(b) Case management service activities provided to or arranged for a person include
245.28services must be provided to each recipient of home and community-based waiver
245.29services and available to those eligible for case management under sections 256B.0621
245.30and 256B.0924, subdivision 4, who choose this service. Case management services for an
245.31eligible person include:
245.32(1) development of the individual coordinated service and support plan;
245.33(2) informing the individual or the individual's legal guardian or conservator, or
245.34parent if the person is a minor, of service options;
245.35(3) consulting with relevant medical experts or service providers;
246.1(4) assisting the person in the identification of potential providers;
246.2(5) assisting the person to access services;
246.3(6) coordination of services, including coordinating with the person's health care
246.4home or health coordinator, if coordination of long-term care or community supports and
246.5health care is not provided by another service provider;
246.6(7) evaluation and monitoring of the services identified in the plan including at least
246.7one face-to-face visit with each person annually by the case manager; and
246.8(8) annual reviews of service plans and services provided providing the lead agency
246.9with recommendations for service authorization based upon the individual's needs
246.10identified in the support plan within ten working days after receiving the community
246.11support plan from the certified assessor under section 256B.0911.
246.12(c) Case management administration and service activities that are provided to the
246.13person with a developmental disability shall be provided directly by county agencies or
246.14under contract a public or private agency that is enrolled as a medical assistance provider
246.15determined by the commissioner to meet all of the requirements in section 256B.0621,
246.16subdivision 5, paragraphs (a) and (b), clauses (1) to (5), and has no financial interest in the
246.17provision of any other services to the person choosing case management service.
246.18(d) Case managers are responsible for the administrative duties and service
246.19provisions listed in paragraphs (a) and (b). Case managers shall collaborate with
246.20consumers, families, legal representatives, and relevant medical experts and service
246.21providers in the development and annual review of the individualized service and
246.22habilitation plans.
246.23(e) The Department of Human Services shall offer ongoing education in case
246.24management to case managers. Case managers shall receive no less than ten hours of case
246.25management education and disability-related training each year.
246.26(f) Persons eligible for home and community-based waiver services may choose a
246.27case management service provider from among the public or private vendors enrolled
246.28according to paragraph (d).
246.29(g) For persons eligible for case management under section 256B.0924, and
246.30Minnesota Rules, parts 9525.0004 to 9525.0036, the county or lead agency shall designate
246.31the case management service provider.
246.32EFFECTIVE DATE.This section is effective January 1, 2013, except subdivision
246.331a, paragraph (b), clause (6), is effective July 1, 2011.

246.34    Sec. 26. Minnesota Statutes 2010, section 256B.092, subdivision 1b, is amended to
246.35read:
247.1    Subd. 1b. Individual Coordinated service and support plan. The individual Each
247.2recipient of case management services and any legal representative shall be provided a
247.3written copy of the coordinated service and support plan must, which:
247.4(1) include is developed within ten working days after the case management service
247.5receives the community support plan from the certified assessor under section 256B.0911;
247.6(2) includes the results of the assessment information on the person's need for
247.7service, including identification of service needs that will be or that are met by the person's
247.8relatives, friends, and others, as well as community services used by the general public;
247.9(3) reasonably assures the health, safety, and welfare of the recipient;
247.10(2) identify (4) identifies the person's preferences for services as stated by the person,
247.11the person's legal guardian or conservator, or the parent if the person is a minor;
247.12(5) provides for an informed choice, as defined in section 256B.77, subdivision 2,
247.13paragraph (o), of service and support providers;
247.14(3) identify (6) identifies long- and short-range goals for the person;
247.15(4) identify (7) identifies specific services and the amount and frequency of the
247.16services to be provided to the person based on assessed needs, preferences, and available
247.17resources. The individual service plan shall also specify other services the person needs
247.18that are not available, and other services the person needs that are not available. The
247.19individual coordinated service and support plan shall also specify service outcomes and
247.20the provider's responsibility to monitor the achievement of the service outcomes;
247.21(5) identify (8) identifies the need for an individual program individual's provider
247.22plan to be developed by the provider according to the respective state and federal licensing
247.23and certification standards, and additional assessments to be completed or arranged by the
247.24provider after service initiation;
247.25(6) identify (9) identifies provider responsibilities to implement and make
247.26recommendations for modification to the individual coordinated service and support plan;
247.27(7) include (10) includes notice of the right to have assessments completed and
247.28service plans developed within specified time periods, the right to appeal action or
247.29inaction, and the right to request a conciliation conference or a hearing an appeal under
247.30section 256.045;
247.31(8) be (11) is agreed upon and signed by the person, the person's legal guardian
247.32or conservator, or the parent if the person is a minor, and the authorized county
247.33representative; and
247.34(9) be (12) is reviewed by a health professional if the person has overriding medical
247.35needs that impact the delivery of services.
248.1Service planning formats developed for interagency planning such as transition,
248.2vocational, and individual family service plans may be substituted for service planning
248.3formats developed by county agencies.
248.4EFFECTIVE DATE.This section is effective January 1, 2013.

248.5    Sec. 27. Minnesota Statutes 2010, section 256B.092, subdivision 1e, is amended to
248.6read:
248.7    Subd. 1e. Case management service monitoring, coordination, and evaluation,
248.8and monitoring of services duties. (a) If the individual coordinated service and support
248.9plan identifies the need for individual program provider plans for authorized services,
248.10the case manager management service provider shall assure that individual program the
248.11individual provider plans are developed by the providers according to clauses (2) to (5).
248.12The providers shall assure that the individual program provider plans:
248.13(1) are developed according to the respective state and federal licensing and
248.14certification requirements;
248.15(2) are designed to achieve the goals of the individual service plan;
248.16(3) are consistent with other aspects of the individual coordinated service and
248.17support plan;
248.18(4) assure the health and safety of the person; and
248.19(5) are developed with consistent and coordinated approaches to services and service
248.20outcomes among the various service providers.
248.21(b) The case manager management service provider shall monitor the provision of
248.22services:
248.23(1) to assure that the individual service plan is being followed according to
248.24paragraph (a);
248.25(2) to identify any changes or modifications that might be needed in the individual
248.26service plan, including changes resulting from recommendations of current service
248.27providers;
248.28(3) to determine if the person's legal rights are protected, and if not, notify the
248.29person's legal guardian or conservator, or the parent if the person is a minor, protection
248.30services, or licensing agencies as appropriate; and
248.31(4) to determine if the person, the person's legal guardian or conservator, or the
248.32parent if the person is a minor, is satisfied with the services provided.
248.33(c) If the provider fails to develop or carry out the individual program provider plan
248.34according to paragraph (a), the case manager shall notify the person's legal guardian or
248.35conservator, or the parent if the person is a minor, the provider, the respective licensing
249.1and certification agencies, and the county board where the services are being provided. In
249.2addition, the case manager shall identify other steps needed to assure the person receives
249.3the services identified in the individual coordinated service and support plan.
249.4EFFECTIVE DATE.This section is effective January 1, 2012.

249.5    Sec. 28. Minnesota Statutes 2010, section 256B.092, subdivision 1g, is amended to
249.6read:
249.7    Subd. 1g. Conditions not requiring development of individual a coordinated
249.8service and support plan. Unless otherwise required by federal law, the county agency is
249.9not required to complete an individual a coordinated service and support plan as defined in
249.10subdivision 1b for:
249.11(1) persons whose families are requesting respite care for their family member who
249.12resides with them, or whose families are requesting a family support grant and are not
249.13requesting purchase or arrangement of habilitative services; and
249.14(2) persons with developmental disabilities, living independently without authorized
249.15services or receiving funding for services at a rehabilitation facility as defined in section
249.16268A.01, subdivision 6 , and not in need of or requesting additional services.
249.17EFFECTIVE DATE.This section is effective January 1, 2012.

249.18    Sec. 29. Minnesota Statutes 2010, section 256B.092, subdivision 3, is amended to read:
249.19    Subd. 3. Authorization and termination of services. County agency case
249.20managers Lead agencies, under rules of the commissioner, shall authorize and terminate
249.21services of community and regional treatment center providers according to individual
249.22coordinated service and support plans. Services provided to persons with developmental
249.23disabilities may only be authorized and terminated by case managers according to (1)
249.24rules of the commissioner and (2) the individual coordinated service and support plan as
249.25defined in subdivision 1b. Medical assistance services not needed shall not be authorized
249.26by county agencies or funded by the commissioner. When purchasing or arranging for
249.27unlicensed respite care services for persons with overriding health needs, the county
249.28agency shall seek the advice of a health care professional in assessing provider staff
249.29training needs and skills necessary to meet the medical needs of the person.
249.30EFFECTIVE DATE.This section is effective January 1, 2012.

249.31    Sec. 30. Minnesota Statutes 2010, section 256B.092, subdivision 8, is amended to read:
250.1    Subd. 8. Screening team Additional certified assessor duties. The screening team
250.2certified assessor shall:
250.3(1) review diagnostic data;
250.4(2) review health, social, and developmental assessment data using a uniform
250.5screening comprehensive assessment tool specified by the commissioner;
250.6(3) identify the level of services appropriate to maintain the person in the most
250.7normal and least restrictive setting that is consistent with the person's treatment needs;
250.8(4) identify other noninstitutional public assistance or social service that may prevent
250.9or delay long-term residential placement;
250.10(5) assess whether a person is in need of long-term residential care;
250.11(6) make recommendations regarding placement services and payment for: (i) social
250.12service or public assistance support, or both, to maintain a person in the person's own home
250.13or other place of residence; (ii) training and habilitation service, vocational rehabilitation,
250.14and employment training activities; (iii) community residential placement services; (iv)
250.15regional treatment center placement; or (v) (iv) a home and community-based service
250.16alternative to community residential placement or regional treatment center placement;
250.17(7) evaluate the availability, location, and quality of the services listed in clause
250.18(6), including the impact of placement alternatives services and supports options on the
250.19person's ability to maintain or improve existing patterns of contact and involvement with
250.20parents and other family members;
250.21(8) identify the cost implications of recommendations in clause (6) and provide
250.22written notice of the annual and monthly average authorized amount to be spent for
250.23services for the recipient;
250.24(9) make recommendations to a court as may be needed to assist the court in making
250.25decisions regarding commitment of persons with developmental disabilities; and
250.26(10) inform the person and the person's legal guardian or conservator, or the parent if
250.27the person is a minor, that appeal may be made to the commissioner pursuant to section
250.28256.045 .
250.29EFFECTIVE DATE.This section is effective January 1, 2012.

250.30    Sec. 31. [256B.0961] STATE QUALITY ASSURANCE, QUALITY
250.31IMPROVEMENT, AND LICENSING SYSTEM.
250.32    Subdivision 1. Scope. (a) In order to improve the quality of services provided to
250.33Minnesotans with disabilities and to meet the requirements of the federally approved
250.34home and community-based waivers under section 1915c of the Social Security Act, a
250.35State Quality Assurance, Quality Improvement, and Licensing System for Minnesotans
251.1receiving disability services is enacted. This system is a partnership between the
251.2Department of Human Services and the State Quality Council established under
251.3subdivision 3.
251.4    (b) This system is a result of the recommendations from the Department of Human
251.5Services' licensing and alternative quality assurance study mandated under Laws 2005,
251.6First Special Session chapter 4, article 7, section 57, and presented to the legislature
251.7in February 2007.
251.8    (c) The disability services eligible under this section include:
251.9    (1) the home and community-based services waiver programs for persons with
251.10developmental disabilities under section 256B.092, subdivision 4, or section 256B.49,
251.11including traumatic brain injuries and services for those who qualify for nursing facility
251.12level of care or hospital facility level of care;
251.13    (2) home care services under section 256B.0651;
251.14    (3) family support grants under section 252.32;
251.15    (4) consumer support grants under section 256.476;
251.16    (5) semi-independent living services under section 252.275; and
251.17    (6) services provided through an intermediate care facility for the developmentally
251.18disabled.
251.19    (d) For purposes of this section, the following definitions apply:
251.20    (1) "commissioner" means the commissioner of human services;
251.21    (2) "council" means the State Quality Council under subdivision 3;
251.22    (3) "Quality Assurance Commission" means the commission under section
251.23256B.0951; and
251.24    (4) "system" means the State Quality Assurance, Quality Improvement and
251.25Licensing System under this section.
251.26    Subd. 2. Duties of the commissioner of human services. (a) The commissioner of
251.27human services shall establish the State Quality Council under subdivision 3.
251.28    (b) The commissioner shall initially delegate authority to perform licensing
251.29functions and activities according to section 245A.16 to a host county in Region 10. The
251.30commissioner must not license or reimburse a participating facility, program, or service
251.31located in Region 10 if the commissioner has received notification from the host county
251.32that the facility, program, or service has failed to qualify for licensure.
251.33    (c) The commissioner may conduct random licensing inspections based on outcomes
251.34adopted under section 256B.0951, subdivision 3, at facilities or programs, and of services
251.35eligible under this section. The role of the random inspections is to verify that the system
252.1protects the safety and well-being of persons served and maintains the availability of
252.2high-quality services for persons with disabilities.
252.3    (d) The commissioner shall ensure that the federal home and community-based
252.4waiver requirements are met and that incidents that may have jeopardized safety and health
252.5or violated services-related assurances, civil and human rights, and other protections
252.6designed to prevent abuse, neglect, and exploitation, are reviewed, investigated, and
252.7acted upon in a timely manner.
252.8    (e) The commissioner shall seek a federal waiver by July 1, 2012 to allow
252.9intermediate care facilities for persons with developmental disabilities to participate in
252.10this system.
252.11    Subd. 3. State Quality Council. (a) There is hereby created a State Quality
252.12Council which must define regional quality councils, and carry out a community-based,
252.13person-directed quality review component, and a comprehensive system for effective
252.14incident reporting, investigation, analysis, and follow-up.
252.15    (b) By August 1, 2011, the commissioner of human services shall appoint the
252.16members of the initial State Quality Council. Members shall include representatives
252.17from the following groups:
252.18    (1) disability service recipients and their family members;
252.19    (2) during the first two years of the State Quality Council, there must be at least three
252.20members from the Region 10 stakeholders. As regional quality councils are formed under
252.21subdivision 4, each regional quality council shall appoint one member;
252.22    (3) disability service providers;
252.23    (4) disability advocacy groups; and
252.24    (5) county human services agencies and staff from the Departments of Human
252.25Services and Health, and Ombudsman for Mental Health and Developmental Disabilities.
252.26    (c) Members of the council who do not receive a salary or wages from an employer
252.27for time spent on council duties may receive a per diem payment when performing council
252.28duties and functions.
252.29    (d) The State Quality Council shall:
252.30    (1) assist the Departments of Human Services and Health in fulfilling federally
252.31mandated obligations by monitoring disability service quality and quality assurance and
252.32improvement practices in Minnesota; and
252.33    (2) establish state quality improvement priorities with methods for achieving results
252.34and provide an annual report to the legislative committees with jurisdiction over policy
252.35and funding of disability services on the outcomes, improvement priorities, and activities
252.36undertaken by the commission during the previous state fiscal year.
253.1    (e) The State Quality Council, in partnership with the commissioner, shall:
253.2    (1) approve and direct implementation of the community-based, person-directed
253.3system established in this section;
253.4    (2) recommend an appropriate method of funding this system, and determine the
253.5feasibility of the use of Medicaid, licensing fees, as well as other possible funding options;
253.6    (3) approve measurable outcomes in the areas of health and safety, consumer
253.7evaluation, education and training, providers, and systems;
253.8    (4) establish variable licensure periods not to exceed three years based on outcomes
253.9achieved; and
253.10    (5) in cooperation with the Quality Assurance Commission, design a transition plan
253.11for licensed providers from Region 10 into the alternative licensing system by July 1, 2013.
253.12    (f) The State Quality Council shall notify the commissioner of human services that a
253.13facility, program, or service has been reviewed by quality assurance team members under
253.14subdivision 4, paragraph (b), clause (13), and qualifies for a license.
253.15    (g) The State Quality Council, in partnership with the commissioner, shall establish
253.16an ongoing review process for the system. The review shall take into account the
253.17comprehensive nature of the system which is designed to evaluate the broad spectrum of
253.18licensed and unlicensed entities that provide services to persons with disabilities. The
253.19review shall address efficiencies and effectiveness of the system.
253.20    (h) The State Quality Council may recommend to the commissioner certain
253.21variances from the standards governing licensure of programs for persons with disabilities
253.22in order to improve the quality of services so long as the recommended variances do
253.23not adversely affect the health or safety of persons being served or compromise the
253.24qualifications of staff to provide services.
253.25    (i) The safety standards, rights, or procedural protections referenced under
253.26subdivision 2, paragraph (c), shall not be varied. The State Quality Council may make
253.27recommendations to the commissioner or to the legislature in the report required under
253.28paragraph (c) regarding alternatives or modifications to the safety standards, rights, or
253.29procedural protections referenced under subdivision 2, paragraph (c).
253.30    (j) The State Quality Council may hire staff to perform the duties assigned in this
253.31subdivision.
253.32    Subd. 4. Regional quality councils. (a) The commissioner shall establish, as
253.33selected by the State Quality Council, regional quality councils of key stakeholders,
253.34including regional representatives of:
253.35    (1) disability service recipients and their family members;
253.36    (2) disability service providers;
254.1    (3) disability advocacy groups; and
254.2    (4) county human services agencies and staff from the Departments of Human
254.3Services, and Health, and Ombudsman for Mental Health and Developmental Disabilities.
254.4    (b) Each regional quality council shall:
254.5    (1) direct and monitor the community-based, person-directed quality assurance
254.6system in this section;
254.7    (2) approve a training program for quality assurance team members under clause
254.8(13);
254.9    (3) review summary reports from quality assurance team reviews and make
254.10recommendations to the State Quality Council regarding program licensure;
254.11    (4) make recommendations to the State Quality Council regarding the system;
254.12    (5) resolve complaints between the quality assurance teams, counties, providers,
254.13persons receiving services, their families, and legal representatives;
254.14    (6) analyze and review quality outcomes and critical incident data reporting
254.15incidents of life safety concerns immediately to the Department of Human Services
254.16licensing division;
254.17    (7) provide information and training programs for persons with disabilities and their
254.18families and legal representatives on service options and quality expectations;
254.19    (8) disseminate information and resources developed to other regional quality
254.20councils;
254.21    (9) respond to state-level priorities;
254.22    (10) establish regional priorities for quality improvement;
254.23    (11) submit an annual report to the State Quality Council on the status, outcomes,
254.24improvement priorities, and activities in the region;
254.25    (12) choose a representative to participate on the State Quality Council and assume
254.26other responsibilities consistent with the priorities of the State Quality Council; and
254.27    (13) recruit, train, and assign duties to members of quality assurance teams, taking
254.28into account the size of the service provider, the number of services to be reviewed,
254.29the skills necessary for the team members to complete the process, and ensure that no
254.30team member has a financial, personal, or family relationship with the facility, program,
254.31or service being reviewed or with anyone served at the facility, program, or service.
254.32Quality assurance teams must be comprised of county staff, persons receiving services
254.33or the person's families, legal representatives, members of advocacy organizations,
254.34providers, and other involved community members. Team members must complete
254.35the training program approved by the regional quality council and must demonstrate
255.1performance-based competency. Team members may be paid a per diem and reimbursed
255.2for expenses related to their participation in the quality assurance process.
255.3    (c) The commissioner shall monitor the safety standards, rights, and procedural
255.4protections for the monitoring of psychotropic medications and those identified under
255.5sections 245.825; 245.91 to 245.97; 245A.09, subdivision 2, paragraph (c), clauses (2)
255.6and (5); 245A.12; 245A.13; 252.41, subdivision 9; 256B.092, subdivision 1b, clause
255.7(7); 626.556; and 626.557.
255.8    (d) The regional quality councils may hire staff to perform the duties assigned in
255.9this subdivision.
255.10    (e) The regional quality councils may charge fees for their services.
255.11    (f) The quality assurance process undertaken by a regional quality council consists of
255.12an evaluation by a quality assurance team of the facility, program, or service. The process
255.13must include an evaluation of a random sample of persons served. The sample must be
255.14representative of each service provided. The sample size must be at least five percent but
255.15not less than two persons served. All persons must be given the opportunity to be included
255.16in the quality assurance process in addition to those chosen for the random sample.
255.17    (g) A facility, program, or service may contest a licensing decision of the regional
255.18quality council as permitted under chapter 245A.
255.19    Subd. 5. Annual survey of service recipients. The commissioner, in consultation
255.20with the State Quality Council, shall conduct an annual independent statewide survey
255.21of service recipients, randomly selected, to determine the effectiveness and quality
255.22of disability services. The survey must be consistent with the system performance
255.23expectations of the Centers for Medicare and Medicaid Services (CMS) Quality
255.24Framework. The survey must analyze whether desired outcomes for persons with different
255.25demographic, diagnostic, health, and functional needs, who are receiving different types
255.26of services in different settings and with different costs, have been achieved. Annual
255.27statewide and regional reports of the results must be published and used to assist regions,
255.28counties, and providers to plan and measure the impact of quality improvement activities.
255.29    Subd. 6. Mandated reporters. Members of the State Quality Council under
255.30subdivision 3, the regional quality councils under subdivision 4, and quality assurance
255.31team members under subdivision 4, paragraph (b), clause (13), are mandated reporters as
255.32defined in sections 626.556, subdivision 3, and 626.5572, subdivision 16.
255.33EFFECTIVE DATE.(a) Subdivisions 1 to 6 are effective July 1, 2011.
255.34    (b) The jurisdictions of the regional quality councils in subdivision 4 must be
255.35defined, with implementation dates, by July 1, 2012. During the biennium beginning July
256.11, 2011, the Quality Assurance Commission shall continue to implement the alternative
256.2licensing system under this section.

256.3    Sec. 32. Minnesota Statutes 2010, section 256B.19, is amended by adding a
256.4subdivision to read:
256.5    Subd. 2d. Obligation of local agency to process medical assistance applications
256.6within established timelines. (a) Except as provided in paragraph (b), when an individual
256.7submits an application for medical assistance and the applicant's eligibility is based on
256.8disability or on being age 65 or older, the county must determine the applicant's eligibility
256.9and mail a notice of its decision to the applicant within:
256.10(1) 60 days from the date of the application for an individual whose eligibility
256.11is based on disability; or
256.12(2) 45 days from the date of the application for an individual whose eligibility is
256.13based on being age 65 or older.
256.14(b) The county must determine eligibility and mail a notice of its decision within the
256.15time frames stated in paragraph (a), except in the following circumstances:
256.16(1) the county cannot make a determination because, despite reasonable efforts by
256.17the county to communicate what is required, the applicant or an examining physician
256.18delays or fails to take a required action; or
256.19(2) there is an administrative or other emergency beyond the county's control. For
256.20purposes of this clause, a staffing shortage does not constitute an emergency beyond
256.21the county's control.
256.22For the events in either clause (1) or (2), the county must document in the applicant's
256.23case record the reason for delaying beyond the established time frames.
256.24(c) The county must not use the time frames established in paragraph (a) as a waiting
256.25period before determining eligibility or as a reason for denying eligibility because it has
256.26not determined eligibility within the established time frames.
256.27(d) Effective July 1, 2011, unless one of the exceptions listed under paragraph (b)
256.28applies, if a county fails to comply with paragraph (a) and the applicant ultimately is
256.29determined to be eligible for medical assistance, the county is responsible for the entire
256.30cost of medical assistance services provided to the applicant by a nursing facility and not
256.31paid for by federal funds, from and including the first date of eligibility through the date
256.32on which the county mails written notice of its decision on the application. The applicable
256.33facility will bill and receive payment directly from the commissioner in customary
256.34fashion, and the commissioner shall deduct any obligation incurred under this paragraph
256.35from the amount due to the local agency under subdivision 1.
257.1(e) This subdivision supersedes subdivision 1, clause (2), if both apply to an
257.2applicant.

257.3    Sec. 33. Minnesota Statutes 2010, section 256B.431, subdivision 2r, is amended to
257.4read:
257.5    Subd. 2r. Payment restrictions on leave days. (a) Effective July 1, 1993, the
257.6commissioner shall limit payment for leave days in a nursing facility to 79 percent of that
257.7nursing facility's total payment rate for the involved resident.
257.8(b) For services rendered on or after July 1, 2003, for facilities reimbursed under this
257.9section or section 256B.434, the commissioner shall limit payment for leave days in a
257.10nursing facility to 60 percent of that nursing facility's total payment rate for the involved
257.11resident.
257.12(c) For services rendered on or after July 1, 2011, for facilities reimbursed under
257.13this chapter, the commissioner shall limit payment for leave days in a nursing facility
257.14to 30 percent of that nursing facility's total payment rate for the involved resident, and
257.15shall allow this payment only when the occupancy of the nursing facility, inclusive of
257.16bed hold days, is equal to or greater than 96 percent, notwithstanding Minnesota Rules,
257.17part 9505.0415.

257.18    Sec. 34. Minnesota Statutes 2010, section 256B.431, is amended by adding a
257.19subdivision to read:
257.20    Subd. 44. Property rate increase for a facility in Bloomington effective
257.21November 1, 2010. Notwithstanding any other law to the contrary, money available for
257.22moratorium projects under section 144A.073, subdivision 11, shall be used, effective
257.23November 1, 2010, to fund an approved moratorium exception project for a nursing
257.24facility in Bloomington licensed for 137 beds as of November 1, 2010, up to a total
257.25property rate adjustment of $19.33.

257.26    Sec. 35. Minnesota Statutes 2010, section 256B.434, subdivision 4, is amended to read:
257.27    Subd. 4. Alternate rates for nursing facilities. (a) For nursing facilities which
257.28have their payment rates determined under this section rather than section 256B.431, the
257.29commissioner shall establish a rate under this subdivision. The nursing facility must enter
257.30into a written contract with the commissioner.
257.31    (b) A nursing facility's case mix payment rate for the first rate year of a facility's
257.32contract under this section is the payment rate the facility would have received under
257.33section 256B.431.
258.1    (c) A nursing facility's case mix payment rates for the second and subsequent years
258.2of a facility's contract under this section are the previous rate year's contract payment
258.3rates plus an inflation adjustment and, for facilities reimbursed under this section or
258.4section 256B.431, an adjustment to include the cost of any increase in Health Department
258.5licensing fees for the facility taking effect on or after July 1, 2001. The index for the
258.6inflation adjustment must be based on the change in the Consumer Price Index-All Items
258.7(United States City average) (CPI-U) forecasted by the commissioner of management and
258.8budget's national economic consultant, as forecasted in the fourth quarter of the calendar
258.9year preceding the rate year. The inflation adjustment must be based on the 12-month
258.10period from the midpoint of the previous rate year to the midpoint of the rate year for
258.11which the rate is being determined. For the rate years beginning on July 1, 1999, July 1,
258.122000, July 1, 2001, July 1, 2002, July 1, 2003, July 1, 2004, July 1, 2005, July 1, 2006,
258.13July 1, 2007, July 1, 2008, October 1, 2009, and October 1, 2010, October 1, 2011, and
258.14October 1, 2012. this paragraph shall apply only to the property-related payment rate,
258.15except that adjustments to include the cost of any increase in Health Department licensing
258.16fees taking effect on or after July 1, 2001, shall be provided. For the rate years beginning
258.17on October 1, 2011, and October 1, 2012, the rate adjustment under this paragraph shall
258.18be suspended. Beginning in 2005, adjustment to the property payment rate under this
258.19section and section 256B.431 shall be effective on October 1. In determining the amount
258.20of the property-related payment rate adjustment under this paragraph, the commissioner
258.21shall determine the proportion of the facility's rates that are property-related based on the
258.22facility's most recent cost report.
258.23    (d) The commissioner shall develop additional incentive-based payments of up to
258.24five percent above a facility's operating payment rate for achieving outcomes specified
258.25in a contract. The commissioner may solicit contract amendments and implement those
258.26which, on a competitive basis, best meet the state's policy objectives. The commissioner
258.27shall limit the amount of any incentive payment and the number of contract amendments
258.28under this paragraph to operate the incentive payments within funds appropriated for this
258.29purpose. The contract amendments may specify various levels of payment for various
258.30levels of performance. Incentive payments to facilities under this paragraph may be in the
258.31form of time-limited rate adjustments or onetime supplemental payments. In establishing
258.32the specified outcomes and related criteria, the commissioner shall consider the following
258.33state policy objectives:
258.34    (1) successful diversion or discharge of residents to the residents' prior home or other
258.35community-based alternatives;
258.36    (2) adoption of new technology to improve quality or efficiency;
259.1    (3) improved quality as measured in the Nursing Home Report Card;
259.2    (4) reduced acute care costs; and
259.3    (5) any additional outcomes proposed by a nursing facility that the commissioner
259.4finds desirable.
259.5    (e) Notwithstanding the threshold in section 256B.431, subdivision 16, facilities that
259.6take action to come into compliance with existing or pending requirements of the life
259.7safety code provisions or federal regulations governing sprinkler systems must receive
259.8reimbursement for the costs associated with compliance if all of the following conditions
259.9are met:
259.10    (1) the expenses associated with compliance occurred on or after January 1, 2005,
259.11and before December 31, 2008;
259.12    (2) the costs were not otherwise reimbursed under subdivision 4f or section
259.13144A.071 or 144A.073; and
259.14    (3) the total allowable costs reported under this paragraph are less than the minimum
259.15threshold established under section 256B.431, subdivision 15, paragraph (e), and
259.16subdivision 16.
259.17The commissioner shall use money appropriated for this purpose to provide to qualifying
259.18nursing facilities a rate adjustment beginning October 1, 2007, and ending September 30,
259.192008. Nursing facilities that have spent money or anticipate the need to spend money
259.20to satisfy the most recent life safety code requirements by (1) installing a sprinkler
259.21system or (2) replacing all or portions of an existing sprinkler system may submit to the
259.22commissioner by June 30, 2007, on a form provided by the commissioner the actual
259.23costs of a completed project or the estimated costs, based on a project bid, of a planned
259.24project. The commissioner shall calculate a rate adjustment equal to the allowable
259.25costs of the project divided by the resident days reported for the report year ending
259.26September 30, 2006. If the costs from all projects exceed the appropriation for this
259.27purpose, the commissioner shall allocate the money appropriated on a pro rata basis
259.28to the qualifying facilities by reducing the rate adjustment determined for each facility
259.29by an equal percentage. Facilities that used estimated costs when requesting the rate
259.30adjustment shall report to the commissioner by January 31, 2009, on the use of this
259.31money on a form provided by the commissioner. If the nursing facility fails to provide
259.32the report, the commissioner shall recoup the money paid to the facility for this purpose.
259.33If the facility reports expenditures allowable under this subdivision that are less than
259.34the amount received in the facility's annualized rate adjustment, the commissioner shall
259.35recoup the difference.

260.1    Sec. 36. Minnesota Statutes 2010, section 256B.437, subdivision 6, is amended to read:
260.2    Subd. 6. Planned closure rate adjustment. (a) The commissioner of human
260.3services shall calculate the amount of the planned closure rate adjustment available under
260.4subdivision 3, paragraph (b), for up to 5,140 beds according to clauses (1) to (4):
260.5(1) the amount available is the net reduction of nursing facility beds multiplied
260.6by $2,080;
260.7(2) the total number of beds in the nursing facility or facilities receiving the planned
260.8closure rate adjustment must be identified;
260.9(3) capacity days are determined by multiplying the number determined under
260.10clause (2) by 365; and
260.11(4) the planned closure rate adjustment is the amount available in clause (1), divided
260.12by capacity days determined under clause (3).
260.13(b) A planned closure rate adjustment under this section is effective on the first day
260.14of the month following completion of closure of the facility designated for closure in the
260.15application and becomes part of the nursing facility's total operating payment rate.
260.16(c) Applicants may use the planned closure rate adjustment to allow for a property
260.17payment for a new nursing facility or an addition to an existing nursing facility or as an
260.18operating payment rate adjustment. Applications approved under this subdivision are
260.19exempt from other requirements for moratorium exceptions under section 144A.073,
260.20subdivisions 2 and 3.
260.21(d) Upon the request of a closing facility, the commissioner must allow the facility a
260.22closure rate adjustment as provided under section 144A.161, subdivision 10.
260.23(e) A facility that has received a planned closure rate adjustment may reassign it
260.24to another facility that is under the same ownership at any time within three years of its
260.25effective date. The amount of the adjustment shall be computed according to paragraph (a).
260.26(f) If the per bed dollar amount specified in paragraph (a), clause (1), is increased,
260.27the commissioner shall recalculate planned closure rate adjustments for facilities that
260.28delicense beds under this section on or after July 1, 2001, to reflect the increase in the per
260.29bed dollar amount. The recalculated planned closure rate adjustment shall be effective
260.30from the date the per bed dollar amount is increased.
260.31(g) For planned closures approved after June 30, 2009, the commissioner of human
260.32services shall calculate the amount of the planned closure rate adjustment available under
260.33subdivision 3, paragraph (b), according to paragraph (a), clauses (1) to (4).
260.34(h) Beginning July 16, 2011, the commissioner shall no longer approve planned
260.35closure rate adjustments under this subdivision.

261.1    Sec. 37. Minnesota Statutes 2010, section 256B.441, is amended by adding a
261.2subdivision to read:
261.3    Subd. 60. Rate increase for low-rate facilities. (a) Effective October 1, 2011,
261.4the commissioner shall adjust the operating payment rates of a nursing facility whose
261.5operating payment rate on September 30, 2011, is greater than the 95th percentile of all
261.6nursing facilities operating payment rates. The commissioner shall:
261.7(1) array all operating payment rates in effect on September 30, 2011, at a case-mix
261.8weight equal to 1.00 (DDF) from lowest to highest;
261.9(2) remove from the array any nursing facility determined by the commissioner to
261.10be providing specialized care, determined in accordance with criteria in subdivision 51a,
261.11paragraph (b), and any facilities receiving a rate increase under paragraph (c), clause (1);
261.12(3) determine the 95th percentile of the array in clause (1);
261.13(4) compute a reduction amount not to exceed three percent, if a facility's amount
261.14in clause (1) is greater than the amount computed in clause (3) by subtracting a facility's
261.15DDF rate in clause (1) from the amount computed in clause (3);
261.16(5) compute the portion of each facility's DDF operating payment rate that is the
261.17direct care per diem based on the rates in effect on September 30, 2011; and
261.18(6) determine the change for all other case-mix levels, by multiplying the amount in
261.19clause (4) by the percentage in clause (5) and by the corresponding case-mix weight for
261.20each care level. Add to this product the non-direct care per diem portion of the amount
261.21in clause (4).
261.22(b) The total amount to be saved by the rate reductions will be computed. The
261.23commissioner shall:
261.24(1) for each facility receiving a rate change in paragraph (a), multiply each case-mix
261.25level's rate change in paragraph (a), clause (6), by the corresponding case-mix resident
261.26days from the most recent cost report that has been desk audited; and
261.27(2) sum all the products computed in clause (1).
261.28(c) The amount of total payment reductions computed in paragraph (b) shall be
261.29distributed to the facilities with the lowest DDF operating payment rates determined in
261.30paragraph (a), clause (1). The commissioner shall:
261.31(1) for nursing facilities located no more than one-quarter mile from a peer group
261.32with higher limits under either subdivision 50 or 51, give an operating rate adjustment.
261.33The operating payment rates of a lower-limit peer group facility must be adjusted to be
261.34equal to those of the nearest facility in a higher-limit peer group if that facility's RUG rate
261.35with a weight of 1.00 is higher than the lower-limit peer group facility. Peer groups are
262.1those defined in subdivision 30. The nearest facility must be determined by the most
262.2direct driving route;
262.3(2) start with the facility or facilities with the lowest DDF operating payment rate
262.4and compute the amount of a rate adjustment needed to make the DDF rate equal to the
262.5DDF of the facility directly below it in the array;
262.6(3) compute the rate increases for the other case-mix levels using the amount
262.7computed in clause (2), and the process stated in paragraph (a), clauses (5) and (6);
262.8(4) compute the total amount the lowest facilities will receive using the process
262.9described in paragraph (b);
262.10(5) compute the running total to be spent at all facilities receiving an increase under
262.11this paragraph by summing each facility's amount computed in clause (4); and
262.12(6) repeat the process in clauses (2) to (5) as long as the amount in clause (5) does
262.13not exceed the amount in paragraph (b), clause (2). In no case shall the DDF operating
262.14payment rate increase determined in clauses (2) to (6) exceed two percent.

262.15    Sec. 38. Minnesota Statutes 2010, section 256B.48, subdivision 1, is amended to read:
262.16    Subdivision 1. Prohibited practices. A nursing facility is not eligible to receive
262.17medical assistance payments unless it refrains from all of the following:
262.18(a) Charging private paying residents rates for similar services which exceed those
262.19which are approved by the state agency for medical assistance recipients as determined by
262.20the prospective desk audit rate, except under the following circumstances:
262.21(1) the nursing facility may:
262.22(1) (i) charge private paying residents a higher rate for a private room,; and
262.23(2) (ii) charge for special services which are not included in the daily rate if medical
262.24assistance residents are charged separately at the same rate for the same services in
262.25addition to the daily rate paid by the commissioner.;
262.26(2) effective July 1, 2011, through September 30, 2012, nursing facilities may charge
262.27private paying residents rates up to two percent higher than the allowable payment rate
262.28determined by the commissioner for the RUGS group currently assigned to the resident;
262.29(3) effective October 1, 2012, through September 30, 2013, nursing facilities
262.30may charge private paying residents rates up to four percent higher than the allowable
262.31payment rate determined by the commissioner for the RUGS group currently assigned
262.32to the resident;
262.33(4) effective October 1, 2013, through September 30, 2014, nursing facilities may
262.34charge private paying residents rates up to six percent higher than the allowable payment
263.1rate determined by the commissioner for the RUGS group currently assigned to the
263.2resident;
263.3(5) effective October 1, 2014, nursing facilities may charge private paying
263.4residents up to eight percent higher than the allowable payment rate determined by the
263.5commissioner for the RUGS group currently assigned to the resident; and
263.6(6) the higher private pay charges allowed in this paragraph shall be limited to actual
263.7costs per resident day, as determined by the commissioner, based on data provided in the
263.8statistical and cost report in section 256B.441.
263.9Nothing in this section precludes a nursing facility from charging a rate allowable
263.10under the facility's single room election option under Minnesota Rules, part 9549.0060,
263.11subpart 11. Services covered by the payment rate must be the same regardless of payment
263.12source. Special services, if offered, must be available to all residents in all areas of the
263.13nursing facility and charged separately at the same rate. Residents are free to select
263.14or decline special services. Special services must not include services which must be
263.15provided by the nursing facility in order to comply with licensure or certification standards
263.16and that if not provided would result in a deficiency or violation by the nursing facility.
263.17Services beyond those required to comply with licensure or certification standards must
263.18not be charged separately as a special service if they were included in the payment rate for
263.19the previous reporting year. A nursing facility that charges a private paying resident a rate
263.20in violation of this clause is subject to an action by the state of Minnesota or any of its
263.21subdivisions or agencies for civil damages. A private paying resident or the resident's legal
263.22representative has a cause of action for civil damages against a nursing facility that charges
263.23the resident rates in violation of this clause. The damages awarded shall include three
263.24times the payments that result from the violation, together with costs and disbursements,
263.25including reasonable attorneys' fees or their equivalent. A private paying resident or the
263.26resident's legal representative, the state, subdivision or agency, or a nursing facility may
263.27request a hearing to determine the allowed rate or rates at issue in the cause of action.
263.28Within 15 calendar days after receiving a request for such a hearing, the commissioner
263.29shall request assignment of an administrative law judge under sections 14.48 to 14.56 to
263.30conduct the hearing as soon as possible or according to agreement by the parties. The
263.31administrative law judge shall issue a report within 15 calendar days following the close
263.32of the hearing. The prohibition set forth in this clause shall not apply to facilities licensed
263.33as boarding care facilities which are not certified as skilled or intermediate care facilities
263.34level I or II for reimbursement through medical assistance.
263.35(b)(1) Charging, soliciting, accepting, or receiving from an applicant for admission
263.36to the facility, or from anyone acting in behalf of the applicant, as a condition of
264.1admission, expediting the admission, or as a requirement for the individual's continued
264.2stay, any fee, deposit, gift, money, donation, or other consideration not otherwise required
264.3as payment under the state plan. For residents on medical assistance, medical assistance
264.4payment according to the state plan must be accepted as payment in full for continued
264.5stay, except where otherwise provided for under statute;
264.6(2) requiring an individual, or anyone acting in behalf of the individual, to loan
264.7any money to the nursing facility;
264.8(3) requiring an individual, or anyone acting in behalf of the individual, to promise
264.9to leave all or part of the individual's estate to the facility; or
264.10(4) requiring a third-party guarantee of payment to the facility as a condition of
264.11admission, expedited admission, or continued stay in the facility.
264.12Nothing in this paragraph would prohibit discharge for nonpayment of services in
264.13accordance with state and federal regulations.
264.14(c) Requiring any resident of the nursing facility to utilize a vendor of health care
264.15services chosen by the nursing facility. A nursing facility may require a resident to use
264.16pharmacies that utilize unit dose packing systems approved by the Minnesota Board of
264.17Pharmacy, and may require a resident to use pharmacies that are able to meet the federal
264.18regulations for safe and timely administration of medications such as systems with specific
264.19number of doses, prompt delivery of medications, or access to medications on a 24-hour
264.20basis. Notwithstanding the provisions of this paragraph, nursing facilities shall not restrict
264.21a resident's choice of pharmacy because the pharmacy utilizes a specific system of unit
264.22dose drug packing.
264.23(d) Providing differential treatment on the basis of status with regard to public
264.24assistance.
264.25(e) Discriminating in admissions, services offered, or room assignment on the
264.26basis of status with regard to public assistance or refusal to purchase special services.
264.27Discrimination in admissions discrimination, services offered, or room assignment shall
264.28include, but is not limited to:
264.29(1) basing admissions decisions upon assurance by the applicant to the nursing
264.30facility, or the applicant's guardian or conservator, that the applicant is neither eligible for
264.31nor will seek information or assurances regarding current or future eligibility for public
264.32assistance for payment of nursing facility care costs; and
264.33(2) engaging in preferential selection from waiting lists based on an applicant's
264.34ability to pay privately or an applicant's refusal to pay for a special service.
264.35The collection and use by a nursing facility of financial information of any applicant
264.36pursuant to a preadmission screening program established by law shall not raise an
265.1inference that the nursing facility is utilizing that information for any purpose prohibited
265.2by this paragraph.
265.3(f) Requiring any vendor of medical care as defined by section 256B.02, subdivision
265.47 , who is reimbursed by medical assistance under a separate fee schedule, to pay any
265.5amount based on utilization or service levels or any portion of the vendor's fee to the
265.6nursing facility except as payment for renting or leasing space or equipment or purchasing
265.7support services from the nursing facility as limited by section 256B.433. All agreements
265.8must be disclosed to the commissioner upon request of the commissioner. Nursing
265.9facilities and vendors of ancillary services that are found to be in violation of this provision
265.10shall each be subject to an action by the state of Minnesota or any of its subdivisions or
265.11agencies for treble civil damages on the portion of the fee in excess of that allowed by
265.12this provision and section 256B.433. Damages awarded must include three times the
265.13excess payments together with costs and disbursements including reasonable attorney's
265.14fees or their equivalent.
265.15(g) Refusing, for more than 24 hours, to accept a resident returning to the same
265.16bed or a bed certified for the same level of care, in accordance with a physician's order
265.17authorizing transfer, after receiving inpatient hospital services.
265.18(h) For a period not to exceed 180 days, the commissioner may continue to make
265.19medical assistance payments to a nursing facility or boarding care home which is in
265.20violation of this section if extreme hardship to the residents would result. In these cases
265.21the commissioner shall issue an order requiring the nursing facility to correct the violation.
265.22The nursing facility shall have 20 days from its receipt of the order to correct the violation.
265.23If the violation is not corrected within the 20-day period the commissioner may reduce
265.24the payment rate to the nursing facility by up to 20 percent. The amount of the payment
265.25rate reduction shall be related to the severity of the violation and shall remain in effect
265.26until the violation is corrected. The nursing facility or boarding care home may appeal the
265.27commissioner's action pursuant to the provisions of chapter 14 pertaining to contested
265.28cases. An appeal shall be considered timely if written notice of appeal is received by the
265.29commissioner within 20 days of notice of the commissioner's proposed action.
265.30In the event that the commissioner determines that a nursing facility is not eligible
265.31for reimbursement for a resident who is eligible for medical assistance, the commissioner
265.32may authorize the nursing facility to receive reimbursement on a temporary basis until the
265.33resident can be relocated to a participating nursing facility.
265.34Certified beds in facilities which do not allow medical assistance intake on July 1,
265.351984, or after shall be deemed to be decertified for purposes of section 144A.071 only.

266.1    Sec. 39. Minnesota Statutes 2010, section 256B.49, subdivision 12, is amended to read:
266.2    Subd. 12. Informed choice. Persons who are determined likely to require the
266.3level of care provided in a nursing facility as determined under sections 144.0724,
266.4subdivision 11, and section 256B.0911, or a hospital shall be informed of the home and
266.5community-based support alternatives to the provision of inpatient hospital services or
266.6nursing facility services. Each person must be given the choice of either institutional or
266.7home and community-based services using the provisions described in section 256B.77,
266.8subdivision 2 , paragraph (p).

266.9    Sec. 40. Minnesota Statutes 2010, section 256B.49, subdivision 13, is amended to read:
266.10    Subd. 13. Case management. (a) Each recipient of a home and community-based
266.11waiver under this section shall be provided case management services according to
266.12section 256B.092, subdivisions 1a, 1b, and 1e, by qualified vendors as described in the
266.13federally approved waiver application. The case management service activities provided
266.14will include:
266.15    (1) assessing the needs of the individual within 20 working days of a recipient's
266.16request;
266.17    (2) developing the written individual service plan within ten working days after the
266.18assessment is completed;
266.19    (3) informing the recipient or the recipient's legal guardian or conservator of service
266.20options;
266.21    (4) assisting the recipient in the identification of potential service providers;
266.22    (5) assisting the recipient to access services;
266.23    (6) coordinating, evaluating, and monitoring of the services identified in the service
266.24plan;
266.25    (7) completing the annual reviews of the service plan; and
266.26    (8) informing the recipient or legal representative of the right to have assessments
266.27completed and service plans developed within specified time periods, and to appeal county
266.28action or inaction under section 256.045, subdivision 3, including the determination of
266.29nursing facility level of care.
266.30    (b) The case manager may delegate certain aspects of the case management service
266.31activities to another individual provided there is oversight by the case manager. The case
266.32manager may not delegate those aspects which require professional judgment including
266.33assessments, reassessments, and care plan development.
266.34EFFECTIVE DATE.This section is effective January 1, 2012.

267.1    Sec. 41. Minnesota Statutes 2010, section 256B.49, subdivision 14, is amended to read:
267.2    Subd. 14. Assessment and reassessment. (a) Assessments of each recipient's
267.3strengths, informal support systems, and need for services shall be completed within 20
267.4working days of the recipient's request as provided in section 256B.0911. Reassessment
267.5of each recipient's strengths, support systems, and need for services shall be conducted
267.6at least every 12 months and at other times when there has been a significant change in
267.7the recipient's functioning.
267.8(b) There must be a determination that the client requires a hospital level of care or a
267.9nursing facility level of care as defined in section 144.0724, subdivision 11 256B.0911,
267.10subdivision 4a, paragraph (d), at initial and subsequent assessments to initiate and
267.11maintain participation in the waiver program.
267.12(c) Regardless of other assessments identified in section 144.0724, subdivision 4, as
267.13appropriate to determine nursing facility level of care for purposes of medical assistance
267.14payment for nursing facility services, only face-to-face assessments conducted according
267.15to section 256B.0911, subdivisions 3a, 3b, and 4d, that result in a hospital level of care
267.16determination or a nursing facility level of care determination must be accepted for
267.17purposes of initial and ongoing access to waiver services payment.
267.18(d) Persons with developmental disabilities who apply for services under the nursing
267.19facility level waiver programs shall be screened for the appropriate level of care according
267.20to section 256B.092.
267.21(e) Recipients who are found eligible for home and community-based services under
267.22this section before their 65th birthday may remain eligible for these services after their
267.2365th birthday if they continue to meet all other eligibility factors.
267.24(f) The commissioner shall develop criteria to identify individuals whose level of
267.25functioning is reasonably expected to improve and reassess these individuals every six
267.26months. Individuals who meet these criteria must have a comprehensive transitional
267.27service plan developed under subdivision 15, paragraphs (b) and (c). Counties, case
267.28managers, and service providers are responsible for conducting these reassessments and
267.29shall complete the reassessments out of existing funds.
267.30EFFECTIVE DATE.This section is effective January 1, 2012, except for paragraph
267.31(f), which is effective July 1, 2013.

267.32    Sec. 42. Minnesota Statutes 2010, section 256B.49, subdivision 15, is amended to read:
267.33    Subd. 15. Individualized Coordinated service and support plan; comprehensive
267.34transitional service plan; maintenance service plan. (a) Each recipient of home and
267.35community-based waivered services shall be provided a copy of the written coordinated
268.1service and support plan which: that complies with the requirements of section 256B.092,
268.2subdivisions 1b and 1e.
268.3(1) is developed and signed by the recipient within ten working days of the
268.4completion of the assessment;
268.5(2) meets the assessed needs of the recipient;
268.6(3) reasonably ensures the health and safety of the recipient;
268.7(4) promotes independence;
268.8(5) allows for services to be provided in the most integrated settings; and
268.9(6) provides for an informed choice, as defined in section 256B.77, subdivision 2,
268.10paragraph (p), of service and support providers.
268.11(b) In developing the comprehensive transitional service plan, the individual
268.12receiving services, the case manager, and the guardian, if applicable, will identify
268.13the transitional service plan fundamental service outcome and anticipated timeline to
268.14achieve this outcome. Within the first 20 days following a recipient's request for an
268.15assessment or reassessment, the transitional service planning team must be identified. A
268.16team leader must be identified who will be responsible for assigning responsibility and
268.17communicating with team members to ensure implementation of the transition plan and
268.18ongoing assessment and communication process. The team leader should be an individual,
268.19such as the case manager or guardian, who has the opportunity to follow the individual to
268.20the next level of service.
268.21Within ten days following an assessment, a comprehensive transitional service plan
268.22must be developed incorporating elements of a comprehensive functional assessment and
268.23including short-term measurable outcomes and timelines for achievement of and reporting
268.24on these outcomes. Functional milestones must also be identified and reported according
268.25to the timelines agreed upon by the transitional service planning team. In addition, the
268.26comprehensive transitional service plan must identify additional supports that may assist
268.27in the achievement of the fundamental service outcome such as the development of greater
268.28natural community support, increased collaboration among agencies, and technological
268.29supports.
268.30The timelines for reporting on functional milestones will prompt a reassessment of
268.31services provided, the units of services, rates, and appropriate service providers. It is
268.32the responsibility of the transitional service planning team leader to review functional
268.33milestone reporting to determine if the milestones are consistent with observable skills
268.34and that milestone achievement prompts any needed changes to the comprehensive
268.35transitional service plan.
269.1For those whose fundamental transitional service outcome involves the need to
269.2procure housing, a plan for the individual to seek the resources necessary to secure
269.3the least restrictive housing possible should be incorporated into the plan, including
269.4employment and public supports such as housing access and shelter needy funding.
269.5(c) Counties and other agencies responsible for funding community placement and
269.6ongoing community supportive services are responsible for the implementation of the
269.7comprehensive transitional service plans. Oversight responsibilities include both ensuring
269.8effective transitional service delivery and efficient utilization of funding resources.
269.9(d) Following one year of transitional services, the transitional services planning
269.10team will make a determination as to whether or not the individual receiving services
269.11requires the current level of continuous and consistent support in order to maintain the
269.12individual's current level of functioning. Individuals who move from a transitional to a
269.13maintenance service plan must be reassessed to determine if the individual would benefit
269.14from a transitional service plan on at least an annual basis. This assessment should
269.15consider any changes to technological or natural community supports.
269.16(b) (e) When a county is evaluating denials, reductions, or terminations of home
269.17and community-based services under section 256B.49 for an individual, the case manager
269.18shall offer to meet with the individual or the individual's guardian in order to discuss the
269.19prioritization of service needs within the individualized service plan, comprehensive
269.20transitional service plan, or maintenance service plan. The reduction in the authorized
269.21services for an individual due to changes in funding for waivered services may not exceed
269.22the amount needed to ensure medically necessary services to meet the individual's health,
269.23safety, and welfare.
269.24EFFECTIVE DATE.This section is effective January 1, 2012, except for
269.25paragraphs (b), (c), and (d), which are effective July 1, 2013.

269.26    Sec. 43. Minnesota Statutes 2010, section 256B.5012, is amended by adding a
269.27subdivision to read:
269.28    Subd. 9. ICF/MR rate increase. Effective July 1, 2011, the commissioner shall
269.29increase the daily rate to $138.23 at an intermediate care facility for the developmentally
269.30disabled located in Clearwater County and classified as a class A facility with 15 beds.
269.31EFFECTIVE DATE.This section is effective July 1, 2011.

269.32    Sec. 44. Minnesota Statutes 2010, section 256B.5012, is amended by adding a
269.33subdivision to read:
270.1    Subd. 10. ICF/MR rate adjustment. For each facility reimbursed under this
270.2section, except for a facility located in Clearwater County and classified as a class A
270.3facility with 15 beds, the commissioner shall decrease operating payment rates equal to ...
270.4percent of the operating payment rates in effect on June 30, 2011. For each facility, the
270.5commissioner shall apply the rate reduction, based on occupied beds, using the percentage
270.6specified in this subdivision multiplied by the total payment rate, including the variable rate
270.7but excluding the property-related payment rate, in effect on the preceding date. The total
270.8rate reduction shall include the adjustment provided in section 256B.501, subdivision 12.

270.9    Sec. 45. Minnesota Statutes 2010, section 256G.02, subdivision 6, is amended to read:
270.10    Subd. 6. Excluded time. "Excluded time" means:
270.11(a) any period an applicant spends in a hospital, sanitarium, nursing home, shelter
270.12other than an emergency shelter, halfway house, foster home, semi-independent living
270.13domicile or services program, residential facility offering care, board and lodging facility
270.14or other institution for the hospitalization or care of human beings, as defined in section
270.15144.50 , 144A.01, or 245A.02, subdivision 14; maternity home, battered women's shelter,
270.16or correctional facility; or any facility based on an emergency hold under sections
270.17253B.05, subdivisions 1 and 2 , and 253B.07, subdivision 6;
270.18(b) any period an applicant spends on a placement basis in a training and habilitation
270.19program, including a rehabilitation facility or work or employment program as defined
270.20in section 268A.01; or receiving personal care assistance services pursuant to section
270.21256B.0659; semi-independent living services provided under section 252.275, and
270.22Minnesota Rules, parts 9525.0500 to 9525.0660; day training and habilitation programs
270.23and assisted living services; and
270.24(c) any placement for a person with an indeterminate commitment, including
270.25independent living.
270.26EFFECTIVE DATE.This section is effective July 1, 2011.

270.27    Sec. 46. Laws 2009, chapter 79, article 8, section 4, the effective date, as amended by
270.28Laws 2010, First Special Session chapter 1, article 24, section 12, is amended to read:
270.29EFFECTIVE DATE.The This section is effective July 1, 2011 on or after January
270.301, 2014, for individuals age 21 and older, and on or after October 1, 2019, for individuals
270.31under age 21.

271.1    Sec. 47. Laws 2009, chapter 79, article 8, section 51, the effective date, as amended by
271.2Laws 2010, First Special Session chapter 1, article 17, section 14, is amended to read:
271.3EFFECTIVE DATE.This section is effective July 1, 2011 January 1, 2014.

271.4    Sec. 48. Laws 2009, chapter 79, article 13, section 3, subdivision 8, as amended by
271.5Laws 2009, chapter 173, article 2, section 1, subdivision 8, and Laws 2010, First Special
271.6Session chapter 1, article 15, section 5, and article 25, section 16, is amended to read:

271.7

Subd. 8.Continuing Care Grants

271.8The amounts that may be spent from the
271.9appropriation for each purpose are as follows:

271.10

(a) Aging and Adult Services Grants

13,499,000

15,805,000

271.11Base Adjustment. The general fund base is
271.12increased by $5,751,000 in fiscal year 2012
271.13and $6,705,000 in fiscal year 2013.
271.14Information and Assistance
271.15Reimbursement. Federal administrative
271.16reimbursement obtained from information
271.17and assistance services provided by the
271.18Senior LinkAge or Disability Linkage lines
271.19to people who are identified as eligible for
271.20medical assistance shall be appropriated to
271.21the commissioner for this activity.
271.22Community Service Development Grant
271.23Reduction. Funding for community service
271.24development grants must be reduced by
271.25$260,000 for fiscal year 2010; $284,000 in
271.26fiscal year 2011; $43,000 in fiscal year 2012;
271.27and $43,000 in fiscal year 2013. Base level
271.28funding shall be restored in fiscal year 2014.
271.29Community Service Development Grant
271.30Community Initiative. Funding for
271.31community service development grants shall
271.32be used to offset the cost of aging support
272.1grants. Base level funding shall be restored
272.2in fiscal year 2014.
272.3Senior Nutrition Use of Federal Funds.
272.4For fiscal year 2010, general fund grants
272.5for home-delivered meals and congregate
272.6dining shall be reduced by $500,000. The
272.7commissioner must replace these general
272.8fund reductions with equal amounts from
272.9federal funding for senior nutrition from the
272.10American Recovery and Reinvestment Act
272.11of 2009.

272.12

(b) Alternative Care Grants

50,234,000

48,576,000

272.13Base Adjustment. The general fund base is
272.14decreased by $3,598,000 in fiscal year 2012
272.15and $3,470,000 in fiscal year 2013.
272.16Alternative Care Transfer. Any money
272.17allocated to the alternative care program that
272.18is not spent for the purposes indicated does
272.19not cancel but must be transferred to the
272.20medical assistance account.

272.21 272.22

(c) Medical Assistance Grants; Long-Term Care Facilities.

367,444,000

419,749,000

272.23 272.24

(d) Medical Assistance Long-Term Care Waivers and Home Care Grants

853,567,000

1,039,517,000

272.25Manage Growth in TBI and CADI
272.26Waivers. During the fiscal years beginning
272.27on July 1, 2009, and July 1, 2010, the
272.28commissioner shall allocate money for home
272.29and community-based waiver programs
272.30under Minnesota Statutes, section 256B.49,
272.31to ensure a reduction in state spending that is
272.32equivalent to limiting the caseload growth of
272.33the TBI waiver to 12.5 allocations per month
272.34each year of the biennium and the CADI
272.35waiver to 95 allocations per month each year
273.1of the biennium. Limits do not apply: (1)
273.2when there is an approved plan for nursing
273.3facility bed closures for individuals under
273.4age 65 who require relocation due to the
273.5bed closure; (2) to fiscal year 2009 waiver
273.6allocations delayed due to unallotment; or (3)
273.7to transfers authorized by the commissioner
273.8from the personal care assistance program
273.9of individuals having a home care rating
273.10of "CS," "MT," or "HL." Priorities for the
273.11allocation of funds must be for individuals
273.12anticipated to be discharged from institutional
273.13settings or who are at imminent risk of a
273.14placement in an institutional setting.
273.15Manage Growth in DD Waiver. The
273.16commissioner shall manage the growth in
273.17the DD waiver by limiting the allocations
273.18included in the February 2009 forecast to 15
273.19additional diversion allocations each month
273.20for the calendar years that begin on January
273.211, 2010, and January 1, 2011. Additional
273.22allocations must be made available for
273.23transfers authorized by the commissioner
273.24from the personal care program of individuals
273.25having a home care rating of "CS," "MT,"
273.26or "HL."
273.27Adjustment to Lead Agency Waiver
273.28Allocations. Prior to the availability of the
273.29alternative license defined in Minnesota
273.30Statutes, section 245A.11, subdivision 8,
273.31the commissioner shall reduce lead agency
273.32waiver allocations for the purposes of
273.33implementing a moratorium on corporate
273.34foster care.
274.1Alternatives to Personal Care Assistance
274.2Services. Base level funding of $3,237,000
274.3in fiscal year 2012 and $4,856,000 in
274.4fiscal year 2013 is to implement alternative
274.5services to personal care assistance services
274.6for persons with mental health and other
274.7behavioral challenges who can benefit
274.8from other services that more appropriately
274.9meet their needs and assist them in living
274.10independently in the community. These
274.11services may include, but not be limited to, a
274.121915(i) state plan option.

274.13

(e) Mental Health Grants

274.14	Appropriations by Fund
274.15	General	77,739,000	77,739,000
274.16	Health Care Access	750,000	750,000
274.17	Lottery Prize	1,508,000	1,508,000

274.18Funding Usage. Up to 75 percent of a fiscal
274.19year's appropriation for adult mental health
274.20grants may be used to fund allocations in that
274.21portion of the fiscal year ending December
274.2231.

274.23

(f) Deaf and Hard-of-Hearing Grants

1,930,000

1,917,000

274.24

(g) Chemical Dependency Entitlement Grants

111,303,000

122,822,000

274.25Payments for Substance Abuse Treatment.
274.26For placements beginning during fiscal years
274.272010 and 2011, county-negotiated rates and
274.28provider claims to the consolidated chemical
274.29dependency fund must not exceed the lesser
274.30of:
274.31(1) rates charged for these services on
274.32January 1, 2009; or
275.1(2) 160 percent of the average rate on January
275.21, 2009, for each group of vendors with
275.3similar attributes.
275.4Rates for fiscal years 2010 and 2011 must
275.5not exceed 160 percent of the average rate on
275.6January 1, 2009, for each group of vendors
275.7with similar attributes.
275.8Effective July 1, 2010, rates that were above
275.9the average rate on January 1, 2009, are
275.10reduced by five percent from the rates in
275.11effect on June 1, 2010. Rates below the
275.12average rate on January 1, 2009, are reduced
275.13by 1.8 percent from the rates in effect on
275.14June 1, 2010. Services provided under
275.15this section by state-operated services are
275.16exempt from the rate reduction. For services
275.17provided in fiscal years 2012 and 2013, the
275.18statewide aggregate payment under the new
275.19rate methodology to be developed under
275.20Minnesota Statutes, section 254B.12, must
275.21not exceed the projected aggregate payment
275.22under the rates in effect for fiscal year 2011
275.23excluding the rate reduction for rates that
275.24were below the average on January 1, 2009,
275.25plus a state share increase of $3,787,000 for
275.26fiscal year 2012 and $5,023,000 for fiscal
275.27year 2013. Notwithstanding any provision
275.28to the contrary in this article, this provision
275.29expires on June 30, 2013.
275.30Chemical Dependency Special Revenue
275.31Account. For fiscal year 2010, $750,000
275.32must be transferred from the consolidated
275.33chemical dependency treatment fund
275.34administrative account and deposited into the
275.35general fund.
276.1County CD Share of MA Costs for
276.2ARRA Compliance. Notwithstanding the
276.3provisions of Minnesota Statutes, chapter
276.4254B, for chemical dependency services
276.5provided during the period October 1, 2008,
276.6to December 31, 2010, and reimbursed by
276.7medical assistance at the enhanced federal
276.8matching rate provided under the American
276.9Recovery and Reinvestment Act of 2009, the
276.10county share is 30 percent of the nonfederal
276.11share. This provision is effective the day
276.12following final enactment.

276.13 276.14

(h) Chemical Dependency Nonentitlement Grants

1,729,000

1,729,000

276.15

(i) Other Continuing Care Grants

19,201,000

17,528,000

276.16Base Adjustment. The general fund base is
276.17increased by $2,639,000 in fiscal year 2012
276.18and increased by $3,854,000 in fiscal year
276.192013.
276.20Technology Grants. $650,000 in fiscal
276.21year 2010 and $1,000,000 in fiscal year
276.222011 are for technology grants, case
276.23consultation, evaluation, and consumer
276.24information grants related to developing and
276.25supporting alternatives to shift-staff foster
276.26care residential service models.
276.27Other Continuing Care Grants; HIV
276.28Grants. Money appropriated for the HIV
276.29drug and insurance grant program in fiscal
276.30year 2010 may be used in either year of the
276.31biennium.
276.32Quality Assurance Commission. Effective
276.33July 1, 2009, state funding for the quality
276.34assurance commission under Minnesota
276.35Statutes, section 256B.0951, is canceled.

277.1    Sec. 49. DIRECTIONS TO COMMISSIONER.
277.2    Subdivision 1. Co-payments for home and community-based services. Upon
277.3federal approval, the commissioner of human services shall develop and implement a
277.4co-payment schedule for individuals receiving home and community-based services under
277.5Minnesota Statutes, chapter 256B.
277.6    Subd. 2. Federal waiver amendment. The commissioner shall seek an amendment
277.7to the 1915c home and community-based waivers under Minnesota Statutes, sections
277.8256B.092 and 256B.49, to allow properly licensed residential programs under Minnesota
277.9Statutes, section 245A.02, subdivision 14, to provide residential services to up to eight
277.10individuals with physical or developmental disabilities, chronic illnesses, or traumatic
277.11brain injuries. A facility licensed for five to eight people must be an existing residential
277.12building, such as a duplex, that is owned by the same company and meets all other
277.13licensing requirements.
277.14    Subd. 3. Recommendations for personal care assistance service changes. The
277.15commissioner shall consult with stakeholder groups, including counties, advocates,
277.16persons receiving personal care assistance services, and personal care assistance providers,
277.17and make recommendations to the legislature by February 1, 2014, on changes that could
277.18be made to the program to improve oversight, program efficiency, and cost-effectiveness.
277.19    Subd. 4. Nursing facility pay-for-performance reimbursement system.
277.20The commissioner of human services shall report to the legislative committees with
277.21jurisdiction over nursing facility policy and finance with recommendations for developing
277.22and implementing a pay-for-performance reimbursement system with a quality add-on by
277.23January 15, 2012.
277.24    Subd. 5. ICF/MR transition plan. The commissioner of human services shall
277.25work with stakeholders to develop and implement a plan by June 30, 2013, to transition
277.26individuals currently residing in intermediate care facilities for persons with developmental
277.27disabilities into the least restrictive community settings possible. The plan must include a
277.28requirement for a cooperative planning process between the counties and providers for
277.29the downsizing or closure of intermediate care facilities for persons with developmental
277.30disabilities, with funding from the bed closures converting to home and community-based
277.31waiver funding to fund services for those leaving the intermediate care facilities for
277.32persons with developmental disabilities based on a plan approved by the commissioner. In
277.33order to facilitate this process, the commissioner shall provide information to facilities and
277.34counties about the number of people in facilities who have requested to move to home and
277.35community-based services. Individuals residing in intermediate care facilities for persons
277.36with developmental disabilities who choose to remain there or whose health or safety
278.1would be put at risk in a less restrictive setting may continue to reside in intermediate care
278.2facilities for persons with developmental disabilities.
278.3    Subd. 6. Representative payee. The commissioner of human services shall make
278.4recommendations to the legislative committees with jurisdiction over health and human
278.5services policy and finance by January 15, 2012, on ways to better manage funds for
278.6persons who rely on a representative payee.
278.7    Subd. 7. Autism treatment. The commissioner of human services shall review
278.8autism treatment benefits under the TEFRA option and make recommendations to the
278.9legislative committees with jurisdiction over health and human services policy and finance
278.10by January 1, 2012, to extend the same autism treatment benefits to MA managed care and
278.11county-based purchasing.

278.12    Sec. 50. STATE PLAN AMENDMENT TO IMPLEMENT SELF-DIRECTED
278.13PERSONAL SUPPORTS.
278.14By July 15, 2011, the commissioner shall submit a state plan amendment to
278.15implement Minnesota Statutes, section 256B.0657, as soon as possible upon federal
278.16approval.

278.17    Sec. 51. AMENDMENT FOR SELF-DIRECTED COMMUNITY SUPPORTS.
278.18By September 1, 2011, the commissioner shall submit an amendment to the home
278.19and community-based waiver programs consistent with implementing the self-directed
278.20option under Minnesota Statutes, section 256B.0657, through statewide enrolled providers
278.21contracted to provide outreach information, training, and fiscal support entity services to
278.22all eligible recipients choosing this option and with shared care in some types of services.
278.23The waiver amendment shall be consistent with changes in case management services
278.24under Minnesota Statutes, section 256B.092.

278.25    Sec. 52. ESTABLISHMENT OF RATES FOR SHARED HOME AND
278.26COMMUNITY-BASED WAIVER SERVICES.
278.27By January 1, 2012, the commissioner shall establish rates to begin paying for
278.28in-home services and personal supports under all of the home and community-based
278.29waiver services programs consistent with the standards in Minnesota Statutes, section
278.30256B.4912, subdivision 2.

278.31    Sec. 53. ESTABLISHMENT OF RATE FOR CASE MANAGEMENT
278.32SERVICES.
279.1By July 1, 2012, the commissioner shall establish the rate to be paid for case
279.2management services under Minnesota Statutes, sections 256B.0621, subdivision 2, clause
279.3(4), 256B.092, and 256B.49, consistent with the standards in Minnesota Statutes, section
279.4256B.4912, subdivision 2.

279.5    Sec. 54. RECOMMENDATIONS FOR FURTHER CASE MANAGEMENT
279.6REDESIGN.
279.7By February 1, 2012, the commissioner of human services shall develop a legislative
279.8report with specific recommendations and language for proposed legislation to be effective
279.9July 1, 2012, for the following:
279.10(1) definitions of service and consolidation of standards and rates to the extent
279.11appropriate for all types of medical assistance case management services, including
279.12targeted case management under Minnesota Statutes, sections 256B.0621; 256B.0625,
279.13subdivision 20; and 256B.0924; mental health case management services for children
279.14and adults, all types of home and community-based waiver case management, and case
279.15management under Minnesota Rules, parts 9525.0004 to 9525.0036. This work shall be
279.16completed in collaboration with efforts under Minnesota Statutes, section 256B.4912;
279.17(2) recommendations on county of financial responsibility requirements and quality
279.18assurance measures for case management;
279.19(3) identification of county administrative functions that may remain entwined in
279.20case management service delivery models; and
279.21(4) implementation of a methodology to fully fund county case management
279.22administrative functions.

279.23    Sec. 55. MY LIFE, MY CHOICES TASK FORCE.
279.24    Subdivision 1. Establishment. The My Life, My Choices Task Force is established
279.25to create a system of supports and services for people with disabilities governed by the
279.26following principles:
279.27(1) freedom to act as a consumer of services in the marketplace;
279.28(2) freedom to choose to take as much risk as any other citizen;
279.29(3) more choices in levels of service that may vary throughout life;
279.30(4) opportunity to work with a trusted partner and fiscal support entity to manage a
279.31personal budget and to be accountable for reporting spending and personal outcomes;
279.32(5) opportunity to live with minimal constraints instead of minimal freedoms; and
279.33(6) ability to consolidate funding streams into an individualized budget.
280.1    Subd. 2. Membership. The My Life, My Choices Task Force shall consist of the
280.2lieutenant governor; the commissioner of human services, or designee; a representative of
280.3the Minnesota Chamber of Commerce; and the following to be appointed by the governor:
280.4one administrative law judge, one labor representative, two family members of people
280.5with disabilities, and one individual with disabilities. In addition, the following shall be
280.6appointed jointly by the speaker of the house and the senate Subcommittee on Committees
280.7of the Committee on Rules and Administration, a representative of a disability advocacy
280.8organization; a representative of a disability legal services advocacy organization;
280.9representatives of two nonprofit organizations, one of which serves all 87 counties; and
280.10a representative of a philanthropic organization. Appointed nongovernmental members
280.11of the task force shall serve as staff for the task force and take on the responsibilities of
280.12coordinating meetings, reporting on committee recommendations, and providing other
280.13staff support as needed to meet the responsibilities of the task force as described in
280.14subdivision 3. Legislative appointment of nongovernmental members of the task force
280.15shall be conditioned upon agreement from the appointees to provide staff assistance to
280.16execute the work of the task force. The chairs and ranking minority members of the
280.17legislative committees with jurisdiction over health and human services policy and finance
280.18shall serve as ex officio members.
280.19    Subd. 3. Duties. The task force shall make recommendations, including proposed
280.20legislation, and report to the legislative committees with jurisdiction over health and
280.21human services policy and finance by November 15, 2011, on creating a system of
280.22supports and services for people with disabilities by July 1, 2012, as governed by the
280.23principles under subdivision 1. In making recommendations and proposed legislation, the
280.24council shall work in conjunction with the Consumer-Directed Community Supports Task
280.25Force and shall include self-directed planning, individual budgeting, choice of trusted
280.26partner, self-directed purchasing of services and supports, reporting of outcomes, ability
280.27to share in any savings, and any additional rules or laws that may need to be waived.
280.28Recommendations from the task force shall be fully implemented by July 1, 2013.
280.29    Subd. 4. Expense reimbursement. The members of the task force shall not be
280.30reimbursed for expenses related to the duties of the task force. The task force shall be
280.31independently staffed and coordinated by nongovernmental appointees who serve on the
280.32task force, and no state funding shall be appropriated for expenses related to the task
280.33force under this section.
280.34    Subd. 5. Expiration. The task force expires on July 1, 2013.
280.35EFFECTIVE DATE.This section is effective the day following final enactment.

281.1ARTICLE 7

281.2REDESIGNING SERVICE DELIVERY

281.3    Section 1. Minnesota Statutes 2010, section 119B.09, is amended by adding a
281.4subdivision to read:
281.5    Subd. 4b. Electronic verification. County agencies are authorized to use all
281.6automated databases containing information regarding recipients' or applicants' income
281.7in order to determine eligibility for the child care assistance under this chapter. The
281.8information is sufficient to determine eligibility.

281.9    Sec. 2. Minnesota Statutes 2010, section 256.01, subdivision 14b, is amended to read:
281.10    Subd. 14b. American Indian child welfare projects. (a) The commissioner of
281.11human services may authorize projects to test tribal delivery of child welfare services to
281.12American Indian children and their parents and custodians living on the reservation.
281.13The commissioner has authority to solicit and determine which tribes may participate
281.14in a project. Grants may be issued to Minnesota Indian tribes to support the projects.
281.15The commissioner may waive existing state rules as needed to accomplish the projects.
281.16Notwithstanding section 626.556, the commissioner may authorize projects to use
281.17alternative methods of investigating and assessing reports of child maltreatment, provided
281.18that the projects comply with the provisions of section 626.556 dealing with the rights
281.19of individuals who are subjects of reports or investigations, including notice and appeal
281.20rights and data practices requirements. The commissioner may seek any federal approvals
281.21necessary to carry out the projects as well as seek and use any funds available to the
281.22commissioner, including use of federal funds, foundation funds, existing grant funds,
281.23and other funds. The commissioner is authorized to advance state funds as necessary to
281.24operate the projects. Federal reimbursement applicable to the projects is appropriated
281.25to the commissioner for the purposes of the projects. The projects must be required to
281.26address responsibility for safety, permanency, and well-being of children.
281.27(b) For the purposes of this section, "American Indian child" means a person under
281.2818 years of age who is a tribal member or eligible for membership in one of the tribes
281.29chosen for a project under this subdivision and who is residing on the reservation of
281.30that tribe.
281.31(c) In order to qualify for an American Indian child welfare project, a tribe must:
281.32(1) be one of the existing tribes with reservation land in Minnesota;
281.33(2) have a tribal court with jurisdiction over child custody proceedings;
282.1(3) have a substantial number of children for whom determinations of maltreatment
282.2have occurred;
282.3(4) have capacity to respond to reports of abuse and neglect under section 626.556;
282.4(5) provide a wide range of services to families in need of child welfare services; and
282.5(6) have a tribal-state title IV-E agreement in effect.
282.6(d) Grants awarded under this section may be used for the nonfederal costs of
282.7providing child welfare services to American Indian children on the tribe's reservation,
282.8including costs associated with:
282.9(1) assessment and prevention of child abuse and neglect;
282.10(2) family preservation;
282.11(3) facilitative, supportive, and reunification services;
282.12(4) out-of-home placement for children removed from the home for child protective
282.13purposes; and
282.14(5) other activities and services approved by the commissioner that further the goals
282.15of providing safety, permanency, and well-being of American Indian children.
282.16(e) When a tribe has initiated a project and has been approved by the commissioner
282.17to assume child welfare responsibilities for American Indian children of that tribe under
282.18this section, the affected county social service agency is relieved of responsibility for
282.19responding to reports of abuse and neglect under section 626.556 for those children
282.20during the time within which the tribal project is in effect and funded. The commissioner
282.21shall work with tribes and affected counties to develop procedures for data collection,
282.22evaluation, and clarification of ongoing role and financial responsibilities of the county
282.23and tribe for child welfare services prior to initiation of the project. Children who have not
282.24been identified by the tribe as participating in the project shall remain the responsibility
282.25of the county. Nothing in this section shall alter responsibilities of the county for law
282.26enforcement or court services.
282.27(f) Participating tribes may conduct children's mental health screenings under section
282.28245.4874, subdivision 1 , paragraph (a), clause (14), for children who are eligible for the
282.29initiative and living on the reservation and who meet one of the following criteria:
282.30(1) the child must be receiving child protective services;
282.31(2) the child must be in foster care; or
282.32(3) the child's parents must have had parental rights suspended or terminated.
282.33Tribes may access reimbursement from available state funds for conducting the screenings.
282.34Nothing in this section shall alter responsibilities of the county for providing services
282.35under section 245.487.
283.1(g) Participating tribes may establish a local child mortality review panel. In
283.2establishing a local child mortality review panel, the tribe agrees to conduct local child
283.3mortality reviews for child deaths or near-fatalities occurring on the reservation under
283.4subdivision 12 . Tribes with established child mortality review panels shall have access
283.5to nonpublic data and shall protect nonpublic data under subdivision 12, paragraphs (c)
283.6to (e). The tribe shall provide written notice to the commissioner and affected counties
283.7when a local child mortality review panel has been established and shall provide data upon
283.8request of the commissioner for purposes of sharing nonpublic data with members of the
283.9state child mortality review panel in connection to an individual case.
283.10(h) The commissioner shall collect information on outcomes relating to child safety,
283.11permanency, and well-being of American Indian children who are served in the projects.
283.12Participating tribes must provide information to the state in a format and completeness
283.13deemed acceptable by the state to meet state and federal reporting requirements.
283.14    (i) In consultation with the White Earth Band, the commissioner shall develop
283.15and submit to the chairs and ranking minority members of the legislative committees
283.16with jurisdiction over health and human services a plan to transfer legal responsibility
283.17for providing child protective services to White Earth Band member children residing in
283.18Hennepin County to the White Earth Band. The plan shall include a financing proposal,
283.19definitions of key terms, statutory amendments required, and other provisions required to
283.20implement the plan. The commissioner shall submit the plan by January 15, 2012.

283.21    Sec. 3. Minnesota Statutes 2010, section 256.01, is amended by adding a subdivision
283.22to read:
283.23    Subd. 14c. American Indian child welfare, social, and human services project;
283.24White Earth Band of Ojibwe. (a) The commissioner of human services shall enter into a
283.25contractual agreement as authorized under subdivision 2, paragraph (a), clause (7), with
283.26the White Earth Band of Ojibwe Indians for the tribe to provide all human services and
283.27public assistance programs that are under the supervision of the commissioner to tribal
283.28members who reside on the reservation. Grants may be issued to the White Earth Band
283.29of Ojibwe Indians to support the project. The commissioner may waive existing rules to
283.30support this project. The commissioner shall seek any federal approvals necessary to carry
283.31out the project as well as seek and use any funds available to the commissioner, including
283.32use of federal funds, foundation funds, existing grant funds, and other funds. The
283.33commissioner is authorized to advance state funds as necessary to operate the projects.
283.34Federal reimbursement applicable to the projects is appropriated to the commissioner for
283.35purposes of the project.
284.1(b) The commissioner shall redirect all funds provided to Mahnomen County for
284.2these services, including administrative expenses, to the White Earth Band of Ojibwe
284.3Indians.
284.4(c) The commissioner, in consultation with the tribe, is authorized to determine: (1)
284.5which programs not currently provided by the White Earth Band of Ojibwe Indians will be
284.6transferred to the tribe; and (2) the process by which the new programs will be transferred.
284.7In the case of a dispute, a two-thirds vote of the tribal council to transfer a program to
284.8the tribe must overrule the decision of the commissioner.
284.9(d) When the commissioner approves transfer of programs and the tribe assumes
284.10responsibility under this section, Mahnomen County is relieved of responsibility for
284.11providing program services to tribal members who live on the reservation while the tribal
284.12project is in effect and funded. The commissioner shall seek and use any funds available,
284.13including federal funds, foundation funds, existing grant funds, and other state funds as
284.14available.
284.15(e) The tribe shall comply with all reporting and record keeping requirements under
284.16state and federal laws and rules.

284.17    Sec. 4. [256.0145] COMPUTER SYSTEM SIMPLIFICATION.
284.18    Subdivision 1. Reprogram MAXIS. The commissioner of human services, as part
284.19of the enterprise architecture project, shall reprogram the MAXIS computer system to
284.20automatically apply child support payments entered into the PRISM computer system to
284.21a MAXIS case file.
284.22    Subd. 2. Program the social service information system. The commissioner of
284.23human services shall require all prepaid health plans to accept a billing format identical to
284.24the MMIS billing format for payment to county agencies for mental health targeted case
284.25management claims, elderly waiver claims, and other claim categories as added to the
284.26benefit set. The commissioner shall make any necessary changes to the SSIS system to
284.27bill prepaid health plans for those claims.

284.28    Sec. 5. [256.0147] COUNTY ELECTRONIC VERIFICATION TO DETERMINE
284.29ELIGIBILITY.
284.30County agencies are authorized to use all automated databases containing
284.31information regarding recipients' or applicants' income in order to determine eligibility
284.32for child support enforcement, general assistance, Minnesota supplemental aid, and
284.33programs, services, and supports under chapter 256J. The information is sufficient to
284.34determine eligibility. State and county caseworkers shall not be cited in error, as part of
285.1any audit and quality review, for an incorrect eligibility determination based on current but
285.2inaccurate information received through a state-approved electronic data source. If there
285.3is a potential error, the reviewer must forward a corrective action notice to the caseworker
285.4for proper and immediate correction. If the state or county caseworker has data available
285.5through client reporting, or other means, that are more accurate than state-approved
285.6electronic data, the caseworker should use the more accurate information in making the
285.7eligibility determination.

285.8    Sec. 6. Minnesota Statutes 2010, section 256B.69, is amended by adding a subdivision
285.9to read:
285.10    Subd. 30. Provision of required materials in alternative formats. (a) For the
285.11purposes of this subdivision, "alternative format" means a medium other than paper and
285.12"prepaid health plan" means managed care plans and county-based purchasing plans.
285.13(b) A prepaid health plan may provide in an alternative format a provider directory
285.14and certificate of coverage, or materials otherwise required to be available in writing
285.15under Code of Federal Regulations, title 42, section 438.10, or under the commissioner's
285.16contract with the prepaid health plan, if the following conditions are met:
285.17(1) the prepaid health plan, local agency, or commissioner, as applicable, informs the
285.18enrollee that:
285.19(i) provision in an alternative format is available and the enrollee affirmatively
285.20requests of the prepaid health plan that the provider directory, certificate of coverage,
285.21or materials otherwise required under Code of Federal Regulations, title 42, section
285.22438.10, or under the commissioner's contract with the prepaid health plan be provided in
285.23an alternative format; and
285.24(ii) a record of the enrollee request is retained by the prepaid health plan in the
285.25form of written direction from the enrollee or a documented telephone call followed by a
285.26confirmation letter to the enrollee from the prepaid health plan that explains that the
285.27enrollee may change the request at any time;
285.28(2) the materials are sent to a secured mailbox and are made available at a
285.29password-protected secured Web site or on a data storage device if the materials contain
285.30enrollee data that is individually identifiable;
285.31(3) the enrollee is provided a customer service number on the enrollee's membership
285.32card that may be called to request a paper version of the materials provided in an
285.33alternative format; and
285.34(4) the materials provided in an alternative format meet all other requirements of
285.35the commissioner regarding content, size of typeface, and any required time frames for
286.1distribution. "Required time frames for distribution" must permit sufficient time for
286.2prepaid health plans to distribute materials in alternative formats upon receipt of enrollees'
286.3requests for the materials.
286.4(c) A prepaid health plan may provide in an alternative format its primary care
286.5network list to the commissioner and to local agencies within its service area. The
286.6commissioner or local agency, as applicable, shall inform a potential enrollee of the
286.7availability of a prepaid health plan's primary care network list in an alternative format. If
286.8the potential enrollee requests an alternative format of the prepaid health plan's primary
286.9care network list, a record of that request shall be retained by the commissioner or local
286.10agency. The potential enrollee is permitted to withdraw the request at any time.
286.11The prepaid health plan shall submit sufficient paper versions of the primary
286.12care network list to the commissioner and to local agencies within its service area to
286.13accommodate potential enrollee requests for paper versions of the primary care network
286.14list.
286.15(d) A prepaid health plan may provide in an alternative format materials otherwise
286.16required to be available in writing under Code of Federal Regulations, title 42, section
286.17438.10, or under the commissioner's contract with the prepaid health plan, if the conditions
286.18of paragraphs (b), (c), and (e), are met for persons who are:
286.19(1) enrolled in integrated Medicare and Medicaid programs under subdivisions
286.2023 and 28;
286.21(2) enrolled in managed care long-term care programs under subdivision 6b;
286.22(3) dually eligible for Medicare and medical assistance; or
286.23(4) in the waiting period for Medicare.
286.24(e) The commissioner shall seek any federal Medicaid waivers within 90 days after
286.25the effective date of this subdivision that are necessary to provide alternative formats of
286.26required material to enrollees of prepaid health plans as authorized under this subdivision.
286.27(f) The commissioner shall consult with managed care plans, county-based
286.28purchasing plans, counties, and other interested parties to determine how materials
286.29required to be made available to enrollees under Code of Federal Regulations, title 42,
286.30section 438.10, or under the commissioner's contract with a prepaid health plan may
286.31be provided in an alternative format on the basis that the enrollee has not opted in to
286.32receive the alternative format. The commissioner shall consult with managed care
286.33plans, county-based purchasing plans, counties, and other interested parties to develop
286.34recommendations relating to the conditions that must be met for an opt-out process
286.35to be granted.

287.1    Sec. 7. Minnesota Statutes 2010, section 256D.09, subdivision 6, is amended to read:
287.2    Subd. 6. Recovery of overpayments. (a) If an amount of general assistance or
287.3family general assistance is paid to a recipient in excess of the payment due, it shall be
287.4recoverable by the county agency. The agency shall give written notice to the recipient of
287.5its intention to recover the overpayment.
287.6(b) Except as provided for interim assistance in section 256D.06, subdivision
287.75, when an overpayment occurs, the county agency shall recover the overpayment
287.8from a current recipient by reducing the amount of aid payable to the assistance unit of
287.9which the recipient is a member, for one or more monthly assistance payments, until
287.10the overpayment is repaid. All county agencies in the state shall reduce the assistance
287.11payment by three percent of the assistance unit's standard of need in nonfraud cases and
287.12ten percent where fraud has occurred, or the amount of the monthly payment, whichever is
287.13less, for all overpayments.
287.14(c) In cases when there is both an overpayment and underpayment, the county
287.15agency shall offset one against the other in correcting the payment.
287.16(d) Overpayments may also be voluntarily repaid, in part or in full, by the individual,
287.17in addition to the aid reductions provided in this subdivision, to include further voluntary
287.18reductions in the grant level agreed to in writing by the individual, until the total amount
287.19of the overpayment is repaid.
287.20(e) The county agency shall make reasonable efforts to recover overpayments to
287.21persons no longer on assistance under standards adopted in rule by the commissioner
287.22of human services. The county agency need not attempt to recover overpayments of
287.23less than $35 paid to an individual no longer on assistance if the individual does not
287.24receive assistance again within three years, unless the individual has been convicted of
287.25violating section 256.98.
287.26(f) Establishment of an overpayment is limited to 12 months prior to the month of
287.27discovery due to agency error and six years prior to the month of discovery due to client
287.28error or an intentional program violation determined under section 256.046.

287.29    Sec. 8. Minnesota Statutes 2010, section 256D.49, subdivision 3, is amended to read:
287.30    Subd. 3. Overpayment of monthly grants and recovery of ATM errors. (a) When
287.31the county agency determines that an overpayment of the recipient's monthly payment
287.32of Minnesota supplemental aid has occurred, it shall issue a notice of overpayment
287.33to the recipient. If the person is no longer receiving Minnesota supplemental aid, the
287.34county agency may request voluntary repayment or pursue civil recovery. If the person is
287.35receiving Minnesota supplemental aid, the county agency shall recover the overpayment
288.1by withholding an amount equal to three percent of the standard of assistance for the
288.2recipient or the total amount of the monthly grant, whichever is less.
288.3(b) Establishment of an overpayment is limited to 12 months from the date of
288.4discovery due to agency error and six years prior to the month of discovery due to client
288.5error or an intentional program violation determined under section 256.046.
288.6(c) For recipients receiving benefits via electronic benefit transfer, if the overpayment
288.7is a result of an automated teller machine (ATM) dispensing funds in error to the recipient,
288.8the agency may recover the ATM error by immediately withdrawing funds from the
288.9recipient's electronic benefit transfer account, up to the amount of the error.
288.10(d) Residents of nursing homes, regional treatment centers, and licensed residential
288.11facilities with negotiated rates shall not have overpayments recovered from their personal
288.12needs allowance.

288.13    Sec. 9. Minnesota Statutes 2010, section 256J.38, subdivision 1, is amended to read:
288.14    Subdivision 1. Scope of overpayment. (a) When a participant or former participant
288.15receives an overpayment due to agency, client, or ATM error, or due to assistance received
288.16while an appeal is pending and the participant or former participant is determined
288.17ineligible for assistance or for less assistance than was received, the county agency must
288.18recoup or recover the overpayment using the following methods:
288.19(1) reconstruct each affected budget month and corresponding payment month;
288.20(2) use the policies and procedures that were in effect for the payment month; and
288.21(3) do not allow employment disregards in section 256J.21, subdivision 3 or 4, in the
288.22calculation of the overpayment when the unit has not reported within two calendar months
288.23following the end of the month in which the income was received.
288.24(b) Establishment of an overpayment is limited to 12 months prior to the month of
288.25discovery due to agency error and six years prior to the month of discovery due to client
288.26error or an intentional program violation determined under section 256.046.

288.27    Sec. 10. Minnesota Statutes 2010, section 393.07, subdivision 10, is amended to read:
288.28    Subd. 10. Food stamp program; Maternal and Child Nutrition Act. (a) The local
288.29social services agency shall establish and administer the food stamp program according
288.30to rules of the commissioner of human services, the supervision of the commissioner as
288.31specified in section 256.01, and all federal laws and regulations. The commissioner of
288.32human services shall monitor food stamp program delivery on an ongoing basis to ensure
288.33that each county complies with federal laws and regulations. Program requirements to be
288.34monitored include, but are not limited to, number of applications, number of approvals,
289.1number of cases pending, length of time required to process each application and deliver
289.2benefits, number of applicants eligible for expedited issuance, length of time required
289.3to process and deliver expedited issuance, number of terminations and reasons for
289.4terminations, client profiles by age, household composition and income level and sources,
289.5and the use of phone certification and home visits. The commissioner shall determine the
289.6county-by-county and statewide participation rate.
289.7(b) On July 1 of each year, the commissioner of human services shall determine a
289.8statewide and county-by-county food stamp program participation rate. The commissioner
289.9may designate a different agency to administer the food stamp program in a county if the
289.10agency administering the program fails to increase the food stamp program participation
289.11rate among families or eligible individuals, or comply with all federal laws and regulations
289.12governing the food stamp program. The commissioner shall review agency performance
289.13annually to determine compliance with this paragraph.
289.14(c) A person who commits any of the following acts has violated section 256.98 or
289.15609.821 , or both, and is subject to both the criminal and civil penalties provided under
289.16those sections:
289.17(1) obtains or attempts to obtain, or aids or abets any person to obtain by means of a
289.18willful statement or misrepresentation, or intentional concealment of a material fact, food
289.19stamps or vouchers issued according to sections 145.891 to 145.897 to which the person
289.20is not entitled or in an amount greater than that to which that person is entitled or which
289.21specify nutritional supplements to which that person is not entitled; or
289.22(2) presents or causes to be presented, coupons or vouchers issued according to
289.23sections 145.891 to 145.897 for payment or redemption knowing them to have been
289.24received, transferred or used in a manner contrary to existing state or federal law; or
289.25(3) willfully uses, possesses, or transfers food stamp coupons, authorization to
289.26purchase cards or vouchers issued according to sections 145.891 to 145.897 in any manner
289.27contrary to existing state or federal law, rules, or regulations; or
289.28(4) buys or sells food stamp coupons, authorization to purchase cards, other
289.29assistance transaction devices, vouchers issued according to sections 145.891 to 145.897,
289.30or any food obtained through the redemption of vouchers issued according to sections
289.31145.891 to 145.897 for cash or consideration other than eligible food.
289.32(d) A peace officer or welfare fraud investigator may confiscate food stamps,
289.33authorization to purchase cards, or other assistance transaction devices found in the
289.34possession of any person who is neither a recipient of the food stamp program nor
289.35otherwise authorized to possess and use such materials. Confiscated property shall be
289.36disposed of as the commissioner may direct and consistent with state and federal food
290.1stamp law. The confiscated property must be retained for a period of not less than 30 days
290.2to allow any affected person to appeal the confiscation under section 256.045.
290.3(e) Food stamp overpayment claims which are due in whole or in part to client error
290.4shall be established by the county agency for a period of six years from the date of any
290.5resultant overpayment Establishment of an overpayment is limited to 12 months prior to
290.6the month of discovery due to agency error and six years prior to the month of discovery
290.7due to client error or an intentional program violation determined under section 256.046.
290.8(f) With regard to the federal tax revenue offset program only, recovery incentives
290.9authorized by the federal food and consumer service shall be retained at the rate of 50
290.10percent by the state agency and 50 percent by the certifying county agency.
290.11(g) A peace officer, welfare fraud investigator, federal law enforcement official,
290.12or the commissioner of health may confiscate vouchers found in the possession of any
290.13person who is neither issued vouchers under sections 145.891 to 145.897, nor otherwise
290.14authorized to possess and use such vouchers. Confiscated property shall be disposed of
290.15as the commissioner of health may direct and consistent with state and federal law. The
290.16confiscated property must be retained for a period of not less than 30 days.
290.17(h) The commissioner of human services may seek a waiver from the United States
290.18Department of Agriculture to allow the state to specify foods that may and may not be
290.19purchased in Minnesota with benefits funded by the federal Food Stamp Program. The
290.20commissioner shall consult with the members of the house of representatives and senate
290.21policy committees having jurisdiction over food support issues in developing the waiver.
290.22The commissioner, in consultation with the commissioners of health and education, shall
290.23develop a broad public health policy related to improved nutrition and health status. The
290.24commissioner must seek legislative approval prior to implementing the waiver.

290.25    Sec. 11. Minnesota Statutes 2010, section 402A.10, subdivision 4, is amended to read:
290.26    Subd. 4. Essential human services or essential services. "Essential human
290.27services" or "essential services" means assistance and services to recipients or potential
290.28recipients of public welfare and other services delivered by counties or tribes that are
290.29mandated in federal and state law that are to be available in all counties of the state.

290.30    Sec. 12. Minnesota Statutes 2010, section 402A.10, subdivision 5, is amended to read:
290.31    Subd. 5. Service delivery authority. "Service delivery authority" means a single
290.32county, or group consortium of counties operating by execution of a joint powers
290.33agreement under section 471.59 or other contractual agreement, that has voluntarily
290.34chosen by resolution of the county board of commissioners to participate in the redesign
291.1under this chapter or has been assigned by the commissioner pursuant to section 402A.18.
291.2A service delivery authority includes an Indian tribe or group of tribes that have voluntarily
291.3chosen by resolution of tribal government to participate in redesign under this chapter.

291.4    Sec. 13. Minnesota Statutes 2010, section 402A.15, is amended to read:
291.5402A.15 STEERING COMMITTEE ON PERFORMANCE AND OUTCOME
291.6REFORMS.
291.7    Subdivision 1. Duties. (a) The Steering Committee on Performance and Outcome
291.8Reforms shall develop a uniform process to establish and review performance and outcome
291.9standards for all essential human services based on the current level of resources available,
291.10and to shall develop appropriate reporting measures and a uniform accountability process
291.11for responding to a county's or human service delivery authority's failure to make adequate
291.12progress on achieving performance measures. The accountability process shall focus on
291.13the performance measures rather than inflexible implementation requirements.
291.14(b) The steering committee shall:
291.15(1) by November 1, 2009, establish an agreed-upon list of essential services;
291.16(2) by February 15, 2010, develop and recommend to the legislature a uniform,
291.17graduated process, in addition to the remedies identified in section 402A.18, for responding
291.18to a county's failure to make adequate progress on achieving performance measures; and
291.19(3) by December 15, 2012, for each essential service, make recommendations
291.20to the legislature regarding (1) (i) performance measures and goals based on those
291.21measures for each essential service, (2) and (ii) a system for reporting on the performance
291.22measures and goals, and (3) appropriate resources, including funding, needed to achieve
291.23those performance measures and goals. The resource recommendations shall take into
291.24consideration program demand and the unique differences of local areas in geography and
291.25the populations served. Priority shall be given to services with the greatest variation in
291.26availability and greatest administrative demands. By January 15 of each year starting
291.27January 15, 2011, the steering committee shall report its recommendations to the governor
291.28and legislative committees with jurisdiction over health and human services. As part of its
291.29report, the steering committee shall, as appropriate, recommend statutory provisions, rules
291.30and requirements, and reports that should be repealed or eliminated.
291.31(c) As far as possible, the performance measures, reporting system, and funding
291.32shall be consistent across program areas. The development of performance measures shall
291.33consider the manner in which data will be collected and performance will be reported.
291.34The steering committee shall consider state and local administrative costs related to
291.35collecting data and reporting outcomes when developing performance measures. The
292.1steering committee shall correlate the performance measures and goals to available levels
292.2of resources, including state and local funding. The steering committee shall also identify
292.3and incorporate federal performance measures in its recommendations for those program
292.4areas where federal funding is contingent on meeting federal performance standards. The
292.5steering committee shall take into consideration that the goal of implementing changes
292.6to program monitoring and reporting the progress toward achieving outcomes is to
292.7significantly minimize the cost of administrative requirements and to allow funds freed
292.8by reduced administrative expenditures to be used to provide additional services, allow
292.9flexibility in service design and management, and focus energies on achieving program
292.10and client outcomes.
292.11(d) In making its recommendations, the steering committee shall consider input from
292.12the council established in section 402A.20. The steering committee shall review the
292.13measurable goals established in a memorandum of understanding entered into under
292.14section 402A.30, subdivision 2, paragraph (b), and consider whether they may be applied
292.15as statewide performance outcomes.
292.16(e) The steering committee shall form work groups that include persons who provide
292.17or receive essential services and representatives of organizations who advocate on behalf
292.18of those persons.
292.19(f) By December 15, 2009, the steering committee shall establish a three-year
292.20schedule for completion of its work. The schedule shall be published on the Department of
292.21Human Services Web site and reported to the legislative committees with jurisdiction over
292.22health and human services. In addition, the commissioner shall post quarterly updates on
292.23the progress of the steering committee on the Department of Human Services Web site.
292.24    Subd. 2. Composition. (a) The steering committee shall include:
292.25(1) the commissioner of human services, or designee, and two additional
292.26representatives of the department;
292.27(2) two county commissioners, representative of rural and urban counties, selected
292.28by the Association of Minnesota Counties;
292.29(3) two county directors of human services, representative of rural and urban
292.30counties, selected by the Minnesota Association of County Social Service Administrators;
292.31and
292.32(4) three clients or client advocates representing different populations receiving
292.33services from the Department of Human Services, who are appointed by the commissioner.
292.34(b) The commissioner, or designee, and a county commissioner shall serve as
292.35cochairs of the committee. The committee shall be convened within 60 days of May
292.3615, 2009.
293.1(c) State agency staff shall serve as informational resources and staff to the steering
293.2committee. Statewide county associations may assemble county program data as required.
293.3(d) To promote information sharing and coordination between the steering committee
293.4and council, one of the county representatives from paragraph (a), clause (2), and one of the
293.5county representatives from paragraph (a), clause (3), must also serve as a representative
293.6on the council under section 402A.20, subdivision 1, paragraph (b), clause (5) or (6).

293.7    Sec. 14. Minnesota Statutes 2010, section 402A.18, is amended to read:
293.8402A.18 COMMISSIONER POWER TO REMEDY FAILURE TO MEET
293.9PERFORMANCE OUTCOMES.
293.10    Subdivision 1. Underperforming county; specific service. If the commissioner
293.11determines that a county or service delivery authority is deficient in achieving minimum
293.12performance outcomes for a specific essential service, the commissioner may impose the
293.13following remedies and adjust state and federal program allocations accordingly:
293.14(1) voluntary incorporation of the administration and operation of the specific
293.15essential service with an existing service delivery authority or another county. A
293.16service delivery authority or county incorporating an underperforming county shall
293.17not be financially liable for the costs associated with remedying performance outcome
293.18deficiencies;
293.19(2) mandatory incorporation of the administration and operation of the specific
293.20essential service with an existing service delivery authority or another county. A
293.21service delivery authority or county incorporating an underperforming county shall
293.22not be financially liable for the costs associated with remedying performance outcome
293.23deficiencies; or
293.24(3) transfer of authority for program administration and operation of the specific
293.25essential service to the commissioner.
293.26    Subd. 2. Underperforming county; more than one-half of service services. If
293.27the commissioner determines that a county or service delivery authority is deficient in
293.28achieving minimum performance outcomes for more than one-half of the defined essential
293.29service services, the commissioner may impose the following remedies:
293.30(1) voluntary incorporation of the administration and operation of the specific
293.31essential service services with an existing service delivery authority or another county.
293.32A service delivery authority or county incorporating an underperforming county shall
293.33not be financially liable for the costs associated with remedying performance outcome
293.34deficiencies;
294.1(2) mandatory incorporation of the administration and operation of the specific
294.2essential service services with an existing service delivery authority or another county.
294.3A service delivery authority or county incorporating an underperforming county shall
294.4not be financially liable for the costs associated with remedying performance outcome
294.5deficiencies; or
294.6(3) transfer of authority for program administration and operation of the specific
294.7essential service services to the commissioner.
294.8    Subd. 2a. Financial responsibility of underperforming county. A county subject
294.9to remedies under subdivision 1 or 2 shall provide to the entity assuming administration of
294.10the essential service or essential services the amount of nonfederal and nonstate funding
294.11needed to remedy performance outcome deficiencies.
294.12    Subd. 3. Conditions prior to imposing remedies. Before the commissioner may
294.13impose the remedies authorized under this section, the following conditions must be met:
294.14(1) the county or service delivery authority determined by the commissioner
294.15to be deficient in achieving minimum performance outcomes has the opportunity, in
294.16coordination with the council, to develop a program outcome improvement plan. The
294.17program outcome improvement plan must be developed no later than six months from the
294.18date of the deficiency determination; and
294.19(2) the council has conducted an assessment of the program outcome improvement
294.20plan to determine if the county or service delivery authority has made satisfactory
294.21progress toward performance outcomes and has made a recommendation about remedies
294.22to the commissioner. The review assessment and recommendation must be made to the
294.23commissioner within 12 months from the date of the deficiency determination.

294.24    Sec. 15. Minnesota Statutes 2010, section 402A.20, is amended to read:
294.25402A.20 COUNCIL.
294.26    Subdivision 1. Council. (a) The State-County Results, Accountability, and Service
294.27Delivery Redesign Council is established. Appointed council members must be appointed
294.28by their respective agencies, associations, or governmental units by November 1, 2009.
294.29The council shall be cochaired by the commissioner of human services, or designee, and a
294.30county representative from paragraph (b), clause (4) or (5), appointed by the Association
294.31of Minnesota Counties. Recommendations of the council must be approved by a majority
294.32of the voting council members. The provisions of section 15.059 do not apply to this
294.33council, and this council does not expire.
294.34(b) The council must consist of the following members:
295.1(1) two legislators appointed by the speaker of the house, one from the minority
295.2and one from the majority;
295.3(2) two legislators appointed by the Senate Rules Committee, one from the majority
295.4and one from the minority;
295.5(3) the commissioner of human services, or designee, and three employees from
295.6the department;
295.7(4) two county commissioners appointed by the Association of Minnesota Counties;
295.8(5) two county representatives appointed by the Minnesota Association of County
295.9Social Service Administrators;
295.10(6) one representative appointed by AFSCME as a nonvoting member; and
295.11(7) one representative appointed by the Teamsters as a nonvoting member.
295.12(c) Administrative support to the council may be provided by the Association of
295.13Minnesota Counties and affiliates.
295.14(d) Member agencies and associations are responsible for initial and subsequent
295.15appointments to the council.
295.16    Subd. 2. Council duties. The council shall:
295.17(1) provide review of the service delivery redesign process, including proposed
295.18memoranda of understanding to establish a service delivery authority to conduct and
295.19administer experimental projects to test new methods and procedures of delivering
295.20services;
295.21(2) certify, in accordance with section 402A.30, subdivision 4, the formation of
295.22a service delivery authority, including the memorandum of understanding in section
295.23402A.30, subdivision 2, paragraph (b);
295.24(3) ensure the consistency of the memorandum of understanding entered into
295.25under section 402A.30, subdivision 2, paragraph (b), with the performance standards
295.26recommended by the steering committee and enacted by the legislature;
295.27(4) (2) ensure the consistency of the memorandum of understanding, to the extent
295.28appropriate, or with other memorandum of understanding entered into by other service
295.29delivery authorities;
295.30(3) review and make recommendations on applications from a service delivery
295.31authority for waivers of statutory or rule program requirements that are needed for
295.32flexibility to determine the most cost-effective means of achieving specified measurable
295.33goals in a redesign of human services delivery;
295.34(5) (4) establish a process to take public input on the service delivery framework
295.35specified in the memorandum of understanding in section 402A.30, subdivision 2,
296.1paragraph (b) scope of essential services over which a service delivery authority has
296.2jurisdiction;
296.3(6) (5) form work groups as necessary to carry out the duties of the council under the
296.4redesign;
296.5(7) (6) serve as a forum for resolving conflicts among participating counties and
296.6tribes or between participating counties or tribes and the commissioner of human services,
296.7provided nothing in this section is intended to create a formal binding legal process;
296.8(8) (7) engage in the program improvement process established in section 402A.18,
296.9subdivision 3; and
296.10(9) (8) identify and recommend incentives for counties and tribes to participate in
296.11human services service delivery authorities.
296.12    Subd. 3. Program evaluation. By December 15, 2014, the council shall request
296.13consideration by the legislative auditor for a reevaluation under section 3.971, subdivision
296.147, of those aspects of the program evaluation of human services administration reported
296.15in January 2007 affected by this chapter.

296.16    Sec. 16. [402A.35] DESIGNATION OF SERVICE DELIVERY AUTHORITY.
296.17    Subdivision 1. Requirements for establishing a service delivery authority.
296.18(a) A county, tribe, or consortium of counties is eligible to establish a service delivery
296.19authority if:
296.20(1) the county, tribe, or consortium of counties is:
296.21(i) a single county with a population of 55,000 or more;
296.22(ii) a consortium of counties with a total combined population of 55,000 or more;
296.23(iii) a consortium of four or more counties in reasonable geographic proximity
296.24without regard to population; or
296.25(iv) one or more tribes with a total combined population of 25,000 or more.
296.26The council may recommend that the commissioner of human services exempt a
296.27single county, tribe, or consortium of counties from the minimum population standard if
296.28the county, tribe, or consortium of counties can demonstrate that it can otherwise meet
296.29the requirements of this chapter.
296.30(b) A service delivery authority shall:
296.31(1) comply with current state and federal law, including any existing federal or state
296.32performance measures and performance measures under section 402A.15 when they are
296.33enacted into law, except where waivers are approved by the commissioner. Nothing
296.34in this subdivision requires the establishment of performance measures under section
297.1402A.15 prior to a service delivery authority participating in the service delivery redesign
297.2under this chapter;
297.3(2) define the scope of essential services over which the service delivery authority
297.4has jurisdiction;
297.5(3) designate a single administrative structure to oversee the delivery of those
297.6services included in a proposal for a redesigned service or services and identify a single
297.7administrative agent for purposes of contact and communication with the department;
297.8(4) identify the waivers from statutory or rule program requirements that are needed
297.9to ensure greater local control and flexibility to determine the most cost-effective means of
297.10achieving specified measurable goals that the participating service delivery authority is
297.11expected to achieve;
297.12(5) set forth a reasonable level of targeted reductions in overhead and administrative
297.13costs for each service delivery authority participating in the service delivery redesign; and
297.14(6) set forth the terms under which a county, tribe, or consortium of counties may
297.15withdraw from participation.
297.16(c) Once a county, tribe, or consortium of counties establishes a service delivery
297.17authority, no county, tribe, or consortium of counties that is a member of the service
297.18delivery authority may participate as a member of any other service delivery authority.
297.19The service delivery authority may allow an additional county, a tribe, or a consortium of
297.20counties to join the service delivery authority subject to the approval of the council and
297.21the commissioner.
297.22(d) Nothing in this chapter precludes local governments from using sections 465.81
297.23and 465.82 to establish procedures for local governments to merge, with the consent
297.24of the voters. Nothing in this chapter limits the authority of a county board or tribal
297.25council to enter into contractual agreements for services not covered by the provisions
297.26of a memorandum of understanding establishing a service delivery authority with other
297.27agencies or with other units of government.
297.28    Subd. 2. Relief from statutory requirements. (a) Unless otherwise identified in
297.29the memorandum of understanding, any county, tribe, or consortium of counties forming a
297.30service delivery authority is exempt from the provisions of sections 245.465; 245.4835;
297.31245.4874; 245.492, subdivision 2; 245.4932; 256F.13; 256J.626, subdivision 2, paragraph
297.32(b); and 256M.30.
297.33(b) This subdivision does not preclude any county, tribe, or consortium of counties
297.34forming a service delivery authority from requesting additional waivers from statutory and
297.35rule requirements to ensure greater local control and flexibility.
297.36    Subd. 3. Duties. The service delivery authority shall:
298.1(1) within the scope of essential services set forth in the memorandum of
298.2understanding establishing the authority, carry out the responsibilities required of local
298.3agencies under chapter 393 and human services boards under chapter 402;
298.4(2) manage the public resources devoted to human services and other public services
298.5delivered or purchased by the counties or tribes that are subsidized or regulated by the
298.6Department of Human Services under chapters 245 to 261;
298.7(3) employ staff to assist in carrying out its duties;
298.8(4) develop and maintain a continuity of operations plan to ensure the continued
298.9operation or resumption of essential human services functions in the event of any business
298.10interruption according to local, state, and federal emergency planning requirements;
298.11(5) receive and expend funds received for the redesign process under the
298.12memorandum of understanding;
298.13(6) plan and deliver services directly or through contract with other governmental,
298.14tribal, or nongovernmental providers;
298.15(7) rent, purchase, sell, and otherwise dispose of real and personal property as
298.16necessary to carry out the redesign; and
298.17(8) carry out any other service designated as a responsibility of a county.
298.18    Subd. 4. Process for establishing a service delivery authority. (a) The county,
298.19tribe, or consortium of counties meeting the requirements of section 402A.30 and
298.20proposing to establish a service delivery authority shall present to the council:
298.21(1) in conjunction with the commissioner, a proposed memorandum of understanding
298.22meeting the requirements of subdivision 1, paragraph (b), and outlining:
298.23(i) the details of the proposal;
298.24(ii) the state, tribal, and local resources, which may include, but are not limited to,
298.25funding, administrative and technology support, and other requirements necessary for
298.26the service delivery authority; and
298.27(iii) the relief available to the service delivery authority if the resource commitments
298.28identified in item (ii) are not met; and
298.29(2) a board resolution from the board of commissioners of each participating county
298.30stating the county's intent to participate, or in the case of a tribe, a resolution from tribal
298.31government, stating the tribe's intent to participate.
298.32(b) After the council has considered and recommended approval of a proposed
298.33memorandum of understanding, the commissioner may finalize and execute the
298.34memorandum of understanding.
298.35    Subd. 5. Commissioner authority to seek waivers. The commissioner may use the
298.36authority under section 256.01, subdivision 2, paragraph (l), to grant waivers identified as
299.1part of a proposed service delivery authority under subdivision 1, paragraph (b), clause
299.2(4), except that waivers granted under this section must be approved by the council under
299.3section 402A.20 rather than the Legislative Advisory Committee.

299.4    Sec. 17. ALIGNMENT OF VERIFICATION AND REDETERMINATION
299.5POLICIES.
299.6The commissioner of human services shall develop recommendations to align
299.7eligibility verification procedures for all health care, economic assistance, food support,
299.8child support enforcement, and child care programs. The commissioner shall report back
299.9to the chairs of the legislative committees with jurisdiction over these issues by January
299.1015, 2012, with recommendations and draft legislation to implement the alignment of
299.11eligibility verifications.

299.12    Sec. 18. ALTERNATIVE STRATEGIES FOR CERTAIN
299.13REDETERMINATIONS.
299.14The commissioner of human services shall develop and implement by January 15,
299.152012, a simplified process to redetermine eligibility for recipient populations in the medical
299.16assistance, Minnesota supplemental aid, food support, and group residential housing
299.17programs who are eligible based upon disability, age, or chronic medical conditions, and
299.18who are expected to experience minimal change in income or assets from month to month.
299.19The commissioner shall apply for any federal waivers needed to implement this section.

299.20    Sec. 19. SIMPLIFICATION OF ELIGIBILITY AND ENROLLMENT
299.21PROCESS.
299.22    Subdivision 1. Request for proposal. (a) The commissioner of human services
299.23shall issue a request for proposals for a contract to create an implementation plan for
299.24an integrated service delivery framework including, at a minimum, all service delivery
299.25components specified in paragraph (f). The implementation plan shall include proposed
299.26implementation phasing with implementation timelines, estimated costs and savings
299.27associated with each implementation phase, tasks related to obtaining federal financial
299.28participation, and a draft of the first implementation request for proposals that will be
299.29issued. The first implementation request for proposals shall be for implementation of a
299.30phased-in integrated online eligibility and application portal for health care programs,
299.31food support, cash assistance, and child care. The implementation request for proposals
299.32may incorporate a performance-based vendor financing option in which the vendor shares
299.33the risk of the project's success. The health care portal must be developed in phases with
300.1the capacity to integrate food support, cash assistance, and child care programs as funds
300.2are available. The request for proposals must require that the system recommended and
300.3implemented by the contractor:
300.4    (1) streamline eligibility determinations and case processing to support statewide
300.5eligibility processing. Responses to the request for proposals must specify components of
300.6the service delivery framework the proposal addresses and the expected administrative
300.7savings;
300.8    (2) enable interested persons to determine eligibility for each program, and to apply
300.9for programs online in a manner that the applicant will be asked only those questions
300.10relevant to the programs for which the person is applying;
300.11    (3) leverage technology that has been operational in other state environments with
300.12similar requirements; and
300.13    (4) include Web-based application, worker application processing support, and the
300.14opportunity for expansion. Responses to the request for proposals must indicate how
300.15future expansion can include remaining service delivery components as specified in
300.16paragraph (f).
300.17    (b) The commissioner shall issue a final report, including the implementation
300.18plan and first implementation request for proposals, to the chairs and ranking minority
300.19members of the legislative committees with jurisdiction over health and human services
300.20no later than April 30, 2012.
300.21    (c) The commissioner shall partner with counties, a service delivery authority
300.22established under Minnesota Statutes, chapter 402A, the Office of Enterprise Technology,
300.23other state agencies, and service partners to develop an integrated service delivery
300.24framework which will simplify and streamline human services eligibility and enrollment
300.25processes. The primary objectives for the simplification effort include significantly
300.26improved eligibility processing productivity resulting in reduced time for eligibility
300.27determination and enrollment, increased customer service for applicants and recipients of
300.28services, increased program integrity, and greater administrative flexibility.
300.29    (d) The commissioner shall develop a service-oriented business architecture
300.30for a fully automated medical, cash support, food support, and child care eligibility
300.31and enrollment process that aligns with, and supports, the business processes. The
300.32commissioner shall use the eligibility and enrollment business architecture to create an
300.33integrated and collaborative service delivery framework for evolving or maintaining
300.34existing information technology and acquiring new information technology. The agency's
300.35plan and program for creating the business architecture and integrated service delivery
300.36framework shall include counties, service delivery authorities, collaborative partners,
301.1the Office of Enterprise Technology, and end-users in the delivery of human services.
301.2An Enterprise Architecture Board shall govern these efforts and shall be chaired by the
301.3commissioner.
301.4    (e) The commissioner will ensure agency compliance with the prompt, efficient, and
301.5effective implementation of these governance provisions and specific service delivery
301.6components. The commissioner, along with a county representative appointed by the
301.7Association of Minnesota Counties, shall report specific implementation progress to the
301.8legislature every six months beginning January 15, 2012.
301.9    (f) The commissioner shall work with the Minnesota Association of County Social
301.10Service Administrators and the Office of Enterprise Technology to develop collaborative
301.11task forces, as necessary, to support implementation of these service delivery components.
301.12The commissioner must develop and include, as part of the integrated eligibility and
301.13enrollment service delivery framework, the following:
301.14    (1) screening tools for applicants to determine potential eligibility as part of an
301.15online application process;
301.16    (2) the capacity to use databases to electronically verify application and renewal
301.17data as required by law;
301.18    (3) online accounts accessible by applicants, enrollees, and third parties acting on
301.19behalf of applicants and enrollees. At a minimum, online accounts must contain date of
301.20application, application data, status of eligibility determination, premium and spenddown
301.21amounts and due dates, recertification dates, required verifications, and supplemental
301.22information. These accounts must be a component of a self-service Web site that includes
301.23the capacity for online application and renewal;
301.24    (4) recertification forms prepopulated with name, case number, eligibility data,
301.25and a bar code for use statewide;
301.26    (5) an Interactive Voice Response system, available statewide, that provides case
301.27information for applicants, enrollees, and authorized third parties;
301.28    (6) a statewide electronic document management system that provides seamless
301.29electronic transfer of all documents required for eligibility and enrollment processes. All
301.30entities processing eligibility and enrollment within the state shall use the electronic
301.31document management system to accept and transfer any eligibility and enrollment
301.32documents. Processing entities include the state, counties, service delivery authorities
301.33established under Minnesota Statutes, chapter 402A, and authorized third parties.
301.34The electronic document management system must interface with existing document
301.35management systems and automated eligibility systems. Agency produced documents will
301.36contain bar codes that must be used by all eligibility processing entities; and
302.1    (7) a centralized customer contact center that applicants, enrollees, and authorized
302.2third parties can use statewide to receive program information, application assistance, and
302.3case information; to report changes; to make cost-sharing payments; and conduct other
302.4eligibility and enrollment transactions.
302.5    (g) All provisions in paragraph (f) must be fully integrated as part of any automated
302.6eligibility systems. The commissioner must seek federal financial participation to fund
302.7system development.
302.8    Subd. 2. Appropriation. $200,000 is appropriated to the commissioner from the
302.9general fund for implementation of this section.
302.10EFFECTIVE DATE.This section is effective the day following final enactment.

302.11    Sec. 20. REPEALER.
302.12(a) Minnesota Statutes 2010, sections 402A.30; and 402A.45, are repealed.
302.13(b) Minnesota Rules, part 9500.1243, subpart 3, is repealed.

302.14ARTICLE 8

302.15CHEMICAL AND MENTAL HEALTH

302.16    Section 1. Minnesota Statutes 2010, section 245.50, is amended to read:
302.17245.50 INTERSTATE CONTRACTS, MENTAL HEALTH, CHEMICAL
302.18HEALTH, DETOXIFICATION SERVICES.
302.19    Subdivision 1. Definitions. For purposes of this section, the following terms have
302.20the meanings given them.
302.21    (a) "Bordering state" means Iowa, North Dakota, South Dakota, or Wisconsin.
302.22    (b) "Receiving agency" means a public or private hospital, mental health center,
302.23chemical health treatment facility, detoxification facility, or other person or organization
302.24which provides mental health or, chemical health, or detoxification services under this
302.25section to individuals from a state other than the state in which the agency is located.
302.26    (c) "Receiving state" means the state in which a receiving agency is located.
302.27    (d) "Sending agency" means a state or county agency which sends an individual to a
302.28bordering state for treatment or detoxification under this section.
302.29    (e) "Sending state" means the state in which the sending agency is located.
302.30    Subd. 2. Purpose and authority. (a) The purpose of this section is to enable
302.31appropriate treatment or detoxification services to be provided to individuals, across state
302.32lines from the individual's state of residence, in qualified facilities that are closer to the
302.33homes of individuals than are facilities available in the individual's home state.
303.1    (b) Unless prohibited by another law and subject to the exceptions listed in
303.2subdivision 3, a county board or the commissioner of human services may contract
303.3with an agency or facility in a bordering state for mental health or, chemical health, or
303.4detoxification services for residents of Minnesota, and a Minnesota mental health or,
303.5chemical health, or detoxification agency or facility may contract to provide services to
303.6residents of bordering states. Except as provided in subdivision 5, a person who receives
303.7services in another state under this section is subject to the laws of the state in which
303.8services are provided. A person who will receive services in another state under this
303.9section must be informed of the consequences of receiving services in another state,
303.10including the implications of the differences in state laws, to the extent the individual will
303.11be subject to the laws of the receiving state.
303.12    Subd. 3. Exceptions. A contract may not be entered into under this section for
303.13services to persons who:
303.14    (1) are serving a sentence after conviction of a criminal offense;
303.15    (2) are on probation or parole;
303.16    (3) are the subject of a presentence investigation; or
303.17    (4) have been committed involuntarily in Minnesota under chapter 253B for
303.18treatment of mental illness or chemical dependency, except as provided under subdivision
303.195.
303.20    Subd. 4. Contracts. Contracts entered into under this section must, at a minimum:
303.21    (1) describe the services to be provided;
303.22    (2) establish responsibility for the costs of services;
303.23    (3) establish responsibility for the costs of transporting individuals receiving
303.24services under this section;
303.25    (4) specify the duration of the contract;
303.26    (5) specify the means of terminating the contract;
303.27    (6) specify the terms and conditions for refusal to admit or retain an individual; and
303.28    (7) identify the goals to be accomplished by the placement of an individual under
303.29this section.
303.30    Subd. 5. Special contracts; bordering states. (a) An individual who is detained,
303.31committed, or placed on an involuntary basis under chapter 253B may be confined or
303.32treated in a bordering state pursuant to a contract under this section. An individual
303.33who is detained, committed, or placed on an involuntary basis under the civil law of a
303.34bordering state may be confined or treated in Minnesota pursuant to a contract under
303.35this section. A peace or health officer who is acting under the authority of the sending
303.36state may transport an individual to a receiving agency that provides services pursuant to
304.1a contract under this section and may transport the individual back to the sending state
304.2under the laws of the sending state. Court orders valid under the law of the sending state
304.3are granted recognition and reciprocity in the receiving state for individuals covered by
304.4a contract under this section to the extent that the court orders relate to confinement for
304.5treatment or care of mental illness or, chemical dependency, or detoxification. Such
304.6treatment or care may address other conditions that may be co-occurring with the mental
304.7illness or chemical dependency. These court orders are not subject to legal challenge in
304.8the courts of the receiving state. Individuals who are detained, committed, or placed under
304.9the law of a sending state and who are transferred to a receiving state under this section
304.10continue to be in the legal custody of the authority responsible for them under the law
304.11of the sending state. Except in emergencies, those individuals may not be transferred,
304.12removed, or furloughed from a receiving agency without the specific approval of the
304.13authority responsible for them under the law of the sending state.
304.14    (b) While in the receiving state pursuant to a contract under this section, an
304.15individual shall be subject to the sending state's laws and rules relating to length of
304.16confinement, reexaminations, and extensions of confinement. No individual may be sent
304.17to another state pursuant to a contract under this section until the receiving state has
304.18enacted a law recognizing the validity and applicability of this section.
304.19    (c) If an individual receiving services pursuant to a contract under this section leaves
304.20the receiving agency without permission and the individual is subject to involuntary
304.21confinement under the law of the sending state, the receiving agency shall use all
304.22reasonable means to return the individual to the receiving agency. The receiving agency
304.23shall immediately report the absence to the sending agency. The receiving state has the
304.24primary responsibility for, and the authority to direct, the return of these individuals
304.25within its borders and is liable for the cost of the action to the extent that it would be
304.26liable for costs of its own resident.
304.27    (d) Responsibility for payment for the cost of care remains with the sending agency.
304.28    (e) This subdivision also applies to county contracts under subdivision 2 which
304.29include emergency care and treatment provided to a county resident in a bordering state.
304.30    (f) If a Minnesota resident is admitted to a facility in a bordering state under this
304.31chapter, a physician, licensed psychologist who has a doctoral degree in psychology, or
304.32an advance practice registered nurse certified in mental health, who is licensed in the
304.33bordering state, may act as an examiner under sections 253B.07, 253B.08, 253B.092,
304.34253B.12 , and 253B.17 subject to the same requirements and limitations in section
304.35253B.02, subdivision 7 . Such examiner may initiate an emergency hold under section
304.36253B.05 on a Minnesota resident who is in a hospital that is under contract with a
305.1Minnesota governmental entity under this section provided the resident, in the opinion of
305.2the examiner, meets the criteria in section 253B.05.
305.3    (g) This section shall apply to detoxification services that are unrelated to treatment
305.4whether the services are provided on a voluntary or involuntary basis.

305.5    Sec. 2. Minnesota Statutes 2010, section 246B.10, is amended to read:
305.6246B.10 LIABILITY OF COUNTY; REIMBURSEMENT.
305.7    The civilly committed sex offender's county shall pay to the state a portion of the
305.8cost of care provided in the Minnesota sex offender program to a civilly committed sex
305.9offender who has legally settled in that county. A county's payment must be made from
305.10the county's own sources of revenue and payments must equal ten 25 percent of the cost of
305.11care, as determined by the commissioner, for each day or portion of a day, that the civilly
305.12committed sex offender spends at the facility. If payments received by the state under this
305.13chapter exceed 90 75 percent of the cost of care, the county is responsible for paying the
305.14state the remaining amount. The county is not entitled to reimbursement from the civilly
305.15committed sex offender, the civilly committed sex offender's estate, or from the civilly
305.16committed sex offender's relatives, except as provided in section 246B.07.
305.17EFFECTIVE DATE.This section is effective for all individuals who are civilly
305.18committed to the Minnesota sex offender program on or after August 1, 2011.

305.19    Sec. 3. Minnesota Statutes 2010, section 252.025, subdivision 7, is amended to read:
305.20    Subd. 7. Minnesota extended treatment options. The commissioner shall develop
305.21by July 1, 1997, the Minnesota extended treatment options to serve Minnesotans who
305.22have developmental disabilities and exhibit severe behaviors which present a risk to
305.23public safety. This program is statewide and must provide specialized residential services
305.24in Cambridge and an array of community-based services with sufficient levels of care
305.25and a sufficient number of specialists to ensure that individuals referred to the program
305.26receive the appropriate care. The individuals working in the community-based services
305.27under this section are state employees supervised by the commissioner of human services.
305.28No midcontract layoffs shall occur as a result of restructuring under this section, but
305.29layoffs may occur as a normal consequence of a low census or closure of the facility
305.30due to decreased census.

306.1    Sec. 4. Minnesota Statutes 2010, section 253B.212, is amended to read:
306.2253B.212 COMMITMENT; RED LAKE BAND OF CHIPPEWA INDIANS;
306.3WHITE EARTH BAND OF OJIBWE.
306.4    Subdivision 1. Cost of care; commitment by tribal court order; Red Lake
306.5Band of Chippewa Indians. The commissioner of human services may contract with
306.6and receive payment from the Indian Health Service of the United States Department of
306.7Health and Human Services for the care and treatment of those members of the Red
306.8Lake Band of Chippewa Indians who have been committed by tribal court order to the
306.9Indian Health Service for care and treatment of mental illness, developmental disability, or
306.10chemical dependency. The contract shall provide that the Indian Health Service may not
306.11transfer any person for admission to a regional center unless the commitment procedure
306.12utilized by the tribal court provided due process protections similar to those afforded
306.13by sections 253B.05 to 253B.10.
306.14    Subd. 1a. Cost of care; commitment by tribal court order; White Earth Band of
306.15Ojibwe Indians. The commissioner of human services may contract with and receive
306.16payment from the Indian Health Service of the United States Department of Health and
306.17Human Services for the care and treatment of those members of the White Earth Band
306.18of Ojibwe Indians who have been committed by tribal court order to the Indian Health
306.19Service for care and treatment of mental illness, developmental disability, or chemical
306.20dependency. The tribe may also contract directly with the commissioner for treatment
306.21of those members of the White Earth Band who have been committed by tribal court
306.22order to the White Earth Department of Health for care and treatment of mental illness,
306.23developmental disability, or chemical dependency. The contract shall provide that the
306.24Indian Health Service and the White Earth Band shall not transfer any person for admission
306.25to a regional center unless the commitment procedure utilized by the tribal court provided
306.26due process protections similar to those afforded by sections 253B.05 to 253B.10.
306.27    Subd. 2. Effect given to tribal commitment order. When, under an agreement
306.28entered into pursuant to subdivision 1 subdivisions 1 or 1a, the Indian Health Service
306.29applies to a regional center for admission of a person committed to the jurisdiction of the
306.30health service by the tribal court as a person who is mentally ill, developmentally disabled,
306.31or chemically dependent, the commissioner may treat the patient with the consent of
306.32the Indian Health Service.
306.33A person admitted to a regional center pursuant to this section has all the rights
306.34accorded by section 253B.03. In addition, treatment reports, prepared in accordance with
306.35the requirements of section 253B.12, subdivision 1, shall be filed with the Indian Health
306.36Service within 60 days of commencement of the patient's stay at the facility. A subsequent
307.1treatment report shall be filed with the Indian Health Service within six months of the
307.2patient's admission to the facility or prior to discharge, whichever comes first. Provisional
307.3discharge or transfer of the patient may be authorized by the head of the treatment facility
307.4only with the consent of the Indian Health Service. Discharge from the facility to the
307.5Indian Health Service may be authorized by the head of the treatment facility after notice
307.6to and consultation with the Indian Health Service.

307.7    Sec. 5. Minnesota Statutes 2010, section 254B.03, subdivision 1, is amended to read:
307.8    Subdivision 1. Local agency duties. (a) Every local agency shall provide chemical
307.9dependency services to persons residing within its jurisdiction who meet criteria
307.10established by the commissioner for placement in a chemical dependency residential
307.11or nonresidential treatment service subject to the limitations on residential chemical
307.12dependency treatment in section 254B.04, subdivision 1. Chemical dependency money
307.13must be administered by the local agencies according to law and rules adopted by the
307.14commissioner under sections 14.001 to 14.69.
307.15    (b) In order to contain costs, the commissioner of human services shall select eligible
307.16vendors of chemical dependency services who can provide economical and appropriate
307.17treatment. Unless the local agency is a social services department directly administered by
307.18a county or human services board, the local agency shall not be an eligible vendor under
307.19section 254B.05. The commissioner may approve proposals from county boards to provide
307.20services in an economical manner or to control utilization, with safeguards to ensure that
307.21necessary services are provided. If a county implements a demonstration or experimental
307.22medical services funding plan, the commissioner shall transfer the money as appropriate.
307.23    (c) A culturally specific vendor that provides assessments under a variance under
307.24Minnesota Rules, part 9530.6610, shall be allowed to provide assessment services to
307.25persons not covered by the variance.

307.26    Sec. 6. Minnesota Statutes 2010, section 254B.03, subdivision 4, is amended to read:
307.27    Subd. 4. Division of costs. Except for services provided by a county under
307.28section 254B.09, subdivision 1, or services provided under section 256B.69 or 256D.03,
307.29subdivision 4 , paragraph (b), the county shall, out of local money, pay the state for
307.3016.14 22.95 percent of the cost of chemical dependency services, including those services
307.31provided to persons eligible for medical assistance under chapter 256B and general
307.32assistance medical care under chapter 256D. Counties may use the indigent hospitalization
307.33levy for treatment and hospital payments made under this section. 16.14 22.95 percent
307.34of any state collections from private or third-party pay, less 15 percent for the cost of
308.1payment and collections, must be distributed to the county that paid for a portion of the
308.2treatment under this section.
308.3EFFECTIVE DATE.This section is effective for claims processed beginning
308.4July 1, 2011.

308.5    Sec. 7. Minnesota Statutes 2010, section 254B.04, subdivision 1, is amended to read:
308.6    Subdivision 1. Eligibility. (a) Persons eligible for benefits under Code of Federal
308.7Regulations, title 25, part 20, persons eligible for medical assistance benefits under
308.8sections 256B.055, 256B.056, and 256B.057, subdivisions 1, 2, 5, and 6, or who meet
308.9the income standards of section 256B.056, subdivision 4, and persons eligible for general
308.10assistance medical care under section 256D.03, subdivision 3, are entitled to chemical
308.11dependency fund services subject to the following limitations: (1) no more than three
308.12residential chemical dependency treatment episodes for the same person in a four-year
308.13period of time unless the person meets the criteria established by the commissioner of
308.14human services; and (2) no more than four residential chemical dependency treatment
308.15episodes in a lifetime unless the person meets the criteria established by the commissioner
308.16of human services. State money appropriated for this paragraph must be placed in a
308.17separate account established for this purpose.
308.18Persons with dependent children who are determined to be in need of chemical
308.19dependency treatment pursuant to an assessment under section 626.556, subdivision 10, or
308.20a case plan under section 260C.201, subdivision 6, or 260C.212, shall be assisted by the
308.21local agency to access needed treatment services. Treatment services must be appropriate
308.22for the individual or family, which may include long-term care treatment or treatment in a
308.23facility that allows the dependent children to stay in the treatment facility. The county
308.24shall pay for out-of-home placement costs, if applicable.
308.25(b) A person not entitled to services under paragraph (a), but with family income
308.26that is less than 215 percent of the federal poverty guidelines for the applicable family
308.27size, shall be eligible to receive chemical dependency fund services within the limit
308.28of funds appropriated for this group for the fiscal year. If notified by the state agency
308.29of limited funds, a county must give preferential treatment to persons with dependent
308.30children who are in need of chemical dependency treatment pursuant to an assessment
308.31under section 626.556, subdivision 10, or a case plan under section 260C.201, subdivision
308.326 , or 260C.212. A county may spend money from its own sources to serve persons under
308.33this paragraph. State money appropriated for this paragraph must be placed in a separate
308.34account established for this purpose.
309.1(c) Persons whose income is between 215 percent and 412 percent of the federal
309.2poverty guidelines for the applicable family size shall be eligible for chemical dependency
309.3services on a sliding fee basis, within the limit of funds appropriated for this group for the
309.4fiscal year. Persons eligible under this paragraph must contribute to the cost of services
309.5according to the sliding fee scale established under subdivision 3. A county may spend
309.6money from its own sources to provide services to persons under this paragraph. State
309.7money appropriated for this paragraph must be placed in a separate account established
309.8for this purpose.
309.9EFFECTIVE DATE.This section is effective for all chemical dependency
309.10residential treatment beginning on or after July 1, 2011.

309.11    Sec. 8. Minnesota Statutes 2010, section 254B.04, is amended by adding a subdivision
309.12to read:
309.13    Subd. 2a. Eligibility for treatment in residential settings. Notwithstanding
309.14provisions of Minnesota Rules, part 9530.6622, subparts 5 and 6, related to an assessor's
309.15discretion in making placements to residential treatment settings, a person eligible for
309.16services under this section must score at level 4 on assessment dimensions related to
309.17relapse, continued use, and recovery environment in order to be assigned to services with
309.18a room and board component reimbursed under this section.

309.19    Sec. 9. Minnesota Statutes 2010, section 254B.06, subdivision 2, is amended to read:
309.20    Subd. 2. Allocation of collections. The commissioner shall allocate all federal
309.21financial participation collections to a special revenue account. The commissioner shall
309.22allocate 83.86 77.05 percent of patient payments and third-party payments to the special
309.23revenue account and 16.14 22.95 percent to the county financially responsible for the
309.24patient.
309.25EFFECTIVE DATE.This section is effective for claims processed beginning
309.26July 1, 2011.

309.27    Sec. 10. Minnesota Statutes 2010, section 256B.0625, subdivision 41, is amended to
309.28read:
309.29    Subd. 41. Residential services for children with severe emotional disturbance.
309.30Medical assistance covers rehabilitative services in accordance with section 256B.0945
309.31that are provided by a county or an American Indian tribe through a residential facility,
310.1for children who have been diagnosed with severe emotional disturbance and have been
310.2determined to require the level of care provided in a residential facility.
310.3EFFECTIVE DATE.This section is effective October 1, 2011.

310.4    Sec. 11. Minnesota Statutes 2010, section 256B.0945, subdivision 4, is amended to
310.5read:
310.6    Subd. 4. Payment rates. (a) Notwithstanding sections 256B.19 and 256B.041,
310.7payments to counties for residential services provided by a residential facility shall only
310.8be made of federal earnings for services provided under this section, and the nonfederal
310.9share of costs for services provided under this section shall be paid by the county from
310.10sources other than federal funds or funds used to match other federal funds. Payment to
310.11counties for services provided according to this section shall be a proportion of the per
310.12day contract rate that relates to rehabilitative mental health services and shall not include
310.13payment for costs or services that are billed to the IV-E program as room and board.
310.14    (b) Per diem rates paid to providers under this section by prepaid plans shall be
310.15the proportion of the per-day contract rate that relates to rehabilitative mental health
310.16services and shall not include payment for group foster care costs or services that are
310.17billed to the county of financial responsibility. Services provided in facilities located in
310.18bordering states are eligible for reimbursement on a fee-for-service basis only as described
310.19in paragraph (a) and are not covered under prepaid health plans.
310.20    (c) Payment for mental health rehabilitative services provided under this section by
310.21or under contract with an American Indian tribe or tribal organization or by agencies
310.22operated by or under contract with an American Indian tribe or tribal organization must
310.23be made according to section 256B.0625, subdivision 34, or other relevant federally
310.24approved rate-setting methodology.
310.25(d) The commissioner shall set aside a portion not to exceed five percent of the
310.26federal funds earned for county expenditures under this section to cover the state costs of
310.27administering this section. Any unexpended funds from the set-aside shall be distributed
310.28to the counties in proportion to their earnings under this section.
310.29EFFECTIVE DATE.This section is effective October 1, 2011.

310.30    Sec. 12. COMMUNITY MENTAL HEALTH SERVICES; USE OF
310.31BEHAVIORAL HEALTH HOSPITALS.
310.32The commissioner shall issue a written report to the chairs and ranking minority
310.33members of the house and senate committees with jurisdiction of health and human
311.1services by December 31, 2011, on how the community behavioral health hospital
311.2facilities will be fully utilized to meet the mental health needs of regions in which the
311.3hospitals are located. The commissioner must consult with the regional planning work
311.4groups for adult mental health and must include the recommendations of the work groups
311.5in the legislative report. The report must address future use of community behavioral
311.6health hospitals that are not certified as Medicaid eligible by CMS or have a less than 65
311.7percent licensed bed occupancy rate, and using the facilities for another purpose that will
311.8meet the mental health needs of residents of the region. The regional planning work
311.9groups shall work with the commissioner to prioritize the needs of their regions. These
311.10priorities, by region, must be included in the commissioner's report to the legislature.

311.11    Sec. 13. INTEGRATED DUAL DIAGNOSIS TREATMENT.
311.12(a) The commissioner shall require individuals who perform chemical dependency
311.13assessments or mental health assessments to use approved screening tools in order to
311.14identify whether an individual who is the subject of the assessment has a co-occurring
311.15mental health or chemical dependency disorder. Screening for co-occurring disorders must
311.16begin no later than December 31, 2011.
311.17(b) No later than October 1, 2011, the commissioner shall develop and implement a
311.18certification process for integrated dual diagnosis treatment providers.
311.19(c) No later than December 31, 2011, the commissioner shall develop and implement
311.20a referral system so that individuals who, at screening, are identified with co-occurring
311.21disorders are referred to certified integrated dual diagnosis treatment providers.
311.22(d) The commissioner shall apply for any federal waivers necessary to secure, to the
311.23extent allowed by law, federal financial participation for the provision of integrated dual
311.24diagnosis treatment to persons with co-occurring disorders.

311.25    Sec. 14. STATE-OPERATED SERVICES FACILITIES.
311.26    (a) The commissioner shall close the Willmar Community Behavioral Health
311.27Hospital no later than October 1, 2011.
311.28    (b) The commissioner shall present a plan to the legislative committees with
311.29jurisdiction over health and human services finance no later than January 1, 2012, on
311.30how the department will:
311.31    (1) accommodate the mental health needs of clients impacted by the closure or
311.32redesign of any state-operated services facilities; and
311.33    (2) accommodate the state employees adversely affected by the closure or redesign
311.34of any state-operated services facilities.

312.1    Sec. 15. REGIONAL TREATMENT CENTERS; EMPLOYEES; REPORT.
312.2(a) No layoffs shall occur as a result of restructuring services at the Anoka-Metro
312.3Regional Treatment Center.
312.4(b) The commissioner shall issue a report to the legislative committees with
312.5jurisdiction over health and human services finance no later than December 31, 2011,
312.6which provides the number of employees in management positions at the Anoka-Metro
312.7Regional Treatment Center and the Minnesota Security Hospital at St. Peter and the ratio
312.8of management to direct-care staff for each facility.

312.9    Sec. 16. COMMISSIONER'S CRITERIA FOR RESIDENTIAL TREATMENT.
312.10The commissioner shall develop specific criteria to approve treatment for individuals
312.11who require residential chemical dependency treatment in excess of the maximum allowed
312.12in section 254B.04, subdivision 1, due to co-occurring disorders, including disorders
312.13related to cognition, traumatic brain injury, or documented disability. Criteria shall be
312.14developed for use no later than October 1, 2011.

312.15    Sec. 17. MINNESOTA STATE-OPERATED COMMUNITY SERVICES.
312.16    The commissioner shall evaluate the effectiveness of overnight supervision
312.17provided at the Minnesota state-operated community services residential programs. The
312.18commissioner shall determine whether safety is compromised when only one overnight
312.19staff person is scheduled to work, and shall document the incidents in which the staff
312.20person called for assistance or reported behavior that threatened the safety of clients or the
312.21staff person. The commissioner shall report findings to the legislative committees with
312.22jurisdiction over health and human services no later than January 15, 2012.

312.23    Sec. 18. REPEALER.
312.24Laws 2009, chapter 79, article 3, section 18, as amended by Laws 2010, First Special
312.25Session chapter 1, article 19, section 19, is repealed.

312.26ARTICLE 9

312.27HEALTH AND HUMAN SERVICES APPROPRIATIONS

312.28

Section 1. SUMMARY OF APPROPRIATIONS.

312.29The amounts shown in this section summarize direct appropriations, by fund, made
312.30in this article.

312.31			2012		2013		Total
312.32	General	$	5,646,994,000	$	5,159,920,000	$	10,806,914,000
313.1 313.2	State Government Special Revenue		63,198,000		63,154,000		126,352,000
313.3	Health Care Access		400,917,000		409,880,000		810,797,000
313.4	Federal TANF		274,091,000		282,814,000		556,905,000
313.5	Lottery Prize Fund		1,665,000		1,665,000		3,330,000
313.6	Total	$	6,386,865,000	$	5,917,433,000	$	12,304,298,000

313.7

Sec. 2. HUMAN SERVICES APPROPRIATIONS.

313.8The sums shown in the columns marked "Appropriations" are appropriated to the
313.9agencies and for the purposes specified in this article. The appropriations are from the
313.10general fund, or another named fund, and are available for the fiscal years indicated
313.11for each purpose. The figures "2012" and "2013" used in this article mean that the
313.12appropriations listed under them are available for the fiscal year ending June 30, 2012, or
313.13June 30, 2013, respectively. "The first year" is fiscal year 2012. "The second year" is fiscal
313.14year 2013. "The biennium" is fiscal years 2012 and 2013.

313.15				APPROPRIATIONS
313.16				Available for the Year
313.17				Ending June 30
313.18					2012		2013

313.19 313.20

Sec. 3. COMMISSIONER OF HUMAN SERVICES

313.21

Subdivision 1.Total Appropriation

$

6,215,925,000

$

5,756,045,000

313.22	Appropriations by Fund
313.23		2012	2013
313.24	General	5,564,174,000	5,081,996,000
313.25 313.26	State Government Special Revenue	565,000	565,000
313.27	Health Care Access	387,143,000	400,718,000
313.28	Federal TANF	262,378,000	271,101,000
313.29	Lottery Prize Fund	1,665,000	1,665,000

313.30Receipts for Systems Projects.
313.31Appropriations and federal receipts for
313.32information systems projects for MAXIS,
313.33PRISM, MMIS, and SSIS must be deposited
313.34in the state systems account authorized in
313.35Minnesota Statutes, section 256.014. Money
313.36appropriated for computer projects approved
313.37by the Minnesota Office of Enterprise
314.1Technology, funded by the legislature,
314.2and approved by the commissioner of
314.3Minnesota Management and Budget, may
314.4be transferred from one project to another
314.5and from development to operations as the
314.6commissioner of human services considers
314.7necessary. Any unexpended balance in
314.8the appropriation for these projects does
314.9not cancel but is available for ongoing
314.10development and operations.
314.11Nonfederal Share Transfers. The
314.12nonfederal share of activities for which
314.13federal administrative reimbursement is
314.14appropriated to the commissioner may be
314.15transferred to the special revenue fund.
314.16TANF Maintenance of Effort.
314.17(a) In order to meet the basic maintenance
314.18of effort (MOE) requirements of the TANF
314.19block grant specified under Code of Federal
314.20Regulations, title 45, section 263.1, the
314.21commissioner may only report nonfederal
314.22money expended for allowable activities
314.23listed in the following clauses as TANF/MOE
314.24expenditures:
314.25(1) MFIP cash, diversionary work program,
314.26and food assistance benefits under Minnesota
314.27Statutes, chapter 256J;
314.28(2) the child care assistance programs
314.29under Minnesota Statutes, sections 119B.03
314.30and 119B.05, and county child care
314.31administrative costs under Minnesota
314.32Statutes, section 119B.15;
314.33(3) state and county MFIP administrative
314.34costs under Minnesota Statutes, chapters
314.35256J and 256K;
315.1(4) state, county, and tribal MFIP
315.2employment services under Minnesota
315.3Statutes, chapters 256J and 256K;
315.4(5) expenditures made on behalf of
315.5noncitizen MFIP recipients who qualify
315.6for the medical assistance without federal
315.7financial participation program under
315.8Minnesota Statutes, section 256B.06,
315.9subdivision 4, paragraphs (d), (e), and (j);
315.10(6) qualifying working family credit
315.11expenditures under Minnesota Statutes,
315.12section 290.0671; and
315.13(7) qualifying Minnesota education credit
315.14expenditures under Minnesota Statutes,
315.15section 290.0674.
315.16(b) The commissioner shall ensure that
315.17sufficient qualified nonfederal expenditures
315.18are made each year to meet the state's
315.19TANF/MOE requirements. For the activities
315.20listed in paragraph (a), clauses (2) to
315.21(7), the commissioner may only report
315.22expenditures that are excluded from the
315.23definition of assistance under Code of
315.24Federal Regulations, title 45, section 260.31.
315.25(c) For fiscal years beginning with state fiscal
315.26year 2003, the commissioner shall assure
315.27that the maintenance of effort used by the
315.28commissioner of management and budget
315.29for the February and November forecasts
315.30required under Minnesota Statutes, section
315.3116A.103, contains expenditures under
315.32paragraph (a), clause (1), equal to at least 16
315.33percent of the total required under Code of
315.34Federal Regulations, title 45, section 263.1.
316.1(d) Minnesota Statutes, section 256.011,
316.2subdivision 3, which requires that federal
316.3grants or aids secured or obtained under that
316.4subdivision be used to reduce any direct
316.5appropriations provided by law, do not apply
316.6if the grants or aids are federal TANF funds.
316.7(e) Notwithstanding any contrary provision
316.8in this article, paragraph (a), clauses (1) to
316.9(7), and paragraphs (b) to (d), expire June
316.1030, 2015.
316.11Working Family Credit Expenditures
316.12as TANF/MOE. The commissioner may
316.13claim as TANF maintenance of effort up to
316.14$6,707,000 per year of working family credit
316.15expenditures for fiscal years 2012 and 2013.
316.16Working Family Credit Expenditures
316.17to be Claimed for TANF/MOE. The
316.18commissioner may count the following
316.19amounts of working family credit
316.20expenditures as TANF/MOE:
316.21(1) fiscal year 2012, $12,037,000;
316.22(2) fiscal year 2013, $29,942,000;
316.23(3) fiscal year 2014, $23,235,000; and
316.24(4) fiscal year 2015, $23,198,000.
316.25Notwithstanding any contrary provision in
316.26this article, this rider expires June 30, 2015.
316.27TANF Transfer to Federal Child Care
316.28and Development Fund. (a) The following
316.29TANF fund amounts are appropriated
316.30to the commissioner for purposes of
316.31MFIP/Transition Year Child Care Assistance
316.32under Minnesota Statutes, section 119B.05:
316.33(1) fiscal year 2012, $11,020,000;
317.1(2) fiscal year 2013, $35,020,000;
317.2(3) fiscal year 2014, $14,020,000; and
317.3(4) fiscal year 2015, $14,020,000.
317.4(b) The commissioner shall authorize the
317.5transfer of sufficient TANF funds to the
317.6federal child care and development fund to
317.7meet this appropriation and shall ensure that
317.8all transferred funds are expended according
317.9to federal child care and development fund
317.10regulations.
317.11Food Stamps Employment and Training
317.12Funds. (a) Notwithstanding Minnesota
317.13Statutes, sections 256D.051, subdivisions 1a,
317.146b, and 6c, and 256J.626, federal food stamps
317.15employment and training funds received
317.16as reimbursement for child care assistance
317.17program expenditures must be deposited in
317.18the general fund. The amount of funds must
317.19be limited to $500,000 per year in fiscal
317.20years 2012 through 2015, contingent upon
317.21approval by the federal Food and Nutrition
317.22Service.
317.23(b) Consistent with the receipt of these
317.24federal funds, the commissioner may
317.25adjust the level of working family credit
317.26expenditures claimed as TANF maintenance
317.27of effort. Notwithstanding any contrary
317.28provision in this article, this rider expires
317.29June 30, 2015.
317.30ARRA Food Support Benefit Increases.
317.31The funds provided for food support benefit
317.32increases under the Supplemental Nutrition
317.33Assistance Program provisions of the
317.34American Recovery and Reinvestment Act
318.1(ARRA) of 2009 must be used for benefit
318.2increases beginning July 1, 2009.
318.3Supplemental Security Interim Assistance
318.4Reimbursement Funds. $2,800,000 of
318.5uncommitted revenue available to the
318.6commissioner of human services for SSI
318.7advocacy and outreach services must be
318.8transferred to and deposited into the general
318.9fund by June 30, 2012.

318.10

Subd. 2.Central Office Operations

318.11The amounts that may be spent from this
318.12appropriation for each purpose are as follows:

318.13

(a) Operations

318.14	Appropriations by Fund
318.15	General	81,458,000	80,335,000
318.16	Health Care Access	11,742,000	11,508,000
318.17 318.18	State Government Special Revenue	440,000	440,000
318.19	Federal TANF	222,000	222,000

318.20DHS Receipt Center Accounting. The
318.21commissioner is authorized to transfer
318.22appropriations to, and account for DHS
318.23receipt center operations in, the special
318.24revenue fund.
318.25Base Adjustment. The general fund base
318.26for fiscal year 2014 shall be increased by
318.27$79,000. This adjustment is onetime.

318.28

(b) Children and Families

318.29	Appropriations by Fund
318.30	General	9,615,000	9,417,000
318.31	Federal TANF	2,160,000	2,160,000

318.32Financial Institution Data Match and
318.33Payment of Fees. The commissioner is
318.34authorized to allocate up to $310,000 each
318.35year in fiscal years 2012 and 2013 from the
319.1PRISM special revenue account to make
319.2payments to financial institutions in exchange
319.3for performing data matches between account
319.4information held by financial institutions
319.5and the public authority's database of child
319.6support obligors as authorized by Minnesota
319.7Statutes, section 13B.06, subdivision 7.

319.8

(c) Health Care

319.9	Appropriations by Fund
319.10	General	16,284,000	16,030,000
319.11	Health Care Access	22,574,000	26,555,000

319.12Minnesota Senior Health Options
319.13Reimbursement. Federal administrative
319.14reimbursement resulting from the Minnesota
319.15senior health options project is appropriated
319.16to the commissioner for this activity.
319.17Utilization Review. Federal administrative
319.18reimbursement resulting from prior
319.19authorization and inpatient admission
319.20certification by a professional review
319.21organization shall be dedicated to the
319.22commissioner for these purposes. A portion
319.23of these funds must be used for activities to
319.24decrease unnecessary pharmaceutical costs
319.25in medical assistance.
319.26Base Adjustment. The general fund base
319.27shall be decreased by $2,000 in fiscal year
319.282014 and $114,000 in 2015.
319.29The health care access fund base is decreased
319.30by $16,000 in fiscal year 2014 and $142,000
319.31in 2015.

319.32

(d) Continuing Care

320.1	Appropriations by Fund
320.2	General	18,110,000	18,011,000
320.3 320.4	State Government Special Revenue	125,000	125,000

320.5Region 10 Administrative Expenses.
320.6$100,000 is appropriated each fiscal
320.7year, beginning in fiscal year 2012, for
320.8the administration of the State Quality
320.9Improvement and Licensing System under
320.10Minnesota Statutes, section 256B.0961.
320.11Base Adjustment. The general fund base is
320.12decreased by $259,000 in each of fiscal years
320.132014 and 2015.

320.14

(e) Chemical and Mental Health

320.15	Appropriations by Fund
320.16	General	4,194,000	4,194,000
320.17	Lottery Prize	157,000	157,000

320.18

Subd. 3.Forecasted Programs

320.19The amounts that may be spent from this
320.20appropriation for each purpose are as follows:

320.21

(a) MFIP/DWP Grants

320.22	Appropriations by Fund
320.23	General	84,256,000	91,212,000
320.24	Federal TANF	84,425,000	75,417,000

320.25

(b) MFIP Child Care Assistance Grants

55,726,000

26,652,000

320.26

(c) General Assistance Grants

43,629,000

42,440,000

320.27General Assistance Standard. The
320.28commissioner shall set the monthly standard
320.29of assistance for general assistance units
320.30consisting of an adult recipient who is
320.31childless and unmarried or living apart
320.32from parents or a legal guardian at $203.
320.33The commissioner may reduce this amount
321.1according to Laws 1997, chapter 85, article
321.23, section 54.
321.3Emergency General Assistance. The
321.4amount appropriated for emergency general
321.5assistance funds is limited to no more
321.6than $7,889,812 in fiscal year 2012 and
321.7$7,889,812 in fiscal year 2013. Funds
321.8to counties shall be allocated by the
321.9commissioner using the allocation method
321.10specified in Minnesota Statutes, section
321.11256D.06.

321.12

(d) Minnesota Supplemental Aid Grants

38,091,000

39,092,000

321.13Emergency Minnesota Supplemental
321.14Aid Funds. The amount appropriated for
321.15emergency Minnesota supplemental aid
321.16funds is limited to no more than $1,100,000
321.17in fiscal year 2012 and $1,100,000 in fiscal
321.18year 2013. Funds to counties shall be
321.19allocated by the commissioner using the
321.20allocation method specified in Minnesota
321.21Statutes, section 256D.46.

321.22

(e) Group Residential Housing Grants

121,092,000

129,250,000

321.23

(f) MinnesotaCare Grants

351,927,000

361,755,000

321.24This appropriation is from the health care
321.25access fund.

321.26

(g) GAMC Grants

120,000,000

280,000,000

321.27Coordinated Care Delivery System. This
321.28appropriation is to fund coordinated care
321.29delivery systems under Minnesota Statutes,
321.30section 256D.031, subdivision 6.
321.31Payments for Cost Settlements. The
321.32commissioner is authorized to use amounts
321.33repaid to the general assistance medical care
321.34program under Minnesota Statutes 2009
322.1Supplement, section 256D.03, subdivision
322.23, to pay cost settlements for claims for
322.3services provided prior to June 1, 2010.
322.4Notwithstanding any contrary provision in
322.5this article, this provision does not expire.
322.6Base Adjustment. The general fund base is
322.7reduced by $120,000,000 in fiscal year 2014
322.8and by $280,000,000 in fiscal year 2015.

322.9

(h) Medical Assistance Grants

4,253,018,000

3,602,473,000

322.10Managed Care Incentive Payments. The
322.11commissioner shall not make managed care
322.12incentive payments for expanding preventive
322.13services during fiscal years beginning July 1,
322.142011 and July 1, 2012.
322.15Reduction of Rates for Congregate
322.16Living for Individuals with Lower Needs.
322.17Beginning October 1, 2011, lead agencies
322.18must reduce rates in effect on January 1,
322.192011, by ten percent for individuals with
322.20lower needs living in foster care settings
322.21where the license holder does not share the
322.22residence with recipients on the CADI, DD,
322.23and TBI waivers and customized living
322.24settings for CADI and TBI. Lead agencies
322.25must adjust contracts within 60 days of the
322.26effective date.
322.27Reduction of Lead Agency Waiver
322.28Allocations to Implement Rate Reductions
322.29for Congregate Living for Individuals
322.30with Lower Needs. Beginning October 1,
322.312011, the commissioner shall reduce lead
322.32agency waiver allocations to implement the
322.33reduction of rates for individuals with lower
322.34needs living in foster care settings where the
322.35license holder does not share the residence
323.1with recipients on the CADI, DD, and TBI
323.2waivers and customized living settings for
323.3CADI and TBI.
323.4Reduce customized living and 24-hour
323.5customized living component rates.
323.6Effective July 1, 2011, the commissioner
323.7shall reduce elderly waiver customized living
323.8and 24-hour customized living component
323.9service spending by ten percent through
323.10reductions in component rates and service
323.11rate limits. The commissioner shall adjust
323.12the elderly waiver capitation payment
323.13rates for managed care organizations paid
323.14under Minnesota Statutes, section 256B.69,
323.15subdivisions 6a and 23, to reflect reductions
323.16in component spending for customized living
323.17services and 24-hour customized living
323.18services under Minnesota Statutes, section
323.19256B.0915, subdivisions 3e and 3h, for the
323.20contract period beginning January 1, 2012.
323.21To implement the reduction specified in
323.22this provision, capitation rates paid by the
323.23commissioner to managed care organizations
323.24under Minnesota Statutes, section 256B.69,
323.25shall reflect a 20 percent reduction for the
323.26specified services for the period January 1,
323.272012, to June 30, 2012, and a ten percent
323.28reduction for those services on or after July
323.291, 2012.
323.30Limit Growth in the Developmental
323.31Disability Waiver. For the biennium
323.32beginning July 1, 2011, the commissioner
323.33shall limit the developmental disability
323.34waiver to the number of recipients served
323.35in March 2010. To achieve this level, the
323.36commissioner shall not refill waiver openings
324.1until the number of waiver recipients
324.2reaches the March 2010 level. Once the
324.3March 2010 enrollment level is reached, the
324.4commissioner shall refill vacated openings to
324.5maintain the March 2010 enrollment level.
324.6To the extent possible, waiver allocations
324.7shall be available to individuals who meet
324.8the priorities for accessing waiver services
324.9described in Minnesota Statutes, section
324.10256B.092, subdivision 12. The limits do not
324.11include conversions from intermediate care
324.12facilities for persons with developmental
324.13disabilities. When implementing the waiver
324.14enrollment limits under this provision, it
324.15is an absolute defense to an appeal under
324.16Minnesota Statutes, section 256.045, if
324.17the commissioner or lead agency proves
324.18that it followed the established written
324.19procedures and criteria and determined that
324.20home and community-based services could
324.21not be provided to the person within the
324.22appropriations or lead agency's allocation of
324.23home and community-based services money.
324.24Limit Growth in the Community
324.25Alternatives for Disabled Individuals
324.26Waiver. For the biennium beginning
324.27July 1, 2011, the commissioner shall limit
324.28the community alternatives for disabled
324.29individuals waiver to the number of
324.30recipients served in March 2010. To achieve
324.31this level, the commissioner shall not
324.32refill waiver openings until the number of
324.33waiver recipients reaches the March 2010
324.34level. Once the March 2010 enrollment
324.35level is reached, the commissioner shall
324.36refill vacated openings to maintain the
325.1March 2010 enrollment level. To the
325.2extent possible, waiver allocations shall
325.3be available to individuals who meet the
325.4priorities for accessing waiver services
325.5described in Minnesota Statutes, section
325.6256B.49, subdivision 11a. The limits include
325.7conversions and diversions, unless the
325.8commissioner has approved a plan to convert
325.9funding due to the closure or downsizing
325.10of a residential facility or nursing facility
325.11to serve directly affected individuals on
325.12the community alternatives for disabled
325.13individuals waiver. When implementing
325.14the waiver enrollment limits under this
325.15provision, it is an absolute defense to an
325.16appeal under Minnesota Statutes, section
325.17256.045, if the commissioner or lead agency
325.18proves that it followed the established written
325.19procedures and criteria and determined that
325.20home and community-based services could
325.21not be provided to the person within the
325.22appropriations or lead agency's allocation of
325.23home and community-based services money.
325.24Limit Growth in the Waiver for
325.25Individuals with Traumatic Brain Injury.
325.26For the biennium beginning July 1, 2011,
325.27the commissioner shall limit the traumatic
325.28brain injury waiver to the number of
325.29recipients served in March 2010. To achieve
325.30this level, the commissioner shall not
325.31refill waiver openings until the number of
325.32waiver recipients reaches the March 2010
325.33level. Once the March 2010 enrollment
325.34level is reached, the commissioner shall
325.35refill vacated openings to maintain the
325.36March 2010 enrollment level. To the
326.1extent possible, waiver allocations shall
326.2be available to individuals who meet the
326.3priorities for accessing waiver services
326.4described in Minnesota Statutes, section
326.5256B.49, subdivision 11a. The limits include
326.6conversions and diversions, unless the
326.7commissioner has approved a plan to convert
326.8funding due to the closure or downsizing of a
326.9residential facility or nursing facility to serve
326.10directly affected individuals on the traumatic
326.11brain injury waiver. When implementing
326.12the waiver enrollment limits under this
326.13provision, it is an absolute defense to an
326.14appeal under Minnesota Statutes, section
326.15256.045, if the commissioner or lead agency
326.16proves that it followed the established written
326.17procedures and criteria and determined that
326.18home and community-based services could
326.19not be provided to the person within the
326.20appropriations or lead agency's allocation of
326.21home and community-based services money.
326.22Management of Fee-for-Service Spending.
326.23Total state and federal funding for the
326.24biennium beginning on July 1, 2011, for
326.25fee-for-service medical assistance basic care
326.26for the elderly and persons with disabilities
326.27is limited to $2,536,949,000. Total state and
326.28federal funding for the biennium beginning
326.29July 1, 2011, for fee-for-service medical
326.30assistance basic care for adults without
326.31children is limited to $526,251,000.
326.32(1) Total state and federal funding for
326.33fee-for-service medical assistance basic care
326.34for the elderly and persons with disabilities is
326.35limited to $950,183,000 for fiscal year 2012
326.36and $1,115,961,000 for fiscal year 2013.
327.1(2) The commissioner shall contract with
327.2a vendor to manage spending within these
327.3limits, beginning January 1, 2012. The
327.4vendor selected may:
327.5(i) manage and coordinate the care provided
327.6by high-cost providers;
327.7(ii) implement payment reform initiatives to
327.8encourage efficient and cost-effective service
327.9provision;
327.10(iii) identify and deny payment for
327.11unnecessary services; and
327.12(iv) implement other initiatives proven to
327.13improve the efficiency of fee-for-service care
327.14delivery.
327.15The contract with the vendor must be
327.16on a contingency basis, under which the
327.17vendor retains six percent of any savings
327.18obtained from management of fee-for-service
327.19spending.
327.20(3) The commissioner, by October 1,
327.212012, shall evaluate the extent to which
327.22initiatives implemented by the vendor will
327.23be successful in managing spending within
327.24the specified limits. If the commissioner
327.25determines that the vendor will not be
327.26successful in managing spending within
327.27the specified limits, the commissioner shall
327.28reduce medical assistance provider payments
327.29by an amount sufficient to comply with
327.30the spending limits. In implementing rate
327.31reductions, the commissioner shall exempt
327.32payments to nursing facilities and providers
327.33of home and community-based waiver
327.34services. No provider payment reduction
328.1shall affect services provided to the elderly
328.2or persons with disabilities.
328.3Contingent Rate Reductions. If
328.4the commissioner determines that
328.5implementation of the global waiver under
328.6Minnesota Statutes, sections 256B.841,
328.7256B.842, and 256B.843, will not achieve a
328.8state general fund savings of $300,000,000
328.9for the biennium beginning July 1, 2011, the
328.10commissioner shall calculate an estimate
328.11of the shortfall in savings, and, for the
328.12fiscal year beginning July 1, 2012, shall
328.13reduce medical assistance provider payment
328.14rates, including but not limited to rates to
328.15individual health care providers and provider
328.16agencies, hospitals, other residential settings,
328.17and capitation rates provided to managed
328.18care and county-based purchasing plans, by
328.19the amount necessary to recoup the shortfall
328.20in savings over that fiscal year. No provider
328.21payment reduction shall affect services
328.22provided to the elderly or persons with
328.23disabilities.

328.24

(i) Alternative Care Grants

44,630,000

44,689,000

328.25Alternative Care Transfer. Any money
328.26allocated to the alternative care program that
328.27is not spent for the purposes indicated does
328.28not cancel but shall be transferred to the
328.29medical assistance account.

328.30

(j) Chemical Dependency Entitlement Grants

104,113,000

127,281,000

328.31

Subd. 4.Grant Programs

328.32The amounts that may be spent from this
328.33appropriation for each purpose are as follows:

328.34

(a) Support Services Grants

329.1	Appropriations by Fund
329.2	General	8,715,000	8,715,000
329.3	Federal TANF	96,525,000	90,611,000

329.4MFIP Consolidated Fund Grants. The
329.5TANF fund base is reduced by $14,000,000
329.6each year beginning in fiscal year 2012.
329.7Subsidized Employment Funding Through
329.8ARRA. The commissioner is authorized to
329.9apply for TANF emergency fund grants for
329.10subsidized employment activities. Growth
329.11in expenditures for subsidized employment
329.12within the supported work program and the
329.13MFIP consolidated fund over the amount
329.14expended in the calendar year quarters in
329.15the TANF emergency fund base year shall
329.16be used to leverage the TANF emergency
329.17fund grants for subsidized employment and
329.18to fund supported work. The commissioner
329.19shall develop procedures to maximize
329.20reimbursement of these expenditures over the
329.21TANF emergency fund base year quarters,
329.22and may contract directly with employers
329.23and providers to maximize these TANF
329.24emergency fund grants.
329.25Healthy Communities. $150,000 in fiscal
329.26year 2012 and $150,000 in fiscal year 2013
329.27are appropriated from the general fund to
329.28the commissioner of human services for
329.29contracting with the Search Institute to
329.30promote healthy community initiatives.
329.31The commissioner may expend up to five
329.32percent of the appropriation to provide for
329.33the program evaluation.
329.34Circles of Support. $200,000 in fiscal year
329.352012 and $200,000 in fiscal year 2013 are
330.1appropriated from the general fund to the
330.2commissioner of human services for the
330.3purpose of providing grants to community
330.4action agencies for circles of support
330.5initiatives.
330.6Northern Connections. $100,000 is
330.7appropriated in fiscal year 2012 and
330.8$100,000 is appropriated in fiscal year 2013
330.9from the general fund to the commissioner
330.10of human services for a grant to expand
330.11Northern Connections workforce program
330.12that provides one-stop supportive services
330.13to individuals as they transition into the
330.14workforce to up to two interested counties in
330.15rural Minnesota.

330.16 330.17

(b) Basic Sliding Fee Child Care Assistance Grants

38,131,000

41,035,000

330.18Base Adjustment. The general fund base is
330.19decreased by $1,131,000 in fiscal year 2014
330.20and $1,126,000 in fiscal year 2015.
330.21Child Care and Development Fund
330.22Unexpended Balance. In addition to
330.23the amount provided in this section, the
330.24commissioner shall expend $5,000,000
330.25in fiscal year 2012 from the federal child
330.26care and development fund unexpended
330.27balance for basic sliding fee child care under
330.28Minnesota Statutes, section 119B.03. The
330.29commissioner shall ensure that all child
330.30care and development funds are expended
330.31according to the federal child care and
330.32development fund regulations.

330.33

(c) Child Care Development Grants

1,487,000

1,487,000

330.34

(d) Child Support Enforcement Grants

50,000

50,000

331.1Federal Child Support Demonstration
331.2Grants. Federal administrative
331.3reimbursement resulting from the federal
331.4child support grant expenditures authorized
331.5under section 1115a of the Social Security
331.6Act is appropriated to the commissioner for
331.7this activity.

331.8

(e) Children's Services Grants

331.9	Appropriations by Fund
331.10	General	46,788,000	46,788,000
331.11	Federal TANF	140,000	140,000

331.12Adoption Assistance and Relative Custody
331.13Assistance Payments. $1,661,000 each
331.14year is for continuation of current payments
331.15for adoption assistance and relative custody
331.16assistance.
331.17Adoption Assistance and Relative Custody
331.18Assistance Transfer. The commissioner
331.19may transfer unencumbered appropriation
331.20balances for adoption assistance and relative
331.21custody assistance between fiscal years and
331.22between programs.
331.23Privatized Adoption Grants. Federal
331.24reimbursement for privatized adoption grant
331.25and foster care recruitment grant expenditures
331.26is appropriated to the commissioner for
331.27adoption grants and foster care and adoption
331.28administrative purposes.
331.29Adoption Assistance Incentive Grants.
331.30Federal funds available during fiscal year
331.312012 and fiscal year 2013 for adoption
331.32incentive grants are appropriated to the
331.33commissioner for these purposes.

331.34

(f) Children and Community Services Grants

64,301,000

64,301,000

332.1

(g) Children and Economic Support Grants

16,755,000

16,265,000

332.2Long-term homeless services. $700,000
332.3is appropriated from the federal TANF
332.4fund for the biennium beginning July
332.51, 2011, to the commissioner of human
332.6services for long-term homeless services
332.7for low-income homeless families under
332.8Minnesota Statutes, section 256K.26. This
332.9is a onetime appropriation and is not added
332.10to the base.
332.11Base Adjustment. The general fund base
332.12is increased by $491,000 in fiscal year 2014
332.13only.

332.14

(h) Health Care Grants

332.15	Appropriations by Fund
332.16	General	195,000	-0-
332.17	Health Care Access	900,000	900,000

332.18Surplus Appropriation Canceled. Of the
332.19appropriation in Laws 2009, chapter 79,
332.20article 13, section 3, subdivision 6, paragraph
332.21(e), for the COBRA premium state subsidy
332.22program, $11,750,000 must be canceled in
332.23fiscal year 2011. This provision is effective
332.24the day following final enactment.
332.25Grant Cancellation. Effective for the
332.26biennium beginning July 1, 2011, the
332.27following appropriations are canceled: (1) a
332.28general fund appropriation of $205,000 for
332.29the U Special Kids program; (2) a general
332.30fund appropriation of $90,000 for medical
332.31assistance outreach grants; and (3) a health
332.32care access fund appropriation of $40,000 for
332.33MinnesotaCare outreach grants.
333.1State Subsidy Program for Community
333.2Mental Health Centers. $100,000 is
333.3appropriated from the general fund to
333.4the commissioner of human services for
333.5the biennium beginning July 1, 2011, to
333.6provide onetime grants to establish new
333.7community mental health centers that are
333.8eligible for payment under Minnesota
333.9Statutes, section 256B.0625, subdivision 5.
333.10In awarding grants, the commissioner shall
333.11give preference to areas of the state that
333.12lack access to mental health services or are
333.13underserved.

333.14

(i) Aging and Adult Services Grants

18,734,000

18,910,000

333.15Aging Grants Reduction. Effective July
333.161, 2011, funding for grants made under
333.17Minnesota Statutes, sections 256.9754 and
333.18256B.0917, subdivision 13, is reduced by
333.19$3,600,000 for each year of the biennium.
333.20These reductions are onetime and do
333.21not affect base funding for the 2014-2015
333.22biennium. Grants made during the 2012-2013
333.23biennium under Minnesota Statutes, section
333.24256B.9754, must not be used for new
333.25construction or building renovation.
333.26Essential Community Support Grant
333.27Delay. Essential community supports
333.28grants under Minnesota Statutes, section
333.29256B.0917, subdivision 14, is reduced
333.30by $6,410,000 in fiscal year 2012 and
333.31$7,279,000 in fiscal year 2013. Base level
333.32funding for fiscal year 2014 is reduced by
333.33$5,919,000. These reductions are onetime
333.34and do not affect base level funding for fiscal
333.35year 2015.

334.1

(j) Deaf and Hard-of-Hearing Grants

1,936,000

1,767,000

334.2

(k) Disabilities Grants

22,025,000

23,863,000

334.3Money Follows the Person Rebalancing
334.4Demonstration Project. Notwithstanding
334.5the provisions of Minnesota Statutes, section
334.6256.011, subdivision 3, estimated general
334.7fund savings resulting from the operation of
334.8the Money Follows the Person federal grant
334.9fund must be retained within the medical
334.10assistance general fund appropriation for the
334.11payment of federally required rebalancing
334.12expenditures. If a rebalancing expenditure
334.13is not eligible for medical assistance, the
334.14corresponding portion of estimated savings
334.15must be transferred to and paid from a special
334.16revenue account established for this purpose.
334.17Money in the account does not cancel and
334.18is appropriated to the commissioner for the
334.19purposes of the demonstration project.
334.20Region 10. Any unspent allocation for
334.21Region 10 Quality Assurance from the
334.22biennium beginning on July 1, 2009, may be
334.23carried over into the biennium beginning on
334.24July 1, 2011.
334.25Local Planning Grants for Creating
334.26Alternatives to Congregate Living for
334.27Individuals with Lower Needs. The
334.28commissioner shall make available a total
334.29of $250,000 per year in local planning
334.30grants, beginning July 1, 2011, to assist
334.31lead agencies and provider organizations in
334.32developing alternatives to congregate living
334.33within the available level of resources for the
334.34home and community-based services waivers
334.35for persons with disabilities.

335.1

(l) Adult Mental Health Grants

335.2	Appropriations by Fund
335.3	General	77,539,000	77,539,000
335.4	Lottery Prize Fund	1,508,000	1,508,000

335.5Funding Usage. Up to 75 percent of a fiscal
335.6year's appropriation for adult mental health
335.7grants may be used to fund allocations in that
335.8portion of the fiscal year ending December
335.931.
335.10Base Adjustment. The lottery prize fund
335.11base for this program shall be increased by
335.12$78,000 in each of fiscal years 2014 and
335.132015.

335.14

(m) Children's Mental Health Grants

16,682,000

16,682,000

335.15Funding Usage. Up to 75 percent of a fiscal
335.16year's appropriation for children's mental
335.17health grants may be used to fund allocations
335.18in that portion of the fiscal year ending
335.19December 31.

335.20 335.21

(n) Chemical Dependency Nonentitlement Grants

1,336,000

1,336,000

335.22

Subd. 5.State-Operated Services

335.23Transfer Authority Related to
335.24State-Operated Services. Money
335.25appropriated for state-operated services
335.26may be transferred between fiscal years
335.27of the biennium with the approval of the
335.28commissioner of management and budget.

335.29

(a) State-Operated Services Mental Health

115,286,000

115,135,000

335.30State-Operated Services. To achieve these
335.31savings, the commissioner shall close the
335.32Willmar Community Behavioral Health
335.33Hospital no later than October 1, 2011, and
335.34shall close the inpatient child and adolescent
336.1behavioral health service program in
336.2Willmar, the subacute mental health facility
336.3in Wadena, and the community behavioral
336.4health hospitals in Alexandria, Annandale,
336.5Baxter, Bemidji, Fergus Falls, and Rochester
336.6no later than October 1, 2012.
336.7Base Adjustment. The general fund base is
336.8reduced by $8,443,000 in fiscal year 2014
336.9and $11,543,000 in fiscal year 2015.

336.10

(b) Minnesota Security Hospital

69,582,000

69,582,000

336.11

Subd. 6.Sex Offender Program

70,416,000

67,570,000

336.12Transfer Authority Related to Minnesota
336.13Sex Offender Program. Money
336.14appropriated for the Minnesota sex offender
336.15program may be transferred between fiscal
336.16years of the biennium with the approval
336.17of the commissioner of management and
336.18budget.
336.19Minnesota Sex Offender Program
336.20Reduction. The fiscal year 2011 general
336.21fund appropriation for Minnesota sex
336.22offender services under Laws 2009, chapter
336.2379, article 13, section 3, subdivision 10,
336.24paragraph (b), is reduced by $3,000,000.

336.25

Subd. 7.Technical Activities

78,206,000

102,551,000

336.26This appropriation is from the federal TANF
336.27fund.

336.28

Sec. 4. COMMISSIONER OF HEALTH

336.29

Subdivision 1.Total Appropriation

$

147,939,000

$

136,632,000

336.30	Appropriations by Fund
336.31		2012	2013
336.32	General	77,634,000	72,738,000
336.33 336.34	State Government Special Revenue	45,268,000	45,325,000
337.1	Health Care Access	13,774,000	9,162,000
337.2	Federal TANF	11,713,000	11,713,000

337.3The amounts that may be spent for each
337.4purpose are specified in the following
337.5subdivisions.

337.6 337.7

Subd. 2.Community and Family Health Promotion

337.8	Appropriations by Fund
337.9	General	50,430,000	45,690,000
337.10 337.11	State Government Special Revenue	1,033,000	1,033,000
337.12	Health Care Access	2,918,000	2,459,000
337.13	Federal TANF	11,713,000	11,713,000

337.14TANF Appropriations. (1) $1,156,000 of
337.15the TANF funds is appropriated each year to
337.16the commissioner for family planning grants
337.17under Minnesota Statutes, section 145.925.
337.18(2) $3,579,000 of the TANF funds is
337.19appropriated each year to the commissioner
337.20for home visiting and nutritional services
337.21listed under Minnesota Statutes, section
337.22145.882, subdivision 7, clauses (6) and (7).
337.23Funds must be distributed to community
337.24health boards according to Minnesota
337.25Statutes, section 145A.131, subdivision 1.
337.26(3) $2,000,000 of the TANF funds is
337.27appropriated each year to the commissioner
337.28for decreasing racial and ethnic disparities
337.29in infant mortality rates under Minnesota
337.30Statutes, section 145.928, subdivision 7.
337.31(4) $4,978,000 of the TANF funds is
337.32appropriated each year to the commissioner
337.33for the family home visiting grant program
337.34according to Minnesota Statutes, section
337.35145A.17. $4,000,000 of the funding must
337.36be distributed to community health boards
338.1according to Minnesota Statutes, section
338.2145A.131, subdivision 1. $978,000 of
338.3the funding must be distributed to tribal
338.4governments based on Minnesota Statutes,
338.5section 145A.14, subdivision 2a.
338.6(5) The commissioner may use up to 6.23
338.7percent of the funds appropriated each fiscal
338.8year to conduct the ongoing evaluations
338.9required under Minnesota Statutes, section
338.10145A.17, subdivision 7, and training and
338.11technical assistance as required under
338.12Minnesota Statutes, section 145A.17,
338.13subdivisions 4 and 5.
338.14TANF Carryforward. Any unexpended
338.15balance of the TANF appropriation in the
338.16first year of the biennium does not cancel but
338.17is available for the second year.

338.18

Subd. 3.Policy Quality and Compliance

338.19	Appropriations by Fund
338.20	General	10,434,000	10,230,000
338.21 338.22	State Government Special Revenue	14,026,000	14,083,000
338.23	Health Care Access	10,856,000	6,703,000

338.24MERC Fund Transfers. The commissioner
338.25of management and budget shall transfer
338.26$9,800,000 from the MERC fund to the
338.27general fund by October 1, 2011.
338.28Comprehensive Advanced Life Support.
338.29Of the general fund appropriation, $31,000
338.30each year is added to the base of the
338.31comprehensive advanced life support
338.32(CALS) program under Minnesota Statutes,
338.33section 144.6062.
338.34Unused Federal Match Funds. Of the
338.35funds appropriated in Laws 2009, chapter
339.179, article 13, section 4, subdivision 3, for
339.2state matching funds for the federal Health
339.3Information Technology for Economic and
339.4Clinical Health Act, $2,800,000 is transferred
339.5to the health care access fund by October 1,
339.62011.
339.7Health Careers Opportunities Grants.
339.8$447,000 each year is appropriated to the
339.9commissioner of health from the health
339.10care access fund for the health careers
339.11opportunities grant program under Minnesota
339.12Statutes, section 144.1499.
339.13Health Professions Opportunities
339.14Scholarship Program. $63,000 each year is
339.15appropriated to the commissioner of health
339.16from the health care access fund for the
339.17health professions opportunities scholarship
339.18program under Minnesota Statutes, section
339.19144.1503. $138,000 in fiscal year 2012 and
339.20$276,000 each year thereafter is appropriated
339.21to the commissioner of health from the
339.22general fund for the health professions
339.23opportunities scholarship program under
339.24Minnesota Statutes, section 144.1503.
339.25Base Level Adjustment. The state
339.26government special revenue fund base shall
339.27be reduced by $141,000 in fiscal years 2014
339.28and 2015. The health care access base shall
339.29be increased by $600,000 in fiscal year 2014.

339.30

Subd. 4.Health Protection

339.31	Appropriations by Fund
339.32	General	9,370,000	9,370,000
339.33 339.34	State Government Special Revenue	30,209,000	30,209,000

339.35

Subd. 5.Administrative Support Services

7,400,000

7,448,000

340.1

Sec. 5. COUNCIL ON DISABILITY

$

524,000

$

524,000

340.2 340.3 340.4

Sec. 6. OMBUDSMAN FOR MENTAL HEALTH AND DEVELOPMENTAL DISABILITIES

$

1,655,000

$

1,655,000

340.5Funds appropriated for fiscal year 2011 are
340.6available until expended.

340.7

Sec. 7. OMBUDSPERSON FOR FAMILIES

$

265,000

$

265,000

340.8

Sec. 8. HEALTH-RELATED BOARDS

340.9

Subdivision 1.Total Appropriation

$

17,365,000

$

17,264,000

340.10This appropriation is from the state
340.11government special revenue fund. The
340.12amounts that may be spent for each purpose
340.13are specified in the following subdivisions.

340.14

Subd. 2.Board of Chiropractic Examiners

469,000

469,000

340.15

Subd. 3.Board of Dentistry

1,959,000

1,914,000

340.16Health Professional Services Program.
340.17$834,000 in fiscal year 2012 and $804,000 in
340.18fiscal year 2013 from the state government
340.19special revenue fund are for the health
340.20professional services program.

340.21 340.22

Subd. 4.Board of Dietetic and Nutrition Practice

110,000

110,000

340.23 340.24

Subd. 5.Board of Marriage and Family Therapy

192,000

167,000

340.25Rulemaking. Of this appropriation, $25,000
340.26in fiscal year 2012 is for rulemaking. This is
340.27a onetime appropriation.

340.28

Subd. 6.Board of Medical Practice

3,866,000

3,866,000

340.29

Subd. 7.Board of Nursing

3,545,000

3,545,000

340.30 340.31

Subd. 8.Board of Nursing Home Administrators

2,153,000

2,145,000

341.1Rulemaking. Of this appropriation, $44,000
341.2in fiscal year 2012 is for rulemaking. This is
341.3a onetime appropriation.
341.4Electronic Licensing System Adaptors.
341.5Of this appropriation, $761,000 in fiscal
341.6year 2013 from the state government special
341.7revenue fund is to the administrative services
341.8unit to cover the costs to connect to the
341.9e-licensing system. Minnesota Statutes,
341.10section 16E.22. Base level funding for this
341.11activity in fiscal year 2014 shall be $100,000.
341.12Base level funding for this activity in fiscal
341.13year 2015 shall be $50,000.
341.14Development and Implementation of a
341.15Disciplinary, Regulatory, Licensing and
341.16Information Management System. Of this
341.17appropriation, $800,000 in fiscal year 2012
341.18and $300,000 in fiscal year 2013 are for the
341.19development of a shared system. Base level
341.20funding for this activity in fiscal year 2014
341.21shall be $50,000.
341.22Administrative Services Unit - Operating
341.23Costs. Of this appropriation, $526,000
341.24in fiscal year 2012 and $526,000 in
341.25fiscal year 2013 are for operating costs
341.26of the administrative services unit. The
341.27administrative services unit may receive
341.28and expend reimbursements for services
341.29performed by other agencies.
341.30Administrative Services Unit - Retirement
341.31Costs. Of this appropriation in fiscal year
341.322012, $225,000 is for onetime retirement
341.33costs in the health-related boards. This
341.34funding may be transferred to the health
341.35boards incurring those costs for their
342.1payment. These funds are available either
342.2year of the biennium.
342.3Administrative Services Unit - Volunteer
342.4Health Care Provider Program. Of this
342.5appropriation, $150,000 in fiscal year 2012
342.6and $150,000 in fiscal year 2013 are to pay
342.7for medical professional liability coverage
342.8required under Minnesota Statutes, section
342.9214.40.
342.10Administrative Services Unit - Contested
342.11Cases and Other Legal Proceedings.
342.12Of this appropriation, $200,000 in fiscal
342.13year 2012 and $200,000 in fiscal year
342.142013 are for costs of contested case
342.15hearings and other unanticipated costs of
342.16legal proceedings involving health-related
342.17boards funded under this section. Upon
342.18certification of a health-related board to the
342.19administrative services unit that the costs
342.20will be incurred and that there is insufficient
342.21money available to pay for the costs out of
342.22money currently available to that board, the
342.23administrative services unit is authorized
342.24to transfer money from this appropriation
342.25to the board for payment of those costs
342.26with the approval of the commissioner of
342.27finance. This appropriation does not cancel.
342.28Any unencumbered and unspent balances
342.29remain available for these expenditures in
342.30subsequent fiscal years.

342.31

Subd. 9.Board of Optometry

106,000

106,000

342.32

Subd. 10.Board of Pharmacy

1,977,000

1,980,000

342.33Prescription Electronic Reporting. Of
342.34this appropriation, $356,000 in fiscal year
342.352012 and $356,000 in fiscal year 2013 from
343.1the state government special revenue fund
343.2are to the board to operate the prescription
343.3electronic reporting system in Minnesota
343.4Statutes, section 152.126. Base level funding
343.5for this activity in fiscal year 2014 shall be
343.6$356,000.

343.7

Subd. 11.Board of Physical Therapy

389,000

345,000

343.8Rulemaking. Of this appropriation, $44,000
343.9in fiscal year 2012 is for rulemaking. This is
343.10a onetime appropriation.

343.11

Subd. 12.Board of Podiatry

75,000

75,000

343.12

Subd. 13.Board of Psychology

846,000

846,000

343.13

Subd. 14.Board of Social Work

1,036,000

1,053,000

343.14

Subd. 15.Board of Veterinary Medicine

228,000

229,000

343.15 343.16

Subd. 16.Board of Behavioral Health and Therapy

414,000

414,000

343.17 343.18

Sec. 9. EMERGENCY MEDICAL SERVICES BOARD

$

2,742,000

$

2,742,000

343.19Of the appropriation, $700,000 in fiscal year
343.202012 and $700,000 in fiscal year 2013 are
343.21for the Cooper/Sams volunteer ambulance
343.22program under Minnesota Statutes, section
343.23144E.40.

343.24    Sec. 10. Minnesota Statutes 2010, section 256.01, is amended by adding a subdivision
343.25to read:
343.26    Subd. 33. Federal administrative reimbursement dedicated. Federal
343.27administrative reimbursement resulting from the following activities is appropriated to the
343.28commissioner for the designated purposes:
343.29(1) reimbursement for the Minnesota senior health options project; and
343.30(2) reimbursement related to prior authorization and inpatient admission certification
343.31by a professional review organization. A portion of these funds must be used for activities
343.32to decrease unnecessary pharmaceutical costs in medical assistance.

344.1    Sec. 11. Laws 2010, First Special Session chapter 1, article 15, section 3, subdivision
344.26, is amended to read:

344.3

Subd. 6.Continuing Care Grants

344.4

(a) Aging and Adult Services Grants

(3,600,000)

(3,600,000)

344.5Community Service/Service Development
344.6Grants Reduction. Effective retroactively
344.7from July 1, 2009, funding for grants made
344.8under Minnesota Statutes, sections 256.9754
344.9and 256B.0917, subdivision 13, is reduced
344.10by $5,807,000 for each year of the biennium.
344.11Grants made during the biennium under
344.12Minnesota Statutes, section 256.9754, shall
344.13not be used for new construction or building
344.14renovation.
344.15Aging Grants Delay. Aging grants must be
344.16reduced by $917,000 in fiscal year 2011 and
344.17increased by $917,000 in fiscal year 2012.
344.18These adjustments are onetime and must not
344.19be applied to the base. This provision expires
344.20June 30, 2012.

344.21 344.22

(b) Medical Assistance Long-Term Care Facilities Grants

(3,827,000)

(2,745,000)

344.23ICF/MR Variable Rates Suspension.
344.24Effective retroactively from July 1, 2009,
344.25to June 30, 2010, no new variable rates
344.26shall be authorized for intermediate care
344.27facilities for persons with developmental
344.28disabilities under Minnesota Statutes, section
344.29256B.5013, subdivision 1 .
344.30ICF/MR Occupancy Rate Adjustment
344.31Suspension. Effective retroactively from
344.32July 1, 2009, to June 30, 2011, approval
344.33of new applications for occupancy rate
344.34adjustments for unoccupied short-term
345.1beds under Minnesota Statutes, section
345.2256B.5013, subdivision 7 , is suspended.

345.3 345.4

(c) Medical Assistance Long-Term Care Waivers and Home Care Grants

(2,318,000)

(5,807,000)

345.5Developmental Disability Waiver Acuity
345.6Factor. Effective retroactively from January
345.71, 2010, the January 1, 2010, one percent
345.8growth factor in the developmental disability
345.9waiver allocations under Minnesota Statutes,
345.10section 256B.092, subdivisions 4 and 5,
345.11that is attributable to changes in acuity,
345.12is suspended to June 30, 2011 eliminated.
345.13Effective January 1, 2012, the one percent
345.14growth factor in the developmental
345.15disability waiver allocations is eliminated.
345.16Notwithstanding any law to the contrary, this
345.17provision does not expire.

345.18

(d) Adult Mental Health Grants

(5,000,000)

-0-

345.19

(e) Chemical Dependency Entitlement Grants

(3,622,000)

(3,622,000)

345.20 345.21

(f) Chemical Dependency Nonentitlement Grants

(393,000)

(393,000)

345.22 345.23

(g) Other Continuing Care Grants

-0-

(2,500,000) (1,414,000)

345.24Other Continuing Care Grants Delay.
345.25Other continuing care grants must be reduced
345.26by $1,414,000 in fiscal year 2011 and
345.27increased by $1,414,000 in fiscal year 2012.
345.28These adjustments are onetime and must not
345.29be applied to the base. This provision expires
345.30June 30, 2012.

345.31

(h) Deaf and Hard-of-Hearing Grants

-0-

(169,000)

345.32Deaf and Hard-of-Hearing Grants Delay.
345.33Effective retroactively from July 1, 2010,
345.34deaf and hard-of-hearing grants must be
345.35reduced by $169,000 in fiscal year 2011 and
346.1increased by $169,000 in fiscal year 2012.
346.2These adjustments are onetime and must not
346.3be applied to the base. This provision expires
346.4June 30, 2012.

346.5    Sec. 12. TRANSFERS.
346.6    Subdivision 1. Grants. The commissioner of human services, with the approval
346.7of the commissioner of management and budget, and after notification of the chairs of
346.8the senate health and human services budget and policy committee and the house of
346.9representatives health and human services finance committee, may transfer unencumbered
346.10appropriation balances for the biennium ending June 30, 2013, within fiscal years among
346.11the MFIP; general assistance; general assistance medical care under Minnesota Statutes
346.122009 Supplement, section 256D.03, subdivision 3; medical assistance; MFIP child care
346.13assistance under Minnesota Statutes, section 119B.05; Minnesota supplemental aid;
346.14and group residential housing programs, and the entitlement portion of the chemical
346.15dependency consolidated treatment fund, and between fiscal years of the biennium.
346.16    Subd. 2. Administration. Positions, salary money, and nonsalary administrative
346.17money may be transferred within the Departments of Health and Human Services as the
346.18commissioners consider necessary, with the advance approval of the commissioner of
346.19management and budget. The commissioner shall inform the chairs of the senate health
346.20and human services budget and policy committee and the house of representatives health
346.21and human services finance committee quarterly about transfers made under this provision.

346.22    Sec. 13. INDIRECT COSTS NOT TO FUND PROGRAMS.
346.23The commissioners of health and human services shall not use indirect cost
346.24allocations to pay for the operational costs of any program for which they are responsible.

346.25    Sec. 14. EXPIRATION OF UNCODIFIED LANGUAGE.
346.26All uncodified language contained in this article expires on June 30, 2013, unless a
346.27different expiration date is explicit.

346.28    Sec. 15. EFFECTIVE DATE.
346.29The provisions in this article are effective July 1, 2011, unless a different effective
346.30date is specified.

347.1ARTICLE 10

347.2HUMAN SERVICES FORECAST ADJUSTMENTS

347.3 347.4

Section 1. DEPARTMENT OF HUMAN SERVICES FORECAST ADJUSTMENT APPROPRIATIONS.

347.5The sums shown are added to, or if shown in parentheses, are subtracted from the
347.6appropriations in Laws 2009, chapter 79, article 13, as amended by Laws 2009, chapter
347.7173, article 2; Laws 2010, First Special Session chapter 1, articles 15, 23, and 25; and
347.8Laws 2010, Second Special Session chapter 1, article 3, to the commissioner of human
347.9services and for the purposes specified in this article. The appropriations are from the
347.10general fund or another named fund and are available for the fiscal year indicated for
347.11each purpose. The figure "2011" used in this article means that the appropriation or
347.12appropriations listed are available for the fiscal year ending June 30, 2011.

347.13 347.14

Sec. 2. COMMISSIONER OF HUMAN SERVICES

347.15

Subdivision 1.Total Appropriation

$

(235,463,000)

347.16	Appropriations by Fund
347.17			2011
347.18	General		(381,869,000)
347.19	Health Care Access		169,514,000
347.20	Federal TANF		(23,108,000)

347.21The amounts that may be spent for each
347.22purpose are specified in the following
347.23subdivisions.

347.24

Subd. 2.Revenue and Pass-through

732,000

347.25This appropriation is from the federal TANF
347.26fund.

347.27 347.28

Subd. 3.Children and Economic Assistance Grants

347.29	Appropriations by Fund
347.30	General		(7,098,000)
347.31	Federal TANF		(23,840,000)

347.32

(a) MFIP/DWP Grants

347.33	Appropriations by Fund
347.34	General		18,715,000
347.35	Federal TANF		(23,840,000)

348.1

(b) MFIP Child Care Assistance Grants

(24,394,000)

348.2

(c) General Assistance Grants

(664,000)

348.3

(d) Minnesota Supplemental Aid Grants

793,000

348.4

(e) Group Residential Housing Grants

(1,548,000)

348.5

Subd. 4.Basic Health Care Grants

348.6	Appropriations by Fund
348.7	General		(335,050,000)
348.8	Health Care Access		169,514,000

348.9

(a) MinnesotaCare Grants

169,514,000

348.10This appropriation is from the health care
348.11access fund.

348.12 348.13

(b) Medical Assistance Basic Health Care - Families and Children

(49,368,000)

348.14 348.15

(c) Medical Assistance Basic Health Care - Elderly and Disabled

(43,258,000)

348.16 348.17

(d) Medical Assistance Basic Health Care - Adults without Children

(242,424,000)

348.18

Subd. 5.Continuing Care Grants

(39,721,000)

348.19 348.20

(a) Medical Assistance Long-Term Care Facilities

(14,627,000)

348.21 348.22

(b) Medical Assistance Long-Term Care Waivers

(44,718,000)

348.23

(c) Chemical Dependency Entitlement Grants

19,624,000

348.24    Sec. 3. Laws 2010, First Special Session chapter 1, article 25, section 3, subdivision 6,
348.25is amended to read:

348.26

Subd. 6.Health Care Grants

348.27

(a) MinnesotaCare Grants

998,000

(13,376,000)

348.28This appropriation is from the health care
348.29access fund.
348.30Health Care Access Fund Transfer to
348.31General Fund. The commissioner of
349.1management and budget shall transfer the
349.2following amounts in the following years
349.3from the health care access fund to the
349.4general fund: $998,000 $0 in fiscal year
349.52010; $176,704,000 $59,901,000 in fiscal
349.6year 2011; $141,041,000 in fiscal year 2012;
349.7and $286,150,000 in fiscal year 2013. If at
349.8any time the governor issues an executive
349.9order not to participate in early medical
349.10assistance expansion, no funds shall be
349.11transferred from the health care access
349.12fund to the general fund until early medical
349.13assistance expansion takes effect. This
349.14paragraph is effective the day following final
349.15enactment.
349.16MinnesotaCare Ratable Reduction.
349.17Effective for services rendered on or after
349.18July 1, 2010, to December 31, 2013,
349.19MinnesotaCare payments to managed care
349.20plans under Minnesota Statutes, section
349.21256L.12 , for single adults and households
349.22without children whose income is greater
349.23than 75 percent of federal poverty guidelines
349.24shall be reduced by 15 percent. Effective
349.25for services provided from July 1, 2010, to
349.26June 30, 2011, this reduction shall apply to
349.27all services. Effective for services provided
349.28from July 1, 2011, to December 31, 2013, this
349.29reduction shall apply to all services except
349.30inpatient hospital services. Notwithstanding
349.31any contrary provision of this article, this
349.32paragraph shall expire on December 31,
349.332013.

349.34 349.35

(b) Medical Assistance Basic Health Care Grants - Families and Children

-0-

295,512,000

350.1Critical Access Dental. Of the general
350.2fund appropriation, $731,000 in fiscal year
350.32011 is to the commissioner for critical
350.4access dental provider reimbursement
350.5payments under Minnesota Statutes, section
350.6256B.76 subdivision 4. This is a onetime
350.7appropriation.
350.8Nonadministrative Rate Reduction. For
350.9services rendered on or after July 1, 2010,
350.10to December 31, 2013, the commissioner
350.11shall reduce contract rates paid to managed
350.12care plans under Minnesota Statutes,
350.13sections 256B.69 and 256L.12, and to
350.14county-based purchasing plans under
350.15Minnesota Statutes, section 256B.692, by
350.16three percent of the contract rate attributable
350.17to nonadministrative services in effect on
350.18June 30, 2010. Notwithstanding any contrary
350.19provision in this article, this rider expires on
350.20December 31, 2013.

350.21 350.22

(c) Medical Assistance Basic Health Care Grants - Elderly and Disabled

-0-

(30,265,000)

350.23 350.24

(d) General Assistance Medical Care Grants

-0-

(75,389,000) (59,583,000)

350.25The reduction to general assistance medical
350.26care grants is contingent upon the effective
350.27date in Laws 2010, First Special Session
350.28chapter 1, article 16, section 48. The
350.29reduction shall be reestimated based upon
350.30the actual effective date of the law. The
350.31commissioner of management and budget
350.32shall make adjustments in fiscal year
350.332011 to general assistance medical care
350.34appropriations to conform to the total
350.35expected expenditure reductions specified in
350.36this section.

351.1

(e) Other Health Care Grants

-0-

(7,000,000)

351.2Cobra Carryforward. Unexpended funds
351.3appropriated in fiscal year 2010 for COBRA
351.4grants under Laws 2009, chapter 79, article
351.55, section 78, do not cancel and are available
351.6to the commissioner for fiscal year 2011
351.7COBRA grant expenditures. Up to $111,000
351.8of the fiscal year 2011 appropriation for
351.9COBRA grants provided in Laws 2009,
351.10chapter 79, article 13, section 3, subdivision
351.116, may be used by the commissioner for costs
351.12related to administration of the COBRA
351.13grants.

351.14    Sec. 4. EFFECTIVE DATE.
351.15This article is effective the day following final enactment.